The designated carer at the hospital

It is the Act that gives a name and a formal role to the person who will take charge of a patient when they leave hospital. The patient designates them, the hospital records it in the file, notifies them before discharge and trains them for the tasks they will have to do at home. This library covers Act 82-2023 separately, the general informal-care Act; the CARE Act is the hospital half of that same world, and Act 82-2023 names it twice.

The duty to offer the designation applies to patients hospitalised in a facility authorised under Act No. 101 of 26 July 1965, and — this is key — “shall be implemented only where that patient already had a carer before being hospitalised”. The designated carer may be a relative, partner, friend or neighbour with a significant relationship to the patient; it may not be a legal person. And the Act only covers the patient returning to their residence: the term expressly excludes rehabilitation centres, hospitals, convalescent homes, assisted living facilities and care homes licensed by the Family Department.

• That the patient already had a carer before being hospitalised: Article 3 says the requirement to offer the designation shall be implemented only in that case.Verified against the official source
• The written consent of the patient or their legal guardian to disclose clinical information to the carer. If they refuse, the hospital is not obliged to notify the carer or provide them with the discharge plan information (Article 3).Verified against the official source
• That the patient will return to their residence. Article 2(f) excludes from that term rehabilitation centres, hospitals, convalescent homes, assisted living facilities and care homes licensed by the Family Department.Verified against the official source

Information pending verification.

1. 1

   Step 1: Twenty-four hours to designate, and one condition

   Article 3 says hospitals shall give each patient or, where applicable, their legal guardian, the opportunity to designate at least one carer “no later than twenty-four (24) hours after admitting the patient and before that patient is discharged from the hospital or transferred to another health-care institution”. And it sets a condition that decides who the Act reaches: “This requirement shall be implemented only where that patient already had a carer before being hospitalised”. If the patient arrives unconscious or with some functional limitation, the hospital shall give them the opportunity to designate within twenty-four hours after they recover or regain consciousness.

2. 2

   Step 2: Designating obliges nobody, and can be changed

   The Act protects both sides. On the patient’s: “Nothing in this Article shall be interpreted as obliging a patient or their legal guardian to designate a person as their carer”, and if they refuse to designate, the hospital documents it immediately in the medical record. On the carer’s: a patient designating them “constitutes no obligation whatsoever for an individual to carry out post-hospital care tasks”. And the patient “may change their designated carer at any time”, with the hospital recording the change in the file within twenty-four hours.

3. 3

   Step 3: The written consent is the hinge

   This is where the process falls apart if nobody attends to it. When the patient or their guardian designates someone, Article 3(i) requires the hospital to seek “immediately the written consent of the patient or their legal guardian to disclose that patient’s clinical information to the carer”, under the hospital’s procedures and any federal or state law. And subsection (ii) states the consequence of not giving it: if the patient or their guardian refuses to disclose the clinical information, “the hospital shall not be obliged to notify the carer” or to provide them with the discharge plan information. The hospital must also comply with the Patient’s Bill of Rights and Responsibilities, Act 194-2000, and with HIPAA.

4. 4

   Step 4: What is written in the file

   Article 3 sets out what the hospital records: “the carer’s designation, the relationship the designated carer has with the patient, as well as the name, telephone number and address of the carer designated by the patient”. That record is what later makes it possible for you to be notified before discharge.

5. 5

   Step 5: They must tell you before discharge or transfer

   Article 4 is short and direct: “The hospital shall notify the designated carer when the patient will be discharged or transferred to another hospital or health services institution so the carer has information on the follow-up the patient will receive at that hospital or institution and the transition to a new care setting is appropriate”. It is not a courtesy: it is the duty that stops the carer finding out when the patient is already at the door.

6. 6

   Step 6: They consult you too, within the same 24 hours

   Article 5 opens with something surprising: as soon as possible and no later than twenty-four hours after the patient is admitted, the hospital shall assess the patient’s needs and capacities “and shall likewise consult the designated carer about their capacities and limitations to attend to the patient”. That information forms part of the medical record and is the basis for the individualised care plan, the discharge plan and the post-hospital care at home. That is, what you can and cannot do is a formal input to the plan, not a detail.

7. 7

   Step 7: What the discharge plan must say

   Article 5 sets a minimum content of three pieces. The designated carer’s name and contact information. A description of the assistance tasks needed in post-hospital care for the patient to keep living at their residence, “taking into account the carer’s capacities and limitations”. And the contact information for any community health-care resource, and long-term health-care services and assistance, as needed to fulfil the plan.

8. 8

   Step 8: And they must teach you, with a hands-on demonstration

   This is the heart of the Act and what most people do not know. The hospital preparing the discharge plan “must ensure that a nursing professional, case manager or other health services provider attached to the hospital and with the required competencies in post-hospital care devotes the time necessary to prepare the carer”, giving them specific instructions for all the assistance tasks described in the plan. Those instructions must include at least: information on the tasks to be performed, medication administration with proper instructions, service requirements the doctor deems necessary and warnings of symptoms or complications — and “where applicable, a practical demonstration of the assistance tasks to be performed shall be carried out”, adapted to your level of understanding and in terms you can understand; the opportunity for the carer and the patient to ask questions; and the answers to those questions, in the same simple terms.

9. 9

   Step 9: And there is a record of who taught you and when

   Article 5 closes that part with a record rule worth knowing if something goes wrong at home: “Any instruction and demonstration provided under this Act shall be recorded in the patient’s medical file, including, at minimum, the date, the time, the content of the instructions and the person who gives them with their credentials”.

10. 10

    Step 10: Two limits the Act writes itself

    Worth publishing alongside the rights. Article 6 says nothing in this Act shall be interpreted so as to interfere with the rights of an agent acting under valid health-care provisions under Act 160-2001 on advance directives; and that if any other health-care power or authorisation granted by the patient conflicts with this Act, that power must have been in force before the hospitalisation. And Article 7 is blunter: “Nothing in this Act shall be interpreted as granting a private right to bring a legal action against a hospital or a hospital employee, or as superseding or replacing any right or remedy existing under any special or general law”. That is, the Act creates duties but no cause of action of its own; whatever remedies exist come from other laws.

At the hospital itself, on which the Act imposes all these duties: offering the designation, seeking the written consent, recording in the file, notifying before discharge or transfer and preparing the carer. The Health Department, coordinating and consulting with the Hospital Association and the Colegio de Médicos Cirujanos, is the one that makes the regulations and protocols to implement the Act.

• Waiting for the hospital to offer it: the duty exists, but only where the patient already had a carer before the hospitalisation.
• Believing you must designate: the Act expressly says nothing obliges the patient or their guardian to designate anyone.
• Thinking being designated obliges you to care: the Act says the designation constitutes no obligation whatsoever to perform those tasks.
• Forgetting the written consent: without it, the hospital is not obliged to notify you or give you the discharge plan information.
• Not correcting the file: if you change carer, the hospital must record it within twenty-four hours.
• Accepting discharge without a written plan: the plan must include your name and contact, the necessary tasks and the contacts for community resources and long-term care.
• Not saying what you cannot do: the Act requires you be consulted about your capacities and limitations, and the plan must take them into account.
• Leaving without the practical demonstration: where applicable, the Act requires it, adapted to your level of understanding.
• Not asking: the Act expressly gives you the opportunity to ask questions and to get answers in terms you understand.
• Assuming a designation under this Act displaces an earlier health-care power: the conflicting power must have been in force before the hospitalisation.
• Believing this Act alone gives you grounds to sue: Article 7 says it grants no private right of action against the hospital.
• Counting on it if the patient goes to a care home: the definition of residence excludes those homes, rehabilitation centres, convalescent homes and assisted living facilities.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov