Existing law requires the State Department of Public Health to license and regulate health facilities, defined to mean a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, as specified. Existing law requires hospitals, among other things, to have a written discharge planning policy and process that requires appropriate arrangements to be made for posthospital care. A violation of those provisions is a crime.

This bill would require a hospital to take specified actions relating to family caregivers, including, among others, notifying the family caregiver of the patients discharge or transfer to another facility and providing information and counseling regarding the posthospital care needs of the patient, if the patient has consented to the disclosure of this information. By expanding the scope of a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law requires the State Department of Public Health to license and regulate health facilities, defined to mean a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, as specified. Existing law requires hospitals, among other things, to have a written discharge planning policy and process that requires appropriate arrangements to be made for posthospital care. A violation of those provisions is a crime.

This bill would require a hospital to take specified actions relating to family caregivers, including, among others, notifying the family caregiver of the patients discharge or transfer to another facility and providing information and counseling regarding the posthospital care needs of the patient, if the patient has consented to the disclosure of this information. By expanding the scope of a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law requires the State Department of Public Health to license and regulate health facilities, defined to mean a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, as specified. Existing law requires hospitals, among other things, to have a written discharge planning policy and process that requires appropriate arrangements to be made for posthospital care. A violation of those provisions is a crime.

This bill would require a hospital to take specified actions relating to family caregivers, including, among others, notifying the family caregiver of the patients discharge or transfer to another facility and providing information and counseling regarding the posthospital care needs of the patient, if the patient has consented to the disclosure of this information. By expanding the scope of a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law requires the State Department of Public Health to license and regulate health facilities, defined to mean a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, as specified. Existing law requires hospitals, among other things, to have a written discharge planning policy and process that requires appropriate arrangements to be made for posthospital care. A violation of those provisions is a crime.

This bill would, subject to the federal Health Insurance Portability and Accountability Act of 1996, would require a hospital to take specified actions relating to family caregivers, including, among others, notifying the family caregiver of the patients discharge or transfer to another facility and providing information or instruction and counseling regarding the posthospital care needs of the patient patient, if the patient has consented to the disclosure of this information. By expanding the scope of a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law requires the State Department of Public Health to license and regulate health facilities, defined to mean a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, as specified. Existing law requires hospitals, among other things, to have a written discharge planning policy and process that requires appropriate arrangements to be made for posthospital care. A violation of those provisions is a crime.

This bill would, subject to the federal Health Insurance Portability and Accountability Act of 1996, require a hospital and any health facility that provides inpatient medical rehabilitation services to take specified actions relating to family caregivers, including, among others, notifying the family caregiver when the person to whom care is provided will be discharged of the patients discharge or transfer to another facility or to home and providing an explanation and live instruction of care that the family caregiver will be providing and providing information or instruction regarding the posthospital care needs of the patient. By expanding the scope of a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law requires the State Department of Public Health to license and regulate health facilities, defined to mean a facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, as specified. Existing law requires hospitals, among other things, to have a written discharge planning policy and process that requires appropriate arrangements to be made for posthospital care. A violation of those provisions is a crime.

This bill would, subject to the federal Health Insurance Portability and Accountability Act of 1996, require a hospital and any health facility that provides inpatient medical rehabilitation services to take specified actions relating to family caregivers, including, among others, notifying the family caregiver when the person to whom care is provided will be discharged to another facility or to home and providing an explanation and live instruction of care that the family caregiver will be providing. By expanding the scope of a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

 UNFINISHED BUSINESS  

Bill No: SB 675

Author: Liu (D), et al.

Amended: 7/16/15

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

SENATE FLOOR: 37-0, 5/22/15

AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Gaines, Galgiani, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Stone, Vidak, Wieckowski, Wolk

NO VOTE RECORDED: Fuller, Runner

ASSEMBLY FLOOR: 78-0, 8/27/15 (Consent) - See last page for vote

SUBJECT: Hospitals: family caregivers

SOURCE: Author

DIGEST: This bill revises the requirements for hospitals to have a discharge planning process by requiring a hospital to provide an opportunity for a 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.

Assembly Amendments revise the structure of this bill so that instead of creating a new section of law, the amendments amend provisions of existing law that already required hospitals to have a discharge planning processes. This change was recommended in the Senate Health Committee analysis, and the bill is substantively nearly identical to what was adopted by the Senate.

ANALYSIS:

Existing law:

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:

1. Requires a hospital, as part of the discharge planning process that is required under existing law, to provide an opportunity for each 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’s discharge planning policy to require that the patient’s designated family caregiver be notified 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 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 comprehensible to the patient and caregiver, consistent with the requirements of state and federal law, and to include an opportunity for the caregiver to ask questions about the post-hospital care needs of the patient.

6. Requires discharge planning policies adopted by a hospital in accordance with the provisions of this bill and existing law 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.

7. 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 has not provided consent that meets the standards required by state and federal laws governing the privacy and security of protected health information.

8. Defines “family caregiver,” for purposes of this bill and related provisions of existing law, as a relative, friend, or neighbor who provides assistance related to an underlying physical or mental disability but who is unpaid for those services.

9. Specifies that the discharge planning provisions of this bill and existing law do not supersede or modify any privacy and information security requirements and protections in federal and state law regarding protected health information, including, but not limited to, the federal Health Insurance Portability and Accountability Act.

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 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 LTC 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.

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 LTC, 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 Com.: Yes Local: Yes

According to the Assembly Appropriations Committee, minor and absorbable costs to the Department of Public Health to verify hospital compliance (Licensing and Certification Fund).

SUPPORT: (Verified 8/28/15)

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: (Verified 8/28/15)

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 resources for further assistance when the patient is discharged can prevent costly readmissions to the hospital or emergency room visits.

ASSEMBLY FLOOR: 78-0, 8/27/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Wood, Atkins

NO VOTE RECORDED: Frazier, Williams

Prepared by: Vince Marchand / HEALTH /

8/28/15 15:29:16

**** END ****

Date of Hearing: August 19, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

SBPCA Bill Id:SB 675

Author:(Liu) – As Amended Ver:July 16, 2015

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill establishes requirements related to family caregivers of patients being discharged from a hospital. Specifically, this bill requires a hospital to:

1. Provide each patient, as part of the discharge planning process, an opportunity to identify a family caregiver who may assist in post hospital care.

2. Provide an opportunity for the patient and his or her family caregiver to engage in the discharge planning process.

3. Ensure that discharge planning is appropriate to the condition and acuity of the patient and the location to where the patient will be discharged.

FISCAL EFFECT:

Minor and absorbable costs to the California Department of Public Health (CDPH) to verify hospital compliance (Licensing and Certification Fund).

COMMENTS:

1. Purpose. 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. This bill is intended to formally recognize family caregivers and ensure they get information and support they need to successfully care for their loved ones post-discharge.

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. This bill is consistent with the report's recommendations to enact legislation requiring hospitals to provide greater recognition to, and support for, caregivers.

3. Related Legislation. ACR 38 (Brown), pending on the Senate Appropriations Committee suspense file, establishes a task force on family caregiving with twenty members appointed by the Senate and Assembly. It also 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.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: July 14, 2015

ASSEMBLY COMMITTEE ON HEALTH

Rob Bonta, Chair

SBPCA Bill Id:SB 675

Author:(Liu) – As Amended Ver: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 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.
   
   
   

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 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:

   1. To be informed of continuing health care requirements following discharge from the hospital;

   2. 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;

   3. To participate actively in decisions regarding medical care, and, to the extent permitted by law, that participation includes the right to refuse treatment; and,

   4. 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.

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 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.

   1. 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.”

2. 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 services relating to community-based options.

1. 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
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

 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:

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:

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 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 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 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 Com.: Yes Local: Yes

SUPPORT: (Verified 5/19/15)

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: (Verified 5/19/15)

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 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 ****

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: SB 675

SUBJECT: Health facilities: family caregivers.

SUMMARY:

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.

Existing law:

1. Licenses and regulates general acute care hospitals, acute psychiatric hospitals, and special hospitals by the Department of Public Health (DPH).

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:

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 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.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

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 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 Aging and Long Term Care 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.

3. Related legislation. ACR 38 (Brown), establishes the California Task Force on Family Caregiving, to collaborate with a broad range of stakeholders to 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 would 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.

4. Prior legislation. AB 1744 (Brown), of 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. 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, 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.

5. 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, as a caregiver, you are focused completely on your family member’s medical treatment, and so is the hospital staff, so you might not be giving much thought to what happens when your relative leaves the hospital. Yet the way this transition is handled is critical to the health and well-being of your loved one, 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 resources for further assistance when the patient is discharged can prevent costly readmissions to the hospital or emergency room visits.

6. Policy comment. Existing law already requires every hospital to have a discharge planning process, and as part of that process, requires that patients be permitted to request that friends or family members be given information on the continuing health requirements following discharge. Existing law also requires a hospital, if it determines that the patient and family members or interested persons need to be counseled to prepare for post-hospital care, to provide for that counseling. This bill creates a new section of law, without amending those existing provisions, which contain both new requirements on hospitals, as well as some duplication of very similar existing requirements. The author may wish to consider amending the existing discharge planning provisions of law to add the new requirements imposed by this bill, such as specifically requiring a hospital to reach out to the patient to inquire about a family caregiver, and to document this in the patient’s medical record, and either revising or replacing the provisions of existing law that would no longer be relevant in light of the new requirements of this bill.

SUPPORT AND OPPOSITION:

Support: California Association of Public Authorities for IHSS

California Association of Area Agencies on Aging

California Chapter of the National Association of Social Workers

Congress of California Seniors

Oppose: None received

-- END –