SECTION 1. The legislature finds that Hawaii's population of older adults is rapidly increasing and the State relies heavily on unpaid caregivers, including family and friends, to provide long-term care and support. In 2012, Hawaii had the highest percentage of residents over the age of eighty-five in the United States and this population, most likely to need long-term care, is projected to grow 65 per cent over the next twenty years. The AARP Public Policy Institute estimated that in 2009, there were 247,000 caregivers in Hawaii who provided approximately 162,000,000 hours of unpaid care in the State, at a value of $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, including shopping and managing finances, it is now common for family caregivers to perform complex medical and nursing tasks that historically were only provided in hospitals and nursing homes, including medication management, help with assistive mobility devices, preparation of special diets, and wound care. The rise in caregivers providing medical or nursing care is attributed to an increase in the prevalence of chronic conditions in older adults, economic pressures to reduce hospital stays, and reduction of formal home-care services due to the growth of in-home technology.

The legislature additionally finds that despite the critical and expanding role of caregivers serving Hawaii's aging population, caregivers are often left out of hospital discussions involving the patient's care and are expected to provide post-hospital care, including medical and nursing tasks, without any training or support from professionals.

According to the Hawaii Health Information Corporation, in 2013, there were approximately five thousand five-hundred hospital readmissions, each lasting thirty days. These readmissions are associated with approximately $239,000,000 in costs, and recently, 56 per cent of Hawaii's hospitals were penalized for excessive readmissions under the federal hospital readmissions reduction program.

To successfully address the challenges of a surging population of older adults and others who have significant needs for long-term care and support, including avoiding costly hospital readmissions, the State must develop methods to help caregivers support their loved ones at home and in the community. Ensuring that caregivers receive basic, uniform training and assistance from a facility where a family member is treated, regardless of the location of the facility, will support family caregivers.

The purpose of this Act is to enable caregivers to provide competent, post-hospital care to family members and other loved ones, at a minimal cost to the taxpayers, to complement initiatives that are being pursued by county agencies, hospitals, and insurance companies in efforts to reduce readmission rates and better train family caregivers.

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 LAY CAREGIVERS

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

"After-care" means any assistance provided by a caregiver to a patient following the patient's discharge from a hospital that is related to the patient's condition at the time of discharge, including but not limited to assisting with basic activities of daily living, instrumental activities of daily living, and other tasks as determined to be appropriate by the discharging physician or other health care professional licensed pursuant to chapter 453.

"Caregiver" means any individual duly designated by a patient to provide after-care to the patient in the patient's residence. The term includes but is not limited to a relative, spouse, partner, friend, or neighbor who has a significant relationship with the patient.

"Contact information" means legal name, phone number, email address, mailing address, and home address, where available.

"Discharge" means a patient's exit or release from a hospital to the patient's residence following any medical care or treatment rendered to the patient following an inpatient admission.

"Entry" means a patient's entrance into a hospital for the purposes of receiving in-patient medical care.

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

"Legally authorized representative" means legal guardians, health care agents, and surrogates (designated or selected by a consensus of interested persons).

"Residence" means a dwelling that the patient considers to be the patient's home and 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 legally authorized representative, with an opportunity to designate one or more caregivers following the patient's entry into a hospital and prior to the patient's discharge to the patient's residence or transfer to another facility, in a timeframe that is consistent with the discharge planning process; 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 patient's legally authorized representative with an opportunity to designate a caregiver within a given timeframe, at the discretion of the attending physician, following the patient's recovery of consciousness or capacity.

(b) If the patient or patient's legally authorized representative declines to designate a caregiver pursuant to subsection (a), the hospital shall promptly document this in the patient's medical record.

(c) If the patient or the patient's legally authorized representative 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 legally authorized representative 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 and regulations. If the patient or the patient's legally authorized representative 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 contact information 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, along with the contact information for the newly designated caregiver, before the patient's discharge to the patient's residence or transfer to another facility.

(e) A designation of caregiver by a patient or a patient's legally authorized representative under this section does not require the caregiver to perform any after-care for the patient.

(f) This section shall not be construed to require a patient or a patient's legally authorized representative to designate an 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 as soon as possible and at the latest, upon issuance of a discharge order by the patient's attending physician. If the hospital is unable to contact the designated caregiver, the lack of contact shall not interfere with, delay, or affect the medical care provided to the patient, or discharge of the patient. The hospital shall promptly document the attempt to contact the designated caregiver in the patient's medical record.

§ -4 Instruction to caregiver; discharge plan. (a) As soon as possible and 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 to the caregiver that describes the patient's after-care needs, if any, at the patient's residence. The consultation and issuance of a discharge plan shall occur on a schedule that takes into consideration the severity of the patient's condition, the setting in which care is to be delivered, and the urgency of the need for caregiver services. In the event the hospital is unable to contact the caregiver, the lack of contact shall not interfere with, delay, or affect the medical care provided to the patient or the discharge or transfer of the patient. The hospital shall promptly document the attempt to contact the caregiver in the patient's medical record. The discharge plan shall include but not be limited to the following:

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

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

(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; and contact information for a hospital employee who can respond to questions regarding the discharge plan following the instruction provided pursuant to this section.

(b) The hospital issuing the discharge plan shall provide the caregiver with instruction in all after-care described in the discharge plan. Training and instructions for caregivers may be conducted in person or through video technology, at the discretion of the caregiver. Any training or instructions provided to a caregiver shall be provided in non-technical language, to the extent possible. Instruction shall include but not be limited to the following:

(1) A live or recorded demonstration of the tasks, performed by an individual designated by the hospital who is authorized to perform the after-care task, 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 regarding caregiver instructions and receive answers in a culturally competent manner, in accordance with the hospital's requirements to provide language access services under state and federal law; and

(3) A written summary and description of the instructions provided.

(c) Any caregiver 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.

(d) 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. Nothing in this chapter shall be construed to interfere with the rights of an agent operating under a valid health care directive under section 327G-3.

§ -6 Limitation of liability. (a) Nothing in this chapter shall be construed to give rise to a private cause of action against a hospital, hospital employee, or a consultant or contractor that has a contractual relationship with a hospital.

(b) A hospital, hospital employee, or a consultant or contractor that has a contractual relationship with a hospital shall not be held liable for the services rendered or not rendered by the caregiver to the patient at the patient's residence.

§ -7 Discharge; transfer of patient. Nothing in this chapter shall delay the discharge of a patient or the transfer of a patient from a hospital to another facility."

SECTION 3. If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.

SECTION 4. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 5. This Act shall take effect on July 1, 2016.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	296
TWENTY-EIGHTH LEGISLATURE, 2015
STATE OF HAWAII