Hospitals are Required to Train a Family Caregiver Prior to Discharge

 Q. My father, Marty, was in a serious car accident last year, where he broke several bones. During the week that followed his discharge from the hospital, my step-mother, Carolyn, struggled as she tried to get dad from the car to his wheelchair, and he ended up falling on his head and having a concussion. According to Carolyn, nobody at the hospital explained to her how to transport dad safely or what to do after they left.


I can’t fathom how a hospital can just discharge someone without training the caregiver on follow-up care and treatment. Especially in cases where a lay person is tasked with administering medication and treating wounds. Are there any laws that require hospitals to train a designated caregiver before a person is discharged?


A. Currently, as many as 42 million Americans take care of a family member at any given time. Traditionally, these family caregivers provide loved ones with assistance in bathing, dressing, eating, shopping for groceries, managing finances, and more. But as the number of seniors with chronic conditions has grown, family caregivers have taken on medical tasks once provided only in hospitals, nursing homes, or by home care professionals. In fact, nearly half of family caregivers administer multiple medications, treat wounds, or operate specialized medical equipment, according to an AARP survey released in 2012. Despite frequent emergency department visits and overnight hospital stays, few of the survey respondents reported receiving any assistance or training from health professionals.

With the new responsibilities of caregivers to take on certain medical tasks, a law took effect in Oklahoma last year, requiring hospitals to train a designated family caregiver to tend to the medical needs of a released patient. Since then, 12 more states (Arkansas, Colorado, Connecticut, Indiana, Mississippi, New Hampshire, New Jersey, New Mexico, Nevada, Oregon, Virginia, and West Virginia) have followed suit, approving Caregiver Advise, Record, Enable (CARE) laws. While the laws and legislation will differ in certain states, all contain three requirements:

• The name of a family caregiver is recorded when someone is admitted to a hospital or rehabilitation center;

• The caregiver is notified if the patient is going to be released or transferred to another facility;

• The facility must provide information and personal instruction on how the caregiver will manage medical and physical tasks, such as medication, injections, caring for wounds, use of medical equipment, and moving the family member.

Local CARE Laws

In Virginia, House Bill 1413 and Senate Bill 851 require hospitals to notify family caregivers when their loved one is being discharged from the hospital and provide instruction on how to do the required medical tasks at home. The summary of the law, as passed, is as follows:

Hospital discharge procedures; designation of individual to receive information and instructions. Requires hospitals to provide each patient admitted as an inpatient or his legal guardian the opportunity to designate an individual who will care for or assist the patient in his residence following discharge from the hospital and to whom the hospital shall provide information regarding the patient’s discharge plan and any follow-up care, treatment, and services that the patient may require. This bill is identical to SB 851.

In Maryland, SB0572 is currently under consideration, with an unfavorable review by the state’s Finance Committee. No details could be found on CARE laws being enacted in DC.

Why are CARE Laws Important?

Patients stand the risk of ending up back in the hospital if their recovery isn’t handled properly. In fact, one of the factors contributing to high readmission rates is inadequate coordination and follow-up care in the community, according to the federal government. A 2013 report by the Robert Wood Johnson Foundation found that in 2010, one out of eight Medicare patients was readmitted to the hospital within 30 days after surgery. For non-surgical patients, the percentage was nearly one in six. The numbers do not include readmissions for Medicaid and private insurers, which are also “high.” CARE laws help prevent readmissions by ensuring that discharge instructions are provided.

What if You End Up in the Hospital?

Serious car accidents, strokes, or other instances that require medical care are never planned for, as you can see from the unfortunate situation with your father. This is why thought needs to be given (in advance, if possible) to what your preferences are for how care will be delivered. Will it be at home, an assisted living facility, or a nursing home? Of course, you cannot predict the exact outcome of your long-term care needs, but before anything happens, it is a wise idea to start a discussion now with the people who might be involved in helping to coordinate your care needs in the future, and include your preferences in your planning documents.

Planning for Long-Term Care

Medicaid planning can be started while a person is still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if a person isalready in a nursing home or receiving other long-term care.  Please visit our Website for more details on Lifecare Planning and Medicaid Asset Protection Planning. If you or your loved ones have not done Long-Term Care Planning, Incapacity Planning, or Estate Planning, please call us as soon as possible to make an appointment for a consultation:

Fairfax Elder Law Attorney: 703-691-1888
Fredericksburg Elder Law Attorney: 540-479-1435
Rockville Elder Law Attorney: 301-519-8041
DC Elder Law Attorney: 202-587-2797
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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.