SB2264.DOC

SECTION 1. The legislature finds that Hawaii's population of older adults is rapidly increasing, and the State relies heavily on unpaid caregivers such as family and friends to provide long-term services and supports. In 2012, Hawaii had the highest percentage in the nation of residents age eighty-five and older. This population is projected to grow sixty-five per cent over the next twenty years and is the population most likely to need long-term care. The AARP Public Policy Institute estimates that in 2009, there were 247,000 caregivers in Hawaii, and that the 162,000,000 hours of unpaid care the caregivers provided would be valued at $2,000,000,000.

The legislature further finds that the role of caregivers is expanding. While family caregivers have traditionally assisted with bathing, dressing, eating, and household tasks such as shopping and managing finances, it is now common for family caregivers to perform medical and nursing tasks that historically were only provided in hospitals and nursing homes or by home care professionals. The most commonly performed medical and nursing tasks are medication management, help with assistive mobility devices, preparing food for special diets, and wound care. The rise of caregivers providing medical or nursing tasks is attributed to an increased prevalence of chronic conditions in older adults, economic pressures to reduce hospital stays, and reduction of formal home care services due to growth of in-home technology.

Despite the critical and expanding role of caregivers serving Hawaii's aging population, caregivers often find that they are left out of discussions involving the patient's care when the patient is in the hospital, and they are expected to provide post-hospital care including medical and nursing tasks without any training or support from professionals. Approximately $17,000,000,000 in medicare funds is spent each year on unnecessary hospital readmissions, and recently seventy-one per cent of Hawaii's hospitals were penalized for excessive readmissions under the federal hospital readmissions reduction program.

In order to successfully address the challenges of a surging population of older adults and others who have significant needs for long-term services and supports, the State must develop methods to enable caregivers to continue to support their loved ones at home and in the community, and avoid costly hospital readmissions. Therefore, the intent of this Act is to enable caregivers to provide competent post-hospital care to their family and other loved ones, at minimal cost to the taxpayers.

The purpose of this Act is to:

(1) Allow a patient an opportunity to designate, upon entry to a hospital, a caregiver in the patient's medical record;

(2) Require a hospital to notify and meet with the designated caregiver to discuss the patient's plan of care prior to the patient's discharge or transfer to another facility; and

(3) Require a hospital to instruct the designated caregiver in certain after-care tasks upon a patient's discharge.

SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

Hospital requirements regarding Caregivers

§ -1 Definitions. For the purpose of this chapter:

"After-care" means any assistance provided by a caregiver to a patient after the patient's discharge from a hospital. Such assistance may include assisting with basic activities of daily living and instrumental activities of daily living and carrying out medical or nursing tasks such as managing wound care, assisting in administering medications, and operating medical equipment.

"Caregiver" means any individual duly designated by a patient to provide after-care assistance to the patient in the patient's residence. A designated caregiver may include a relative, partner, friend, or neighbor who has a significant relationship with the patient.

"Discharge" means a patient's exit or release from a hospital to the patient's residence following any medical care, treatment, or observation.

"Entry" means a patient's entrance into a hospital for the purposes of medical care, treatment, or observation. "Entry" includes but is not limited to formal admittance to a hospital.

"Hospital" means a facility licensed under section 321‑14.5.

"Residence" means a dwelling that the patient considers to be the patient's home. "Residence" shall not include any rehabilitation facility, hospital, nursing home, assisted living facility, or group home licensed by the State.

§ -2 Opportunity to designate caregiver. (a) A hospital shall provide each patient or, if applicable, the patient's legal guardian with at least one opportunity to designate one or more caregivers no later than twenty-four hours following the patient's entry into a hospital and prior to the patient's discharge or transfer to another facility; provided that in the event that the patient is unconscious or otherwise incapacitated upon entry into a hospital, the hospital shall provide the patient or the patient's legal guardian with an opportunity to designate a caregiver within twenty-four hours following the patient's recovery of consciousness or capacity.

(b) If the patient or the patient's legal guardian declines to designate a caregiver, the hospital shall promptly document this in the patient's medical record.

(c) If the patient or the patient's legal guardian designates an individual as a caregiver under this chapter, the hospital shall:

(1) Promptly request the written consent of the patient or the patient's legal guardian to release medical information to the patient's caregiver following the hospital's established procedures for releasing personal health information and in compliance with all federal and state laws. If the patient or the patient's legal guardian declines to consent to release medical information to the patient's caregiver, the hospital is not required to provide notice to the caregiver under section -3 or provide information contained in the patient's discharge plan under section -4; and

(2) Record the patient's designation of caregiver, the relationship of the caregiver to the patient, and the name, telephone number, and address of the patient's caregiver in the patient's medical record.

(d) A patient may elect to change the patient's designated caregiver at any time. The hospital shall record this change in the patient's medical record within twenty-four hours of notification by the patient.

(e) A designation of a caregiver by a patient or a patient's legal guardian under this section does not obligate any individual to perform any after-care tasks for the patient.

(f) This section shall not be construed to require a patient or a patient's legal guardian to designate any individual as a caregiver.

§ -3 Notice to caregiver. A hospital shall notify the patient's caregiver of the patient's discharge or transfer to another licensed facility at least four hours before the patient's actual discharge or transfer.

§ -4 Instruction to caregiver; discharge plan. (a) As soon as possible and not later than twenty-four hours prior to a patient's discharge from a hospital, the hospital shall consult with the patient's caregiver regarding the caregiver's capabilities and limitations and issue a discharge plan that describes the patient's after-care needs at the patient's residence. At a minimum, the discharge plan shall include:

(1) The name and contact information of the designated caregiver;

(2) A description of all after-care tasks necessary to maintain the patient's ability to reside at home, taking into account the capabilities and limitations of the caregiver; and

(3) Contact information for any health care, community resources, and long-term services and supports necessary to successfully carry out the patient's discharge plan.

(b) The hospital issuing the discharge plan shall provide the caregiver with instruction in all after-care tasks described in the discharge plan.

(1) A live demonstration of the tasks performed by a hospital employee authorized to perform the after-care tasks, provided in a culturally competent manner and in accordance with the hospital's requirements to provide language access services under state and federal law;

(2) An opportunity for the caregiver to ask questions about the after-care tasks; and

(3) Answers to the caregiver's questions provided in a culturally competent manner and in accordance with the hospital's requirements to provide language access services under state and federal law.

(d) Any instruction required under this chapter shall be documented in the patient's medical record. At a minimum, the patient's medical record shall reflect the date, time, and content of the instruction.

(e) The department of health may adopt rules pursuant to chapter 91 to carry out the purpose of this chapter, including rules to further define the content and scope of any instruction provided to caregivers under this chapter.

§ -5 Non-interference with existing health care directives. (a) Nothing in this chapter shall be construed to interfere with the rights of an agent operating under a valid health care directive under Hawaii law.

(b) No health care directive may claim to be in conflict with this chapter unless it had been in existence prior to the patient's entry into a hospital."

SECTION 3. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2264
TWENTY-SEVENTH LEGISLATURE, 2014
STATE OF HAWAII