BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Leland Y. Yee, Chair
BILL NO: AB 620
A
AUTHOR: Buchanan
B
VERSION: June 6, 2013
HEARING DATE: June 25, 2013
6
FISCAL: Yes
2
0
CONSULTANT: Sara Rogers
SUBJECT
Health Care and Community Care Facilities: Missing patients
and participants
SUMMARY
Requires specified health facilities, community care
facilities, residential care facilities for the elderly,
and adult day health care centers to develop and implement
a safety care plan to address issues arising when a
patient, resident or participant is missing from the
facility.
ABSTRACT
Existing Law
1.Provides for the Department of Public Health (DPH) to
license and regulate health care facilities providing
diagnosis, care, prevention, and treatment of human
illness, physical or mental, to which more than one
persons are admitted for a 24-hour stay or longer. (HSC
1250 et seq.)
2.Establishes the California Community Care Facilities Act,
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 620 (Buchanan) Page
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which provides for the Department of Social Services
(DSS) to license and regulate community care facilities
providing non-medical residential care, day treatment,
and adult day care under. (HSC 1500 et seq.)
3.Provides for DSS to license and regulate residential care
facilities for the elderly (RCFE) defined as a housing
arrangement chosen voluntarily by persons 60 years of age
or over, 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. (HSC 1569 et
seq.)
4.Provides for DPH to license and regulate adult day health
care centers providing an organized day program of
therapeutic, social, and skilled nursing health
activities and services provided to elderly persons or
adults with disabilities. (HSC 1570 et. seq)
5.Establishes the Lanterman Developmental Disability
Services Act, which provides that persons with
developmental disabilities have the same legal rights and
responsibilities guaranteed all other individuals by the
United States Constitution and laws and the Constitution
and laws of the State of California. (WIC 4502)
This bill
1.Requires specified health facilities to develop,
implement and comply with, and annually review a patient
safety plan that includes a requirement that a facility
administrator, or a designee, inform authorized relatives
or caretakers when a patient is missing from the
facility. Specifically, the applicable health facilities
specified under the bill are:
All types of intermediate care facilities
(ICFs).
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Congregate living health facilities.
Nursing facilities.
1.Requires community care facilities that provide
residential care or adult day care services to develop,
implement and comply with, and annually review a resident
or participant safety plan that includes a requirement
that a facility administrator, or a designee, inform
authorized relatives or caretakers when a patient is
missing from the facility.
2.Requires RCFEs to develop, implement and comply with, and
annually review a resident safety plan that includes a
requirement that a facility administrator, or a designee,
inform authorized relatives or caretakers when a patient
is missing from the facility.
3.Requires adult day health care centers to develop,
implement and comply with, and annually review a
participant safety plan that includes a requirement that
a facility administrator, or a designee, inform
authorized relatives or caretakers when a patient is
missing from the facility.
FISCAL IMPACT
The Assembly Appropriations Committee estimates negligible
state costs associated with this legislation.
BACKGROUND AND DISCUSSION
The author states that this bill responds to three examples
in the past year where a patient has gone missing from a
licensed care facility and come to harm as a result.
Specifically, an 86-year-old with Alzheimer's disease died
outside a facility after her exit from the facility on a
day with extremely high temperatures went undetected for an
unknown amount of time. In another incident, a 24-year-old
woman with developmental disabilities was found seven miles
from a facility after being gone from the facility for over
seven hours. Police were not called until the woman's
mother arrived for a visit and could not find her daughter.
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In another incident last year, a 16-year-old autistic girl
went missing from a facility for developmentally disabled
youth and was found severely disoriented on a public bus
two days later after having been assaulted. A missing
persons report was not filed until later that night,
although police were involved much earlier. The author
states that there is currently no statutory requirement for
care facilities to report that a patient, resident or
participant is missing.
Personal Rights in Community Care and Medical Facilities
Community care facilities include a broad category of
facilities that provide nonmedical residential care to
physically or mentally impaired children or adults,
incompetent persons, or children who are abused or
neglected and are licensed and regulated by DSS. Community
care facilities are generally required to be non-secure,
meaning the facility may not lock residents inside the
facility or physically restrain a resident, in any
restraint device. (22 CCR 80072(a)(8)) For many facility
types, including Adult Day programs and RCFEs, residents
have the express right to leave or depart the facility at
any time, although a licensee may impose facility rules for
the protection of the client. RCFE licensees are required
to assess the resident's need for personal assistance and
care (such as the need for time sensitive medication, level
of disorientation and propensity for wandering, etc.) and
to determine the level of supervision necessary to protect
the resident. Additionally, some community care facilities
are permitted to use systems of controlled egress,
consistent with the personal rights of residents or
participants. (22 CCR Division 6)
ADHCs are permitted to use restraints only for the
protection of the participant during treatment and
diagnostic procedures, as supportive restraints for
positioning and to prevent falling out of chair or bed (22
CCR 78315(b)(1)) or to protect the participant from injury
to self, based on assessment of multidisciplinary team. (22
CCR 78315(a))
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Federal law provides that an ICF may employ physical
restraint only under certain circumstances as an integral
part of an individual program plan, as an emergency
measure, or as a health related protection prescribed by a
physician. (42 CFR 483.450(d)(i) to (iii)) The use of such
restraints are subject to various limitations and
requirements including appropriate documentation of the
need, staff training, limited duration, and constant
supervision during restraint.
Skilled nursing facilities may use physical restraints only
under the written order of a physician and when "designed
to lead to a less restrictive way of managing, and
ultimately to the elimination of, the behavior for which
the restraint is applied." The requirement for a physician
order may be exempted in an emergency which threatens to
bring immediate injury to patient or other. (22 CCR
72319(i)(2))
COMMENTS
The incidents described in this bill raise long-standing
and continuing policy discussions regarding how best to
strike a balance between the rights of a community care
facility resident and ensuring their safety. Frequently,
federal law prohibits the use of locked facilities or
restraints as a condition of funding. Additionally,
fundamental protections against unlawful detention of
persons who have not been provided due process has
prevented the widespread use of locked facilities for
persons who have not been convicted of a crime or formally
determined to be a danger to self or others. Community care
facilities serve a wide variety of residents with varying
levels of need and as a result broad policies regarding a
patient's ability to leave a facility are impractical. This
bill does not directly address this question, but rather
ensures that police and relatives or other persons
responsible for a community care facility resident are
notified in a timely manner in order to maximize the
opportunity for quick resolution to a patient's
disappearance from a facility.
Though the stated intent for this bill is to address
missing person incidents related to residents with mental
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or physical disabilities, the provisions of the bill apply
to all community care facility residents, including foster
youth in group homes or foster family agency placements.
Similar issues have arisen in recent media reports at group
homes. Specifically, multiple foster youth in a group home
in Davis were found to have been repeatedly leaving the
facility without permission or supervision, and an 11-year
old girl who had absented the facility was raped by two
other residents of the group home who had also absented the
facility.
Prior Legislation
AB 322 (Yamada, 2013), Would have established the Home Care
Services Act of 2013 to license and regulate home care
organizations providing services for the elderly, frail and
persons with disabilities. Held in Assembly Appropriations
Committee.
SB 411 (Price, 2011), Would have established the Home Care
Services Act of 2011, which requires the Department of
Public Health (DPH) to license and regulate home care
organizations. Vetoed by the Governor
AB 899 (Yamada, 2011), Would have established the Home Care
Services Act of 2013 to license and regulate home care
organizations providing services for the elderly, frail and
persons with disabilities. Held in Assembly Appropriations
Committee.
AB 853 (Jones, 2007), Would have established the Home Care
Services Act to license and regulate home care services for
the elderly, frail and persons with disabilities. Held in
Assembly Appropriations Committee
PRIOR VOTES
Senate Health 9-0
Assembly Floor 75-0
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Assembly Appropriation17-0
Assembly Health 19-0
POSITIONS
Support: AARP
Alzheimer's Association
California Assisted Living Association
(CALA)
California Association of Psychiatric
Technicians
California Mental Health Directors
Association
California Senior Legislature
San Ramon Valley Primary Care Medical Group,
Inc.
1 individual
Oppose: Department of Finance
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