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.