New Hampshire The CARE Act Implementation December 2015

Overview History/Details Requirements of the Act Definitions of the CARE Act Compliance and Best Practices

Why? AARP campaign in 30+ states to support “family caregivers – an unpaid silent army” – who help make it possible for older Americans to live independently at home , supported by family and loved ones. If caregivers are well prepared when patients are discharged from the hospital, the patient will be healthier and less likely to be readmitted to the hospital (decrease in hospital penalties for re-admissions.) Majority of caregivers (approx. 42 million in the U.S.) say they feel that they need more help or information regarding caregiving. There are 173,000 family caregivers in NH providing care. CMS §482.43 Condition of Participation The hospital must have in effect a discharge planning process that applies to all patients. n

General Overview NHHA, NH AARP and bill sponsors worked together to maintain intent of legislation and avoid any increased burden on hospitals No conflict with CoPs or NH licensing requirements Only applies to NH general acute care hospitals for admitted patients being discharged to their own “residence” No requirements that might hinder discharge No requirements for specific timeline for training No specific training or technology requirement Precludes private rights of action – avoids any new liability exposure

SB 187 AN ACT allowing a patient to designate a caregiver upon entry to a medical facility Please refer to RSA 151 Section 42 to read the law http://www.gencourt.state.nh.us/rsa/html/xi/151/151-mrg.htm Effective January 1, 2016

Requirements Requires that acute care hospitals shall provide each patient/legal decision maker with at least one opportunity to designate one caregiver following the patient’s entry into the hospital. Requires the hospital to attempt to consult with the designated lay caregiver to prepare the lay caregiver to provide aftercare, and provide the lay caregiver with a discharge plan.

Definitions “Caregiver” means someone designated by a patient who provides after care assistance to a patient in their residence. A caregiver may include but is not limited to a relative, partner, friend or neighbor. “Aftercare” is intended to be assistance provided in a residence after patient’s discharge from the hospital, that does not require a licensed/certified or otherwise authorized caregiver; such as: assisting with basic and instrumental activities of daily living, carrying out medical / nursing tasks such as managing wound care, assisting in administering medications and operating medical equipment and includes exclusively those tasks related to the patient’s condition at the time of discharge

Definitions “Entry” means a patient’s entrance into a hospital for medical care A patient’s “residence” is defined as a “dwelling that the patient considers to be his or her home. Shall NOT include any licensed rehabilitation facility, hospital, nursing home, assisted living facility or group home.” “Discharge” is a patient’s exit or release from a hospital to their residence following a hospital stay

Requirements If patient declines to designate a caregiver, hospital shall document this in the medical record If patient designates a caregiver: Hospital shall request written consent to release information (following hospital’s established procedures) If patient declines consent, hospital is not required to provide information to caregiver

Requirements (continued) If patient consents: Document name, telephone number and address of caregiver in medical record (as information is available) Patient may elect to change designation at any time Designation does not obligate the caregiver to perform any after care tasks

Requirements (continued) Discharge plan Describes patient’s after-care needs Includes name & contact information of caregiver Lists appropriate resources / supports to help carry out discharge plan Education Includes a live demonstration of the tasks provided, in a culturally competent manner Provides an opportunity for lay caregiver to ask questions Is documented in the medical record

Requirements (continued) If the lay caregiver cannot be contacted, this will not interfere with the appropriate discharge of the patient, including the discharge education a hospital would routinely provide a patient. Hospital may allow the patient to change designation in the event the originally designated lay caregiver becomes unavailable or unwilling. Hospital shall not allow the process of appointing or refusal or failure to appoint a lay caregiver for a patient to interfere with, delay, or otherwise affect the hospital care and services.

How Caregiver Information is Captured Captured on entry (hospital can designate WHO/WHAT DEPT, e.g. Admitting Dept., Admitting RN, Care Manager, Social Worker) Clinical Documentation fields may need to be revised (e.g. add required fields to admission assessment /discharge plan sections)

Summary SETTING = Acute care hospital patients only Not those in an outpatient setting Psychiatric, Specialty/LTAC, and Rehabilitation licensed hospitals excluded DESIGNATION = voluntary designation by inpatient PARTICIPATION = voluntary participation by named caregiver DOCUMENTATION = mandatory documentation by hospital “ask” name of caregiver patient’s declination to designate a caregiver refusal or inability of caregiver to perform tasks training provided to caregiver