H.B. NO.














Relating to caregiving.





     SECTION 1.  The legislature finds that Hawaii's population of older adults is rapidly increasing and the State relies heavily on unpaid caregivers, including family and friends, to provide long-term care and support.  In 2012, Hawaii had the highest percentage of residents over the age of eighty-five in the United States and this population, most likely to need long-term care, is projected to grow sixty-five per cent over the next twenty years.  The AARP Public Policy Institute estimated that in 2013, there were 154,000 caregivers in Hawaii who provided approximately 144,000,000 hours of unpaid care in the State, at a value of $2,100,000,000.

     The legislature further finds that the role of caregivers is expanding.  While family caregivers have traditionally assisted with bathing, dressing, eating, and household tasks, including shopping and managing finances, it is now common for family caregivers to perform complex medical and nursing tasks that historically were only provided in hospitals and nursing homes, including medication management, help with assistive mobility devices, preparation of special diets, and wound care.  The rise in caregivers providing medical or nursing care is attributed to an increase in the prevalence of chronic conditions in older adults, economic pressures to reduce hospital stays, and reduction of formal home-care services due to the growth of in-home technology.

     The legislature additionally finds that despite the critical and expanding role of caregivers serving Hawaii's aging population, caregivers are often left out of hospital discussions involving the patient's care and are expected to provide post-hospital care, including medical and nursing tasks, without any training or support from professionals.

     According to the Hawaii Health Information Corporation, in 2013, there were approximately five thousand five hundred preventable hospital readmissions within thirty days of discharge.  These readmissions are associated with approximately $239,000,000 in costs, and recently, fifty-six per cent of Hawaii's hospitals were penalized for excessive readmissions under the federal hospital readmissions reduction program.

     To successfully address the challenges of a surging population of older adults and others who have significant needs for long-term care and support, including avoiding costly hospital readmissions, the State must develop methods to help caregivers support their loved ones at home and in the community.  Ensuring that caregivers receive basic, uniform training and assistance from a facility where a family member is treated, regardless of the location of the facility, will support family caregivers.

     The purpose of this Act is to enable caregivers to provide competent, post-hospital care to family members and other loved ones, at a minimal cost to the taxpayers, to complement initiatives that are being pursued by county agencies, hospitals, and insurance companies in efforts to reduce readmission rates and better train family caregivers.

     SECTION 2.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:



     §   -1  Definitions.  For the purpose of this chapter:

     "After-care" means any assistance provided by a caregiver to a patient following the patient's discharge from a hospital that is related to the patient's condition at the time of discharge, including but not limited to assisting with basic activities of daily living, instrumental activities of daily living, and other tasks as determined to be appropriate by the discharging physician or other health care professional licensed pursuant to chapter 453.

     "Caregiver" means any individual duly designated by a patient to provide after-care to the patient in the patient's residence.  The term includes but is not limited to a relative, spouse, partner, friend, or neighbor who has a significant relationship with the patient.

     "Contact information" means legal name, phone number, electronic mailing address, mailing address, and home address, where available.

     "Discharge" means a patient's exit or release from a hospital to the patient's residence following any medical care or treatment rendered to the patient following an inpatient admission.

     "Entry" means a patient's entrance into a hospital for the purposes of receiving in-patient medical care.

     "Hospital" means a facility licensed under section 321-14.5.

     "Legally authorized representative" means legal guardians, health care agents, and surrogates designated or selected by a consensus of interested persons.

     "Residence" means a dwelling that the patient considers to be the patient's home and shall not include any rehabilitation facility, hospital, nursing home, assisted living facility, or group home licensed by the State.

     §   -2  Opportunity to designate caregiver.  (a)  A hospital shall provide each patient or, if applicable, the patient's legally authorized representative, with an opportunity to designate one or more caregivers following the patient's entry into a hospital and prior to the patient's discharge to the patient's residence or transfer to another facility, in a timeframe that is consistent with the discharge planning process; provided that if the patient is unconscious or otherwise incapacitated upon entry into a hospital, the hospital shall provide the patient or patient's legally authorized representative with an opportunity to designate a caregiver within a given timeframe, at the discretion of the attending physician, following the patient's recovery of consciousness or capacity.

     (b)  If the patient or patient's legally authorized representative declines to designate a caregiver pursuant to subsection (a), the hospital shall promptly document this in the patient's medical record.

     (c)  If the patient or the patient's legally authorized representative designates an individual as a caregiver under this chapter, the hospital shall:

     (1)  Promptly request the written consent of the patient or the patient's legally authorized representative to release medical information to the patient's caregiver following the hospital's established procedures for releasing personal health information and in compliance with all federal and state laws and regulations.  If the patient or the patient's legally authorized representative declines to consent to release medical information to the patient's caregiver, the hospital is not required to provide notice to the caregiver under section     -3 or include the caregiver in discharge planning or provide instruction in aftercare pursuant to the hospital discharge policies under section     -4; and

     (2)  Record the patient's designation of caregiver, the relationship of the caregiver to the patient, and the contact information of the patient's caregiver in the patient's medical record.

     (d)  A patient may elect to change the patient's designated caregiver at any time.  The hospital shall record this change in the patient's medical record, along with the contact information for the newly designated caregiver, before the patient's discharge to the patient's residence or transfer to another facility.

     (e)  A designation of caregiver by a patient or a patient's legally authorized representative under this section does not require the caregiver to perform any after-care for the patient.

     (f)  This section shall not be construed to require a patient or a patient's legally authorized representative to designate an individual as a caregiver.

     §   -3  Notice to caregiver.  A hospital shall notify the patient's caregiver of the patient's discharge or transfer to another licensed facility as soon as possible and at the latest, upon issuance of a discharge order by the patient's attending physician.  If the hospital is unable to contact the designated caregiver, the lack of contact shall not interfere with, delay, or affect the medical care provided to the patient, or discharge of the patient.  The hospital shall promptly document the attempt to contact the designated caregiver in the patient's medical record.

     §   -4  Hospital discharge policies.  (a)  Hospitals shall adopt, maintain, and enforce written discharge policies for all hospital inpatients that include the following components:

     (1)  An opportunity for the patient and any caregiver designated pursuant to section     -2 to participate in the discharge planning;

     (2)  An opportunity for the patient and any caregiver designated pursuant to section     -2 to receive instruction, prior to discharge, to prepare the caregiver to perform required medical and nursing aftercare following discharge;

     (3)  An opportunity for the patient and any caregiver designated pursuant to section     -2 to ask questions to the hospital staff and receive answers, prior to discharge, regarding the patient's discharge plan and after-care;

     (4)  With respect to paragraphs (1) to (3), procedures which require that the opportunities given the patient and the designated caregiver shall be offered personally and expressly by the responsible hospital staff and that the acceptance or declining of the opportunities be personally expressed by the caregiver or, if the caregiver cannot be contacted, by the patient; and

     (5)  Requirements for documenting in the patient's medical record the details of the discharge plan and a description of the instructions provided.

     (b)  The discharge policies may incorporate established evidence-based practices, including but not limited to:

     (1)  Standards for accreditation adopted by the Joint Commission or other nationally recognized hospital accreditation organization; and

     (2)  The Conditions of Participation for hospitals adopted by the Centers for Medicare and Medicaid Services.

     (c)  The discharge policies must ensure that the discharge planning is appropriate to the condition of the patient and shall be interpreted in a manner and as necessary to meet the needs and acuity of the patient and the abilities of the caregiver.

     (d)  The department of health may adopt rules pursuant to chapter 91 to carry out the purpose of this chapter, including rules to further define the content and scope of any instruction provided to caregivers under the hospital discharge policies.

     §   -5  Non-interference with existing health care directives.  Nothing in this chapter shall be construed to interfere with the rights of an agent operating under a valid health care directive under section 327G-3.

     §   -6  Limitation of liability.  (a)  Nothing in this chapter shall be construed to give rise to a private cause of action against a hospital, hospital employee, or a consultant or contractor that has a contractual relationship with a hospital.

     (b)  A hospital, hospital employee, or a consultant or contractor that has a contractual relationship with a hospital shall not be held liable for the services rendered or not rendered by the caregiver to the patient at the patient's residence.

     §   -7  Discharge; transfer of patient.  Nothing in this chapter shall delay the discharge of a patient or the transfer of a patient from a hospital to another facility."

     SECTION 3.  If any provision of this Act, or the application thereof to any person or circumstance, is held invalid, the invalidity does not affect other provisions or applications of the Act that can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.

     SECTION 4.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 5.  This Act shall take effect on July 1, 2017.












Report Title:

Kupuna Caucus; Human Services; Hospitals; Caregivers; Training



Requires hospitals to provide patients the opportunity to designate a caregiver upon entry to a hospital.  Establishes hospital requirements regarding caregivers, including designation of a caregiver, notification to a caregiver, and a discharge plan for patients.  Provides hospitals, hospital employees, and consultants or contractors that have a contractual relationship with a hospital with immunity regarding caregiving.




The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.