New York could become the eighth state to mandate that hospitals offer training to family and friends who care for patients after they are discharged from the hospital.
The Caregiver Advise, Record and Enable Act, also known as the CARE Act, would allow patients to designate an informal caregiver in their medical record and require hospitals to provide instruction and demonstration to help the person care for the patient after discharge.
AARP, the advocacy group for senior citizens, has made the CARE Act its top priority in state legislatures for 2015. New York's Senate passed the legislation on Tuesday. It's now under review in the state Assembly.
The Empire State would represent a major victory for AARP. About 1.6 million New Yorkers are discharged to their homes from the state's hospitals every year. Similar legislation has been passed in Arkansas, Mississippi, New Jersey, New Mexico, Oklahoma, Virginia and West Virginia,
The proposed law requires hospitals to provide training to the patient's caregiver, often a family member or friend, in simple medical tasks needed after discharge, like administering multiple medications, dressing wounds and operating medical equipment.
Though many hospitals already do this as a part of discharge planning, the CARE Act ensures that caregiver education is required by state law, said Bill Ferris, AARP's New York state legislative representative.
“It recognizes in state statute the important role that a caregiver plays in caring for a patient when they leave the hospital,” Ferris said. “There's nothing clearly defined in New York state law that recognizes the care giving and the importance of the patient's well-being.”
While drafting the bill, AARP consulted both the Greater New York Hospital Association, which represents hospitals in the metropolitan New York City area, and the Healthcare Association of New York State, or HANYS, which represents hospitals across the state.
“HANYS has been working together with AARP on the New York bill and is supportive of the bill's intent, which is to ensure patients being discharged home have an appropriate support system in place to provide after-care needs of the patient,” a HANYS spokeswoman said in a statement.
The Greater New York Hospital Association did not provide comment for this article.
These laws are in no way meant to train family or friends to replace home health workers, Ferris said, but rather to ensure that a patient's loved ones understand how to follow through with discharge instructions. If a patient's doctor orders professional home care, then that would still be a necessary part of their post-hospital treatment plan.
That's not to say that a monetary value can't be placed on family care. Family caregivers in the U.S. donated care at an estimated economic value of $234 billion in 2011, according to a report (PDF) from the Congressional Budget Office, which estimated that figure based on if a home health aide had provided the same, around-the-clock care.
(The CBO calculated the figure based on an average home health aide wage of $21 an hour in 2011. The U.S. Bureau of Labor Statistics, however, estimated that the median hourly pay of home health aides was about half that amount in 2012, at $10.01 an hour.)
Skilled home health workers are an important part of the continuum of care, but they're rarely with a patient around the clock, said Kristy Wright, director of clinical operations at Simione Healthcare Consultants. Patient companions need to know how to provide basic care.
“It's not a threat to home health in any way, and the difference is that the family caregiver can learn to do technical procedures,” Wright said. “Home health brings the skilled nurse or the skilled therapist that comes in intermittently and makes sure that the care being provided is reaching the goals that are intended.”
The Home Care Association of New York State did not respond to a request for comment.
The CARE Act could also help prevent readmissions by ensuring that discharge instructions are followed properly, Wright said. Patients stand the risk of ending up back in the hospital if their recovery isn't handled properly.
“If you don't have an engaged caregiver, then what do you do between visits that home care workers can make?” Wright said. “I actually think it adds to home health. I don't think it's either or, it has to be both.”
