BILL ANALYSIS Ó
SB 675
Page 1
Date of Hearing: July 14, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
SB
675 (Liu) - As Amended June 23, 2015
SENATE VOTE: 37-0
SUBJECT: Hospitals: family caregivers.
SUMMARY: Requires a hospital, as part of the discharge planning
process, to provide each patient with an opportunity to identify
a family caregiver who may assist in post hospital care; to
provide an opportunity for the patient and his or her family
caregiver to engage in the discharge planning process; and, to
ensure that discharge planning is appropriate to the condition
and acuity of the patient and the location to where the patient
will be discharged. Specifically, this bill:
1)Requires a hospital to provide a patient who has been admitted
with an opportunity to identify one family caregiver who may
assist in post hospital care and record that information in
the patient's medical chart.
2)Requires a hospital, if the patient is unconscious or
otherwise incapacitated when admitted, to provide the patient
or patient's legal guardian with an opportunity to designate a
caregiver, at the discretion of the attending physician, once
the patient is conscious. Requires the hospital to document
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the attempt in the patient's medical record. Requires the
hospital, when a patient declines to designate a caregiver, to
document the declination in the patient's medical record when
appropriate.
3)Requires hospitals, as part of the discharge process, to
provide an opportunity for the patient and his or her
designated family caregiver to engage in the discharge
planning process, which must include providing information and
instruction regarding the post hospital care of the patient.
Requires this information to include, but not be limited to,
education and counseling about the patient's medications,
including dosing and proper use of medication delivery
devices, when applicable.
4)Requires the information be provided in a culturally competent
manner in a language that is comprehensible to the patient and
caregiver, and includes an opportunity for the caregiver to
ask questions.
5)Requires hospital discharge planning policies to ensure that
planning is appropriate to the condition of the patient, meets
the patient's needs and acuity, and is appropriate to the
discharge destination.
6)Specifies the provisions in this bill do not require a
hospital to adopt a policy that would delay the discharge or
transfer of a patient, or, disclose information if the patient
has not provided consent that meets state and federal
standards regarding the privacy and security of protected
health information. Specifies that these provisions do not
supersede any state or federal law regarding protected health
information, including the federal Health Insurance
Portability and Accountability Act.
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7)Defines family caregiver as a relative, friend, or neighbor
who provides assistance related to an underlying physical or
mental disability who is unpaid for those services.
EXISTING LAW:
1)Establishes the Department of Public Health, which licenses
and regulates general acute care hospitals, acute psychiatric
hospitals, and special hospitals, and requires hospitals to
have a written discharge planning policy and process.
2)Requires the hospital discharge policies to require that
arrangements for post hospital care, including, but not
limited to: care at home; in a skilled nursing facility (SNF)
or intermediate care facility (ICF); or from a hospice, are
made prior to discharge for patients who are likely to suffer
adverse health consequences if there is no adequate discharge
planning. Requires the hospital to provide counseling to
prepare patients and families for post hospital care if the
hospital determines counseling is needed.
3)Requires discharge planning policies to ensure the patient is
informed, orally or in writing, of the continuing heath care
requirements following discharge. Specifies the right to this
information applies to the person who has legal responsibility
to make decision on behalf of a patient if the patient is
unable to make decisions for him- or herself. Allows a
patient to request their friends or family members be given
this information even if the patient is able to make his or
her own decisions regarding medical care.
4)Requires a transfer summary to accompany the patient to a SNF
or ICF or to the distinct part-SNF or intermediate care unit
of the hospital. Requires the transfer summary to include
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essential information regarding the patient's diagnosis, pain
treatment and management, medications, treatments, dietary
requirements, rehabilitation potential, known allergies, and
treatment plan. Requires the transfer summary be signed by
the physician.
5)Requires a copy of the transfer summary be given to the
patient and the patient's legal representative, if any, prior
to transfer to a SNF or ICF.
6)Requires a hospital to establish and implement a written
policy ensuring each patient receives, at discharge,
information regarding each medication dispensed.
7)Requires a hospital, at time of discharge, to provide patients
anticipated to be in need of long-term care (LTC) when
discharged, with contact information for at least one public
on nonprofit agency dedicated to providing information or
referral services relating to LTC options.
8)Requires a hospital to provide a patient, upon admission or as
soon as practical, written information regarding the patient's
right to the following:
a) To be informed of continuing health care requirements
following discharge from the hospital;
b) To be informed, if the patient authorizes, that a friend
or family member be provided information about the
patient's continuing health care requirements following
discharge;
c) To participate actively in decisions regarding medical
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care, and, to the extent permitted by law, that
participation includes the right to refuse treatment; and,
d) To receive appropriate pain assessment and treatment.
9)Allows a hospital to include the required information with
other notices to the patient regarding patient rights.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, unpaid family
caregivers provide the majority of LTC support for their loved
ones, yet the health and LTC system is slow to recognize them
as partners. The author states, 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. The author notes, without
full understanding and appropriate training to meet the
consumer's needs, both the caregiver and consumer suffer, and
assisting a caregiver to understand the expectations for care
to be provided when the consumer is transferred from one
facility to another enhances that caregiver's ability to
advocate on behalf of his or her loved one. The author
concludes, caregiver tasks at home, especially paramedical
tasks such as tube feeding and wound care, can be complex, and
caregivers often require more information and demonstration
before they are in the home setting and must perform these
tasks by themselves.
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2)BACKGROUND. According to the Select Committee on Aging and
Long-Term Care's 2014 report, A Shattered System: Reforming
Long Term Care in California, one of the critical areas
needing reform is hospital-to-home transitions. The report
states, 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, identifying and meeting the needs of
California's caregivers can help ensure that individuals
remain at home and avoid institutionalization. The report
contends, family caregivers should be an integral part of the
discharge and transition process because, properly supported,
caregivers play a critical role in keeping consumers out of
costly institutions and help to reduce preventable
readmissions. The report recommends California enact
legislation requiring hospitals to: record the name of the
family caregiver when a loved one is admitted to a hospital or
rehabilitation facility; notify the family caregiver when the
loved one is to be discharged to another facility or home;
provide an explanation and instruction of the medical tasks
that the family caregiver would perform; and, provide
telephonic technical assistance to the caregiver when
questions arise.
3)SUPPORT. AARP and the American Federation of State, County
and Municipal Employees, AFL-CIO support this bill because it
will provide a family caregiver with an opportunity to be
engaged in a patient's discharge planning process and obtain
instruction for post-discharge care, the obvious benefit being
that the caregiver will have a better understanding of the
tasks required once home.
The Biotechnology Industry Organization, BIOCOM, and the
California Life Sciences Association support this bill,
stating, as hospital stays become shorter and caregiving in
the home becomes more complicated, it is extremely important
that caregivers are given the tools necessary to keep their
family members or loved ones health to avoid prolonged
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recovery or readmissions to the hospital. The organizations
also note, medication adherence is necessary to guarantee a
positive recovery and to assure patients remain as health as
possible in their home or LTC facility.
4)RELATED LEGISLATION. ACR 38 (Brown) establishes a task force
on family caregiving with twenty members appointed by the
Senate and Assembly. Requires the task force to consider
issues relating to family caregivers and report to the
Legislature on those issues no later than July 1, 2018. ACR
38 is currently pending on the Senate Appropriations Committee
suspense file.
5)PREVIOUS LEGISLATION.
a) AB 1744 (Brown) of 2014, would have required California
Department of Aging (CDA) to establish a blue-ribbon task
force comprised of at least 13 members to make legislative
recommendations to improve services for unpaid and family
caregivers in California if CDA received sufficient
non-state funds to implement these provisions; would have
required the task force report to the Legislature on or
before July 1, 2017; and, would have sunset the task force
on January 1, 2014. 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."
b) SB 633 (Dymally), Chapter 472, Statutes of 2007,
requires hospitals to provide every patient anticipated to
be in need of LTC, at the time of discharge, with contact
information of entities providing information or referral
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services relating to community-based options.
6)SUGGESTED AMENDMENT. In order to ensure state law remains
consistent with federal regulations, the Committee may wish to
amend the bill to re-insert language deleted in previous
amendments as follows:
On page 3, line 35 of the bill, section (b) should read: The
policy required by subdivision (a) shall require that
appropriate arrangements for posthospital care, including, but
not limited to, care at home, in a skilled nursing or
intermediate care facility, or from a hospice, 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. If the hospital
determines that the patient and family members or interested
persons need to be counseled to prepare them for posthospital
care, the hospital shall provide for that counseling.
REGISTERED SUPPORT / OPPOSITION:
Support
AARP
American Federation of State, County and Municipal Employees,
AFL-CIO
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Arthritis Foundation
BIOCOM
Biotechnology Industry Organization
California Black Health Network
California Association for Nurse Practitioners
California Association of Public Authorities for IHSS
California Life Sciences Association
Health Access California
National Association of Social Workers - California Chapter
Opposition
None on file.
Analysis Prepared by:Lara Flynn / HEALTH / (916)
319-2097