Legislature(2015 - 2016)BELTZ 105 (TSBldg)
02/23/2016 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB72 | |
| SB165 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 72 | TELECONFERENCED | |
| += | SB 165 | TELECONFERENCED | |
| += | SB 134 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 72-DESIGNATED CAREGIVERS FOR PATIENTS
1:35:13 PM
CHAIR COSTELLO announced the consideration of SB 72. She noted
this is the first hearing. [CSSB 72(HSS) is before the
committee.]
1:35:18 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, sponsor of SB
72, stated that this legislation is otherwise referred to as the
Caregiver, Advise, Record and Enable (CARE) Act. It is about
enabling, educating, and preparing caregivers to take care of
family members when they leave the hospital. The goal of the
legislation is to reduce healthcare costs and improve the health
of Alaska's citizens. She reported that the U.S. has the highest
healthcare costs in the world and Alaska has the highest
healthcare costs in the nation.
She stated that SB 72 seeks to improve post-discharge health
outcomes by improving coordination with designated caregivers,
improving the training in aftercare, enabling older Alaskans to
stay safely in their homes longer, and reduce preventable and
costly hospital readmissions.
SENATOR GIESSEL highlighted that at any given time, about
128,000 Alaskans are providing some type of caregiving service
and support to a loved-one, friend or neighbor. Helping
caregivers do this job more effectively is estimated to save
over $1 billion. Lay caregivers are increasingly being asked to
perform complex nursing and medical tasks such as dispensing
medications, administering injections, and providing wound care.
Oftentimes they have had little or no training. She related a
personal experience.
SENATOR GIESSEL explained that SB 72 is designed to help
individuals learn to provide appropriate care so a patient can
go home from the hospital earlier and not be readmitted. She
noted the maps in the packet and related that when the bill was
introduced last year there were only five states that had
approved the CARE Act, whereas today an additional 14 states
have passed similar legislation.
She deferred further comment to her Intern, Emmie Van Wyhn.
1:38:34 PM
EMMIE VAN WYHN, Student Intern, Senator Cathy Giessel, directed
attention to the U.S. map in the packets to highlight the
significant number of states that have passed designated
caregiver legislation in the past year and many more that are
considering similar legislation. She listed the four things that
SB 72 will do: 1) ensure patients are given the opportunity to
name a caregiver to provide aftercare following hospital
discharge; 2) ensure the designated caregiver is notified of the
patient's discharge or transfer to another facility as soon as
practicable; 3) the hospital shall consult with the designated
caregiver and offer training for after medical and nursing tasks
prior to discharge; and 4) ensure that hospitals adopt and
maintain written discharge policies.
1:39:52 PM
SENATOR GIESSEL informed the committee that since the bill was
introduced last year, the Alaska Hospital and Nursing Home
Association, AARP Alaska, and her office have collaborated to
improve the bill. To this end, a committee substitute (CS) is
forthcoming.
CHAIR COSTELLO clarified for the listening public that the
committee would work with the sponsor to introduce the CS at a
future meeting.
SENATOR MEYER questioned which version was before the committee.
1:41:09 PM
At ease
1:42:45 PM
CHAIR COSTELLO reconvened the hearing and welcomed Ms. Etheridge
to provide comment and the administration's perspective of the
legislation.
1:43:07 PM
DEB ETHERIDGE, Deputy Director, Division of Senior and
Disabilities Services, testified on SB 72 stating that the
department views better post-hospital care in a patient's home
as a positive.
CHAIR COSTELLO asked if the administration supports the
legislation.
MS. ETHERIDGE answered yes.
CHAIR COSTELLO asked if the legislation would change the
questions the hospital asks a patient prior to discharge,
because hospitals generally only ask patients if they have
family to provide aftercare.
MS. ETHERIDGE replied SB 72 allows a patient to designate a
person who may or may not be a family member.
SENATOR MEYER asked how anyone would know whether or not the
caregiver was providing the appropriate care.
MS. ETHERIDGE answered that the bill requires the hospital to do
education and training of the designated caregiver.
SENATOR MEYER asked if the legislation allows the patient to
designate the caregiver.
MS. ETHERIDGE confirmed that was correct and added that the
patient also can choose not to designate a caregiver.
SENATOR MEYER asked if the hospital is responsible for the
quality of care when the patient has designated the caregiver.
MS. ETHERIDGE offered her understanding that the bill clarifies
that the new sections in AS 18.20 may not be construed to create
a right of action against the hospital.
1:46:06 PM
SENATOR STEVENS joined the committee.
CHAIR COSTELLO asked how this would affect a power of attorney.
MS. ETHERIDGE explained that someone with a power of attorney is
not required to provide actual care and doesn't necessarily have
medical authority for that person.
1:46:37 PM
CHAIR COSTELLO opened public testimony.
1:46:54 PM
AMANDA MCCORMICK, representing herself, Anchorage, Alaska,
testified in support of SB 72. She shared a story about a tenant
with a mental disability who entered the hospital for knee
replacement surgery. The attending physician assured Ms.
McCormick that she would be notified when Nora was ready to be
released from the hospital so she could pick her up, but that
didn't happen. Instead, Nora was put on a city bus to go home
with her husband who also has a mental disability. Nora died
that night and it was completely unnecessary. She said she is
testifying as a voice for Nora and others in similar situations.
1:50:13 PM
KEN HELANDER, Advocacy Director, AARP Alaska, testified in
strong support of SB 72. He stated that family caregivers have
traditionally provided assistance with bathing, dressing,
eating, and household tasks. These tasks remain critical to the
wellbeing of care recipients, but the role of family caregiver
has expanded rapidly to include medical and nursing tasks.
The AARP Public Policy Institute and the United Hospital Fund in
2012 documented this major shift in a national survey of 1,677
caregivers that asked what medical and nursing tasks caregivers
were performing. Additionally, a report titled Home Alone:
Family Caregivers Providing Complex Chronic Care highlighted
that 46 percent performed medical and nursing tasks for persons
with multiple chronic, physical and cognitive conditions; 78
percent managed medications, including administering intravenous
fluids and injections; more than 33 percent wanted more training
in wound care; most felt they were helping their family member
avoid an institution; and most reported they received little or
no instruction to perform the tasks.
MR. HELANDER described an AARP survey of 800 Alaskans age 45 and
over that asked about their experiences in caregiving. Among the
findings: 56 percent identified themselves as being a current or
former caregiver and 6 in 10 reported helping with medication
management tasks; 50 percent of registered voters said it is
likely they will provide care for a friend or family member in
the future. He said the 128,000 unpaid caregivers in Alaska are
the foundation of the state's care system, providing care valued
at over $1.1 billion annually. Supporting these caregivers keeps
people out of more expensive levels of care and provides
independence, choice, and dignity that the system is based on.
Many of these caregivers are thrust into this role unexpectedly
and if they don't have the needed tools to provide appropriate
care, the patient may be re-hospitalized.
SB 72 helps this situation, he said. Its goal is to involve
family caregivers as part of the care team. The bill requires
all hospitals in Alaska to adopt policies to ensure they
identify and record who the family caregiver is, if one is
designated; notify the caregiver that a patient is being
discharged; and demonstrate the care they are expected to
provide at home.
MR. HELANDER stated that the collaboration referenced earlier
led to the mutually agreeable language in the [forthcoming]
amended bill. He pointed out that while many hospitals are
already doing what the bill provides, this will ensure that all
hospitals are on the same page involving family caregivers as
part of the care team. This is particularly important in the
current fiscal climate, he said.
1:56:55 PM
ED ZASTROW, representing himself, Ketchikan, testified in strong
support of SB 72. He shared a personal story of his experience
with a successful hospital discharge in Ketchikan. His wife was
schooled in how to care for him and they were assisted in how to
prepare their home to accommodate his needs. SB 72 addresses
this type of program and he finds it difficult to understand why
any hospital wouldn't make these accommodations. He highlighted
that Ketchikan General Hospital is currently rewriting the
policies for their program and is very pleased with their
caregiver training program.
1:59:00 PM
JEANNIE MONK, Alaska State Hospital and Nursing Home
Association, Juneau, Alaska, confirmed that ASHNA has been
collaborating with the sponsor and AARP Alaska and supports the
forthcoming CS. She stated that a transition from the hospital
to home is stressful, but the best-case scenario is when a
willing caregiver is available to provide aftercare. She said
ASHNA supports family caregivers and wants to give them the
confidence and skills needed to handle the aftercare.
She related that Alaska hospitals are working on strategies to
reduce re-admissions, provide coordinated care services and
planning across a continuum, and meet rigorous Medicare and
Medicaid conditions of participation. As part of every patient's
discharge assessment, the hospital works to determine who will
provide ongoing care, include that individual in the transition
planning, and provide them with information about medications
and follow-up care. SB 72 builds on and strengthens the existing
discharge planning processes that are in place at all hospitals;
ASHNA, therefore, supports the legislation.
2:01:30 PM
CHAIR COSTELLO related a personal story about a loved one who
entered the hospital and was asked if she had family in
Anchorage to help with aftercare. This person answered no, which
was technically correct but didn't take into account the life-
long family-like relationship with Senator Costello's family.
She questioned how hospitals will educate their staff to look
beyond the traditional family caregiver when it's appropriate.
"Essentially, we were cut out of the process and they were ready
to assume she had nobody in Alaska when, in fact, she had my
family," Senator Costello said.
MS. MONK offered her understanding that each hospital will
integrate this into their discharge policies and will ask if the
patient wants to designate a caregiver. If so, the patient will
sign an agreement so the hospital can release information and
the hospital will fully involve that designated caregiver.
SENATOR STEVENS asked who will pay for the training.
MS. MONK replied hospitals already work with family caregivers
and provide training that is relevant to the patient's needs at
discharge. This is simply integrating into their discharge
policies the process of allowing a patient to designate a
caregiver. She clarified, "This bill will not address the full
range of caregiver needs."
2:05:19 PM
SENATOR MEYER asked who pays for the caregivers.
MS. MONK clarified that these are all unpaid caregivers.
SENATOR MEYER asked if the hospital provides someone if a
patient doesn't have a family caregiver.
MS. MONK clarified that this legislation does not speak to the
hospital providing any caregivers. It speaks to the patient
designating someone who is willing to provide post-hospital
care. If a patient does not have someone to care for them at
home, the hospital social services department works out an
appropriate transition plan. This is a large problem, but this
legislation does not address that aspect of post-release care,
she said.
2:06:32 PM
CHAIR COSTELLO closed public testimony on SB 72 and held the
bill in committee.