The Basics: A bill aimed at helping caregivers when patients leave the hospital

Sen. Dante Bartolomeo drove her grandmother home from the hospital last summer thinking she was prepared to continue providing her care. But when she drove into the garage and tried to help her grandmother use her walker, she realized there was a problem: No one at the hospital had mentioned that her grandmother was no longer able to walk.

“It was really, really frightening,” Bartolomeo, D-Meriden, said Thursday, hours before she joined fellow Senators in unanimously passing a bill aimed at preventing those sorts of situations by requiring hospitals to ensure that patients’ caregivers know the person’s care plan and how to provide assistance before the patient is sent home.

Nearly 500,000 Connecticut residents serve as unpaid caregivers for friends or family at any given time, according to research by the AARP Public Policy Institute.

And experts say caregivers often don’t get instructions on how to best provide care, even if it involves complex tasks like administering injections or medication.

Getting out of the hospital can be a particularly vulnerable time for patients. People’s medications often change while they’re in the hospital, and it can be difficult to figure out which ones to take when they get home. And patients don’t always remember all the instructions they receive while in hospital rooms surrounded by noisy monitors.

Addressing the potential pitfalls for patients as they move between settings — such as from hospitals to nursing homes or home — has been a major focus in the health care industry in recent years, spurred in part by federal penalties for hospitals that have high numbers of Medicare patients who return to the hospital for preventable reasons within 30 days of being discharged.

The bill the Senate passed Thursday, known as the CARE Act, is aimed at helping caregivers of people discharged from the hospital.

Here are some things to know.

What does the bill do?

Under the bill, hospital patients being discharged home would be allowed to designate a caregiver.

If the patient does so before receiving his or her discharge instructions, the hospital would have to list the caregiver’s name and contact information in the discharge plan and attempt to notify the caregiver that the patient is being sent home.

The hospital would also be required to give the caregiver instructions on the assistance tasks included in the discharge plan, including by demonstrating the tasks. The instructions would have to be delivered in person or on video, using nontechnical language and in a culturally competent manner. The caregiver would also be given a chance to ask questions about those tasks.

However, the bill specifies that none of those requirements would be allowed to delay a patient’s discharge from the hospital. Similarly, the hospital’s inability to reach the patient’s designated caregiver would not interfere with or delay the patient’s discharge under the bill.

What does the bill not do?

The bill does not apply to situations in which patients are discharged from hospitals to rehabilitation facilities, nursing homes, assisted living facilities or group homes, unless the patient lived there before the hospitalization.

No patient would be required to designate a caregiver. And being designated as a caregiver would not obligate a person to provide assistance to the patient.

Who does it affect?

The bill affects hospitals, hospital patients and those who serve as unpaid caregivers for them.

Why did it come up?

AARP has advocated for these policy changes in Connecticut and in other states. New Jersey and Oklahoma passed similar measures last year, and other states are considering similar proposals.

The proposal found many receptive legislators in Connecticut, some of whom have had their own experiences as caregivers.

During a press conference on the bill Thursday, several lawmakers described the difficulties of knowing how to properly care for their loved ones. Sen. Mae Flexer, D-Killingly, co-chair of the Aging Committee, recalled that her father, who was injured in a motorcycle accident, was once given instructions in a hospital on how to care for a wound that he couldn’t reach, when none of his caregivers were present.

Patients often leave the hospital soon after surgery, and often require continuing care at home, Senate President Pro Tem Martin M. Looney, D-New Haven, noted. And he said research indicates that many caregivers fear they will make a mistake.

“Those first few hours and days at home after a hospital stay are critical to the recovery of the individual. However, the caregiver performing these tasks receives little or no training to do so,” Deb Migneault, senior policy analyst for Connecticut’s Legislative Commission on Aging, said in written testimony on the bill.

Melinda Montovani, a social worker who works for the Brain Injury Alliance of CT, wrote in testimony that she’s heard many stories of people with brain injuries who are discharged from hospitals without the proper instructions, leaving caregivers overwhelmed and unsure what to do when complications arise. Giving caregivers proper discharge instructions can prevent emergency room visits and hospital readmissions, which can set back patients’ recoveries, she added.

Proponents of the bill say some hospitals already do a good job of making sure caregivers receive instructions when patients are being discharged, but not all do. They say the bill will ensure there are standards.

What happens next?

The bill now moves to the House.