BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 620
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 620 (Buchanan)
          As Amended September 5, 2013
          Majority vote
           
           ----------------------------------------------------------------- 
          |ASSEMBLY:  |75-0 |(May 9, 2013)   |SENATE: |39-0 |(September 9,  |
          |           |     |                |        |     |2013)          |
           ----------------------------------------------------------------- 
            
           Original Committee Reference:    HEALTH  

           SUMMARY  :  Requires intermediate care facilities, nursing  
          facilities, congregate living facilities, and adult day centers  
          to develop and comply with a patient or resident absentee  
          notification plan for the purpose of addressing issues that  
          arise when a resident is missing from the facility.

           The Senate amendments  clarify that the absentee notification  
          plans must include, and are limited to, provisions requiring a  
          resident's or participant's authorized representative be  
          notified when the resident or participant is missing and include  
          the circumstances in which an administrator of a facility or  
          program shall notify local law enforcement when a resident or  
          participant is missing.  Senate amendments also clarify that the  
          patient safety plans be either stand-alone plans, or a part of  
          the written plans and procedures required by existing federal or  
          state law, depending on the type of facility, and exempt State  
          Hospitals from the requirements of this bill if it is determined  
          that informing the patient's authorized representative will  
          create a risk to the safety and security of the State Hospital.

           AS PASSED BY THE ASSEMBLY  , this bill required specified health  
          facilities offering adult day health programs and adult day  
          health centers to develop, implement, comply with, and review  
          annually a patient safety plan for the purposes of addressing  
          issues that arise when a patient is missing from the facility.

           FISCAL EFFECT  :  According to the Senate Appropriations  
          Committee, pursuant to Senate Rule 28.8, negligible state costs.

           COMMENTS  :  According to the author, current state regulations  
          require these long-term care facilities (LTFs) to report to  
          regulators when the facility has filed a missing persons report  
          with a law enforcement agency.  However, LTFs are not required  








                                                                  AB 620
                                                                  Page  2

          to file a missing persons report with law enforcement or to  
          notify relevant family members or caregivers when a person is  
          missing.  The author states that the safety of individuals  
          living in care facilities, or participating in a day program, is  
          at risk, as is evidenced by recent cases.  According to an  
          October 10, 2012, article in the Contra Costs Times provided by  
          the author, an 86-year old female resident went missing from  
          Julia's Home, an adult care home in Concord.  The woman was  
          discovered missing by a caretaker at approximately 4:30 pm, who  
          then conducted a search for an hour before notifying the police  
          at 5:30 pm.  The resident, an Alzheimer's patient who also  
          suffered from terminal heart failure, was found dead later that  
          evening after a police dog traced her scent.  The woman's  
          relatives were never notified she was missing.

          According to information provided by the Department of Social  
          Services (DSS), community care facilities offer a home-like  
          environment that is less restrictive than the institutionalized  
          setting of a nursing home or developmental center, for example.   
          Resident care and supervision needs are determined on a case by  
          case basis by the residents, their responsible parties, and the  
          licensee, and the care plans are documented in the resident  
          record.  The residents have personal rights allowing them to  
          leave the facility if they wish to do so.  However, supervision  
          is to be provided in cases where it is needed when a resident  
          wants to leave.  Statute prohibits residents from being in a  
          locked environment.  Licensees are currently required to contact  
          emergency personnel when needed.  Law enforcement and some  
          family members have expressed concerns with the licensee calling  
          9-1-1 whenever an independent resident leaves the facility.  If  
          the resident is not an immediate danger to themselves or others,  
          law enforcement has communicated that it is an abuse of the  
          9-1-1 system.  Overuse of 9-1-1 has also strained the  
          relationship between licensees and law enforcement.

          Adult residential facilities are facilities of any capacity that  
          provide 24-hour non-medical care for adults ages 18 through 59,  
          who are unable to provide for their own daily needs.  Adults in  
          these facilities may be physically handicapped, developmentally  
          disabled, and/or mentally disabled.  Adult day programs are  
          community-based facilities or programs that provide care to  
          persons 18 years of age or older in need of personal services,  
          supervision, or assistance essential for sustaining the  
          activities of daily living or for the protection of these  
          individuals on less than a 24-hour basis.  Residential care  








                                                                  AB 620
                                                                  Page  3

          facilities for the elderly (RCFEs) provide care, supervision,  
          and assistance with activities of daily living, such as bathing  
          and grooming.  RCFEs may also provide incidental medical  
          services under special care plans.  RCFEs provide services to  
          persons 60 years of age and over and persons under 60 with  
          compatible needs.  RCFEs may also be known as assisted living  
          facilities, retirement homes, and board and care homes and can  
          range in size from six beds or less to over 100 beds.  The  
          residents in these facilities require varying levels of personal  
          care and protective supervision.

          According to DSS, regulations state that if a client requires  
          protective supervision because of running or wandering away,  
          supervision may be enhanced by fencing yards, using self-closing  
          latches and gates, and installing operational bells, buzzers, or  
          other auditory devices on exterior doors to alert staff when the  
          door is opened.  However, DSS notes that the fencing and devices  
          must not substitute for appropriate staffing.

          According to federal skilled nursing facility regulations,  
          elopement occurs when a resident leaves the premises or a safe  
          area without authorization (i.e., an order for discharge or  
          leave of absence) and/or any necessary supervision to do so.  A  
          resident who leaves a safe area may be at risk of (or has the  
          potential to experience) heat or cold exposure, dehydration,  
          and/or other medical complications, drowning, or being struck by  
          a motor vehicle.  A facility's disaster and emergency  
          preparedness plan should include a plan to locate a missing  
          resident.

          The Alzheimer's Association writes in support of this bill that  
          they believe it is of great importance for these facilities to  
          have plans and procedures in place when patients go missing  
          under circumstances that are unusual or suspicious.  This is of  
          particular importance for those living with Alzheimer's, as six  
          in 10 wander at some point and in these instances, it is  
          critical that steps are taken immediately since roughly 50% of  
          these individuals risk serious injury or death if not found in  
          the first 24 hours.  


           Analysis Prepared by  :    Lara Flynn / HEALTH / (916) 319-2097 


          FN:  








                                                                  AB 620
                                                                  Page  4

          0002617