OLR Bill Analysis

sSB 290 (File 194, as amended by Senate "A")*

AN ACT CONCERNING PATIENT-DESIGNATED CAREGIVERS.

SUMMARY:

This bill requires a hospital, when discharging a patient to his or her home, to:

1. allow the patient to designate a caregiver at, or before, the time the patient receives a written copy of his or her discharge plan;

2. document the designated caregiver in the patient's discharge plan;

3. attempt to notify the designated caregiver of the patient's discharge home; and

4. instruct the caregiver on post-discharge tasks with which he or she will assist the patient at home.

The bill specifies that it does not create a private right of action against a hospital or its employees, contractors, or consultants. It prohibits these entities and people from being held liable for services a caregiver provides or fails to provide to the patient in his or her home.

Additionally, the bill does not affect (1) health insurers' benefit plan or reimbursement obligations, (2) a patient's discharge or transfer from a hospital to another facility, or (3) a patient's proxy health care rights.

By law, a “hospital” is an establishment that provides lodging, care, and treatment for people suffering from disease or other abnormal physical or mental conditions and includes general hospitals' inpatient psychiatric services.

*Senate Amendment “A” requires hospitals to determine which format (e.g., in-person or video technology) will effectively provide caregiver training on post-discharge tasks, instead of leaving it to the caregiver's discretion.

EFFECTIVE DATE: October 1, 2015

DESIGNATED CAREGIVERS

Under the bill, a “caregiver” is a person the patient designates to provide post-discharge assistance in the patient's home (e.g., a relative, spouse, neighbor, or friend). A patient's home does not include a long-term facility (e.g., a nursing home or assisted living facility), rehabilitation facility, hospital, or group home.

The bill requires caregivers to provide post-discharge assistance in accordance with the patient's written discharge plan signed by the patient or his or her representative. Such assistance includes help with basic and instrumental activities of daily living and support tasks (e.g., wound care, medication administration, and medical equipment use).

The bill prohibits a caregiver from receiving compensation for providing such assistance, including reimbursement from a private or public health insurer.

It does not require a patient to designate a caregiver nor does it obligate the caregiver to perform any post-discharge assistance for the patient.

DOCUMENTATION AND NOTIFICATION REQUIREMENTS

If an inpatient designates a caregiver before receiving his or her written discharge instructions, the bill requires the hospital to:

1. record in the patient's discharge plan the caregiver's name, address, telephone number, and relationship to the patient and

2. make reasonable attempts to notify the caregiver of the patient's discharge home as soon as practical.

The bill specifies that the hospital's inability to contact the designated caregiver must not interfere with, delay, or otherwise affect the patient's medical care or appropriate discharge.

CAREGIVER INSTRUCTION

Requirements

The bill requires hospitals, before discharging a patient, to provide the designated caregiver with instructions in all post-discharge assistance tasks included in the patient's discharge plan.

To the extent possible, caregiver training or instruction must use nontechnical language and may be conducted in person or using video technology. The bill requires hospitals to determine which format will effectively provide the training but does not specify where the training must take place. At a minimum, it must include:

1. a live or recorded demonstration of the post-discharge assistance tasks performed by a hospital designee authorized to perform the tasks,

2. an opportunity for the caregiver to ask questions about the tasks, and

3. answers to the caregiver's questions.

The demonstration must be conducted in a culturally competent manner according to the hospital's requirements for providing language access services under state and federal law.

Documentation

The bill requires hospitals to document in the patient's medical record any training provided to the (1) patient or (2) his or her representative or designated caregiver on how to initially implement the discharge plan.

The hospital must also document in the patient's medical record any caregiver instruction provided on post-discharge assistance tasks, including the date, time, and content of such instruction.

HEALTH INSURER OBLIGATIONS

The bill specifies that its provisions must not be construed to:

1. eliminate the obligation of an insurance company; health, hospital, or medical service corporation; HMO; or any other entity issuing health benefit plans to provide required benefit coverage or

2. impact, impede, or otherwise disrupt or reduce these entities' reimbursement obligations.

PATIENTS' PROXY HEALTH RIGHTS

The bill specifies that its provisions do not affect or take precedence over an advance directive, conservatorship, or other proxy health care rights the patient delegates or applies by law.

COMMITTEE ACTION

Aging Committee

Joint Favorable Substitute

Yea

13

Nay

0

(03/05/2015)

Public Health Committee

Joint Favorable

Yea

25

Nay

0

(04/17/2015)

Judiciary Committee

Joint Favorable

Yea

44

Nay

0

(05/05/2015)