Legislature(2015 - 2016)BUTROVICH 205
04/10/2015 01:30 PM Senate HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB78 | |
| SB74 | |
| SB90 | |
| SB53 | |
| HB4 | |
| HB8 | |
| SB72 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 8 | TELECONFERENCED | |
| *+ | SB 72 | TELECONFERENCED | |
| *+ | SB 74 | TELECONFERENCED | |
| *+ | SB 53 | TELECONFERENCED | |
| *+ | SB 90 | TELECONFERENCED | |
| *+ | HB 4 | TELECONFERENCED | |
| *+ | SB 78 | TELECONFERENCED | |
SB 72-DESIGNATED CAREGIVERS FOR PATIENTS
2:15:58 PM
CHAIR STEDMAN announced the consideration of SB 72.
SENATOR CATHY GIESSEL, Alaska State Legislature, sponsor of SB
72. She read from the sponsor statement:
SB 72 seeks to improve post-discharge health outcomes
by improving coordination with designated caregivers,
providing training to them on discharge tasks,
reducing preventable and costly hospital readmissions
and enabling older Alaskans to stay in their own homes
longer.
At any given time, around 88,000 Alaskans are
providing some type of caregiving services and
supports to a loved one, friend or neighbor.
Caregivers are increasingly being asked to perform
complex nursing and medical tasks - such as dispensing
numerous medications, administering injections and
providing wound care - often with inadequate skill
training.
Caregivers are a critical link in the transitional
care for frail adults and those with disabilities;
with few exceptions, caregivers are responsible for
providing and coordinating much of the care received
at home following discharge. Untrained and unsupported
caregiving jeopardizes the patient's recovery, as well
as often puts the caregiver at risk for their own
injury and burnout, frequent symptoms of those caring
for others.
SB 72 contains three important provisions:
The name of a caregiver is recorded when a loved one
is admitted into a hospital facility, if the patient
so desires to name a caregiver.
The designated caregiver is notified of the patient's
discharge home or transfer to another facility as soon
as practicable
The hospital must attempt to consult with the
designated caregiver about the discharge plan
describing the patient's aftercare needs and offer
training to the caregiver for aftercare tasks.
The value of family caregiving in Alaska is valued at
over a billion dollars a year….money that would
otherwise likely have to come from the state coffers
for paid caregiving in the home or in a facility.
Unsupported caregivers are more likely to experience
burnout, develop their own health problems, or see
their loved one moved into a facility for more
expensive care. Most of all, SB 72 will help people
continue to live independently at home, and will
support the family caregivers who make this possible.
2:18:48 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, explained the sectional analysis of SB 72 on behalf
of the sponsor. She read from the sectional:
Sec. 1: Amends 18.20 by adding a new section:
Article 5: Caregivers of Hospital Patients after
Discharge
Sec. 18.20.500 Naming a caregiver. Gives a patient the
opportunity to name a caregiver to provide aftercare
following discharge and outlines the details of that
process.
Section 18.20.510 Release of medical information.
This section provides hospital to ask for patient
consent to release the patient's medical info to the
caregiver. (b) allows for the patient to prohibit the
release of the medical records, thereby releasing the
hospital from its obligation to notify or inform a
caregiver.
Section 18.20.520 Notice to named caregiver. Requires
the hospital to notify the named caregiver of the
planned discharge date and time or of a transfer to
another facility as soon as it can.
Section 18.20.530 Caregiver not obligated. This
section says that if a person is named by the patient
as the caregiver, that person has the right to refuse
the designation.
Section 18.20.540 Discharge plan. Requires the
hospital to prepare a discharge plan for the patient
and assesses the named caregiver's skills to provide
the prescribed aftercare to the patient. It outlines
what needs to be included in the discharge plan and
provides a hospital contact or hospital contractor
contact who can answer questions the caregiver might
have.
Section 18.20.550 Caregiver instruction. Requires a
hospital or hospital contractor to instruct a named
caregiver on the tasks outlined in discharge plan for
aftercare. The section outlines the various means by
which this can be done and that the instruction must
be culturally sensitive and comply with federal law.
It requires that the training be done before the
discharge if possible, unless that would delay the
discharge; in that event the training can take place
as soon as possible after the patient's discharge.
Section 18.20.560 Recording obligations. This section
outlines what must be recorded in the patient's
medical record.
Section 18.20.565 No delay of discharge or transfer.
This section states that the required caregiver
instruction cannot delay a patient's discharge or
transfer to another facility.
Section 18.20.570 Construction of provisions. States
that the provisions of this bill do not create a
liability for the hospital, a hospital contractor or
employee for their performance or non-performance of
tasks.
Section 18.20.580 Coordination with other authority.
The provisions in this bill do not override the duties
of an agent under an advance health care directive or
the powers or duties of a legal guardian.
Section 18.20.585 Regulations. Gives the Department of
Health and Social Services the authority to write
regulations to carry out the provisions of this bill.
Section 18.20.590 Definitions. Provides 10 definitions
of terms used in the bill.
Sec. 2 Adds a new section that gives the Department of
Health and Social Services the authority to adopt
regulations necessary to implement the provisions of
the bill and that the regulations will take effect on
January 1, 2016.
Sec. 3 Allows the Department to begin the regulation
process immediately
Sec. 4 Provisions of the bill are effective on January
1, 2016.
2:23:16 PM
CHAIR STEDMAN opened public testimony.
2:23:48 PM
ANN LOVEJOY, Mountain Pacific Improvement (MPI), testified in
support of SB 72. She related that MPI is a quality improvement
organization for Alaska and is under contract with the Centers
for Medicare and Medicaid. She listed the reasons MPI supports
the bill - it is beneficial for people and for the health
industry. It benefits people who are discharged from the
hospital without clear roles and responsibilities for who will
deliver their aftercare. She said one of the drivers for high
readmission rates and for very poor health outcomes is that
individuals do not receive the necessary aftercare. Secondly,
readmission is a very important issue because the industry is
receiving negative payment adjustments, or penalties, for
excessively high rates of readmissions. If a hospital took the
extra time to educate the caregiver, the readmissions rates
would go down. Another benefit to the industry is that their
accreditation would be assured. The bill does not mandate what
the caregiver education says, it just says the education must be
done.
2:27:10 PM
DEBBY RETHERFORD, representing herself, testified in support of
SB 72. She said she has personal experience with being a
caregiver of a senior relative. She stressed how important this
bill is because it requires the hospital to provide the
caregiver with instructions.
2:30:29 PM
VICTORIA MARTIN, representing herself, testified in support of
SB 72. She shared a personal experience as a caregiver who was
given no instructions after a patient was discharged. She said
it was important for the hospital to provide the information for
a discharge plan. She said she does not want to see another
person go through what she had to.
2:33:38 PM
TERRY SNYDER, State President, AARP, testified in support of SB
72. She suggested that everyone will be a caregiver at some time
during their lives. She shared that 65 percent of older persons
with long-term care needs will need to be cared for by family
and friends, the majority of whom are women. She said it is
essential that the caregiver and the patient are given
instructions for a discharge plan with successful outcomes. The
state must develop methods for Alaskans to be caregivers at home
and avoid costly readmissions. The bill will benefit Alaskans of
all ages and will save money.
2:36:48 PM
ED ZASTROW, representing himself, testified in support of SB 72.
He shared a personal story of his experience with a hospital
discharge in Ketchikan. He said the discharge program in
Ketchikan is similar to the plan in SB 72. He said his wife, his
caregiver, was schooled in how to care for him and they were
assisted in how to prepare home accommodations. However, others
did not receive the same discharge information and became
confused. He opined the bill would address that situation.
2:39:17 PM
KEN HELANDER, Advocacy Director, AARP Alaska, testified in
support of SB 72. He stated that the bill is about caregivers.
He said at any given moment there are about 88,000 family
caregivers in Alaska. Over a course of a year, about 128,000
people serve in that role to some degree. This represents over a
billion dollars in care that otherwise would have likely been
borne by the state.
He referred to an article in the Fairbanks Daily News Minor that
covered the annual cost of care report from Genworth Financial,
which tracks the costs of long-term care across the country. In
the U.S, one year in a nursing home is equal to three years'
tuition at a private college. Alaska has the highest average
cost of nursing home care in the nation - $281,415 a year. The
degree to which we can support family caregivers, saves families
and the state money.
He described a survey by AARP of 800 Alaskans from age 45 and
over to hear about their experiences in caregiving. Among the
findings, 56 percent identified themselves as being a current or
former caregiver; 50 percent said it was likely they would
provide care for a friend or family member. The average Alaska
caregiver is over 55 and female, who works full or part time, in
addition to caregiving for someone over the age of 73. They all
face challenges; emotional and financial stress, balancing jobs
and caregiving, finding enough rest, difficulty managing
medications and medical tasks. There is a need for support for
patients living at home, for respite for caregivers, and
resources and training for caregivers. Most indicated that there
was no instruction after a hospital discharge. They agreed that
hospitals should keep families informed of major decisions and
the discharge and keep records.
He pointed out that discharged plans are required, but are
complex and not clear. Hospitals are aware of the need to
improve the transition from hospital to home and some are
working hard to do so. He concluded that the bill provides the
incentive for all hospitals to do so.
2:45:25 PM
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
testified in support of SB 72. She stated that it is a very
important bill and it contains many important provisions, such
as instruction and training. The senior population is growing
and will need to rely increasingly more on their family
caregivers.
2:47:25 PM
BECKY HULTBERG, CEO, Alaska State Hospital and Nursing Home
Association, testified in opposition to SB 72. She said she is
willing to work with the sponsor on the bill. She said she is
very concerned about successful transitions from hospital to
home. This work is happening well in some places. The bill does
not address a lack of caregivers, nor many of the problems of
those with chronic diseases. She listed problems with the bill.
Setting this in statute does not provide for changes in process,
medicine, and technology. There is a great deal of variety in
hospitals across Alaska. Imposing the same standards on all-
sized hospitals will not work. This bill is setting a fourth
level of administrative regulation on a nursing process. The
focus should be on patient care and quality, not on resources
for keeping records.
2:51:36 PM
She voiced specific concerns. The hospital is expected to
contact and follow up with a caregiver, which is a huge
requirement of nurses. It requires hospitals to assess the
caregiver's ability to provide aftercare, which could be very
challenging for hospitals. There is no explanation of what a
hospital's obligation is when the caregiver is incapable. There
are concerns about how hospitals will provide instruction "as
soon as possible" and a problem with aftercare follow up. It is
a problem that hospitals are required to document and instruct
caregivers, but caregivers have no accountability to accept that
instruction. Language is unclear about who provides the
instruction and records information. She pointed out that the
electronic health network said it could cost about $100,000 to
capture this information.
2:54:29 PM
She said the concepts in the bill have been identified by AARP
as a priority. She suggested looking at other states to identify
how to support the intent of the bill.
2:55:16 PM
SENATOR STOLTZE asked what the nurses' organizations think.
MS. HULTBERG explained they have only received feedback from
their own association's administrative nurses, but not from
nurses' associations.
2:56:20 PM
CHAIR STEDMAN held SB 72 in committee.