BILL NUMBER: AB 1166	CHAPTERED  09/05/03

	CHAPTER  312
	FILED WITH SECRETARY OF STATE  SEPTEMBER 5, 2003
	APPROVED BY GOVERNOR  SEPTEMBER 4, 2003
	PASSED THE ASSEMBLY  AUGUST 21, 2003
	PASSED THE SENATE  JULY 21, 2003
	AMENDED IN SENATE  MAY 29, 2003
	AMENDED IN ASSEMBLY  APRIL 8, 2003

INTRODUCED BY   Assembly Member Berg
   (Coauthors:  Assembly Members Daucher, Garcia, and Lieber)

                        FEBRUARY 21, 2003

   An act to amend Sections 1507.3, 1569.73, and 1569.74 of the
Health and Safety Code, relating to care facilities.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1166, Berg.  Residential facilities:  terminally ill persons.
   Existing law provides for the licensure and regulation of
community care facilities, including residential facilities for
adults, by the State Department of Social Services.  Existing law
defines a residential facility as, among other things, a facility for
nonmedical care of persons.
   Existing law authorizes a residential facility that provides care
for adults to obtain a waiver from the department to allow a resident
who has been diagnosed as terminally ill to remain in the facility
when certain conditions are met.
   This bill would extend this waiver authority to include a waiver
to allow a person who has been diagnosed as terminally ill to become
a resident of the facility if that person is already receiving
hospice services and would continue to receive hospice services
without disruption, when certain conditions are met.
   Existing law provides for the licensure and regulation of
residential care facilities for the elderly by the department.
Existing law prohibits any person who requires 24-hour skilled
nursing or intermediate care, or who is bedridden, other than for a
temporary illness or for recovery from surgery, from being a resident
at a residential care facility for the elderly.
   Existing law authorizes a residential care facility for the
elderly to obtain a waiver from the department to allow a resident
who has been diagnosed as terminally ill to remain in the facility,
or a person who has been diagnosed as terminally ill to become a
resident of the facility if that person is already receiving hospice
services and would continue to receive hospice services without
disruption, when certain conditions are met.
   This bill would provide that a residential care facility for the
elderly and a residential facility for adults that has obtained the
above described waiver for hospice services need not call emergency
response services at the time of a life-threatening emergency if the
hospice agency is notified instead and certain conditions are met.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 1507.3 of the Health and Safety Code is amended
to read:
   1507.3.  (a) A residential facility that provides care to adults
may obtain a waiver from the department for the purpose of allowing a
resident who has been diagnosed as terminally ill by his or her
physician or surgeon to remain in the facility, or allowing a person
who has been diagnosed as terminally ill by his or her physician and
surgeon to become a resident of the facility if that person is
already receiving hospice services and would continue to receive
hospice services without disruption if he or she became a resident,
when all of the following conditions are met:
   (1) The facility agrees to retain the terminally ill resident, or
accept as a resident the terminally ill person, and to seek a waiver
on behalf of the individual, provided the individual has requested
the waiver and is capable of deciding to obtain hospice services.
   (2) The terminally ill resident, or the terminally ill person to
be accepted as a resident, has obtained the services of a hospice
certified in accordance with federal medicare conditions of
participation and licensed pursuant to Chapter 8 (commencing with
Section 1725) or Chapter 8.5 (commencing with Section 1745).
   (3) The facility, in the judgment of the department, has the
ability to provide care and supervision appropriate to meet the needs
of the terminally ill resident, or the terminally ill person to be
accepted as a resident, and is in substantial compliance with
regulations governing the operation of residential facilities that
provide care to adults.
   (4) The hospice has agreed to design and provide for care,
services, and necessary medical intervention related to the terminal
illness as necessary to supplement the care and supervision provided
by the facility.
   (5) An agreement has been executed between the facility and the
hospice regarding the care plan for the terminally ill resident, or
the terminally ill person to be accepted as a resident.  The care
plan shall designate the primary caregiver, identify other
caregivers, and outline the tasks the facility is responsible for
performing and the approximate frequency with which they shall be
performed.  The care plan shall specifically limit the facility's
role for care and supervision to those tasks authorized for a
residential facility under this chapter.
   (6) The facility has obtained the agreement of those residents who
share the same room with the terminally ill resident, or any
resident who will share a room with the terminally ill person to be
accepted as a resident, to allow the hospice caregivers into their
residence.
   (b) At any time that the licensed hospice, the facility, or the
terminally ill resident determines that the resident's condition has
changed so that continued residence in the facility will pose a
threat to the health and safety of the terminally ill resident or any
other resident, the facility may initiate procedures for a transfer.

   (c) A facility that has obtained a hospice waiver from the
department pursuant to this section need not call emergency response
services at the time of a life-threatening emergency if the hospice
agency is notified instead and all of the following conditions are
met:
   (1) The resident is receiving hospice services from a licensed
hospice agency.
   (2) The resident has completed an advance directive, as defined in
Section 4605 of the Probate Code, requesting to forego resuscitative
measures.
   (3) The facility has documented that facility staff have received
training from the hospice agency on the expected course of the
resident's illness and the symptoms of impending death.
   (d) Nothing in this section is intended to expand the scope of
care and supervision for a residential facility, as defined in this
chapter, that provides care to adults nor shall a facility be
required to alter or extend its license in order to retain a
terminally ill resident, or allow a terminally ill person to become a
resident of the facility, as authorized by this section.
   (e) Nothing in this section shall require any care or supervision
to be provided by the residential facility beyond that which is
permitted in this chapter.
   (f) Nothing in this section is intended to expand the scope of
life care contracts or the contractual obligation of continuing care
retirement communities as defined in Section 1771.
   (g) The department shall not be responsible for the evaluation of
medical services provided to the resident by the hospice and shall
have no liability for the independent acts of the hospice.
   (h) The department, in consultation with the State Fire Marshal,
shall develop and expedite implementation of regulations related to
residents who have been diagnosed as terminally ill who remain in the
facility and who are nonambulatory that ensure resident safety but
also provide flexibility to allow residents to remain in the least
restrictive environment.
   (i) Nothing in this section shall be construed to relieve a
licensed residential facility that provides care to adults of its
responsibility, for purposes of allowing a resident who has been
diagnosed as terminally ill to remain in the facility, to do both of
the following:
   (1) With regard to any resident who is bedridden, as defined in
subdivision (a) of Section 1566.45, to, within 48 hours of the
resident's retention in the facility, notify the local fire authority
with jurisdiction in the bedridden resident's location of the
estimated length of time the resident will retain his or her
bedridden status in the facility.
   (2) Secure a fire clearance approval from the city or county fire
department, fire district, or any other local agency providing fire
protection services, or the State Fire Marshal, whichever has primary
fire protection jurisdiction.
  SEC. 2.  Section 1569.73 of the Health and Safety Code is amended
to read:
   1569.73.  (a) Notwithstanding Section 1569.72 or any other
provision of law, a residential care facility for the elderly may
obtain a waiver from the department for the purpose of allowing a
resident who has been diagnosed as terminally ill by his or her
physician and surgeon to remain in the facility, or allowing a person
who has been diagnosed as terminally ill by his or her physician and
surgeon to become a resident of the facility if that person is
already receiving hospice services and would continue to receive
hospice services without disruption if he or she became a resident,
when all the following conditions are met:
   (1) The facility agrees to retain the terminally ill resident, or
accept as a resident the terminally ill person, and to seek a waiver
on behalf of the individual, provided the individual has requested
the waiver and is capable of deciding to obtain hospice services.
   (2) The terminally ill resident, or the terminally ill person to
be accepted as a resident, has obtained the services of a hospice
certified in accordance with federal medicare conditions of
participation and licensed pursuant to Chapter 8 (commencing with
Section 1725) or Chapter 8.5 (commencing with Section 1745).
   (3) The facility, in the judgment of the department, has the
ability to provide care and supervision appropriate to meet the needs
of the terminally ill resident or the terminally ill person to be
accepted as a resident, and is in substantial compliance with
regulations governing the operation of residential care facilities
for the elderly.
   (4) The hospice has agreed to design and provide for care,
services, and necessary medical intervention related to the terminal
illness as necessary to supplement the care and supervision provided
by the facility.
   (5) An agreement has been executed between the facility and the
hospice regarding the care plan for the terminally ill resident or
terminally ill person to be accepted as a resident.  The care plan
shall designate the primary caregiver, identify other caregivers, and
outline the tasks the facility is responsible for performing and the
approximate frequency with which they shall be performed.  The care
plan shall specifically limit the facility's role for care and
supervision to those tasks allowed under this chapter.
   (6) The facility has obtained the agreement of those residents who
share the same room with the terminally ill resident, or any
resident who will share a room with the terminally ill person to be
accepted as a resident, to allow the hospice caregivers into their
residence.
   (b) At any time that the licensed hospice, the facility, or the
terminally ill resident determines that the resident's condition has
changed so that continued residence in the facility will pose a
threat to the health and safety to the terminally ill resident or any
other resident, the facility may initiate procedures for a transfer.

   (c) A facility that has obtained a hospice waiver from the
department pursuant to this section need not call emergency response
services at the time of a life-threatening emergency if the hospice
agency is notified instead and all of the following conditions are
met:
   (1) The resident is receiving hospice services from a licensed
hospice agency.
   (2) The resident has completed an advance directive, as defined in
Section 4605 of the Probate Code, requesting to forego resuscitative
measures.
   (3) The facility has documented that facility staff have received
training from the hospice agency on the expected course of the
resident's illness and the symptoms of impending death.
   (d) Nothing in this section is intended to expand the scope of
care and supervision for a residential care facility for the elderly
as defined in this act, nor shall a facility be required to alter or
extend its license in order to retain a terminally ill resident or
allow a terminally ill person to become a resident of the facility as
authorized by this section.
   (e) Nothing in this section shall require any care or supervision
to be provided by the residential care facility for the elderly
beyond that which is permitted in this chapter.
   (f) Nothing in this section is intended to expand the scope of
life care contracts or the contractual obligation of continuing care
retirement communities as defined in Section 1771.
   (g) The department shall not be responsible for the evaluation of
medical services provided to the resident by the hospice and shall
have no liability for the independent acts of the hospice.
   (h) Nothing in this section shall be construed to relieve a
licensed residential care facility for the elderly of its
responsibility to notify the appropriate fire authority of the
presence of a bedridden resident in the facility as required under
subdivision (f) of Section 1569.72, and to obtain and maintain a fire
clearance as required under Section 1569.149.
  SEC. 3.  Section 1569.74 of the Health and Safety Code is amended
to read:
   1569.74.  (a) Licensed residential care facilities for the elderly
that employ health care providers may establish policies to honor a
request to forego resuscitative measures as defined in Section 4780
of the Probate Code.
   (b) Any policy established pursuant to subdivision (a) shall meet
all of the following conditions:
   (1) The policy shall be in writing and specify procedures to be
followed in implementing the policy.
   (2) The policy and procedures shall, at all times, be available in
the facility for review by the department.
   (3) The licensee shall ensure that all staff are aware of the
policy as well as the procedures to be followed in implementing the
policy.
   (4) A copy of the policy shall be given to each resident who makes
a request to forego resuscitative measures and to the resident's
primary physician.
   (5) A copy of the resident's request to forego resuscitative
measures shall be maintained in the facility and shall be immediately
available for review by facility staff, the licensed health care
provider, and the department.
   (6) Facility staff are prohibited, on behalf of any resident, from
signing any directive document as a witness or from being the
legally recognized surrogate decisionmaker.
   (7) The facility shall provide the resident's physician with a
copy of the resident's request to forego resuscitative measures form.

   (c) Any action by a facility that has established policies
pursuant to subdivision (a), to honor a resident's request to forego
resuscitative measures as provided for in subdivision (a) may only be
taken in either of the following ways:
   (1) By a licensed health care provider who is employed by the
facility and on the premises at the time of the life threatening
emergency.
   (2) By notifying, under those conditions specified in subdivision
(c) of Section 1569.73, the hospice agency that is caring for a
resident receiving hospice services.
   (d) Licensed residential care facilities for the elderly that have
not established policies pursuant to subdivision (a), may keep an
executed request to forego resuscitative measures form in the
resident's file and present it to an emergency medical technician or
paramedic when authorized to do so in writing by the resident or his
or her legally recognized surrogate decisionmaker.  The request may
be honored by an emergency medical technician or by any health care
provider as defined in Section 4621 of the Probate Code, who, in the
course of professional or volunteer duties, responds to emergencies.