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This is how it starts

Monday, Mar 30, 2015

* It sure looks like a good bill

A proposal designed to ensure people are trained to take care of recently hospitalized loved ones is moving forward in the Illinois General Assembly.

The legislation, proposed by Republican state Sen. Chapin Rose of Mahomet, was approved unanimously in the Senate Thursday and now heads to the House.

“The big key here is, when someone is discharged from the hospital, we will give training to their caregiver to make sure they get good after-care,” Rose said.

The legislation asks the patient to identify a loved one as a caregiver. The hospital then contacts the caregiver before the patient is released and explains to the caregiver how to properly take care of the patient.

How could you not support that? I don’t know what it’ll cost, but it appears worth a look and the unanimous Senate vote shows legislators solidly support it.

* Just keep in mind that most of the targeted programs on Gov. Rauner’s Fiscal Year 16 chopping block began life exactly like this one: with unanimous or nearly unanimous legislative votes.

It’s one reason why the budget has grown to this point (although by far not the biggest reason, which would be the state finally making its required pension payments along with the growth in education, Medicaid and public safety costs), but it’s also why these small programs are so difficult to eliminate. Everybody wants them. But too few want to find the money to actually pay for them.

…Adding… AARP just called to say the bill doesn’t cost the state anything. It’s a mandate on hospitals.

I’ve been thinking about the original point for a few days, but then I picked the wrong darned bill to illustrate it. Oops.

Nevertheless, we can still talk about the broader point here.

- Posted by Rich Miller        

30 Comments
  1. - Norseman - Monday, Mar 30, 15 @ 1:42 pm:

    I’m not sure what hospitals the people that suggested this legislation go to, but this is already the practice in the Chicago and Springfield hospitals we’ve been to. Both focused on referral to home therapy.


  2. - Slick Willy - Monday, Mar 30, 15 @ 1:43 pm:

    Is this really a problem that needs legislation? If I was taking care of a loved one, I would be sure to speak to the doctor, nurse, etc, to make sure that I understood any nuances. I could be wrong, but it seems like a solution looking for a problem.


  3. - OneMan - Monday, Mar 30, 15 @ 1:48 pm:

    Without seeing the bill the first thing (being paying malpractice insurance time for my household) is what are the liability implications for the caregiver and the training provider.

    I know what you are saying, would someone sue a ‘loved one’, well if they screw up and cause injury they might not have a choice and/or they might sue knowing someone else (like an insurance policy) would be on the hook.


  4. - Liberty - Monday, Mar 30, 15 @ 1:53 pm:

    Big sigh. A Republican no less.


  5. - Bogey Golfer - Monday, Mar 30, 15 @ 1:55 pm:

    Does this mean that when someone has outpatient surgery, a caregiver has to be appointed and that person has to undergo ‘training’. A month ago my wife underwent eye surgery and my mother-in-law drove her to and from the hospital. Under the proposed legislation, my mother-in-law would have needed to live with us for 2 weeks because she would have been trained and not me. AND THIS IS A GOOD THING?????


  6. - Jogger - Monday, Mar 30, 15 @ 1:56 pm:

    ==I could be wrong, but it seems like a solution looking for a problem.==

    No, you’re not wrong.


  7. - 47th Ward - Monday, Mar 30, 15 @ 2:00 pm:

    ===I could be wrong, but it seems like a solution looking for a problem.===

    A buddy of mine was taking care of his dad, who suffered from Alzheimer’s and dementia. The dad had been in the hospital recently, and discharged again to go home. They even had a nurse come in to the house every day too. Pretty good care, right?

    Except no one bothered to tell my friend that late-term Alzheimers patients often forget how to swallow food and you should NEVER allow them to use straws when eating. Kind of an inportant detail, don’t you think?

    Long story short, his dad was re-admitted to a hospital for pneumonia, brought on by pulminary aspiration (inhaling your food).

    These aren’t dumb people. Both my friend and his sisters were very involved in his care and spoke often with their dad’s doctors. Civilians just don’t have the proper training to deal with a lot of this stuff. I’m not sure phone instructions are enough, but it would have probably helped my friend’s situation by giving them some help with something that seems so basic: feeding.


  8. - spidad60 - Monday, Mar 30, 15 @ 2:01 pm:

    See a need, propose legislation…if there is no need, propose legislation


  9. - Ahoy! - Monday, Mar 30, 15 @ 2:05 pm:

    I wonder if this is something that could actually be a cost savings. If people (especially folks on Medicaid) have an understanding of treatment, are people less likely to return to the Doctor? The benefit could be greater than the cost here. Besides, having a nurse have a conversation with a relative seems like it should be automatic and free. In fact, this already happens when we’ve been to the hospital or needed medical attention.


  10. - Fr. Murphy - Monday, Mar 30, 15 @ 2:10 pm:

    47th Ward: You are so correct. Many years ago we took our dying mom home and were among the first in the area to do home hospice - we had no training at all. Way complicated taking care of a person dying of cancer - so much to do and your heart is breaking more every day. Lets just say the stress was incredible and led to a family split that - 35 years later - will never heal.


  11. - illinifan - Monday, Mar 30, 15 @ 2:13 pm:

    This is a bill looking for a problem. My husband was recently in the hospital and needed home care. Before the discharge the hospital and doctor worked to get approval for the care. When we arrived home the visiting nurse came to our home (same day) to review what had to be done for his treatment. The next day they came back to observe how well we were following instructions. I asked what would happen if we had failed, and the answer was he would have been sent to a rehab facility. This seems to fairly standard in light of hospitals not receiving reimbursement if the person is readmitted in 30 days for the same condition. I asked if there was no one willing to care for him, or able, what would happen and again I was told he would have been sent to rehab.


  12. - Waffle Fries - Monday, Mar 30, 15 @ 2:14 pm:

    You could look at the Community Services Act in the same way - advancing policy that makes sense for helping people, but never truly committing the resources over time.


  13. - Gerardo Cardenas - Monday, Mar 30, 15 @ 2:16 pm:

    This is a great bill and Illinois can certainly model it for other states. AARP is right on the money about the no fiscal impact to the state, it’s a win-win!


  14. - 47th Ward - Monday, Mar 30, 15 @ 2:20 pm:

    ===This is a bill looking for a problem.===

    Maybe, maybe not. Under the ACA, hospitals have increasing incentives to discharge patients as soon as possible. Families are going to be the primary care-givers in many of these cases. If the goal is keeping patients out of the hospital to lower our health care costs, then providing some training to the default care-givers is a smart investment.

    That it doesn’t cost taxpayers is a feature, not a bug. Hospitals dumping patients back on their families is going to save them a lot of money. This isn’t the worst mandate Springfield ever camp up with.


  15. - NIU Grad - Monday, Mar 30, 15 @ 2:23 pm:

    It doesn’t cost the state anything, but puts it on the hospital. I’d hope the legislative research team looks at what kind of operational cost this might have for different-sized hospitals and if it’ll affect patient’s bills. Also, does the hospital become liable if the caregiver makes a mistake and claims they weren’t trained properly?


  16. - sloman - Monday, Mar 30, 15 @ 2:27 pm:

    OH, if it costs someone else money, no problem. But just who do you think that hospital is going to pass the that cost along to. Spend, spend, spend. Well at least the good news is that eventually they will run out of other peoples money. Good grief, anything for a vote, even if it means the continued decline of Illinois.


  17. - IL - Monday, Mar 30, 15 @ 2:34 pm:

    Common sense bill - no cost to the state, IL Hospital Assn. backs and it allows family caregivers the education and resources needed to keep their loved one at home post-hospital stay. This is the type of bill Illinois needs more of….cost savings, compassionate and addresses a need in a fiscally sound manner.


  18. - Anonymous - Monday, Mar 30, 15 @ 2:36 pm:

    That social worker at the hospital is on you like a used car salesman.some sorta kickback?


  19. - zatoichi - Monday, Mar 30, 15 @ 2:38 pm:

    Nice heartfelt start, but where do the ripple effects drift to? Put in mandates like these, even when they sound great, and they get interpreted differently later. ‘They didn’t teach me that’, ‘how am I supposed to remember all that’, who checks the quality 5 days later, when does the state Quality Management team start up, ‘I can’t do that so send him to Rehab’, ‘We talked about that and here is your signature on the form we discussed’, the list just grows.


  20. - Anonymous - Monday, Mar 30, 15 @ 2:40 pm:

    No Costs? Who pays for the training personell and time? What is the minimum requrement, Recordkeeping etc. This might be a good idea, but there is some cost to the hospital. Is there a future liability potential?


  21. - downstate commissioner - Monday, Mar 30, 15 @ 2:41 pm:

    Springfield hospitals (and Sprfld Clinc) ALWAYS talk to the “caregiver” and explain things to them, then send a note home explaining the information given orally. Included are who to call for various problems, and phone numbers. I just assumed that this was routine. “Training” worries me a bit; are they going to demand specialized training that will cost money and take time? If the hospital pays for it, who pays the hospital- one way or another, it is going to cost someone.


  22. - Just askin' - Monday, Mar 30, 15 @ 2:41 pm:

    Seems like this should be a best practice at a hospital. That doesn’t mean it should be a law.


  23. - Sir Reel - Monday, Mar 30, 15 @ 2:48 pm:

    The General Assembly comes up with this stuff year after year. I don’t believe there’s no cost and I’m sure there’ll never be any follow up to find out if it works, if it’s cost effective, etc. Just another good idea that adds to costs.

    I also heard that a bill to require combination tops/locks on prescription bottles for opiates. The intent is to prevent theft leading to dependence, addiction, crime, etc. It would cost $4 per bottle. Sounds good but it’s pretty easy to break into a plastic prescription bottle.

    The list goes on and on.


  24. - Bogey Golfer - Monday, Mar 30, 15 @ 2:49 pm:

    So the cost of training is added to the hospital bill - will the insurance companies cover it?
    In reading the link, Senator Rose’s mother had surgery in Arizona, and developed an infection afterward. Ah Senator, if your mother appointed you as caregiver, would you have flown out west to be with her when she recuperated? Why didn’t you fly out there and be with her to begin with? If she is living alone in a retirement community, could the community designate someone? Spot on, zatoichi - the list grows.


  25. - Norseman - Monday, Mar 30, 15 @ 2:51 pm:

    === Under the ACA, hospitals have increasing incentives to discharge patients as soon as possible. ===

    Not a fan of ACA, but this trend started WAY before ACA. First child, wife with no complications spent 4 days in hospital. Four years later, 2nd child and wife out in two days - veto session no less. Similar experience with other procedures.

    === It doesn’t cost the state anything, but puts it on the hospital. I’d hope the legislative research team looks at what kind of operational cost this might have for different-sized hospitals and if it’ll affect patient’s bills. ===

    This and so many other bills create a mandate without any clear enforcement measures. While it doesn’t task IDPH with the role of overseeing the mandate, people will call it with complaints should a family run into a non-compliant hospital. That leaves the agency with a question of whether they need to check for compliance as part of a routine inspection. IDPH doesn’t have resources to do hospital inspections now without doing so in conjunction with a federally funded inspection.
    Patient families could try to sue, but that is a costly step with dubious likelihood of success.

    === Also, does the hospital become liable if the caregiver makes a mistake and claims they weren’t trained properly? ===

    The bill does contain a hold harmless clause for the training.


  26. - Norseman - Monday, Mar 30, 15 @ 3:27 pm:

    P.S. Then there are those “innocuous” resolutions asking agencies to study thing or create task forces that cause additional drain on resources.


  27. - Rod - Monday, Mar 30, 15 @ 3:52 pm:

    I am a bit baffled by this passage in the bill: “A designation of a caregiver by a patient or the patient’s legal representative does not obligate any individual to provide any after care for the patient.” So what is the point of the bill? Those that seem to be worried about mandates on this blog need not worry, the bill has no teeth, no right of private action if the released patient dies because the caregiver does not show.


  28. - Pot calling kettle - Monday, Mar 30, 15 @ 6:11 pm:

    Rich, you original point is correct; of course it costs the state. The state pays medicare, medicade, and insurance on its employees, and each of those pay the hospital.


  29. - walker - Monday, Mar 30, 15 @ 6:20 pm:

    The mountain from Mahomet. He’s usually saying the state should stay out of such things, and we certainly shouldn’t burden business with mandated costs.


  30. - Mama - Monday, Mar 30, 15 @ 9:54 pm:

    Does this mean they are planning to throw the patients out of the hospital sooner than they normally would? Such as sending people home right after major surgery?


Sorry, comments for this post are now closed.


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