Healthcare is one of the most overly regulated industries. Sometimes the ideas that motivate creation of legislation seem simple and straightforward, but the complexity of healthcare environments and relationships is too often misunderstood.
Unfortunately, those writing regulations sometimes fail to engage the right healthcare professionals in development to ensure the requirements or limitations are rational and can produce the desired outcomes. Far too often, there are unintended consequences, conflicts with other requirements and those always-popular unfunded mandates.
The healthcare industry is under pressure to reduce costs and improve efficiency and effectiveness. Realizing the impact of value-based purchasing and population health, healthcare leaders have started to come around to the importance of more effective family caregiver engagement.
However, recognizing the importance of working with family in transition planning for patients being discharged home may not have been enough — or a little too slow in coming.
So, this brings us to California's new legislation (SB-675 Hospital; family caregivers) "requiring hospitals to have a written discharge planning policy and process that requires appropriate arrangements to be made for post-hospital care. A violation is a crime." While this seems to be an overlap with what is already required by state licensing requirements, this new legislation goes a bit farther.
Among other things, it requires:
- The hospital to provide each patient admitted to the hospital as an inpatient with an opportunity to identify one family caregiver who may assist in post-hospital care
- Document the identified family caregiver in the patient's medical chart
- Actively notify the family caregiver of the patient's discharge or transfer to another facility
- Provide information and counseling regarding the post-hospital care needs of the patient to the caregiver
California isn't alone because several other states are considering or have already passed similar legislation. Those supporting the legislation point to family caregivers not always having sufficient information and demonstration to help them perform needed tasks.
They suggest that adequate planning, access to home-based services and supports and enabling access to information via phone or online can reduce expensive emergency visits and readmissions to the hospital, as well as stressors for both the family caregiver and patient.
As anyone knows, working with patients and their family dynamics can be a challenge. It will be interesting to see how this legislation will support hospitals in the process of identifying one primary caregiver when objections from family members arise and family dynamics create barriers.
The application of this law will most likely occur during visits from State Licensing as a result of complaints or during scheduled inspections. Only then will we see how it is being applied and whether any unintended consequences are revealed.
There is one bright light in this legislation, and that is the reinforcement of making information available to patients once they leave the facility. Too often educational content available in the facility isn't made available to patients once they leave — perhaps when they need it most. This legislation will spur some conversations about making more educational content available to patients after their discharge and information technology will be the key mode of delivery.
