When a bill is passed, it is “codified” as an “Oregon Revised Statute.” This is where it becomes an enforceable law of the state. House Bill 2023 (2015) is now a law – ORS 441.196 Discharge of Patients Receiving Mental Health Treatment.
This Oregon statute requires hospitals to:
- Adopt and enforce policies for discharging patients who are hospitalized for mental health treatment, meaning patients admitted to a psychiatric inpatient hospital for treatment, and
- Put the policies in writing and make them publicly available.
Discharge process requires hospitals to:
(1) Offer all patients receiving inpatient care the opportunity to designate a lay caregiver. “Lay Caregiver” is the legal terminology that refers to who will be helping the patient with their follow up care when they leave the hospital. This may be a family member or other support person as designated by the patient. All adult patients have the right to designate a family member or representative of his or her choice and have that person notified of their admission and discharge to the hospital. For patients under 14, a parent or legal guardian of the patient should be automatically designated as the lay caregiver. For patients between 14 and 18 years of age, a parent or legal guardian will also be automatically designated as the lay caregiver except under certain defined circumstances where the patient may designate his or her own caregiver (ie. the legal guardians refuse or there are clear clinical indications to the contrary such as sexual abuse by the guardian or evidence of emancipation).
(2) Encourage patients to sign an authorization to allow the disclosure of relevant health information with the designated lay caregiver. This one is often tricky due to varying interpretations of HIPAA (the Health Information Portability and Accountability Act). That is what HB 2948 helps to clarify.
(3) Conduct a risk assessment of the patient’s risk of suicide, seeking input from the patient’s designated lay caregiver, including interviews and patient history. NOTE: Providers may accept unsolicited information from family and friends not authorized for disclosure.
(4) Conduct a needs assessment to understand the long-term needs of the patient, including lay caregiver in this conversation. What to include in the needs assessment:
- The patient’s capacity for self-care, including but not limited to:
- The risk that the patient may engage in self-harm as identified in the risk
- The patient’s support network in place at the location of anticipated discharge.
- Patient resources and ability to access prescribed medications or travel to follow-up appointments.
- The patient’s need for community-based services.
- Appropriate post-discharge placement for the patient, including whether the patient may return to the place from which they resided prior to hospital admission or if step-down resources are needed.
(5) Coordinate the patient’s care and transition to outpatient treatment and share the patient’s post-discharge treatment plan with the patient and lay caregiver. Discussion of the plan should describe what the next level of care is, how it differs from the inpatient hospitalization, what the patient should expect from that level treatment, and address and phone number of the provider.
(6) Schedule a follow-up appointment for no later than seven days after discharge, unless there is a reason why this can’t happen, in which case, the hospital needs to document the reason.
(7) Provide instructions or training to the patient and lay caregiver prior to discharge. Instructions should address how to provide assistance to the patient and may include securing and administering medications, safety plans, name and location of follow-up appointment and community resources, or any other anticipated assistance relating to the patient’s condition.
(8) Notify the designated lay caregiver in advance of patient discharge or transfer.
Oregon Administrative Rules: 333-505-0055 Discharge Planning Requirements
For a copy of the law, go here: ORS 441.196 Discharge of Patients Receiving Mental Health Treatment