BILL ANALYSIS Ó
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THIRD READING
Bill No: AB 620
Author: Buchanan (D)
Amended: 7/11/13 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 6/19/13
AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,
Nielsen, Pavley, Wolk
SENATE HUMAN SERVICES COMMITTEE : 6-0, 6/25/13
AYES: Yee, Berryhill, Emmerson, Evans, Liu, Wright
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 75-0, 5/9/13 (Consent) - See last page for vote
SUBJECT : Health and care facilities: missing patients and
participants
SOURCE : Author
DIGEST : This bill requires specified health facilities,
community care facilities, residential care facilities for the
elderly, and adult day health care centers to develop and comply
with a safety care plan to address issues arising when a
patient, resident or participant is missing from the facility.
ANALYSIS :
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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.
2.Establishes the California Community Care Facilities Act,
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.
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.
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.
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.
This bill
1.Requires specified health facilities to develop and comply
with a patient safety plan that includes a requirement that a
facility administrator, or a designee, inform the patients
authorized representative when that patient is missing from
the facility.
2.Requires community care facilities that provide adult
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residential care or an adult day program to develop 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.
3.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.
4.Requires adult day health care centers (ADHCs) to develop 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.
Background
Personal Rights in Community Care and Medical Facilities .
According to the Senate Human Services Committee analysis,
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. 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.
ADHCs are permitted to use restraints only for the protection of
the participant during treatment and diagnostic procedures, as
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supportive restraints for positioning and to prevent falling out
of chair or bed or to protect the participant from injury to
self, based on assessment of multidisciplinary team.
Federal law provides that an intermediate care facility 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. 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.
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. This bill was held in Assembly
Appropriations Committee.
SB 411 (Price, 2011), would have established the Home Care
Services Act of 2011, which requires DPH to license and regulate
home care organizations. This bill was vetoed by the Governor
Brown.
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. This bill was 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. This bill was
held in Assembly Appropriations Committee
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FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/9/13)
AARP
Alzheimer's Association
California Assisted Living Association
California Association of Psychiatric Technicians
California Mental Health Directors Association
California Senior Legislature
California State Council on Developmental Disabilities
San Ramon Valley Primary Care Medical Group, Inc.
The ARC and United Cerebral Palsy California
ARGUMENTS IN SUPPORT : 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
who 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. 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.
ASSEMBLY FLOOR : 75-0, 5/9/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Blumenfield, Bocanegra, Bonilla, Bonta, Bradford, Brown,
Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway,
Cooley, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gomez, Gordon, Gorell, Gray,
Grove, Hagman, Hall, Harkey, Roger Hernández, Jones,
Jones-Sawyer, Levine, Linder, Lowenthal, Maienschein, Mansoor,
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Medina, Melendez, Mitchell, Morrell, Mullin, Muratsuchi,
Nazarian, Nestande, Olsen, Pan, Patterson, Perea, V. Manuel
Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner, Stone,
Ting, Torres, Wagner, Weber, Wieckowski, Wilk, Williams,
Yamada, John A. Pérez
NO VOTE RECORDED: Donnelly, Holden, Logue, Waldron, Vacancy
JL:nl 8/12/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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