by Sarah Volpenhein
A bill passed by the Wisconsin Legislature
will make it easier for hospitals to discharge certain patients
deemed incapacitated to nursing homes, freeing up hospital beds
that might otherwise be tied up for weeks.
The
bill, which Gov. Tony Evers signed into law on March 20, has the
support of hospital systems that complain of long, costly delays in
discharging patients who can no longer make medical decisions for
themselves and haven’t designated someone to act on their behalf. At
present, they remain in the hospital while awaiting court
proceedings to appoint a guardian.
“This
legislation will help ensure patients can move more quickly to the
most appropriate setting for their recovery, while also improving
hospital capacity for those who need hospital care,” said Kyle
O’Brien, president and chief executive of the Wisconsin Hospital
Association, a trade group representing hospitals.
The
legislation was opposed by disability and aging rights advocates,
who say it circumvents the guardianship process, designed to
protect the rights of vulnerable individuals, and could result in
patients becoming confined to institutions against their will.
“The
guardianship process is complex for a reason,” Lisa Hassenstab,
public policy manager at Disability Rights Wisconsin, said
during a November hearing on the bill. “That reason is due process.”
The
Senate voted 28-5 in favor of the legislation on March 17 during
what could be the body’s last floor session for the year.
The
bill passed the Assembly in February with bipartisan support,
following an amendment adding price transparency requirements for
hospitals.
Health systems engaged in heavy lobbying for bill
The
legislation received a major push from Wisconsin health systems,
hospitals and industry trade groups, which collectively spent more
than 400 hours lobbying in favor of the bill, according to reports
made to the Wisconsin Ethics Commission.
Wisconsin
hospitals spend hundreds of millions of dollars every year
housing patients who no longer need hospital care and are awaiting
discharge or transfer to nursing homes or other facilities. While
the reasons behind
discharge delays are many, the bill addresses only the guardianship issue.
It
does not address other underlying causes, such as limited bed
availability at nursing homes or the lack of medical facilities
accepting complex patients.
Up until now,
if physicians deemed a patient no longer able to make medical
decisions for themselves and they did not have a power of attorney,
the hospital could not discharge the patient to a nursing home until a
guardianship petition was filed with a court, even when family
members agreed to the transfer. Those proceedings could take weeks
or months, hospital officials said.
The
patient may be someone who had a stroke, suffered a traumatic brain
injury, or has dementia or another agerelated disease and lacks the
ability to manage their own health care, whether temporarily or
permanently.
The new law removes the
requirement to file for guardianship and allows a family member,
called a patient representative, to agree to the patient’s
admission to a nursing home, make health care decisions for them and
approve health-related spending.
Disability
advocates argue the legislation removes protections like court
oversight that come with the guardianship process while also
granting a lot of the same authority as a guardian. They say the
legislation does not require that the patient be notified of the
representative’s appointment or of their rights to ask for a
reevaluation of their mental capacity. Nor does it require the
representative to consider the wishes of the patient, they say.
The legislation, they said, also lacks protections against an abuser or estranged relative assuming the role.
“Oftentimes
the person who is an abuser is the person who is really keeping an
eye on the person in the hospital,” said Tami Jackson, public policy
analyst and legislative liaison with the WisconVon sin Board for
People with Developmental Disabilities. “Somebody who gets picked
under this bill ends up with a whole lot of authority.”
Under the new law, the patient or another family member may object to the nursing home placement, if aware.
Anyone
may ask a court to review the patient representative’s actions or
may request a reevaluation of the patient’s capacity.
Extended hospital stays can contribute to overcrowding
While
promoting the bill, health systems argued that patients may miss out
on crucial rehabilitation or other health care while waiting in
the hospital for discharge. By remaining in the hospital, they also
are at increased risk of hospital-acquired infections or falls
especially dangerous for elderly patients.
From
January to October 2025, Mayo Clinic Health System counted about 35
patients with extended stays at its northwest Wisconsin
hospitals, Gina
Ruden, a Mayo senior nurse
administrator, said at a November hearing on the bill. At Mayo’s Eau
Claire hospital, that added up to patients spending a collective
1,200 days in the hospital because of guardianship delays, she said.
The
extended stays contribute to hospital overcrowding. Mayo Clinic
has seen an influx of patients, Von Ruden said, ever since the abrupt
closure in 2024 of two area hospitals by Hospital Sisters Health
System, a competing health system.
When
overcrowded, the Mayo hospital in Eau Claire has to board patients in
the emergency department, Von Ruden said, where they may spend the
rest of their hospital visit if no bed becomes available on an
inpatient floor.
“They might be in a
hallway in the emergency department or even in the ambulance bay
when things get real tight,” Von Ruden said.
The
bill has a three-year sunset provision, which allows legislators
to check if the bill is working as intended before renewing it.
Full Article & Source:
Hospital discharge law concerns advocates