BILL ANALYSIS
AB 2555
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Date of Hearing: April 6, 2010
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
AB 2555 (Feuer) - As Introduced: February 19, 2010
SUBJECT : Ombudsman programs: appropriations.
SUMMARY : Appropriates $1.6 million to the California
Department of Aging (CDA) for the Long-Term Care Ombudsman
Program (LTCOP). Specifically, this bill :
1)Appropriates $1.6 million from the State Health Facilities
Citation Penalties Account to CDA to fund local ombudsman
programs.
2)Specifies that the funds may be used through the end of the
2010-11 fiscal year, at which time the remaining unencumbered
funds will revert to the State Health Facilities Citation
Penalties Account.
EXISTING LAW
1)Establishes the LTCOP which is authorized through the federal
Older Americans Act and its state companion, the
Mello-Granlund Older Californians Act. The primary
responsibility of the program is to investigate and attempt to
resolve complaints made by, or on behalf of, individual
residents in long-term care facilities.
2)Requires the LTCOP staff and volunteers to serve as mandated
reporters of suspected elder or dependent adult abuse and to
investigate cases of suspected abuse in long-term care
facilities.
3)Authorizes the Office of the State Long-Term Care Ombudsman to
develop policy and provide guidance to the local LTCOP
providers.
4)Requires the Department of Public Health (DPH) to license
long-term care facilities and monitor their compliance with
state and federal law.
5)Authorizes DPH to assess penalties on long-term care
facilities that it finds in violation of state and federal
AB 2555
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requirements.
6)Establishes the State Health Facilities Citation Penalties
Account into which monies derived from civil penalties levied
against long-term care facilities for violations of state law
are deposited.
7)Establishes the Federal Health Facilities Citation Penalties
Account, into which monies derived from civil penalties levied
against long-term care facilities for violations of federal
law are deposited.
FISCAL EFFECT : $1.6 million transfer of funds from the State
Health Facilities Citation Penalties Account to CDA for the
LTCOP; however, this bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
Program Background:
The LTCOP is administered by CDA and includes 35 local programs
that extensively utilize volunteers. Under federal law, the
primary responsibility of the LTCOP is to investigate and
endeavor to resolve complaints made by, or on behalf of,
individual residents in long-term care facilities. These
facilities include nursing homes, residential care facilities
for the elderly, and assisted living facilities. In addition,
California places an additional responsibility upon LTCOP staff
and volunteers - the investigation of elder and dependent adult
abuse complaints in long-term care facilities.
According to CDA's web site, the goal of the LTCOP is to
advocate for the rights of all residents of long-term care
facilities. The individual ombudsman's advocacy role takes two
forms: 1) to receive and resolve individual complaints and
issues by, or on behalf of, these residents; and 2) to pursue
resident advocacy in the long-term care system, its laws,
policies, regulations, and administration through public
education and consensus building. Residents or their family
members can file a complaint directly with the local Long-Term
Care Ombudsman or by calling the CRISISline. All long-term care
facilities are required to post, in a conspicuous location, the
phone number for the local Ombudsman office and the Statewide
CRISISline number 1-800-231-4024. This CRISISline is available
24 hours a day, 7 days a week to take calls and refer complaints
from residents.
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In 2008, the Governor vetoed all state funding, approximately
$3.8 million or nearly half of the program's overall funding,
for the LTCOP. Advocates maintain that the loss of funds
created a devastating impact on local programs and greatly
compromised the program's ability to investigate complaints,
monitor facilities, and advocate on behalf of residents, putting
vulnerable Californians at risk of abuse and neglect.
Citation Penalty Accounts:
Fines imposed on facilities as a result of DPH monitoring can
range from $100 to $100,000 for violations of state requirements
and $50 to $10,000 per day and from $1,000 to $10,000 per
instance, for other violations of federal requirements. State
law provides the authority to deposit moneys collected as a
result of state and federal civil penalties imposed against
health facilities by DPH for non-compliance with state and
federal laws into two accounts: the State Health Facilities
Citation Penalties Account, and the Federal Health Facilities
Citation Penalties Account. Monies from these accounts are to
be used for the protection of the health or property of
residents of long-term care facilities, including relocation
expenses incurred by the state in the event of a facility
closure, maintenance of a facility, including temporary
management or receivership,or resident reimbursement for funds
lost. There is a $10 million cap on the allowable fund balance
for the state account, and no cap on the fund balance for the
federal account.
State law requires DPH to produce reports on a quarterly basis
regarding the funds in both accounts. The report ending June
30, 2009 stated a fund balance of $4.8 million in the state
account and projected a fund balance of $4.510 million at the
end of June 30, 2010. The federal account balance on June 30,
2009 was $1.931 million and the projected fund balance for June
30, 2010 was $172,000, following the transfer of $1.6 million to
CDA pursuant to AB 392 (Feuer), Chapter 102, Statutes of 2009.
In January, several legislators requested an audit of the two
accounts by the State Auditor through the Joint Legislative
Audit Committee, citing inconsistent reports from DPH on the
fund balances and large retroactive adjustments that have
greatly reduced those fund balances.
Arguments in Opposition:
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The California Association of Health Facilities (CAHF) expresses
concerns about shifting funds from the penalties account to pay
for ongoing costs and argues that monies in the State Health
Facilities Citation Penalties Account should remain available to
DPH for their use in critical programs for the protection of the
health or property of residents of long-term care facilities.
In addition, CAHF contends that the account is not a sustainable
source to continue to fund another state agency's programs.
Both CAHF and Crestwood Behavioral Health, Inc. suggest that
instead of the transfer of $1.6 million from the state account
to the LTCOP, proponents could direct that any funds in excess
of the $10 million cap on the state account go toward funding
the LTCOP.
Arguments in Support:
California Advocates for Nursing Home Reform (CANHR), one of the
co-sponsors of the bill, argues that AB 2555 would prevent
further damaging cuts to the LTCOP by maintaining the $1.6
million appropriation established by AB 392 (Feuer), Chapter
102, Statutes of 2009. CANHR contends that it is fitting that
the fines paid by substandard facilities be used to support the
ombudsman program given its critical role in protecting
residents' health and safety.
According to the author, the LTCOP protects vulnerable residents
of nursing homes and assisted living facilities from abuse and
neglect through unannounced monitoring visits and investigations
of the thousands of abuse cases reported to them each year.
These programs are the front line in the provision of immediate
investigative services for the isolated and frail residents of
long-term care facilities. Because of the significant risk to
these vulnerable members of society, AB 2555 is an urgency bill
that would immediately appropriate another $1.6 million in
funding to the LTCOP by using existing, and unused, penalties
paid by facilities that fail to comply with state laws for the
protection of residents.
Related Legislation:
AB 392 (Feuer), Chapter 102, Statutes of 2009 - transferred
$1.6 million to the LTCOP from the Federal Health Facilities
Citation Penalties Account.
REGISTERED SUPPORT / OPPOSITION :
AB 2555
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Support
Advocacy, Inc.
AARP
Alzheimer's Association
California Advocates for Nursing Home Reform (CANHR)
California Association of Area Agencies on Aging (C4A)
Catholic Charities of California United
California Long-Term Care Ombudsman Association
Golden Agers for Progress
Ombudsman & HICAP Services of Northern California
4 individuals
Opposition
California Association of Health Facilities (CAHF)
Crestwood Behavioral Health, Inc.
Analysis Prepared by : Allison Ruff / AGING & L.T.C. / (916)
319-3990