BILL ANALYSIS Ó
AB 620
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Date of Hearing: April 9, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 620 (Buchanan) - As Amended: April 2, 2013
SUBJECT : Health and care facilities: missing patients and
participants.
SUMMARY : Requires specified health facilities offering adult
day health programs and adult day health centers to develop,
implement, comply with, and review annually a patient safety
plan for the purposes of addressing issues that arise when a
patient is missing from the facility. Specifically, this bill :
1)Requires intermediate care facilities (ICFs), intermediate
care facilities/developmentally disabled habilitative
(ICF-DDH), intermediate care facilities/developmentally
disabled (ICF-DD), intermediate care
facilities/developmentally disabled-nursing (ICF-DDN),
congregate living health facilities, nursing facilities,
intermediate care facilities/developmentally
disabled-continuous nursing (ICF/DD-CN), and community care
facilities offering adult day programs and adult day health
centers (ADHCs) to develop, implement, comply with and review
annually a patient safety plan for the purposes of addressing
issues that arise when a patient is missing from the facility.
2)Requires the safety plan to include a requirement that the
administrator of the facility, or his or her designee, inform
designated relatives or caretakers, or both, who are
authorized to receive information regarding the patient or
participant and inform local law enforcement when a patient is
missing from the facility.
EXISTING LAW :
1)Provides for the licensure and regulation of health facilities
including ICFs and ADHCs by the Department of Public Health
(DPH).
2)Provides for the licensure and regulation of community care
facilities and adult day programs by the Department of Social
Services (DSS).
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3)Requires certain types of health facilities, including acute
care hospitals and skilled nursing facilities, to develop,
implement, and comply with a patient safety plan for the
purpose of improving the health and safety of patients and
reducing preventable patient safety events, as specified.
4)Requires in federal regulations, ICF-DDHs, ICF-DDs, ICF-DDNs,
ICF/DD-CNs, and skilled nursing facilities (SNFs) to develop
and implement detailed written plans and procedures to meet
all potential emergencies and disasters such as fire, severe
weather, and missing clients or residents.
5)Requires in state regulations, community care facilities to
prepare a written intake assessment and a needs and service
plan prior to admission for each individual resident or client
to determine if the licensee has the ability to provide the
services needed and the type and extent of care and
supervision needed. Requires the assessment and needs and
service plan to include the following:
a) Consideration of the client's propensity for behaviors
that result in harm to self or others.
b) Physical condition, including: i) vision; ii)hearing;
iii) speech; iv) walking with or without equipment or other
assistance; v) dietary limitations; vi) medical history and
problems; and, vii) need for prescribed medications.
c) Determination of the amount of supervision necessary by
assessing if the individual: i) tends to wander; ii) is
confused or forgetful; iii) is capable of managing his/her
own cash resources; iv) actively participates in social
activities or is withdrawn; functional limitations
including physical impairments; or, v) has a documented
history of behaviors which may result in harm to self or
others.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, current state
regulations require these long-term care facilities (LTFs) to
report to regulators when the facility has filed a missing
persons report with a law enforcement agency. However, LTFs
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are not required to file a missing persons report with law
enforcement or to notify relevant family members or caregivers
when a person is missing. The author states that the safety
of individuals living in care facilities, or participating in
a day program, is at risk, as is evidenced by recent cases.
According to an October 10, 2012 article in the Contra Costs
Times provided by the author, an 86-year old female resident
went missing from Julia's Home, an adult care home in Concord.
The woman was discovered missing by a caretaker at
approximately 4:30 pm, who then conducted a search for an hour
before notifying the police at 5:30 pm. The resident, an
Alzheimer's patient who also suffered from terminal heart
failure, was found dead later that evening after a police dog
traced her scent. The woman's relatives were never notified
about her missing.
2)COMMUNITY CARE FACILITIES . According to information provided
by DSS, community care facilities offer a home like
environment that is less restrictive than the
institutionalized setting of a nursing home or developmental
center, for example. Resident care and supervision needs are
determined on a case by case basis by the residents, their
responsible parties and the licensee, and the care plans are
documented in the resident record. The residents have
personal rights allowing them to leave the facility if they
wish to do so. However, supervision is to be provided in
cases where it is needed when a resident wants to leave.
Statute prohibits residents from being in a locked
environment. The laws and regulations must be applied in a
balanced manner which protects the resident's right to depart
from the facility with the resident's need for required
supervision as the resident may be vulnerable to harm in the
community due to dementia or a number of other medical
diagnoses. Licensees are currently required to contact
emergency personnel when needed. Law enforcement and some
family members have expressed concerns with the licensee
calling 9-1-1 whenever an independent resident leaves the
facility. If the resident is not an immediate danger to
themselves or others, law enforcement has communicated that it
is an abuse of the 9-1-1 system. Overuse of 9-1-1 has also
strained the relationship between licensees and law
enforcement.
There are three types of community care facilities. Adult
residential facilities are facilities of any capacity that
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provide 24-hour non-medical care for adults ages 18 through
59, who are unable to provide for their own daily needs.
Adults in these facilities may be physically handicapped,
developmentally disabled, and/or mentally disabled. Adult day
programs are community-based facilities or programs that
provide care to persons 18 years of age or older in need of
personal services, supervision, or assistance essential for
sustaining the activities of daily living or for the
protection of these individuals on less than a 24-hour basis.
Residential care facilities for the elderly (RCFEs) provide
care, supervision, and assistance with activities of daily
living, such as bathing and grooming. RCFEs may also provide
incidental medical services under special care plans. RCFEs
provide services to persons 60 years of age and over and
persons under 60 with compatible needs. RCFEs may also be
known as assisted living facilities, retirement homes, and
board and care homes and can range in size from six beds or
less to over 100 beds. The residents in these facilities
require varying levels of personal care and protective
supervision.
According to DSS, regulations state that if a client requires
protective supervision because of running/wandering away,
supervision may be enhanced by fencing yards, using
self-closing latches and gates, and installing operational
bells, buzzers, or other auditory devices on exterior doors to
alert staff when the door is opened. However, DSS notes that
the fencing and devices must not substitute for appropriate
staffing.
3)ELOPEMENT . According to federal SNF regulations, elopement
occurs when a resident leaves the premises or a safe area
without authorization (i.e., an order for discharge or leave
of absence) and/or any necessary supervision to do so. A
resident who leaves a safe area may be at risk of (or has the
potential to experience) heat or cold exposure, dehydration,
and/or other medical complications, drowning, or being struck
by a motor vehicle. Facility policies that clearly define the
mechanisms and procedures for monitoring and managing
residents at risk for elopement can help to minimize the risk
of a resident leaving a safe area without authorization and/or
appropriate supervision. In addition, the resident at risk
should have interventions in their comprehensive plan of care
to address the potential for elopement. Furthermore, a
facility's disaster and emergency preparedness plan should
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include a plan to locate a missing resident.
4)SUPPORT . The Alzheimer's Association writes in support of
this bill that they believe it is of great importance for
these facilities to have plans and procedures in place when
patients go missing under circumstances that are unusual or
suspicious. This is of particular importance for those living
with Alzheimer's, as six in 10 wander at some point and in
these instances, it is critical that steps are taken
immediately since roughly 50% of these individuals risk
serious injury or death if not found in the first 24 hours.
The California Association of Psychiatric Technicians also
writes in support that this is a common-sense bill that
requires family members to be informed when loved ones bolt,
wander, or otherwise go missing and it also outlines the
involvement of law enforcement.
5)LETTER OF CONCERN . The California Association of Health
Facilities (CAHF) has concerns about this bill. CAHF explains
that their members currently have a federal requirement for a
patient safety plan that addresses missing patients. CAHF's
concern is whether the new state requirements being developed
in this bill either conflict with federal law, or add a series
of new, burdensome requirements for facilities to implement.
CAHF states the current version of this bill does not conflict
with federal requirements. However, it does add new
requirements for specific individuals and governmental
agencies that need to be notified. Everyone is concerned when
a resident elopes or is missing and CAHF does not oppose this
bill's new notification requirements, but will ask for the
state Medi-Cal program to pay its fair share of the mandate.
6)SUGGESTED AMENDMENTS . This bill requires the patient safety
plan to include a requirement that the facility inform
designated relatives or caretakers and notify law enforcement
when a patient/participant is missing; if, after contacting
the relative or caretaker, the facility discovers the person
is not missing, it is unclear if the facility would still be
required to notify law enforcement. The Committee may want to
amend the bill to clarify that the plan should specify when
their facility should notify law enforcement when a patient is
missing.
The plan shall include a requirement that an
administrator of the facility, or his or her designee,
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inform designated relatives or caretakers, or both,
who are authorized to receive information regarding
that patient, and local law enforcement when a patient
is missing from the facility. The plan shall include
when an administrator of the facility, or his or her
designee, should notify local law enforcement when a
patient is missing from the facility.
7)RELATED LEGISLATION . AB 961 (Levine) requires DPH to complete
its investigation of an LTC facility and issue a citation, if
any, within specified time frames and authorizes DPH and DSS
to publicly notice facility investigation and evaluation
information as long as the facility has a license capacity of
16 beds or more and the name and personally identifiable
information of any person with developmental disabilities or
who is involuntarily detained is not included.
8)PREVIOUS LEGISLATION .
a) SB 1047 (Alquist), Chapter 651, Statutes of 2012,
authorizes a law enforcement agency to request the
California Highway Patrol to activate a "Silver Alert" if a
person 65 years of age or older is missing.
b) SB 38 (Alquist) of 2009 which would have required
development and implementation of a Silver Alert system,
was held on the Assembly Appropriations Committee's
Suspense File.
REGISTERED SUPPORT / OPPOSITION :
Support
Alzheimer's Association
California Association of Psychiatric Technicians
Opposition
None on file.
Analysis Prepared by : Patty Rodgers / HEALTH / (916) 319-2097
AB 620
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