BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                    THIRD READING


          Bill No:  AB 620
          Author:   Buchanan (D)
          Amended:  8/15/13 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,  
          including various kinds of intermediate care facilities,  
          congregate living health facilities, and skilled nursing  
          facilities, community care facilities providing adult  
          residential care or offering adult day programs, residential  
          care facilities for the elderly, and adult day health care  
          centers to develop and comply with an absentee notification  
          plan, as specified, for the purpose of addressing issues that  
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          arise when a patient, is missing from the facility.  This bill  
          requires the plan to include a requirement that an administrator  
          of the facility, inform the patient's, authorized representative  
          when that patient is missing from the facility, except under  
          specified circumstances, and to include the circumstances in  
          which local law enforcement must be notified. 

           Senate Floor Amendments  of 8/15/13 exempt state hospitals from  
          the requirements of this bill and change the name of the patient  
          safety plan to absentee notification plan.  

           ANALYSIS  :    

          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  

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            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 an absentee notification 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.Exempts state hospitals under the jurisdiction of the  
            Department of State Hospitals from the provisions of this bill  
            when the executive director of the state hospital determines  
            that informing the patient's authorized representative that a  
            patient is missing will create a risk to the safety and  
            security of the state hospital.

          3.Requires community care facilities that provide adult  
            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.

          4.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.

          5.Requires adult day health care centers (ADHCs) to develop and  
            comply with, and annually review an absentee notification 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  

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          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  
          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  

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          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 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.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

           SUPPORT  :   (Verified  8/23/13)

          AARP
          Alzheimer's 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  

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          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,  
            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  8/23/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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