PA 16-59—sSB 166
Public Health Committee
AN ACT EXPANDING UTILIZATION OF PATIENT-DESIGNATED CAREGIVERS
SUMMARY: This act extends to nursing homes existing requirements for hospitals regarding the designation of patient caregivers at the time of a patient's discharge. Specifically, the act requires a nursing home, when discharging a resident to his or her home, to do the following:
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 information about 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 act 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 resident in his or her home.
The act 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 resident's proxy health care rights.
The act allows the Department of Public Health (DPH) to adopt related regulations. It also makes a conforming change.
EFFECTIVE DATE: October 1, 2016
Under the act, a “caregiver” is a person (e. g. , a relative, spouse, neighbor, or friend) the resident or his or her representative designates to provide post-discharge assistance in the resident's home. A resident's “home” is the dwelling the resident considers to be his or her home in the community; it does not include a setting that was not his or her home immediately before entering the nursing home (e. g. , assisted living facility, rehabilitation facility, hospital, or group home).
The act 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 act prohibits a caregiver from receiving compensation, including reimbursement from a public or private health insurer, for providing such assistance.
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 act 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 act 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.
The act 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, conducted in person, or delivered using video technology. The act 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 the following:
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.
Each nursing home must provide the demonstration, including answers to the caregiver's questions, in a culturally competent manner according to the home's requirements for providing language access services under state and federal law.
Under the act, a designated caregiver is not obligated to agree to receive the above instruction.
The act requires nursing homes to document in the resident's medical record any (1) training provided to the resident or his or her representative or designated caregiver on how to initially implement the discharge plan and (2) caregiver instruction provided on post-discharge assistance tasks, including the date, time, and subject of the instruction.
HEALTH INSURER OBLIGATIONS
The act 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.
RESIDENT'S PROXY HEALTH RIGHTS
The act specifies that its provisions do not affect or take precedence over an advance directive, conservatorship, or other proxy health care rights that the resident delegates or that apply by law.
The act allows DPH to adopt regulations setting minimum standards for nursing home discharge planning services. These standards must require a (1) written discharge plan prepared in consultation with the resident, the resident's family or representative, and resident's physician and (2) procedure for notifying the resident in advance of his or her discharge and providing the resident a copy of the discharge plan before discharge.
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