New Hampshire CARE Act Caregiver Notification

What SB 187 Requires Hospitals to Do

New Hampshire's Caregiver Advise, Record, Enable (CARE) Act, enacted through Senate Bill 187, imposes specific obligations during discharge planning. The hospital must offer the patient or, if applicable, the patient's legally designated health care decision maker an opportunity to designate a caregiver; if a caregiver is designated, the hospital must record it; and, when the patient or decision maker consents in writing to release information, the hospital must notify and instruct the designated caregiver:

1. Offer an opportunity to designate and record a caregiver in the patient's medical record. This opportunity must be provided after entry and before discharge or transfer; if your parent is incapacitated at entry, it must be provided within 24 hours after recovery of consciousness or capacity. Your parent or their legally designated health care decision maker names the person who may provide post-discharge care at home.

2. Notify that designated caregiver as soon as possible and, at the latest, when the physician or APRN issues the discharge or transfer order. The CARE Act does not itself delay discharge or transfer, but timely notice helps prevent a family member from discovering that their parent was discharged hours earlier without anyone telling them.

3. Provide instruction to the caregiver on all after-care tasks described in the discharge plan. This means a live demonstration by an authorized hospital employee, an opportunity for questions, and answers to those questions — not just a photocopied instruction sheet. If your parent needs wound care, medication management through a specific device, catheter maintenance, or another task listed in the plan, the hospital must document the instruction.

Why This Matters in Practice

The CARE Act exists because hospitals routinely discharged patients to family caregivers who had no training in the medical tasks suddenly expected of them. A daughter who has never administered subcutaneous injections gets handed a bag of syringes and a discharge summary she can barely read. A son is told his mother needs daily wound packing but has never seen the procedure.

When families can't manage these clinical tasks safely at home, the result can be preventable hospital readmissions, medication errors, and infections. The CARE Act is designed to close that gap by requiring instruction on the tasks in the discharge plan.

What to Do If the Hospital Skips These Steps

Start by asking the discharge planner or case manager directly: "Has a designated caregiver been recorded in my parent's medical chart?" If not, ask your parent or their legally designated health care decision maker to make the designation and request that the hospital record it. A caregiver cannot unilaterally designate themself under the CARE Act; the patient or their legally designated health care decision maker must make the designation.

If the hospital is moving toward discharge without providing you instruction on the after-care tasks described in the discharge plan, document that gap in writing. Send a written message — even a hand-delivered note — to the case manager stating that you have not received the instruction required under SB 187 for the following tasks. List them specifically.

This documentation serves two purposes. First, it may prompt the hospital to actually provide the training. Second, it creates a record of noncompliance that strengthens any formal discharge appeal you may need to file through Acentra Health, New Hampshire's BFCC-QIO (1-888-319-8452).

When the CARE Act applies, failure to provide the required notice or instruction is a statutory compliance problem. That record may matter if complications arise after your parent gets home.

Limits of the CARE Act

The CARE Act does not give the designated caregiver decision-making authority over the patient's medical care. That authority still flows through the healthcare power of attorney under RSA 137-J or, if no advance directive exists, through New Hampshire's clinical surrogacy priority (spouse, then adult children, then parents, then siblings).

The CARE Act also doesn't create a private right of action — you can't sue the hospital for violating SB 187 the way you could for a breach of contract. Its power is procedural: it establishes requirements the hospital must follow and creates documentation that supports formal appeal processes when those requirements aren't met.

For families navigating a New Hampshire hospital discharge, the CARE Act is one layer in a broader set of protections that includes RSA 151:21 patient rights, federal Medicare appeal rules, and the Acentra Health review process. The New Hampshire Hospital Discharge Guide maps all of these protections into a single workflow with the specific deadlines and contact information you need during a crisis.

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