A task force’s failure to agree that hospitals should do more to ensure that patients go home with capable caregivers must not spell the end of this issue. It is in the best interest of patients, caregivers and the hospitals themselves to improve the competency of unpaid family members who play such a key role in our health care system. The need for consensus on how to achieve that goal will grow only more urgent in the coming years.
The reality of the modern American health care system is that patients are generally discharged from the hospital as quickly as possible, leaving it to spouses and grown children to provide increasingly complex after-care at home.
This is a growing issue in Hawaii, where the population is rapidly aging and where the culture rightly demands that revered kupuna are assisted in "aging in place," content in their own homes for as long as possible.
This family-oriented approach is sound social policy that makes economic sense, too, because helping family caregivers ably assist in common tasks such as wound care, medication management and the operation of assistive devices is sure to reduce the likelihood that the patients they care for will be quickly readmitted to the hospital for what could have been preventable problems.
Such an in-and-out cycle is misery for patients, of course, but it’s also a problem for the hospitals, which can be penalized by the federal government if they have too many preventable readmissions of Medicare and Medicaid patients.
It was against this backdrop that the local chapter of the AARP, as part of a national initiative, promoted passage of the CARE Act, Senate Bill 2264, last legislative session.
It would have required hospitals to give every patient the option to designate a family caregiver, whose name would be recorded in the patient’s records; notify the designated caregiver before the patient is transferred to another facility or sent home; and, most controversially, require hospitals to train the designated caregiver to provide appropriate after-care before the patient is discharged.
The Healthcare Association of Hawaii, representing its health-care facility members, successfully opposed the bill, primarily on the grounds that being responsible for training lay people to perform medical tasks better performed by professionals would open up the hospitals to undue legal liability, and that hospitals already follow federal regulations and other formal discharge procedures.
The measure died, but a working group was formed to assess the various issues, with instructions to report back before the 2015 Legislature convenes.
It is that working group, consisting of far more members representing health care facilities than family caregivers, that could come to no consensus and voted 16-8 to take no action on a legislative resolution regarding the CARE Act.
The AARP, which counts patients and caregivers among its members, who are 50 and older, vows to forge ahead, seeking the CARE Act’s passage again this upcoming legislative session, bolstered by passage in Oklahoma and New Jersey of similar versions. New Jersey’s law is stricter, and has language specifically addressing the liability concern.
The Healthcare Association of Hawaii remains resolute in its opposition, insisting that a statutory mandate is both unnecessary and unwise, and that the AARP is overreaching in its desire to achieve the aims of a national initiative.
With two powerful lobbying organizations so far apart, Hawaii lawmakers might be inclined to set aside this issue for now. But they should not. AARP estimates there are 247,000 family caregivers in Hawaii, struggling to do right by their loved ones despite scant training and resources. They deserve a resolution.
Hospitals should provide caregivers plainspoken, direct instruction for expected after-care, before the patient is sent home. Caregivers say that does not occur consistently now, at all facilities throughout the state. Whether a uniform standard to provide such training can be created and upheld by the hospitals themselves, or whether it will take a state mandate remains open to debate — a debate that must continue, despite the deep divide.
