BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 620| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 CONTINUED AB 620 Page 2 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 CONTINUED AB 620 Page 3 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 CONTINUED AB 620 Page 4 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 CONTINUED AB 620 Page 5 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 CONTINUED AB 620 Page 6 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 **** END **** CONTINUED