BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 675| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: SB 675 Author: Liu (D) Amended: 4/21/15 Vote: 21 SENATE HEALTH COMMITTEE: 8-0, 4/29/15 AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth, Wolk NO VOTE RECORDED: Nielsen SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8 SUBJECT: Health facilities: family caregivers SOURCE: Author DIGEST: This bill requires a hospital to provide an opportunity for an individual patient who has been admitted to the hospital as an inpatient to identify one family caregiver to assist in post-hospital care, to record that information in the patient's medical chart, and to provide an opportunity for the patient and his or her designated family caregiver to engage in the discharge planning process, as specified. ANALYSIS: Existing law: SB 675 Page 2 1)Licenses and regulates general acute care hospitals, acute psychiatric hospitals, and special hospitals by the Department of Public Health. 2)Requires every hospital to have a written discharge planning policy and process, and requires this policy to require that appropriate arrangements for post-hospital care, including but not limited to, care at home, are made prior to discharge for those patients who are likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning. 3)Requires every hospital, as part of the discharge planning process, if the hospital determines that the patient and family members or interested persons need to be counseled to prepare them for post-hospital care, to provide for that counseling. 4)Requires the discharge planning process to require that patients be informed, orally or in writing, of the continuing health requirements following discharge, and permits a patient to request that friends or family members be given this information, even if the patient is able to make his or her own decisions regarding medical care. 5)Requires every hospital to provide each patient, upon admission or as soon thereafter as reasonably practical, written information regarding the patient's right to be informed of continuing health care requirements following discharge, and that if the patient so authorizes, that a family friend or family member may be provided information about the patient's continuing health care requirements following discharge. 6)Permits a health facility to disclose medical information about a patient in order to notify a family member or a personal representative of the patient about the patient's location, general condition, or death, if specified procedures are followed. This bill: SB 675 Page 3 1)Requires a hospital, subject to the federal Health Insurance Portability and Accountability Act (HIPAA), to provide an opportunity for an individual patient who has been admitted to the hospital as an inpatient to identify one family caregiver who may assist in post-hospital care, and to record that information in the patient's medical chart. 2)Requires the hospital, in the event that the patient is unconscious or otherwise incapacitated upon admittance to the hospital, to provide the patient or patient's legal guardian with an opportunity to designate a caregiver within a specific time period, at the discretion of the attending physician, following the patient's recovery of consciousness or capacity, and to promptly document the attempt in the patient's medical record. 3)Requires a hospital, in the event that the patient or legal guardian declines to designate a caregiver pursuant to this bill, to promptly document this declination in the patient's medical record, when appropriate. 4)Requires a hospital, subject to HIPAA, to notify the patient's designated family caregiver of the patient's discharge or transfer to another facility as soon as possible and, in any event, upon issuance of a discharge order by the patient's attending physician. Prohibits a lack of contact, if the hospital is unable to contact the designated caregiver, from interfering with, delaying, or otherwise affecting the medical care provided to the patient or an appropriate discharge of the patient, and requires the hospital to promptly document the attempted notification in the patient's medical record. 5)Requires a hospital, subject to HIPAA, to provide an opportunity for the patient and his or her designated family caregiver to engage in the discharge planning process, which is required to include providing information or instruction regarding the post-hospital care needs of the patient, and education and counseling about the patient's medications, including dosing and proper use of medication delivery devices, when applicable. Requires instruction to be provided in a culturally competent manner and in a language that is SB 675 Page 4 comprehensible to the patient and caregiver, consistent with the requirements of state and federal law. 6)Requires a hospital to provide contact information for any health care service, community resource, or other service necessary to successfully carry out the care plan. 7)Requires discharge planning policies adopted by a hospital in accordance with the provisions of this bill to ensure that planning is appropriate to the condition of the patient being discharged from the hospital, and to the discharge destination and meets the needs and acuity of patients and the abilities of the designated family caregiver. 8)Prohibits the provisions of this bill from requiring a hospital to either adopt a policy that would delay discharge or transfer of a patient, or to disclose information if the patient as not provided consent that meets the standards required by state and federal laws governing the privacy and security of protected health information. 9)Defines "family caregiver," for purposes of this bill, as a relative, friend, or neighbor who provides assistance related to an underlying physical or mental disability but who is unpaid for those services. Comments 1)Author's statement. According to the author, unpaid family caregivers provide the majority of long-term care (LTC) support for their loved ones, yet the health and LTC system is slow to recognize them as partners. Identifying and meeting the needs of California's caregivers can help ensure that appropriate care is provided for aging adults at home or in a rehabilitation or nursing facility and avoid unnecessary readmissions or prolonged stays. Without full understanding and appropriate training to meet the consumer's needs, both the caregiver and consumer suffer. Assisting a caregiver to understand the expectations for care to be provided when the consumer is transferred from one facility to another enhances SB 675 Page 5 that caregiver's ability to advocate on behalf of his or her loved one. Caregiver tasks at home, especially paramedical tasks such as tube feeding and wound care, can be complex. Caregivers often require more information and demonstration once they are in the home setting and must perform these tasks by themselves. Enabling them to access information over the phone or online can prevent costly readmissions and ER visits as well as stress and suffering for both the caregiver and the consumer. 2)Select Committee on Long-term Care and Aging Report. According to the author, this bill is intended to implement one of the recommendations of the Select Committee on Aging and Long Term Care's 2014 report, "A Shattered System: Reforming Long Term Care in California" (report). According to the Select Committee on Aging and Long Term Care, this report was the result of a comprehensive effort in 2014 to identify the structural, policy, and administrative changes necessary to realize an ideal long-term care delivery system and develop recommendations and a strategy to achieve that vision. One of the critical policy areas identified by the report was "hospital-to-home transitions," with the report stating that inadequate planning and lack of access to services and supports in the home setting often lead to repeat hospitalizations and a greater likelihood of long-term institutional placement. To address this issue, the report recommending requiring hospital-to-home transition support for family caregivers. Specifically, the report recommended that California enact legislation requiring hospitals to (a) record the name of the family caregiver when a loved one is admitted to a hospital or rehabilitation facility; (b) notify the family caregiver when the loved one is to be discharged to another facility or home; (c) provide an explanation and live instruction of the medical tasks that the family caregiver would perform; and (d) provide telephonic technical assistance to the caregiver when questions arise. Related Legislation ACR 38 (Brown) establishes the California Task Force on Family Caregiving to collaborate with a broad range of stakeholders to SB 675 Page 6 examine resources available to caregivers and make legislative recommendations regarding the development of an Internet Web site containing resources for caregivers, the enhancement of outreach and education efforts, and the development of a caregiver screening and assessment tool. The Task Force will be required to submit an interim report to the Legislature no later than January 1, 2017, and a final report no later than July 1, 2018. Prior Legislation AB 1744 (Brown, 2014) proposed to require, until January 1, 2018, the California Department of Aging (CDA) to establish a blue-ribbon task force comprised of at least 13 members, as specified, to make legislative recommendations to improve services for unpaid and family caregivers in California if CDA received sufficient non-state funds from private sources to implement these provisions. The bill would have required the task force to prepare a report of its findings and recommendations and provide it to the Legislature on or before July 1, 2017. AB 1744 was vetoed by the Governor, who stated: "The California State Plan on Aging, the California Plan for Alzheimer's Disease, the significant reports and action plans developed by the 33 Area Agencies on Aging, the Alzheimer's Association, the AARP and so many others have produced ample evidence for knowledgeable and caring people to recommend ways to improve support for family caregivers. Establishing another task force in state law simply isn't necessary." SB 633 (Dymally, Chapter 472, Statutes of 2007) required hospitals to provide every patient anticipated to be in need of long-term care, at the time of discharge, with contact information of entities providing information or referral services relating to community-based options, as specified. AB 974 (Hall, Chapter 711, Statutes of 2014) required a hospital to alert a patient's emergency contact person prior to transferring the patient from one hospital to another for nonmedical reasons, and required the hospital to document any attempts to contact a preferred contact person in the patient's medical record. FISCAL EFFECT: Appropriation: No Fiscal SB 675 Page 7 Com.:YesLocal: Yes SUPPORT: (Verified5/19/15) AARP AstraZeneca Biocom Biotechnology Industry Organization California Association of Area Agencies on Aging California Association of Public Authorities for IHSS California Black Health Network California Chapter of the National Association of Social Workers California Healthcare Institute Congress of California Seniors Health Access California Latinas Contra Cancer OPPOSITION: (Verified5/19/15) None received ARGUMENTS IN SUPPORT: The California Association of Public Authorities for IHSS (CAPA) states in support that a trip to the hospital can be an intimidating event for patients and their families. According to CAPA, caregivers are focused completely on the family member's medical treatment, and so is the hospital staff, so there might not be much thought to what happens when a relative leaves the hospital. Yet the way this transition is handled is critical to the health and well-being of the patient, and according to CAPA, studies have found that improvements in hospital discharge planning can dramatically improve the outcome for patients as they move to the next level of care. The California Association of Area Agencies on Aging (C4A) also supports this bill, stating that hospitals are slow in recognizing the importance of working with the family in a transition plan of the patient being discharged to home. According to C4A, the family or caregiver is often ill-equipped to assist with medications, wound care, or other complex tasks once the patient gets home, and that providing instruction and SB 675 Page 8 resources for further assistance when the patient is discharged can prevent costly readmissions to the hospital or emergency room visits. Prepared by:Vince Marchand / HEALTH / 5/20/15 14:32:22 **** END ****