Caregiver Advise, Record and Enable (CARE) Act
SAMPLE Hospital Policy and Procedural Issues to Consider:
(This policy may be added to you organization’s policy guidance related to patient rights, informed consent,
etc. This Model Policy is not intended to include the entire New Hampshire statute regarding the new
Caregiver law. Please refer to RSA 151 Section 42 to read the law:
http://www.gencourt.state.nh.us/rsa/html/xi/151/151-mrg.htm
Procedures to implement this policy and staff training about it should be included in developing a policy for
your organization. This document reflects the collective input of an interdisciplinary group of hospital leaders.
Model Hospital Policy
Patient Designated Caregiver
I.
Purpose
Hospital Name respects the right of all adults to make decisions about their health care including the selection
of a person who they want to assist them with after-care following discharge from the hospital. It is the
obligation of this hospital to ask a patient if they want to designate a caregiver who provides assistance
following hospital discharge to the patient when they return to their residence. Their residence means a
dwelling that the patient considers to be his or her home. A “residence” shall not include any licensed
rehabilitation facility, hospital, nursing home, assisted living facility, or group home. This policy establishes a
process to identify a caregiver.
II.
Identifying a Caregiver
The caregiver may be a relative, friend, partner or neighbor who has a significant relationship with the patient.
It is the obligation of our hospital to ask the patient, or their legally designated health care decision maker if
they lack the capacity to understand the question, to identify a caregiver. Legally designated health care
decision maker” means a durable power of attorney for health care, a surrogate decision maker, or a guardian
with specific authority granted by the probate court. The hospital shall provide each patient or, if applicable,
the patient’s legally designated health care decision maker with at least one opportunity to designate a
caregiver, following the patient’s entry into a hospital, in a timeframe that is consistent with the discharge
planning process. A patient may decide to change their designated caregiver at any time.
III.
Responsibilities
A.
Documentation
Hospital staff shall promptly document the patient’s response to identifying a caregiver in the medical record.
The hospital shall record the patient’s designation of caregiver, the relationship of the designated caregiver to
the patient, and the name, telephone number, and address of the patient’s designated caregiver in the
patient’s medical record. A patient or, if applicable, their legally designated health care decision maker, may
decline to identify a caregiver and that decision shall be documented in the medical record.
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B.
Notification
The hospital shall notify the patient’s designated caregiver of the patient’s discharge or transfer to another
hospital or facility as soon as possible, and in any event, upon issuance of a discharge order by the physician or
APRN responsible for the patient’s transfer to another facility.
C.
Instruction to Designated Caregiver
The hospital will consult with the designated caregiver and the patient regarding the caregiver’s capabilities
and limitations and issue a discharge plan that describes a patient’s after-care needs at his or her residence.
The discharge plan shall include: name and contact information of the caregiver; a description of all after-care
tasks necessary to maintain the patient’s ability to reside at home, taking into account the capabilities and
limitations of the caregiver; and contact information for any health care, community resources, and long-term
services and supports necessary to successfully carry out the patient’s discharge plan.
The hospital will provide caregivers with instruction in all after-care tasks described in the discharge plan. The
instruction will include: a live demonstration of the tasks performed by a hospital employee authorized to
perform the after-care task, provided in a culturally competent manner and in accordance with the hospital’s
requirements to provide language access services under state and federal law; an opportunity for the
caregiver to ask questions about the after-care tasks; answers to the caregiver’s questions provided in a
culturally competent manner and in accordance with the hospital’s requirements to provide language access
services under state and federal law.
The required instruction will be documented in the patient’s medical record, including, at minimum, the date,
time, and contents of the instruction.
IV.
Limitations
A designation of a caregiver by a patient or a patient’s legally designated health care decision maker under this
section shall not obligate any individual to perform any after-care tasks for any patient.
V.
Filing Instructions
This policy shall be filed in the Patient's Rights section of the Hospital Policy Manual and online. It supersedes
any and all previous policies issued relative to this subject.
VI.
Distribution
The organization is responsible for orientation of all staff to this policy. This policy shall be distributed
organization-wide to all departments.
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Below are Questions on Procedural Issues and Suggestions to Consider to
Implement this Model Policy
(Staff to consult to discuss this list: hospitalists, nursing, social work/care management, medical records,
patient registration and risk management. All the above staff will need to understand how these procedures
are addressed for the people who receive care at your facility.)
1. How will the hospital interpret “hospital stay” in regard to application of this law? The legislative intent
was that this law is to apply when a person or patient stays in the hospital for a day or more and not for outpatient services. Will patients that stay overnight or longer for “observation” but not an “admission” (per CMS
definition) be asked about a caregiver before they are “discharged” or “leave” the hospital?
2. When is the best time to ask a patient if they want to designate a caregiver?
The selection of a caregiver may change from admission to discharge depending upon the outcome of a
procedure or treatment.
3. How will your hospital address “promptly request the written consent of the patient or the patient’s
legally designated health care decision maker to release medical information to the patient’s designated
caregiver?
The statute states the process “follow the hospital’s established procedures for releasing personal health
information and in compliance with all federal and state laws. If the patient or the patient’s legally designated
health care decision maker declines to consent to release medical information to the patient’s designated
caregiver, the hospital shall not be required to provide notice to the caregiver under RSA 151:44 or provide
information contained in the patient’s discharge plan under RSA 151:45.”
4. Who does the patient need to tell if they want to change their designated caregiver before discharge and
who will have primary responsibility for ensuring that updated caregiver information is current in the
medical record? If the patient tells a hospital staff person about their decision to identify a caregiver, other
than whoever they may have identified when asked earlier, how that is communicated among staff and
updated in the medical record will need to be decided by the hospital.
5. Who will be responsible for contacting the caregiver to schedule a time to receive the discharge plan and
what is the appropriate amount notice for the caregiver to be able to participate in discharge instruction?
Many staff members are involved in procedures to complete a discharge. There is a need to identify which
staff member will contact the caregiver. Hospitals need to define what they consider is a reasonable
timeframe for that contact, notice of discharge to take place and providing the caregiver an opportunity for
education of discharge instructions (including the opportunity to ask questions about after-care).
6. What is the procedure to identify and address providing the caregiver with instruction “in a culturally
competent manner and in accordance with the hospital’s requirements to provide language access services
under state and federal law”? A patient’s caregiver may have culture and language needs different from the
patient.
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