Legislature(2015 - 2016)CAPITOL 106
04/07/2016 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB72 | |
| SB89 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 72 | TELECONFERENCED | |
| + | SB 89 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 72-DESIGNATED CAREGIVERS FOR PATIENTS
3:04:21 PM
CHAIR SEATON announced that the first order of business would be
CS FOR SENATE BILL NO. 72(L&C), "An Act relating to the
discharge of patients from hospitals and to caregivers of
patients after discharge from a hospital; and providing for an
effective date."
3:04:52 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature was available to offer the sectional and answer
questions.
EMMY VAN WHY, Intern, Senator Cathy Giessel, Alaska State
Legislature, paraphrased the sponsor statement, as follows:
Senate Bill 72, the caregiver advise, record, and
enable act, or the Care Act is not about hospitals,
it's not really even about patients, it's about
caregivers. And it's important to reduce health care
costs and improve the health of Alaska citizens. This
bill seeks to improve post-discharge health outcomes
for patients by improving coordination with designated
caregivers, providing training to caregivers on
discharge tasks, enabling older or disabled Alaskans
to stay safely in their homes longer, and decreasing
the likelihood of hospital readmissions.
At any given time, around 128,000 Alaskans are
providing some type of caregiving services and support
to a loved one, friend, or neighbor. This assistance
is crucial and helps patients remain healthy in their
homes as long as possible. This is also a better
alternative than costly long-term care facilities like
nursing homes. And it is estimated to save
approximately $1 billion that would otherwise be spent
by the state. Alaska caregivers are increasingly
being asked to perform complex nursing and medical
tasks, such as dispensing countless medications,
administering injections and providing wound care
often with little or no training. Many family
caregivers report that they received little or no
training to perform these tasks and ended up stressed
and with a lack of confidence. Lack of adequate
preparation to perform post-discharge tasks
jeopardizes the patient's recovery, as well as often
puts the caregiver at risk for their own injury and
burnout.
Most of all, SB 72 will help Alaskans to live
independently at home and will support the family
caregivers who make this possible. Many states, 20 so
far, have passed the Care Act or similar legislation
and several other states are in the process. And, SB
72 contains these important provisions: it allows the
patient to name a lay caregiver with his or her
consent to provide after-care following discharge from
the hospital; the designated caregiver is notified of
the patient's discharge or transfer to another
facility; the hospital consults with the designated
caregiver and offers training to the caregiver for
aftercare medical or nursing tasks, either in person
or through video instruction; and the hospital will
adopt and maintain written policies.
And, we'd be happy to walk through the sectional, Mr.
Chairman, if you'd like.
CHAIR SEATON asked Ms. Conway to go through the sectional.
3:07:59 PM
MS. CONWAY paraphrased from the Sectional Overview [included in
members' packets], which read, [original punctuation provided]:
Section 1. AS 18.20 adds new sections:
Sec. 18.20.500: Requires hospital, before discharge,
assess the patient, provide patient opportunity to
designate a caregiver, who consents/agrees to provide
patient with aftercare
Sec. 18.20.510: Requires a hospital to provide
opportunity for a designated caregiver to participate
in the discharge planning of the patient; and that the
hospital provide training and/or instruction to the
designated caregiver on how to perform medical and
nursing aftercare prior to patient's discharge
Sec. 18.20.520: Requires a hospital to notify the
designated caregiver of the patient's discharge or
transfer
Sec. 18.20.530: Directs the hospital to adopt and
maintain written discharge policies. The policies must
comply with this chapter. The written policy must
specify requirements for naming of the designated
caregiver and those policies may incorporate best
practices for hospital discharge planning, such as
those outlined in Center for Medicaid and Medicare
Services (CMS) …and that the discharge plan is
appropriate for the patient's condition. The
discharge plan may not delay a discharge or transfer
of a patient or oblige hospital to divulge patient's
health information to the designated caregiver without
patient's consent
Sec. 18.20.540: The hospital and its contractors are
protected from lawsuit in regard to the discharge
planning of a patient
Sec. 18.20.550: This chapter many (sic) not interfere
with or supersede the powers/duties of an agent or
legal guardian acting upon a health care directive
Sec. 18.20.590: Provides definitions
Section 2: effective date of January 1, 2017.
3:10:46 PM
CHAIR SEATON asked whether this was for all patients after
discharge, and noted there were no age requirements or condition
requirements. He opined that this allows them to designate but
does not require that it be done.
MS. CONWAY said correct.
3:11:21 PM
REPRESENTATIVE TARR offered that she understands why the fiscal
note from the state would be zero, and asked for the response
from health care providers and possible increase in costs for
hospitals.
MS. CONWAY replied that the sponsor's office has worked closely
with the Alaska State Hospital and Nursing Home Association
(ASHNHA), the American Association of Retired Persons (AARP),
and the Alaska Nurses Association. She explained that SB 72
maps out policies that they strive to do, and that most
hospitals actually do have fairly good discharge planning
policies, but not all. This legislation would bring all
hospitals in alignment with each other, which has been an active
cooperation between those three entities and the sponsor's
office, she said.
CHAIR SEATON opened public testimony.
3:12:54 PM
KATHLEEN TODD, M.D., asked whether this only applies to
inpatient admissions, overnight outpatient observation, or is it
to every emergency room visit which actually would be a costly
and difficult thing to do. Also, she opined that according to
the Nursing Practice Act from a few years ago, nurses are not
allowed by their rules to teach anyone who is not a nurse and is
not a family member to do things that usually are only done by
nurses. They are not to teach aides or persons hired to get the
patient in and out of bed and into their wheelchair, those
people cannot do things that are deemed to be nursing acts.
This bill would probably be a step in the right direction if it
is, in fact, counter mandating that and saying that the paid
caregiver can be taught, who is not a family member, how to take
care of a burn as opposed to having to either assign an RN or
find a family member. She is hopeful this is a step in the
right direction and that it doesn't apply to every single
emergency room visit, she related.
MS. CONWAY answered that the bill is for hospital admissions
only, not emergency rooms. She deferred to Jeannie Monk for the
answer to Dr. Todd's second question.
CHAIR SEATON clarified that the second question related to the
ability to train or teach care to non-family members.
3:15:44 PM
JEANNIE MONK, Senior Program Officer, Alaska State Hospital and
Nursing Home Association (ASHNHA), in response to the second
question opined that the bill is focused on unpaid family
caregivers. These unpaid family caregivers provide a wide range
of care at home, although, some of it could be nursing level if
the patient was in a facility. She explained that family
members are asked to give medication, wound care, and a variety
of care that would require a nurse if they were in a nursing
home, and when the patient is in their own home it is up to the
family members. She said she is unaware of anything that
precludes hospital staff training family caregivers in how to
care for their loved ones once they go home. She pointed out
that this is something that happens every day already, and no
change is being proposed in what is already happening.
CHAIR SEATON related that the bill will be up for another
hearing on Tuesday, and suggested that possibly she could
address that issue and get back to the committee.
MS. MONK said she would leave it to the sponsor to contact the
Nurses Association or someone with the answer.
3:17:08 PM
REPRESENTATIVE TARR asked whether this was a billable service,
how much time would be spent on this particular component, and
how is it reimbursed to the hospital.
MS. MONK responded that ASHNHA has been working with the
sponsor's office and AARP for more than one year. The original
version was prescriptive with specific timelines with concerns
of adding extra work with modifications of electronic health
records, they feel fine about Version Y. She related that it
will add some additional work but for the most part hospitals
already have discharge policies and this legislation forces them
to strengthen their discharge policies in a helpful manner. A
large problem hospitals face is when there is not a family
caregiver. The best possible scenario is when a person is
willing to be designated as the patient's caregiver and willing
to be trained. Hospitals want to be sure those caregivers have
the skills they need to take care of their family member at home
and this will require hospitals to modify their discharge
policies. There is a national CMS rule very similar to this,
she pointed out.
3:18:44 PM
REPRESENTATIVE TARR asked whether this was a billable service.
MS. MONK replied that she would not say yes or no because
hospital billing is complicated. Discharge planning is part of
the billable services that hospitals do, and she said she was
unsure whether it was a standalone billable code.
3:21:16 PM
REPRESENTATIVE VAZQUEZ said that this bill is needed and she
appreciates its intent; however, the chapter dealing with the
definition of hospital is broad. She referred to AS
18.20.210(5), which read as follows:
(5) "hospital" includes a public health center and
general, tuberculosis, mental, chronic disease, and
other type of hospital, and related facilities,
including laboratory, outpatient department, nurses'
homes, and training facilities, and central services
facilities operated in connection with a hospital, but
does not include a hospital furnishing primarily
domiciliary care;
REPRESENTATIVE VAZQUEZ reiterated that it is a broad definition.
CHAIR SEATON asked whether she was reading the definition in AS
18.21.130.
REPRESENTATIVE VAZQUEZ responded no, there is another definition
presently in the statutes, and she did not see where this was
totally replacing that definition.
MS. MONK offered that this legislation does not change any of
the definitions, it is referencing the definition of hospital
and no changes are proposed to change any definitions.
3:23:26 PM
REPRESENTATIVE VAZQUEZ pointed out that she was reading the
definition AS 18.20.210, in the chapter dealing with
"hospitals." She referred to Article 02. Alaska Hospital and
Medical Facilities Survey and Construction Act, AS 18.20.140 -
18.20.220, and she said she was wondering whether something
needed to be reconciled.
CHAIR SEATON suggested asking the sponsor to address the
definition of hospitals.
REPRESENTATIVE VAZQUEZ noted that it is not impossible to fix
and that she was bringing up the possible unintended
consequences.
MS. MONK said it was important to the drafters that this not
apply to hospitals treating mental disorders, that it be limited
to hospitals providing "traditional hospital services."
3:25:21 PM
MARIE DARLIN, AARP, agreed that there has been a lot of work on
this legislation to make it acceptable to all stakeholders. She
pointed out that a lot of the information the committee has been
provided in support of this legislation speaks to the fact there
are approximately 8,500 people providing unpaid care. This
legislation does not address paid caregivers, this is for the
unpaid family caregiver who takes care of the patient after they
leave the hospital. A concern of AARP is that there are
thousands and thousands of people doing this job that need this
kind of information to help them when taking the patient home.
MS. DARLIN pointed out that this legislation is not intended to
cover a lot of other things, even the definition of hospital.
It has been reviewed so that everyone is in agreement, some
hospitals are already doing it and doing a good job of it. This
also places responsibility so that there is an assigned
caregiver because too many people go home from the hospital with
no caregiver, or no one actually assigned the responsibility to
take care of that patient. By having an assigned caregiver
possibly the patient will not end up back in the hospital again
because they didn't receive the proper care at home.
3:28:13 PM
JAYNE ANDREEN, AARP, said she supports the testimony of Marie
Darlin in that this bill does a great job of recognizing the
role that caretakers have to provide, how important that is in
keeping people out of readmission to the hospital, and keeping
health care costs down. She offered that she has provided
aftercare for a loved one and it can be confusing, especially
when discussing wounds, treatment, bandaging, and various
medications. She said that a caregiver has the ability to
obtain the information they need.
CHAIR SEATON asked whether her understanding of the bill is also
that this allows a patient to designate a caregiver, but it's
not assigning a caregiver.
MS. ANDREEN agreed that is her understanding.
3:29:29 PM
KEN HELANDER, Advocacy Director, AARP, pointed out that the bill
is not about hospitals or even patients, it's about caregivers.
A study performed by the AARP Public Policy Institute a few
years ago found that approximately 46 percent of family
caregivers were faced with providing these complex medical tasks
when a family member was discharged. This would include
anything from medications or special diets to wound care, and/or
operating specialized medical equipment. He asked the committee
to consider someone going in for a hip replacement and at
discharge the caregiver is not prepared and does not understand
how to transfer that person, or assist in their mobility, and
that the risk of injury for the patient and the caregiver is
enormous. This bill was drafted as model legislation, he
explained, that has been passed in 22 states, to support family
caregivers with the idea that no family member, no lay
caregiver, should have to face these kinds of stresses and
perform these kinds of tasks at home alone because it increases
stress, the risk of injury, and certainly of hospital
readmission. He reminded the committee that readmission is
costly for hospitals. During these budget times in Alaska, the
idea of having a readmission, or a burned out family member
caregiver, and having to place the patient in paid care
somewhere, ultimately, will have an impact on the state budget.
He put forth that there are approximately 88,000 family
caregivers in the State of Alaska at any given time, and over
the course of a year it is approximately 128,000. When doing
the math, he said, with the cost of a nursing home approximately
$27,000 a month, it's easy to see how supporting family
caregivers is the way to go, and this bill is about supporting
family, friends, or neighbor caregivers.
3:32:45 PM
CHAIR SEATON, after ascertaining no one further wished to
testify, closed public testimony.
CHAIR SEATON asked the sponsor's staff to address the two
previous questions: looking at the ability for nurses to teach
non-family members the levels of care necessary, and the
definition of hospital.
MS. CONWAY said she would research the answers and appear before
the committee next week.
3:35:00 PM
REPRESENTATIVE VAZQUEZ clarified that the whole section adds
additional provisions to Article 04. Overtime limitations for
nurses. She related that the definition is confusing because it
is plugging that section in here when perhaps it should be
inserted under Article 01. Regulation of hospitals, where there
is another hospital definition cited. It may be more
appropriate to have the entire bill inserted under the
regulation of hospitals versus overtime limitations for nurses.
CHAIR SEATON noted that Ms. Conway understands the question and
will research it and come back to the committee.
3:36:02 PM
REPRESENTATIVE VAZQUEZ asked why this legislation exempts mental
hospitals.
MS. CONWAY opined that a discharge plan for mentally disabled
could be far different and more complicated than a regular
hospital discharge, and the drafters stayed with medical.
REPRESENTATIVE VAZQUEZ said she understood why it would simplify
the matter, but it has been her personal experience that this
requirement would be needed in a mental health setting.
Perhaps, even more critically, and it may be something down the
road in dealing with the different stakeholders, she said.
CHAIR SEATON asked Ms. Conway to discuss the issue and advise
the committee.
3:37:37 PM
MS. CONWAY referred to the National Care Act, the Caregiver
Advise, Report, and Enable Act, and said it was a national model
legislation and basically all of the states implementing this
type of legislation deal with the medical side. When the
sponsor was approached by AARP about legislation it was about
medical discharge planning.
REPRESENTATIVE VAZQUEZ said it is a step in the right direction
and Rome wasn't built in a day.
[SB 72 was held over.]