A California state law that takes effect in the new year aims to help hospital patients better transition home with the aid of informed family members and friends, a move that could improve quality of care, prevent readmissions and cut costs. But some warn laws like it add a layer of bureaucracy that doesn't solve the often personal issues that could muddle a hospital discharge plan.
Beginning Jan. 1, California hospitals will be required to identify a caregiver during a patient's hospitalization and inform that caregiver of the individual's discharge date and instructions, including proper medication schedules. Some patients' caregivers complain that they aren't often kept in the loop regarding important details of the patient's status and that the discharge process is confusing and complex.
The law, SB 675, which was backed by the American Association of Retired Persons and was passed unanimously by California's Legislature, will engage caregivers and stimulate conversations surrounding preferences and capabilities to help loved ones remain independent, said Suzanne Reed, chief of staff for bill sponsor Sen. Carol Liu.
Hospitals are still required to maintain privacy requirements and cannot release information without the patient's consent.
The California Hospital Association, which represents 400 hospitals and health systems, did not adopt a formal position on the law, according to a spokeswoman.
But in a written statement, CHA said it supports policies and practices that will result in effective and sustainable transitions of care. It underscored the importance of family caregivers in a patient's recovery.
And therein lies the rub, say some opponents in other states. About a dozen or so states have passed similar laws.
When Kansas legislators debated a bill this year, many cautioned that in addition to adding another mandate to hospitals, which already are required to follow certain Medicare discharge rules, the law didn't address what's often the biggest problem in quality care: family dynamics.
Even Reed acknowledged that it's possible an identified family member may not be interested in carrying out the required duties. Situations may occur where a spouse or step-spouse living with a patient clashes with the patient's children, she said. And then some children of patients simply aren't interested in caring for their parents, she said. One piece of legislation won't solve the bigger problem, Reed said.
Still, there's a need to find better and more cost-effective ways to care for the aging baby boom population.
AARP has put these types of laws, referred to by the organization as the CARE Act, on the front burner for state legislatures in 2016, as it places the spotlight on family caregivers who perform duties similar to some providers. According to AARP's 2012 survey (PDF), 46% of caregivers perform medical tasks such as injections, the majority without training from medical professionals.
AARP estimates that one quarter of California's population will be over 65 by 2030. People 85 years of age and over are California's fastest growing population, said Reed.
“Longevity is increasing exponentially,” she said.
According to a June 2015 joint report released by the National Alliance for Caregiving and AARP Public Policy Institute, an estimated 39.8 million adults in the U.S. provided unpaid care to another adult in the previous 12 months.
Home healthcare providers, such as case managers have also been working to better implement at-home care, which is far less expensive than long-term facilities.
Organizations like the United Hospital Fund are pushing to inform patients of their rights and ensure that all involved parties, including doctors and care managers who might be covered through Medicare Advantage plans, communicate and coordinate care.