OLR Bill Analysis

sSB 166 (File 163, as amended by Senate "A")*

AN ACT EXPANDING UTILIZATION OF PATIENT-DESIGNATED CAREGIVERS.

SUMMARY:

This bill extends to nursing homes existing requirements for hospitals regarding the designation of patient caregivers at the time of a patient's discharge. Specifically, the bill requires a nursing home, when discharging a resident to his or her home to:

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

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

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

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

The bill specifies that it does not create a private right of action against a nursing home 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 resident's discharge or transfer from a nursing home to another facility, or (3) a patient's proxy health care rights.

The bill allows the Department of Public Health (DPH) to adopt related regulations. It also makes a conforming change.

*Senate Amendment “A” replaces the original bill (File 163). It (1) specifies that a designated caregiver is not obligated to agree to receive caregiver training, (2) specifies the nursing home must make more than one reasonable attempt to notify the caregiver of the resident's discharge, (3) allows caregiver training to be provided in writing, (4) defines “resident” as a nursing home resident or the resident's representative, and (5) makes minor and technical changes.

EFFECTIVE DATE: October 1, 2016

DESIGNATED CAREGIVERS

Under the bill, a “caregiver” is a person the resident or his or her representative designates to provide post-discharge assistance in the resident's home (e.g., a relative, spouse, neighbor, or friend). A resident's home does not include a setting that was not his or her home in the community immediately before entering the nursing home (e.g., assisted living facility, rehabilitation facility, hospital, or group home).

The bill requires caregivers to provide post-discharge assistance in accordance with the resident's written discharge plan signed by the resident 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 public or private health insurer.

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

DOCUMENTATION AND NOTIFICATION REQUIREMENTS

If a resident or his or her representative designates a caregiver before receiving his or her written discharge instructions, the bill requires the nursing home to:

1. record in the resident's discharge plan the caregiver's relationship to the resident and, if known, his or her name, address, and telephone number and

2. make more than one reasonable attempt to notify the caregiver of the resident's discharge home as soon as practical.

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

CAREGIVER INSTRUCTION

Requirements

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

To the extent possible, caregiver training or instruction must use nontechnical language and may be provided in writing or conducted in person or using video technology. The bill requires nursing homes 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 written, live, or recorded demonstration of the post-discharge assistance tasks performed by a nursing home 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 nursing home's requirements for providing language access services under state and federal law.

Under the bill, a designated caregiver is not obligated to agree to receive the above instruction.

Documentation

The bill requires nursing homes to document in the resident's medical record any training provided to the resident or his or her representative or the designated caregiver on how to initially implement the discharge plan.

The nursing home must also document in the resident's medical record any caregiver instruction provided on post-discharge assistance tasks, including the date, time, and subject of the 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 resident delegates or applies by law.

REGULATIONS

The bill allows DPH to adopt regulations setting minimum standards for nursing home discharge planning services. These standards must require (1) a written discharge plan prepared in consultation with the resident, the resident's family or representative, and resident's physician and (2) a procedure for notifying the resident in advance of his or her discharge and providing the resident a copy of the discharge plan before discharge.

COMMITTEE ACTION

Aging Committee

Joint Favorable Substitute

Yea

13

Nay

0

(03/08/2016)

Public Health Committee

Joint Favorable

Yea

23

Nay

0

(04/11/2016)

Judiciary Committee

Joint Favorable

Yea

34

Nay

1

(04/21/2016)