DAL 16-06: Caregiver Advise, Record and Enable Act Reminder

May 11, 2016

Dear Chief Executive Officer:

This letter is to inform you about recently enacted legislation, known as the CARE Act (Caregiver Advise, Record and Enable Act), Public Health Law Article 29-CCCC (attached) and effective April 23rd 2016. A general hospital inpatient must be given an opportunity to formally identify a caregiver (such as a relative, partner, friend or neighbor) who would provide after-care assistance. This letter will summarize the hospital's responsibilities to comply with this new law and reinforce existing regulatory requirements for patient designated family/representative participation in the patient's discharge plan.


The New York State Department of Health expects hospitals to develop a policy and procedure to implement the requirements of the CARE Act. The CARE Act requires the hospital to provide each patient or legalguardian withatleast one opportunity to identify at least one caregiver prior to the patient's discharge or transfer to another facility. A caregiver is an individual who provides after-care assistance to a patient who will be discharged home.

Patients are not required to designate caregivers and caregivers are not obligated to perform after-care tasks for patients. The patient must consent to disclose the patient's health information to the caregiver if the patient wants to designate a caregiver.If the patient does designate a CARE Act caregiver, the hospital must include the name and contact information of the caregiver in the patient's discharge plan.


The hospital must attempt to notify the caregiver of the patient's transfer to another health care facility. The hospital must attempt to contact the caregiver prior to a patient's discharge to his or her residence so that the caregiver can provide after-care assistance in accordance with the hospital's instruction to the caregiver.


Thehospital as soon as possible prior (and if possible, 24 hours prior) to the patient's dischargemustconsultwiththe identified caregiver along with the patient regarding the patient'safter-careneedsathis or her residence. The hospital must offer caregivers instruction in all after-care tasks, taking into account the capabilities and limitations of the caregiver. Instruction to the caregiver is only required for patients being discharged to their homes, not patients being dischargedto other health care facilities.

The following written or verbal instruction to the caregiver must be provided:

  1. A demonstration of the after-care tasks. The demonstration may be performed live by amember of the hospital's workforce authorized to perform the after-care task, or it may be a recorded demonstration.
  2. After the patient and the caregiver have been given an opportunity to ask questions about the after-care tasks, questions will be answered.

The hospital must document in the medical record that the instructions to the caregiver have been given.


The requirements for a comprehensive discharge plan to meet a patient's post-hospital needs are specified in 10 NYCRR §405.9(f). The CARE Act does not change these existing requirements. Instruction to the CARE Act caregiver would not negate the need for home health care or other services. All patients must be assessed for the need for health care services as part of their discharge plan. This includes, but is not limited to, home health care, long-term home health care, hospice, day care and respite care or residential health facility care.

Under 10 NYCRR §405.9(f), a hospital must ensure that each patient has a discharge plan which meets the patient's post-hospital needs. A patient in need of post-hospital care must be assessed to determine the patient's post-hospital care needs, and the assessment must include an evaluation of the extent to which the patient's personal support system can provide for identified care needs if the patient is discharged home. Consistent with these existing requirements, the CARE Act specifically requires that, if a patient is being discharged home and the patient chooses to designate a CARE Act caregiver, the discharge plan under 10 NYCRR §405.9 must include:

  1. The name and contact information of the caregiver.
  2. A description of the assistance with after-care tasks that the caregiver is recommended to provide.
  3. Contact information for health care, community resources and long-term care supports to help the caregiver provide after-care assistance.

Should you have questions about the CARE Act, please contact the Division of Hospitals and Diagnostic & Treatment Centers at (518) 402-1003 or by email at hospinfo@health.ny.gov.


Ruth Leslie
Division of Hospitals and Diagnostic & Treatment Centers