2015 -- H 6150

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LC002555

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

____________

A N   A C T

RELATING TO HEALTH AND SAFETY - CAREGIVER ADVISE, RECORD AND ENABLE

ACT

     Introduced By: Representatives Naughton, Ajello, McNamara, Ackerman, and Fogarty

     Date Introduced: April 30, 2015

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

CHAPTER 17.27

CAREGIVER ADVISE, RECORD AND ENABLE ACT

     23-17.27-1. Legislative findings and purpose. – An estimated 148,000 Rhode Islanders

provide varying degrees of unreimbursed care to adults with limitations in daily activities. The

total value of the unpaid care provided to individuals in need of long-term services and supports

amounts to an estimated $1.9 billion every year, based on 2009 data. Caregivers are often

members of the individual's immediate family, but friends and other community members also

serve as caregivers. While most caregivers are asked to assist an individual with basic activities

of daily living, such as mobility, eating, and dressing, many are expected to perform complex

tasks on a daily basis such as administering multiple medications, providing wound care, and

operating medical equipment.

     Despite the vast importance of caregivers in the individual's day-to-day care, many

caregivers find that they are often left out of discussions involving a patient's care while in the

hospital and, upon the patient's discharge, receive little to no instruction on the tasks they are

expected to perform. The federal Centers for Medicare & Medicaid Services (CMS) estimates

that $17 billion in Medicare funds or spent each year on unnecessary hospital readmissions.

Additionally, hospitals desire to avoid the imposition of new readmission penalties under the

federal Patient Protection and Affordable Care Act (ACA).

     In order to successfully address the challenges of a surging population of older adults and

others living with chronic conditions and who have significant needs for long-term services and

supports, the purpose of the state must be to develop methods to enable caregivers to continue to

support their loved ones at home and in the community, and avoid costly hospital readmissions.

Therefore, it is the intent that this chapter enables caregivers to provide competent post-hospital

care to their family and other loved ones, at minimal cost to the taxpayers of this state.

     23-17.27-2. Definitions. – As used in this chapter:

     (1) "After-care" means any assistance provided by a caregiver to a patient under this

chapter after the patient's discharge from a hospital. Such assistance may include, but is not

limited to, assisting with basic activities of daily living (ADLs), instrumental activities of daily

living (IADLs), or carrying out medical/nursing tasks, such as managing wound care, assisting in

administering medications, and operating medical equipment.

     (2) "Caregiver" means any individual duly designated as a caregiver by a patient under

this chapter who provides after-care assistance to a patient living in his or her residence. A

designated caregiver may include, but is not limited to, a relative, partner, friend, or neighbor who

has a significant relationship with the patient.

     (3) "Discharge" means a patient's exit or release from a hospital to the patient's residence

following an inpatient admission.

     (4) "Entry" means a patient's admission into a hospital for the purposes of medical care.

     (5) "Hospital" means a facility licensed under Rhode Island statute.

     (6) "Residence" means a dwelling that the patient considers to be his or her home. A

"residence" for the purposes of this chapter shall not include any rehabilitation facility, hospital,

nursing home, assisted living facility, or group home licensed by Rhode Island.

     23-17.27-3. Caregiver designation. – (a) Any hospital licensed pursuant to this title

shall provide each patient or, if applicable, the patient's legal guardian with at least one

opportunity to designate at least one caregiver under this chapter, no later than twenty-four (24)

hours following the patient's entry into a hospital and prior to the patient's discharge or transfer to

another facility.

     (1) In the event that the patient is unconscious or otherwise incapacitated upon his or her

entry into a hospital, the hospital shall provide such patient or his/her legal guardian with an

opportunity to designate a caregiver within twenty-four (24) hours following the patient’s

recovery of his or her consciousness of capacity.

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     (2) In the event that the patient or the patient’s legal guardian declines to designate a

caregiver under this chapter, the hospital shall promptly document this in the patient’s medical

record.

     (3) In the event that the patient or the patient’s legal guardian designates an individual as

a caregiver under this chapter:

     (i) The hospital shall promptly request the written consent of the patient or the patient’s

legal guardian to release medical information to the patient’s designated caregiver following the

hospital’s established procedures for releasing personal health information and in compliance

with all federal and state laws.

     (A) If the patient or the patient’s legal guardian declines to consent to release medical

information to the patient’s designated caregiver the hospital is not required to provide notice to

the caregiver under § 23-17.27-4 or provide information contained in the patient’s discharge plan

under § 23-17.27-5.

     (ii) The hospital shall record the patient’s designation of the caregiver, the relationship of

the designated caregiver to the patient, and the name, telephone number, and the address of the

patient’s designated caregiver in the patient’s medical record.

     (4) A patient may elect to change his or her designated caregiver at any time, and the

hospital must record this change in the patient’s medical record within twenty-four (24) hours.

     (b) A designation of a caregiver by a patient or patient’s legal guardian under this section

does not obligate any individual to perform any after-care tasks for any patient.

     (c) This section shall not be construed to require a patient or a patient’s legal guardian to

designate any individual as a caregiver as defined by this chapter.

     23-17.27-4. Notice to Designated Caregiver. – (a) Any hospital licensed pursuant to this

title shall notify the patient’s designated caregiver of the patient’s discharge or transfer to another

hospital or facility licensed by the state as soon as possible, which may be after the patient’s

physician issues a discharge order, and not later than four (4) hours prior to the patient’s actual

discharge or transfer to such facility.

     23-17.27-5. Instruction to Designated Caregiver. – (a) As soon as possible and not later

than twenty than twenty-four (24) hours prior to a patient’s discharge from a hospital, the hospital

shall consult with the designated caregiver along with the patient regarding the caregiver’s

capabilities and limitations and issue a discharge plan that describes a patient’s after-care needs at

his or her residence.

     (1) At minimum, a discharge plan shall include:

     (i) The name and contact information of the caregiver designated under this chapter;

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     (ii) A description of all after-care tasks necessary to maintain the patient’s ability to

reside home, taking into account the capabilities and limitations of the caregiver;

     (iii) Contact information for any health care, community resources, and long-term

services and support necessary to successfully carry out the patient’s discharge plan.

     (b) The hospital issuing the discharge plan must provide caregivers with instruction in all

after-care tasks described in the discharge plan.

     (1) At minimum, such instruction shall include:

     (i) A live demonstration of the tasks performed by the hospital employee or individual

with whom the hospital has a contractual relationship 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 under state and federal law;

     (ii) An opportunity for the caregiver and patient to ask questions about the after-care

tasks; and

     (iii) Answers to the caregiver’s and the patient’s questions 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) Any instruction required under this chapter shall be documented in the patient’s

medical record, including, at minimum, the date, time, and contents of the instruction.

     (c) The Rhode Island department of health is authorized to promulgate regulations to

implement the provisions of this chapter including, but not limited to, regulations to further define

the content and scope of any instruction provided to caregivers under this chapter.

     23-17.27-6. Non-Interference with Powers of 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 pursuant to Rhode Island general law.

     23-17.27-7. Limitations of Actions. – Nothing in this chapter shall be construed to create

a private right of action against a hospital, a hospital employee, or an individual, with whom a

hospital has a contractual relationship, or to otherwise supersede or replace existing rights or

remedies under any other provision of law.

     23-17.27-8. Penalties. – Whoever violates the provision of this chapter shall, upon

conviction, be punished by imprisonment for not more than one year or by a fine of not more than

five thousand dollars ($5,000).

     23-17.27-9. Severability. – If any provision of this chapter or the application of any

provision to any person or circumstances is held invalid or unconstitutional, the invalidity or

unconstitutionality shall not affect other provisions or applications of this chapter which can be

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given effect without the invalid or unconstitutional provision or application, and to this end the

provisions of this chapter are declared to be severable.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY - CAREGIVER ADVISE, RECORD AND ENABLE

ACT

***

     This act would create the "Caregiver Advise, Record and Enable Act" to provide support

and assistance to individuals with post hospital care.

     This act would take effect upon passage.

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