Hospital patients are frequently readmitted after discharge due to complications caused by the lack of appropriate aftercare in the home. Many seniors rely exclusively on unpaid family caregivers once they are discharged from the hospital, and often, due to state or federal privacy restrictions such as HIPAA, these caregivers are not given full explanation or instruction on routine aftercare tasks such as medication management, wound care, bed transfers, injections, and operating medical equipment. HIPAA precludes release of Protected Health Information to anyone but the patient except under a narrow set of circumstances. The federal government has taken measures to lower hospital readmissions such as reduced Medicare reimbursement to hospitals with high readmission rates under the federal Patient Protection and Affordable Care Act.
On May 18, 2015, Governor Hassan signed the Caregiver Advise, Record, and Enable (CARE) Act, an act originally proposed by AARP, which allows a hospital patient or a patient’s legally appointed healthcare decision maker (guardian, durable power of attorney for healthcare, or health care surrogate) to designate a caregiver (e.g., relative, partner, friend, neighbor) to be instructed on aftercare measures. New Hampshire joins 11 other states in adopting this legislation including Connecticut, Maine, and New York. The law takes effect on January 1, 2016.
The CARE Act, codified at RSA 151:42, works as follows. Any time prior to discharge from a hospital, a patient or her legally designated healthcare decision maker may designate a caregiver. If the patient is unconscious at the time of arrival, the patient or her representative may designate a caregiver within 24 hours of recovery. The hospital must record the caregiver’s name, address, and phone number in the patient’s medical record. Patients may change their designated caregiver at any time during their hospital stay, and the designation of a caregiver does not legally obligate the caregiver to assume the role or to actually provide care.
When a hospital intends to discharge a patient to their home, or transfer the patient to another facility, the hospital must notify the designated caregiver of its intent to discharge or transfer “as soon as possible” and then must provide detailed instructions to the caregiver regarding the types of assistance the patient will likely require after discharge. At a minimum, the hospital must provide a live demonstration of the mandatory aftercare tasks, and an opportunity for the caregiver to ask questions about these tasks. The hospital must also provide the caregiver with contact information for healthcare, community, and long-term services and support agencies.
The CARE Act is certainly a step in the right direction towards reducing hospital readmissions and addressing the needs of an increasing population of elderly adults with chronic conditions and significant healthcare needs.