Report Title:

Transfer Trauma; Adult Residential Care Homes

Description:

Recognizes transfer trauma and its impact on health care decisions. Requires the DOH to consider threats to an individual's health and safety caused by transfer trauma when considering transfer of adult residential care home residents, and license revocation, and/or closure of or reduction of beds in the facilities.

HOUSE OF REPRESENTATIVES

H.B. NO.

2126

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to transfer trauma.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that transfer trauma is a well-documented medical and psychological phenomenon that can cause severe illness or even death. Its effects are more pronounced in the elderly and the physically and mentally impaired. Stability of familiar people, surroundings, and routine are important elements for sustaining life for people of advanced age or disability, thereby minimizing trauma. Transfer trauma is most acutely felt when the elderly or individuals with disabilities are first moved to nursing homes or other long term care facilities, both institutional or community based. A subsequent move to another facility can be devastating.

In spite of this recognition, state law makes no provision for the consideration of transfer trauma as decisions are made which affect the transfer of care home residents. Moreover, the department of health, which licenses the majority of such facilities, has taken the position that it does not consider the transfer trauma which may occur to residents as it renders decisions on whether to revoke licenses and order the closure of facilities, or the reduction of available beds in a facility.

While it may be appropriate to close a facility if it is detrimental to the health and safety of a resident to remain there, the legislature finds that a balance must be attained whereby the needs of the residents must be considered and that at times it may be more protective of health and safety to refrain from closing a facility if the closure is likely to result in transfer trauma to the residents. Residents and their guardians need to be consulted in advance of any change in residence.

The purpose of this Act is to require that transfer trauma be considered before the department of health can revoke a facility's license and order the removal of the facility's residents.

SECTION 2. Section 321-15.6, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) The director shall adopt rules regarding adult residential care homes in accordance with chapter 91 which shall be designed to:

(1) Protect the health, safety, and civil rights of persons residing in facilities regulated;

(2) Provide for the licensing of adult residential care homes; provided that the rules shall allow group living in two categories of adult residential care homes as licensed by the department of health:

(A) Type I allowing group living by five or fewer unrelated persons; and

(B) Type II allowing six or more persons including but not limited to the mentally ill, elders, the handicapped, the developmentally disabled, or totally disabled persons who are not related to the home operator or facility staff.

For purposes of this section:

"Mentally ill person" means a mentally ill person as defined under section 334-1.

"Elder" means an elder as defined under sections 201G-1 and 201G-151.

"Handicapped person" means an individual with a physical handicap as defined under section 515-2.

"Developmentally disabled person" means a person with developmental disabilities as defined under section 333F-1.

"Totally disabled person" means a person totally disabled as defined under section 235-1;

"Transfer trauma" means the combination of physical, medical, or psychological reactions to abrupt physical transfer that may increase the risk of serious injury, grave illness, or death;

(3) Comply with applicable federal laws and regulations of Title XVI of the Social Security Act, as amended; and

(4) Provide penalties for the failure to comply with any rule.

Notwithstanding any other law or administrative rule, the department shall not revoke the license of any adult residential care home unless it determines that the risk to the health, safety, and welfare of each resident is greater if the resident remains in the home than the risk of suffering consequences caused by transfer trauma which would occur if the resident is relocated."

SECTION 3. Section 321-15.62, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) The director shall adopt rules regarding expanded adult residential care homes in accordance with chapter 91 which shall implement a social model of health care designed to:

(1) Protect the health, safety, civil rights, and rights of choice of the persons to reside in a nursing facility or in home- or community-based care;

(2) Provide for the licensing of expanded adult residential care homes for persons who are certified by the department of human services, a physician, advanced practice registered nurse, or registered nurse case manager as requiring skilled nursing facility level or intermediate care facility level of care who have no financial relationship with the home care operator or facility staff; provided that the rules shall allow group living in two categories of expanded adult residential care homes as licensed by the department of health:

(A) Type I home shall consist of five or less residents with no more than two nursing facility level residents; provided that more nursing facility level residents may be allowed at the discretion of the department; and

(B) Type II home shall consist of six or more residents, with no more than twenty per cent of the home's licensed capacity as nursing facility level residents; provided that more nursing facility level residents may be allowed at the discretion of the department;

provided further that the department shall exercise its discretion for a resident presently residing in a Type I or Type II home, to allow the resident to remain as an additional nursing facility level resident based upon the best interests of the resident. The best interests of the resident shall be determined by the department after consultation with the resident, the resident's family, guardian, primary physician, case manager, primary caregiver, and home operator; and shall include an assessment of whether the resident may be likely to suffer transfer trauma if not allowed to remain as an additional nursing level resident;

(3) Comply with applicable federal laws and regulations of Title XVI of the Social Security Act, as amended; and

(4) Provide penalties for the failure to comply with any rule."

SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.

INTRODUCED BY:

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