BILL ANALYSIS Ó
AB 663
Page 1
Date of Hearing: April 16, 2013
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 663 (Gomez) - As Introduced: February 21, 2013
SUBJECT : Community Care Facilities: Administrator Training
Requirements
SUMMARY : Would require an additional five hours of training for
Administrators of Adult Residential Facilities (ARFs).
Specifically, this bill : Requires administrators of ARFs to
undergo five additional hours of training in cultural competency
and sensitivity in aging lesbian, gay, bisexual, and transgender
minority issues.
EXISTING LAW
1)Establishes the California Community Care Facilities Act
(CCFA) to provide a comprehensive statewide service system of
quality community care for people who have a mental illness, a
developmental or physical disability, and children and adults
who require care or services by a facility or organization.
2)Defines a "community care facility" (CCF) as a facility,
place, or building maintained and operated to provide
nonmedical residential care, day treatment, adult day care, or
foster family agency services for children, adults, or
children and adults, including, but not limited to, the
physically handicapped, mentally impaired, incompetent
persons, and abused or neglected children.
3)Requires administrators of CCFs to successfully complete a
minimum of 35 hours of classroom instruction from a California
Department of Social Services (DSS) approved certification
program, as specified.
4)Establishes the California Residential Care Facilities for the
Elderly (RCFE) Act to provide for the housing, social and
service needs of older persons that can provide a homelike
environment for older persons with a variety of care needs.
5)Defines a RCFE as a facility that provides personal care and
supervision, protective supervision or health related services
for persons 60 years of age or older who voluntarily choose to
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reside in that facility, and requires RCFEs to be licensed by
DSS.
6)Requires administrators of RCFEs to successfully complete a
minimum of 40 hours of classroom instruction from a DSS
approved certification program, as specified.
FISCAL EFFECT : Unknown
BACKGROUND:
Community Care Facilities
Established in 1973, the CCFA was adopted in response to the
need to provide a system of nonmedical community care, to
provide care and supervision services for persons with
developmental and mental health needs, as well as socially
dependent children and adults in California. Over the years,
CCFs have evolved to become more sophisticated in the range of
care they provide, which now includes providing care for persons
with severe behavioral or emotional problems, serious mental or
developmental disorders and significant medical needs.
Community care facilities provide non-medical care and
supervision for children and adults, including persons with
disabilities, seniors in need of residential care, children in
foster care and at-risk children needing shelter services,
families in need of early childhood education (child care), and
adult care services.
Under the CCFA, adult residential facilities (ARFs) are
generally considered facilities that provide residentially-based
care for adults age 18-59, who are unable to provide for their
own daily needs. ARFs typically provide residential care for
adults with mental health needs or developmental disabilities
that prevent them from living at home safely on their own.
CCF administrators must undergo 35 hours of classroom
instruction provided by a DSS-approved certification program.
The instruction is required to provide training on a uniform
core of knowledge that is necessary to operate a CCF, which
includes the understanding of:
Laws, regulations, and policies and procedural standards
that impact the operations of the type of facility for
which the applicant will be an administrator;
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Business operations;
Management and supervision of staff;
Psychosocial needs of the facility residents;
Community and support services;
Physical needs for facility residents;
Use, misuse, and interaction of medication commonly used
by facility residents;
Resident admission, retention, and assessment
procedures; and
Nonviolent crisis intervention for administrators.
According to DSS, as of February 6, 2013 there were 77,243
licensed CCFs in California with a capacity to serve 1,395,577
residents.
Residential Care Facilities for the Elderly
It is the intent of the Legislature, in creating for RCFEs their
own licensing category, to help provide a system of residential
care to allow older persons to live as independently as possible
while not forcing them to move between medical and nonmedical
services. Commonly referred to as assisted living facilities,
retirement homes and board and care homes, RCFEs are licensed
facilities that provide services to individuals who are 60 years
of age and over and persons under the age of 60 with compatible
needs. RCFEs provide a wide array of care, which can include
varying levels of personal care and protective supervision,
based upon the needs of the resident.
Much like CCF certification requirements, RCFE administrators
must undergo a similar training, but with more hours. They are
required to successfully complete 40 hours of classroom
instruction provided by a DSS-approved certification program,
which includes additional hours of instruction relating to
serving clients with dementia.
According to DSS, as of February 6, 2013 there are 7,613
licensed RCFEs in California with a capacity to serve 173,333
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residents.
Office of the Long Term Care (LTC) Ombudsman
As established by the Mello-Granlund Older Californians Act, the
LTC Ombudsman serves as an independent entity within the
California Department of Aging. Its primary responsibilities
are two-fold. First, it identifies, investigates and resolves
complaints made by residents of RCFEs, nursing homes and
assisted living facilities. Second, it plays an advocacy role
in the development of policies, regulations and statute to
improve California's system of care for older persons.
Need for the bill
One of the most significant demographic changes occurring in the
United States (US) today is the growth of our aging population.
According to the US Census, in 2000, there were just over 41
million Americans over the age of 62, representing almost 15% of
the county's population. In the 2010 Census, that number
increased by more than 21% to nearly 50 million people who are
62 years of age and over. Americans aged 62 and over grew at a
faster rate than any other age group in the country.
Additionally, with advances in health care and medical
treatment, life expectancy is increasing. It is estimated that
by the year 2030, seniors will represent more than 20% of the
nation's population and be made up of a greater proportion of
seniors over the age of 85. This will result in longer periods
of retirement for seniors, and increased reliance on housing,
health care, and social services.
Parallel to this increase in the nation's senior population, is
the growth in the number of Lesbian, Gay, Bisexual and
Transgender (LGBT) seniors. Although LGBT seniors and their
heterosexual counterparts will experience similar issues
associated with growing older, they encounter a different and
unique set of challenges and circumstances that can serve as
barriers to accessing needed services. In the 2004 report
"Aging in Equity" by the Funders for Gay and Lesbian Issues, it
notes:
LGBT elders are? less likely to have children than their
heterosexual counterparts. Since life partners and children
play an important role in caregiving, many LGBT elders
become reliant on formal caregiving services sooner than
elders who can turn to family members and partners for
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informal support.
The report goes on to say:
LGBT couples face unequal treatment in hospital visitation,
health decision making, nursing care policies, Medicaid
regulations, Medicare and Social Security Coverage, pension
and tax regulations, housing rights, and a host of other
issues that fundamentally affect their financial security,
health status, and quality of life.
There are also numerous cultural and equity issues that have yet
to percolate into the world of senior and aging care in
California. Whereas there is greater tolerance and
understanding of the LGBT community in younger generations, this
acceptance and equity of treatment has yet to immerse itself
into older generations, including seniors.
Writing in support of the bill, the AARP states:
The LGBT community has made incredible strides battling
social discrimination. They shouldn't be forced back into
hiding in the late stages of life. Increasing training in
cultural competence regarding LGBT seniors is necessary to
enable these individuals to live lives of dignity and
autonomy.
COMMENTS :
As introduced, AB 663 amends the instructional certification
requirements for administrators of ARFs. However, the stated
intent of the bill is to provide greater cultural competence for
administrators of facilities that serve LGBT seniors. ARFs are
facilities that predominantly provide residential care for
adults with developmental or mental health needs that prevent
them from living independently on their own.
It would appear that in order to meet the author's intent, this
measure should address the training requirements for
administrators of RCFEs. This would encompass the types of
facilities that provide residential services for California's
older population, including LGBT seniors.
The committee may also want to consider whether the LTC
Ombudsman should also undergo some reasonable amount of cultural
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competency training. This would help to ensure that the LTC
Ombudsman has the requisite training to identify, investigate
and correct any discrimination or disparity in the treatment and
provision of services for LGBT seniors who reside in a RCFE.
It is unclear why five additional hours are needed to address
just cultural competency or sensitivity training for LGBT
seniors, when it could be integrated into existing training time
requirements. According to DSS, existing available training
modules for LGBT cultural competency or sensitivity can be
provided in one hour. It would seem reasonable to integrate this
additional training requirement into the existing training
framework.
RECOMMENDED AND SUGGESTED AMENDMENTS
Staff recommends the following amendment:
Amendment #1
On page two, line 23 delete "40" and replace with "35"
Amendment #2
On page three, line 1 delete "Five hours of training on
cultural" and replace with "Cultural"
Amendment #3
On page three, line three delete "40" and replace with "35"
Amendment #4
On page three, line nine delete "40-hour" and replace with "35"
Amendment #5
Amend Section 1569.616(c)(1) of the Health and Safety Code (RCFE
Act) to read:
(c) (1) The administrator certification program shall require
a minimum of 40 hours of classroom instruction that provides
training on a uniform core of knowledge in each of the
following areas:
(A) Laws, regulations, and policies and procedural
standards that impact the operations of residential care
facilities for the elderly.
(B) Business operations.
(C) Management and supervision of staff.
(D) Psychosocial needs of the elderly.
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(E) Community and support services.
(F) Physical needs for elderly persons.
(G) Use, misuse, and interaction of medication commonly
used by the elderly.
(H) Resident admission, retention, and assessment
procedures.
(I) Training focused specifically on serving clients with
dementia. This training shall be for at least four hours.
(J) Cultural competency or sensitivity in aging lesbian,
gay, bisexual, and transgender minority issues.
Staff suggests the following amendment:
Amend Section 9719 of the Welfare and Institutions Code
(Mello-Granlund Older Californians Act) to read:
(a) (1) The office shall sponsor a training of representatives
of approved organizations at least twice each year. The
office shall provide training to these representatives as
appropriate. Prior to the certification of an ombudsman by
the office, individuals shall meet both of the following
requirements:
(A) Have a criminal offender record clearance conducted
by the State Department of Social Services. A clearance
pursuant to Section 1569.17 of the Health and Safety Code
shall constitute clearances for the purpose of entry to
any long-term care facility.
(B) Have received a minimum of 36 hours of certification
training that is approved by the office and offered by an
approved organization. organization, which shall include
training on cultural competency or sensitivity in aging
lesbian, gay, bisexual, and transgender minority issues.
(2) Upon receipt of an applicant's criminal record
clearance and acceptance by the office, the office shall
issue a card identifying the bearer as a certified
ombudsman. Each ombudsman shall receive a minimum of 12
hours of additional training annually.
(b) (1) The department shall contract with the State
Department of Social Services to conduct a criminal offender
record information search, pursuant to Section 1569.17 of the
Health and Safety Code, for each applicant seeking
certification as an ombudsman. The State Department of Social
Services shall notify the individual and the office of the
individual's clearance or denial.
(2) An applicant for certification as an ombudsman shall
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not be responsible for any costs associated with
transmitting the fingerprint images and related information
or conducting criminal record clearances.
(c) Nothing in this section shall be construed to prohibit the
Department of Justice from assessing a fee pursuant to Section
11105 of the Penal Code to cover the cost of searching for or
furnishing summary criminal offender record information.
DOUBLE REFERRAL : This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to the
Assembly Aging and Long Term Care Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
Equality California (EQCA) - co-sponsor
AARP
California Advocates for Nursing Home Reform (CANHR)
California Immigrant Policy Center (CIPC)
Consumer Federation of California
L.A. Gay & Lesbian Center
Our Family Coalition
Opposition
None on file
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089