ÌìÃÀÊÓƵ

Hawaii caregivers provide unpaid care worth $2.1 billion each year.

But the numbers of available caregivers are dwindling as the population ages, and without needed changes, there won’t be enough people left to care for those in need. Why are so many people providing care for free?

For many, there aren’t any other options. Long-term care facilities are not covered by insurance companies, with the exception for Medicaid for the truly indigent. But for those with some means, but not enough, the cost of an average nursing home is approximately . As a result, dedicated friends and family are stepping in to help to close the enormous gap in the care for the elderly in need across the state.

In a valiant attempt to help, the Caregiver Advise Record and Enable or Act is being proposedÌýin Hawaii to help caregivers with this ever-increasing burden. The CARE Act is meant to protect patients upon their hospital discharge. It’s already passed in several states and is on the legislative agenda for 2016 in the islands.

The basic idea is admittedly a good one. Give patients the opportunity to designate a caregiver and have the staff notify and educate that individual when the patient is ready to go home. After all, studies have shown that half of all family caregivers provide complex medical and nursing care for their loved ones, three quarters of which is administering medications including intravenous fluids, and most caregivers admitted to having on how to provide that level of care.

So, why wouldn’t a legislative mandate to train caregivers help?

Because making patients designate an unpaid caregiver and requiring mandatory training is actually lowering the standard of medical care that everyone deserves.

There are several significant flaws in the proposal. First of all, this is another example of how society takes advantage of caregivers with no compensation for their time. By law, designated caregivers cannot be paid for their services. So, in addition to being a family member or friend who is dealing with the emotional turmoil of helping with a sick loved one, there is now an additional burden to become a designated caregiver to comply with the new law.

Insurance companies should be paying professionals to go to the home and provide whatever care is needed.

Insurance companies are not paying these caregivers. In fact, having someone there to do what are traditionally considered nursing tasks could now lead to earlier discharges, because loved ones are having to do medical treatment for patients on their own with little or no supervision once the patient is home.

If people can’t take care of themselves, then maybe they should be sent to a facility for extra nursing care until they are truly better.

The caregivers themselves may be liable for their actions, and even with the best of intentions, mistakes can happen. The hospital could also be held accountable if designated caregivers are incompetent, or unable to do the listed tasks, despite their insistence that they think they know what they are doing.

When patients get hurt, even by accident, someone always gets blamed.

Putting caregivers in this position is irresponsible. Those who are already taking care of a loved one know that it’s not an easy job, and if they could get more help, they probably would. But if the law requires that they be trained to do nursing tasks for free, what insurance company is going to pay to have a professional come in to do the job?

Insurance companies save millions of dollars by keeping people out of the hospital. That’s just money in their pockets. They should be paying professionals to go to the home and provide whatever care is needed. If there are medical tasks that need to be done, then only a trained professional should be expected to do it.

Gone are the days when doctors could go to the home to visit sick patients. It’s just not financially feasible. Home health agencies are already struggling with low reimbursement. This should be an area of expanded insurance coverage funded by the savings from people not needing expensive hospital care.

Not only does the CARE Act put an added burden on friends and family, it also requires their training to take place before the patient leaves the hospital. But when? The nursing staff on the hospital floors are already overburdened with a mountain of charting, in addition to administering medications, coordinating tests, changing IV lines, taking patients to the bathroom, making sure patients are fed, their job description is endless. There aren’t enough hours in the day to expect that they can add caregiver training as well.

Another provision in the law requires access to instructions in any language the patient requests. Even with computerized translators, this is just going to delay discharge planning.

Should caregivers be expected to leave work to go to classes and training on what they will be doing at home? What happens if they aren’t available until late in the day? Should patients ready to be discharged stay longer, taking up needed space for those who are still sick? No one wants to be in the emergency room all night long waiting for an available room in the hospital. But if there is a mandated requirement to have training before patients can legally be discharged home, what can hospitals do?

Dr. Kuo-Chiang Lian, medical director of Queen’s Medical Group, takes care of people in the hospital and sees what happens first hand when untrained caregivers are given complex instructions for their loved ones’ care. He feels that the increased requirements are just going to delay urgent care for others, and says there are no studies to prove that assigning caregivers at home improves overall patient outcomes.

The only way to address the deficiencies in the CARE Act is to require insurance companies to pay for the services in the first place, not expect more free care fromÌý designated caregivers that patients would be required to name. Rather, any post-hospital care should be provided by trained medical professionals who are already experts at identifying what patients need, and can make sure they get it right, the first time.

Anything less is just not enough.