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