S.B. NO.



S.D. 1
















SECTION 1. The legislature finds that Hawaii's population of older adults continues to increase. In 2012, Hawaii had the highest percentage of residents over the age of eighty-five in the United States, and this population is projected to grow to sixty-five per cent over the next twenty years. These individuals are the most likely to need long-term supports and services and will likely rely on family and friends as their caregivers due to financial and resource constraints. Hawaii's aging population growth will require an increasing number of caregivers for assistance. The AARP Public Policy Institute estimated the number of family caregivers to be 154,000 in 2013. To help successfully address the challenges of an increasing population of older adults and others who have significant needs for long-term care and support, all partners must come together to create a network of supports and services that help caregivers support their loved ones at home and in the community.

The legislature further finds that while strong home- and community-based resources, such as respite, non-medical transportation services, and home-delivered meals, are important to help caregivers and their loved ones, medical supports are also important. Coordination among primary care providers along with preventive care will enable many seniors and other individuals with chronic or debilitating conditions to stay in their homes longer. However, in the event of an acute episode, hospitals must provide assistance to patients and their caregivers in order to prepare them for discharge and help them transition back to their home.

The legislature also finds that all hospitals must comply with comprehensive guidelines mandated by the federal government related to discharge planning and transitions of care. Among other things, hospitals must assess and consider the unique preferences and needs of patients and their caregivers when developing a discharge plan. Hospitals are also responsible for helping to arrange after-care services, including setting up appointments with the patient's primary care physician, specialists, or other special services. For a successful transition from hospital to home setting, the patient requires collaboration on the part of inpatient health care professionals and at-home caregivers.

The purpose of this Act is to ensure that families are supported by ensuring that all patients in an inpatient hospital designate a caregiver who shall be notified prior to the discharge or transfer of their loved one, to ensure that the patient and the designated caregiver are involved in the discharge planning process, and that the patient and caregiver are provided a consistent level of instructional support, both written and oral, prior to discharge to facilitate the patient's transition to the home setting regardless of which facility the patient is in.

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


Hospital discharge planning designation of a caregiver

   -1 Definitions. As used in 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 or 457.

"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 name, phone number, electronic mail address, and address of residence, 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 purpose of receiving inpatient medical care.

"Hospital" means a facility licensed under section 321‑14.5, excluding children's hospitals and specialty hospitals.

"Patient" means an individual admitted to a hospital for inpatient treatment.

"Residence" means a dwelling that the patient considers to be the patient's home and shall not include any residential facility, treatment facility, or home licensed or certified by the department of health under chapter 321, or a private residence used for commercial purposes to care for dependent individuals.

   -2 Designation of a caregiver. (a) Each hospital shall adopt and maintain a written discharge policy or policies that include the following components:

(1) Each patient is provided an opportunity to designate a caregiver, to be included in the patient's electronic health record;

(2) Each patient and the patient's designated caregiver are given the opportunity to participate in the discharge planning;

(3) Each patient and the patient's designated caregiver are given the opportunity to receive instruction, prior to discharge, related to the patient's after-care needs; and

(4) Each patient's caregiver is notified of the patient's discharge or transfer. A hospital shall make reasonable attempts to notify the patient's caregiver of the patient's discharge to the patient's residence as soon as practicable. In the event that the hospital is unable to contact the designated caregiver, the lack of contact shall not interfere with, delay, or otherwise affect the medical care provided to the patient or an appropriate discharge of the patient.

(b) The discharge policy or policies shall specify the requirements for documenting:

(1) The caregiver who is designated by the patient; and

(2) The caregiver's contact information.

(c) The discharge policy or policies shall also include one of the following:

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

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

(d) This section does not require hospitals to adopt discharge policies that would:

(1) Delay a patient's discharge or transfer to another facility; or

(2) Require the disclosure of protected health information without obtaining the patient's consent as required by state and federal laws governing health information privacy and security.

   -3 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 327E-3 or confer upon the caregiver any authority to make healthcare decisions on behalf of the patient unless the caregiver is designated as an agent in a health care directive under section 327E-3.

   -4 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 a caregiver to a patient at the patient's residence.

   -5 Preservation of coverage. Nothing in this chapter shall be construed to remove the obligation of a third-party payer to cover a healthcare item or service that the third-party payer is obligated to provide to a patient under the terms of a valid agreement, insurance policy, plan, or certification of coverage or health maintenance organization contract."

SECTION 3. This Act shall take effect on July 1, 2017.



Report Title:

Hospital Discharge Planning; Caregiver Designation; Health Care



Requires hospitals to adopt and maintain discharge policies, consistent with recent updates to federal regulations, to ensure that patients continue to receive necessary care after leaving the hospital. Effective July 1, 2017. (SD1)




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