BILL ANALYSIS                                                                                                                                                                                                    Ó




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          |SENATE RULES COMMITTEE            |                        SB 675|
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                                UNFINISHED BUSINESS 


          Bill No:  SB 675
          Author:   Liu (D), et al.
          Amended:  7/16/15  
          Vote:     21  

           SENATE HEALTH COMMITTEE:  8-0, 4/29/15
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth,  
            Wolk
           NO VOTE RECORDED:  Nielsen

          SENATE APPROPRIATIONS COMMITTEE:  Senate Rule 28.8

           SENATE FLOOR:  37-0, 5/22/15
           AYES:  Allen, Anderson, Bates, Beall, Berryhill, Block,  
            Cannella, De León, Gaines, Galgiani, Hall, Hancock, Hernandez,  
            Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu,  
            McGuire, Mendoza, Mitchell, Monning, Moorlach, Morrell,  
            Nguyen, Nielsen, Pan, Pavley, Roth, Stone, Vidak, Wieckowski,  
            Wolk
           NO VOTE RECORDED:  Fuller, Runner

           ASSEMBLY FLOOR:  78-0, 8/27/15 (Consent) - See last page for  
            vote

           SUBJECT:   Hospitals: family caregivers


          SOURCE:    Author

          DIGEST:   This bill revises the requirements for hospitals to  
          have a discharge planning process by requiring a hospital to  
          provide an opportunity for a patient who has been admitted to  
          the hospital as an inpatient to identify one family caregiver to  
          assist in post-hospital care, to record that information in the  
          patient's medical chart, and to provide an opportunity for the  








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          patient and his or her designated family caregiver to engage in  
          the discharge planning process, as specified.

          Assembly Amendments revise the structure of this bill so that  
          instead of creating a new section of law, the amendments amend  
          provisions of existing law that already required hospitals to  
          have a discharge planning processes.  This change was  
          recommended in the Senate Health Committee analysis, and the  
          bill is substantively nearly identical to what was adopted by  
          the Senate.

          ANALYSIS: 
          
          Existing law:

          1)Licenses and regulates general acute care hospitals, acute  
            psychiatric hospitals, and special hospitals by the Department  
            of Public Health.

          2)Requires every hospital to have a written discharge planning  
            policy and process, and requires this policy to require that  
            appropriate arrangements for post-hospital care, including but  
            not limited to, care at home, are made prior to discharge for  
            those patients who are likely to suffer adverse health  
            consequences upon discharge if there is no adequate discharge  
            planning.

          3)Requires every hospital, as part of the discharge planning  
            process, if the hospital determines that the patient and  
            family members or interested persons need to be counseled to  
            prepare them for post-hospital care, to provide for that  
            counseling.

          4)Requires the discharge planning process to require that  
            patients be informed, orally or in writing, of the continuing  
            health requirements following discharge, and permits a patient  
            to request that friends or family members be given this  
            information, even if the patient is able to make his or her  
            own decisions regarding medical care.

          5)Requires every hospital to provide each patient, upon  
            admission or as soon thereafter as reasonably practical,  








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            written information regarding the patient's right to be  
            informed of continuing health care requirements following  
            discharge, and that if the patient so authorizes, that a  
            family friend or family member may be provided information  
            about the patient's continuing health care requirements  
            following discharge.

          6)Permits a health facility to disclose medical information  
            about a patient in order to notify a family member or a  
            personal representative of the patient about the patient's  
            location, general condition, or death, if specified procedures  
            are followed.

          This bill:

          1)Requires a hospital, as part of the discharge planning process  
            that is required under existing law, to provide an opportunity  
            for each patient who has been admitted to the hospital as an  
            inpatient to identify one family caregiver who may assist in  
            post-hospital care, and to record that information in the  
            patient's medical chart.

          2)Requires the hospital, in the event that the patient is  
            unconscious or otherwise incapacitated upon admittance to the  
            hospital, to provide the patient or patient's legal guardian  
            with an opportunity to designate a caregiver within a specific  
            time period, at the discretion of the attending physician,  
            following the patient's recovery of consciousness or capacity,  
            and to promptly document the attempt in the patient's medical  
            record.

          3)Requires a hospital, in the event that the patient or legal  
            guardian declines to designate a caregiver pursuant to this  
            bill, to promptly document this declination in the patient's  
            medical record, when appropriate.

          4)Requires a hospital's discharge planning policy to require  
            that the patient's designated family caregiver be notified of  
            the patient's discharge or transfer to another facility as  
            soon as possible and, in any event, upon issuance of a  
            discharge order by the patient's attending physician.  
            Prohibits a lack of contact, if the hospital is unable to  








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            contact the designated caregiver, from interfering with,  
            delaying, or otherwise affecting the medical care provided to  
            the patient or an appropriate discharge of the patient, and  
            requires the hospital to promptly document the attempted  
            notification in the patient's medical record.

          5)Requires a hospital to provide an opportunity for the patient  
            and his or her designated family caregiver to engage in the  
            discharge planning process, which is required to include  
            providing information or instruction regarding the  
            post-hospital care needs of the patient, and education and  
            counseling about the patient's medications, including dosing  
            and proper use of medication delivery devices, when  
            applicable. Requires instruction to be provided in a  
            culturally competent manner and in a language that is  
            comprehensible to the patient and caregiver, consistent with  
            the requirements of state and federal law, and to include an  
            opportunity for the caregiver to ask questions about the  
            post-hospital care needs of the patient.

          6)Requires discharge planning policies adopted by a hospital in  
            accordance with the provisions of this bill and existing law  
            to ensure that planning is appropriate to the condition of the  
            patient being discharged from the hospital, and to the  
            discharge destination and meets the needs and acuity of  
            patients.

          7)Prohibits the provisions of this bill from requiring a  
            hospital to either adopt a policy that would delay discharge  
            or transfer of a patient, or to disclose information if the  
            patient has not provided consent that meets the standards  
            required by state and federal laws governing the privacy and  
            security of protected health information.

          8)Defines "family caregiver," for purposes of this bill and  
            related provisions of existing law, as a relative, friend, or  
            neighbor who provides assistance related to an underlying  
            physical or mental disability but who is unpaid for those  
            services.

          9)Specifies that the discharge planning provisions of this bill  
            and existing law do not supersede or modify any privacy and  








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            information security requirements and protections in federal  
            and state law regarding protected health information,  
            including, but not limited to, the federal Health Insurance  
            Portability and Accountability Act.

          Comments
          
          1)Author's statement.  According to the author, unpaid family  
            caregivers provide the majority of long-term care (LTC)  
            support for their loved ones, yet the health and LTC system is  
            slow to recognize them as partners. Identifying and meeting  
            the needs of California's caregivers can help ensure that  
            appropriate care is provided for aging adults at home or in a  
            rehabilitation or nursing facility and avoid unnecessary  
            readmissions or prolonged stays. Without full understanding  
            and appropriate training to meet the consumer's needs, both  
            the caregiver and consumer suffer. Assisting a caregiver to  
            understand the expectations for care to be provided when the  
            consumer is transferred from one facility to another enhances  
            that caregiver's ability to advocate on behalf of his or her  
            loved one. Caregiver tasks at home, especially paramedical  
            tasks such as tube feeding and wound care, can be complex.  
            Caregivers often require more information and demonstration  
            once they are in the home setting and must perform these tasks  
            by themselves. Enabling them to access information over the  
            phone or online can prevent costly readmissions and ER visits  
            as well as stress and suffering for both the caregiver and the  
            consumer.

          2)Select Committee on Long Term Care and Aging report.   
            According to the author, this bill is intended to implement  
            one of the recommendations of the Select Committee on Aging  
            and Long Term Care's 2014 report, "A Shattered System:  
            Reforming Long Term Care in California" (report). According to  
            the Select Committee on Aging and Long Term Care, this report  
            was the result of a comprehensive effort in 2014 to identify  
            the structural, policy, and administrative changes necessary  
            to realize an ideal LTC delivery system and develop  
            recommendations and a strategy to achieve that vision. One of  
            the critical policy areas identified by the report was  
            "hospital-to-home transitions," with the report stating that  
            inadequate planning and lack of access to services and  








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            supports in the home setting often lead to repeat  
            hospitalizations and a greater likelihood of long-term  
            institutional placement. To address this issue, the report  
            recommending requiring hospital-to-home transition support for  
            family caregivers. Specifically, the report recommended that  
            California enact legislation requiring hospitals to (a) record  
            the name of the family caregiver when a loved one is admitted  
            to a hospital or rehabilitation facility; (b) notify the  
            family caregiver when the loved one is to be discharged to  
            another facility or home; (c) provide an explanation and live  
            instruction of the medical tasks that the family caregiver  
            would perform; and (d) provide telephonic technical assistance  
            to the caregiver when questions arise.

          Prior Legislation
          
          AB 1744 (Brown, 2014) proposed to require, until January 1,  
          2018, the California Department of Aging (CDA) to establish a  
          blue-ribbon task force comprised of at least 13 members, as  
          specified, to make legislative recommendations to improve  
          services for unpaid and family caregivers in California if CDA  
          received sufficient non-state funds from private sources to  
          implement these provisions.  The bill would have required the  
          task force to prepare a report of its findings and  
          recommendations and provide it to the Legislature on or before  
          July 1, 2017. 
          AB 1744 was vetoed by the Governor, who stated: "The California  
          State Plan on Aging, the California Plan for Alzheimer's  
          Disease, the significant reports and action plans developed by  
          the 33 Area Agencies on Aging, the Alzheimer's Association, the  
          AARP and so many others have produced ample evidence for  
          knowledgeable and caring people to recommend ways to improve  
          support for family caregivers. Establishing another task force  
          in state law simply isn't necessary."

          SB 633 (Dymally, Chapter 472, Statutes of 2007) required  
          hospitals to provide every patient anticipated to be in need of  
          LTC, at the time of discharge, with contact information of  
          entities providing information or referral services relating to  
          community-based options, as specified.

          AB 974 (Hall, Chapter 711, Statutes of 2014) required a hospital  








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          to alert a patient's emergency contact person prior to  
          transferring the patient from one hospital to another for  
          nonmedical reasons, and required the hospital to document any  
          attempts to contact a preferred contact person in the patient's  
          medical record.

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes


          According to the Assembly Appropriations Committee, minor and  
          absorbable costs to the Department of Public Health to verify  
          hospital compliance (Licensing and Certification Fund).


          SUPPORT:   (Verified8/28/15)


          AARP
          AstraZeneca 
          Biocom 
          Biotechnology Industry Organization
          California Association of Area Agencies on Aging
          California Association of Public Authorities for IHSS
          California Black Health Network 
          California Chapter of the National Association of Social Workers
          California Healthcare Institute
          Congress of California Seniors
          Health Access California
          Latinas Contra Cancer


          OPPOSITION:   (Verified8/28/15)


          None received


          ARGUMENTS IN SUPPORT:     The California Association of Public  
          Authorities for IHSS (CAPA) states in support that a trip to the  
          hospital can be an intimidating event for patients and their  
          families. According to CAPA, caregivers are focused completely  








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          on the family member's medical treatment, and so is the hospital  
          staff, so there might not be much thought to what happens when a  
          relative leaves the hospital. Yet the way this transition is  
          handled is critical to the health and well-being of the patient,  
          and according to CAPA, studies have found that improvements in  
          hospital discharge planning can dramatically improve the outcome  
          for patients as they move to the next level of care. The  
          California Association of Area Agencies on Aging (C4A) also  
          supports this bill, stating that hospitals are slow in  
          recognizing the importance of working with the family in a  
          transition plan of the patient being discharged to home.  
          According to C4A, the family or caregiver is often ill-equipped  
          to assist with medications, wound care, or other complex tasks  
          once the patient gets home, and that providing instruction and  
          resources for further assistance when the patient is discharged  
          can prevent costly readmissions to the hospital or emergency  
          room visits.
           

           ASSEMBLY FLOOR:  78-0, 8/27/15
           AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,  
            Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,  
            Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,  
            Daly, Dodd, Eggman, Beth Gaines, Gallagher, Cristina Garcia,  
            Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,  
            Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,  
            Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,  
            Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,  
            Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,  
            Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,  
            Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,  
            Wilk, Wood, Atkins
           NO VOTE RECORDED: Frazier, Williams


          Prepared by:Vince Marchand / HEALTH / 
          8/28/15 15:29:16


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