BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 620
AUTHOR: Buchanan
AMENDED: June 6, 2013
HEARING DATE: June 19, 2013
CONSULTANT: Marchand
SUBJECT : Health and care facilities: missing patients and
participants.
SUMMARY : Requires certain types of facilities, including
intermediate care facilities, nursing facilities, congregate
living facilities, and adult day centers, to develop a patient
safety plan for the purposes of addressing issues that arise
when a patient is missing from the facility, and requires this
plan to include a requirement that the facility inform
designated relatives or caretakers when a patient is missing.
Existing law:
1.Licenses and regulates various types of facilities by DPH,
including skilled nursing facilities, intermediate care
facilities (ICFs), and congregate living health facilities.
2.Licenses and regulates community care facilities and
residential care facilities for the elderly by the Department
of Social Services (DSS).
3.Permits a residential care facility for the elderly that cares
for people with dementia to utilize secured perimeter fences
or locked exit doors, if it meets requirements for additional
safeguards required by regulations.
4.Licenses and regulates adult day health care centers by the
Department of Aging.
This bill:
1.Requires congregate living health facilities, nursing
facilities, community care facilities that provide residential
care or offers an adult day program, adult day health care
centers, residential care facilities for the elderly, and all
types of ICFs, for the purpose of addressing issues that arise
when a patient is missing from the facility, to develop,
implement, comply with, and review annually a patient safety
plan, either as a stand-alone plan or as part of the written
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plans and procedures that are required pursuant to federal or
state law.
2.Requires the patient safety plan to include a requirement that
an administrator of the facility, or his or her designee,
inform designated relatives or caretakers, or both, who are
authorized to receive information regarding a patient, when
that patient is missing from the facility.
3.Requires the patient safety plan to include when the
circumstances in which an administrator of the facility, or
his or her designee, are required to notify local law
enforcement when a patient is missing from the facility.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis, this bill would have negligible state costs.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 75- 0
COMMENTS :
1.Author's statement. This bill protects the health and safety
of clients of certain adult health and community care
facilities that serve developmentally disabled individuals and
the elderly. It requires the development, implementation, and
annual review of safety plans that address issues that arise
when a patient or participant is missing. Although certain
facilities are required to develop plans under federal or
state regulations, no current regulations or statutes require
immediate notification of relevant emergency contacts and law
enforcement. This bill will provide a comprehensive approach
by doing the following: requiring a safety plan for situations
when a patient is missing and an annual review of that plan;
requiring the facility to notify the designated
relative/caretaker when a patient is missing; and, requires
the plan to identify when it is appropriate to call law
enforcement when a patient is missing. A number of incidents
have arisen recently in the Bay Area where patients have left
care facilities and suffered injury and even death. This bill
is a common sense approach that will clarify procedures and
obligation when a client is missing from a facility and
hopefully, prevent some of the types of tragedies that have
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occurred.
2.Adult care home cited in client's death. This bill is a
response, at least in part, to an incident at an adult care
home licensed by DSS. According to newspaper reports and an
investigation completed by DSS, on September 30 of last year,
an 86-year-old woman walked out of an adult care home in
Concord, and was found dead some hours later. According to
the DSS report, the cause of death was heat stroke, which was
preventable. The DSS report stated that the resident was
known to have eloped previously (left the facility without
authorization), and there was inadequate supervision. When
staff realized the resident was missing, they waited an hour
before notifying police. The resident was found approximately
two hours after police were notified, and family was contacted
after the body was found. Upon completion of its
investigation, DSS cited the facility for violating various
state codes, and fined the facility $1050 for failure to file
a plan of correction by the required deadline.
3.Types of facilities affected by this bill. This bill requires
certain specified types of facilities licensed by DPH, DSS and
the Department of Aging to develop and implement patient
safety plans to address issues that arise when a patient is
missing. The following are descriptions of the types of
facilities affected by this bill:
DPH-licensed facilities
Skilled nursing facilities, which are defined as
health facilities that provide skilled nursing care and
supportive care to patients whose primary need is for
availability of skilled nursing care on an extended
basis;
(ICF), which are defined as health facilities that
provide inpatient care to ambulatory or non-ambulatory
patients who have recurring need for skilled nursing
supervision, and need supportive care, but who do not
require availability of continuous skilled nursing care;
ICF/developmentally disabled habilitative, which are
defined as facilities with a capacity of 4 to 15 beds
that provides 24-hour personal care, habilitation,
developmental, and supportive health services to persons
with developmental disabilities who have intermittent
recurring needs for nursing services, but do not require
continuous nursing care;
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ICF/developmentally disabled-nursing, which are
defined as facilities with a capacity of 4 to 15 beds
that provide 24-hour personal care, developmental
services, and nursing supervision for persons with
developmental disabilities who have intermittent
recurring needs for skilled nursing care but do not
require continuous nursing care;
ICF/developmentally disabled-continuous nursing,
which are defined as homelike facilities with a capacity
of four to eight beds that provide 24-hour personal care
for persons with developmental disabilities who have
continuous needs for skilled nursing care; and,
Congregate living health facilities, which are
defined as residential homes with a capacity of no more
than 12 beds, except as specified, that provide inpatient
care, including medical supervision, 24-hour skilled
nursing and supportive care, pharmacy and dietary, with
care that is generally less intense than that in a
hospital, but more intense that that provided in skilled
nursing facilities;
DSS-licensed facilities
Community care facilities that provide residential
care or offer an adult day program. Community care
facilities, in general, are defined as any facility,
place, or building that is maintained and operated to
provide nonmedical residential care, day treatment, adult
day care, or foster family agency services for children
and/or adults, including the physically handicapped,
mentally impaired, incompetent persons, and abused or
neglected children; and,
Residential care facilities for the elderly, which
are defined as a housing arrangement chosen voluntarily
by persons 60 years of age or older, or their authorized
representative, where varying levels and intensities of
care and supervision, protective supervision, or personal
care are provided, based upon their varying needs, as
determined in order to be admitted and to remain in the
facility.
Department of Aging facilities
Adult day health care centers, which are defined as
an organized day program of therapeutic, social, and
skilled nursing health activities and services to elderly
persons or adults with disabilities with functional
impairments, either physical or mental, for the purpose
of restoring or maintaining optimal capacity for
self-care.
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1.Federal regulations. Skilled nursing facilities and ICF/DDs
are required to comply with certain federal regulations in
order to receive payment from Medicare and Medi-Cal. These
federal regulations include a requirement that facilities
"develop and implement detailed written plans and procedures
to meet all potential emergencies and disasters such as fire,
severe weather, and missing clients."
2.Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Committee on Human Services.
3.Prior legislation. SB 1047 (Alquist), Chapter 651, Statutes of
2012, authorized a law enforcement agency to request the
California Highway Patrol activate a "Silver Alert" if a
person 65 years of age or older is missing.
4.Support. This bill is supported by AARP, which states that
health and community care facilities that provide residential
or day services must ensure that vulnerable patients or
participants are accounted for at all times. This is
especially true for seniors suffering from dementia and/or
Alzheimer's as statistics show that 6 in 10 individuals will
wander at some point. Prompt notification of the person's
designated emergency contact and law enforcement helps ensure
that the individual can be quickly located without harm. The
Alzheimer's Association states in support that it is of great
importance that these facilities have plans and procedures in
place when patients go missing under circumstances that are
unusual or suspicious. The California Association of
Psychiatric Technicians states in support that this bill will
require family members to be informed when loved ones bolt,
wander or otherwise go missing from facility grounds, and
would also outline the involvement of law enforcement. The
California Mental Health Directors Association states that
this bill offers additional safeguards and protections for
vulnerable patients of care facilities, which includes
individuals with serious mental health disorders.
5.Opposition. The Department of Finance (DOF) opposes this bill
because it would require DSS to review safety plans for the
inclusion of missing patient notification requirements, but
does not define the term "missing." DOF states that the lack
of definition in statute may result in different
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interpretations by individual health facilities and could lead
to confusion and litigation brought forth by
relatives/caretakers of patients. DOF also argues that it
would create unfunded General Fund costs that are not part of
the Administration's fiscal plan.
6.Suggested technical amendment. This bill requires various
types of facilities to develop a patient safety plan,
including "nursing facilities." However, the subdivision cited
by the bill for "nursing facilities," is not technically a
category of licensure recognized by DPH, which licenses
"skilled nursing facilities," as defined by a different
subdivision. For clarity, the author may wish to consider the
following technical amendment:
On page 2, Lines 3 and 4:
1279.8. Every health facility, as defined in subdivision
(c), (d), (e),
(g), (h), (i), (k), or (m) of Section 1250, shall, for the
purpose of
SUPPORT AND OPPOSITION :
Support: AARP
Alzheimer's Association
California Association of Psychiatric Technicians
California Mental Health Directors Association
California Senior Legislature
San Ramon Valley Primary Care Medical Group
One individual
Oppose:Department of Finance
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