BILL ANALYSIS                                                                                                                                                                                                    Ó




                                                                  AB 663
                                                                  Page A
          Date of Hearing:   April 23, 2013

                   ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
                                Mariko Yamada, Chair
                     AB 663 (Gomez) - As Amended:  April 22, 2013
           
          SUBJECT  :   Residential Care Facilities for the Elderly  
          administrators and Long-Term Care Ombudsman: training  
          requirements

           SUMMARY  :   Would require lesbian, gay, bi-sexual and transgender  
          cultural training for Administrators of Adult Residential  
          Facilities (ARFs), Residential Care Facilities for the Elderly  
          (RCFE) and Long-Term Care Ombudsman.  Specifically,  this bill  :   
          Requires administrators of ARFs, RCFEs and the Office of the  
          State Long-Term Care Ombudsman to provide training of cultural  
          competencies and sensitivities toward the needs of lesbian, gay,  
          bisexual, and transgender 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)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.

          3)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.

          4)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  
            reside in that facility, and requires RCFEs to be licensed by  
            DSS.

          5)Requires administrators of RCFEs to successfully complete a  
            minimum of 40 hours of classroom instruction from a DSS  









                                                                  AB 663
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            approved certification program, as specified.

          6)Provides for the Mello-Grandlund Older Californians Act that  
            reflects the policy mandates and directives of the Older  
            Americans Act of 1965, as amended, and sets forth the state's  
            commitment to its older population and other populations  
            served by the programs administered by the California  
            Department of Aging (CDA).

          7)Provides for the Office of the State Long-Term Care Ombudsman  
            to encourage community contact and involvement with elderly  
            patients or residents of long-term care facilities or  
            residential facilities through the use of volunteers and  
            volunteer programs, protecting and advocating for the rights  
            and health and safety of long-term care facility residents,  
            and in providing leadership, direction, and support to local  
            long-term care ombudsman programs.

           FISCAL EFFECT:   Unknown

           BACKGROUND:  

           1)COMMUNITY CARE FACILITIES ACT  : The CCFA provides a system of  
            nonmedical community care, to extend care and supervision to  
            persons with developmental and mental health needs, as well as  
            dependent children and adults.  Under the CCFA, ARFs provide  
            residentially-based custodial supports and services for adults  
            age 18-59, who are unable to provide for their own daily  
            needs.  ARFs typically serve those whose health needs or  
            developmental disabilities prevent them from living at home  
            safely on their own. CCF administrators undergo 35 hours of  
            instruction to provide training on a uniform core knowledge.   
            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.

           2)RESIDENTIAL CARE FACILITIES FOR THE ELDERLY  : RCFE licensure  
            provides a system of residential support and service for older  
            persons to "age in place" as independently as possible.   
            Commonly referred to as assisted living facilities, retirement  
            homes and board and care homes, RCFEs provide services to  
            individuals who are 60 years of age and over and persons under  
            the age of 60 with compatible needs.  RCFE administrators  
            undergo 40 hours of classroom instruction.  According to DSS,  
            as of February 6, 2013 there are 7,613 licensed RCFEs in  









                                                                  AB 663
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            California with a capacity to serve 173,333 residents. 

           3)OFFICE OF LONG-TERM CARE OMBUDSMAN  : As established by the  
            Older American's act and authorized in California by the  
            Mello-Granlund Older Californians Act, the LTC Ombudsman  
            serves as an independent entity within the CDA.  California's  
            Ombudsman program began in 1979 in response to federal efforts  
            to improve conditions for residents of nursing homes and other  
            long-term care facilities.  Long-term care ombudsmen are  
            advocates for residents of nursing homes, board and care homes  
            and assisted living facilities. The office endeavors to  
            resolve complaints made by, or on behalf of, individual  
            residents in long-term care facilities. Thirty-five local  
            Ombudsman offices support a paid staff as well as a cadre of  
            several hundred volunteers, each of whom undergo 40 hours of  
            individual certification training.  The CDA and the Office of  
            the State Ombudsman host twice yearly training for the 35  
            program administrators.

           4)NEED FOR BILL  : Significant demographic shifts signal  
            unprecedented growth of the aging population.  California's  
            65+ population is expected to increase 44% in the decade  
            between 2010 and 2020, and by 2035, the 65+ population will  
            comprise 20% of the population in California.  By 2035 the 85+  
            population in California will have grown by 125% to 2,713,000  
            people<1>. This will result in longer periods of retirement  
            for seniors, and increased reliance upon housing, and  
            community based supports and services.  Parallel to the  
            increase in the nation's senior population is the emergence,  
            and the growing awareness of barriers confronting the aging  
            Lesbian, Gay, Bisexual and Transgender (LGBT) population.   
            LGBT seniors encounter a range of legal, social, health,  
            housing, and mental health challenges that if left unaddressed  
            lead to negative outcomes, or circumstances that can create  
            barriers to services that help keep people independent of  
            public social services longer.  For instance a 2004 report<2>  
            notes that 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  
            informal support.  Older LGBT people face discrimination from  

          ---------------------------
          <1> California Department of Finance Demographic Research Unit
          <2> Funders for Lesbian and Gay Issues, "Aging In Equity: LGBT  
          Elders in America," (2004).








                                                                  AB 663
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            families, and society alike.  After a lifetime of indignities,  
            discrimination, and abuse, older LGBT people may tend to seek  
            anonymity to avoid further conflict.  This could impair  
            necessary communication, a hallmark of quality care.  Though  
            tricky for individuals, LGBT couples face more complex issues  
            when hospital visitation, decision making, federal programs,  
            private pensions, tax regulations, and a host of other issues  
            are considered.  According to a recent study<3>; "Over the  
            course of their lifetime, most LGBT older adult participants  
            have faced serious adversity: 82% have been victimized at  
            least once because of their perceived sexual orientation or  
            gender identity, and 64% have been victimized three or more  
            times.  Many LGBT older adults have encountered discrimination  
            in employment and housing, impacting economic security.   
            Experiences of discrimination are linked with poor health  
            outcomes, such as depression among both chronically ill LGBT  
            older adults and their informal caregivers.  Nearly four out  
            of ten LGBT older adult participants have contemplated suicide  
            at some point during their lives. More than one in ten LGBT  
            older adults (13%) who participated in the project have been  
            denied healthcare or provided with inferior care.  Fifteen  
            percent of LGBT older adults fear accessing healthcare outside  
            the LGBT community, and 8% fear accessing healthcare inside  
            the community."  Health and social service providers must go  
            beyond their usual procedures and practices to confront  
            homophobia or discomfort, and make themselves aware of LGBT  
            needs and resources within their communities to assure scarce  
            personal and public funds available to support the needs of an  
            aging population are not misappropriated due to irrational and  
            unfounded fears or biases.  

           5)SUPPORT  :  AARP states that 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.

           6)COMMENTS  :  As amended, AB 663 appropriately expands its  
          ---------------------------
          <3> Fredriksen-Goldsen, K. I., Kim, H.-J., Emlet, C. A., Muraco,  
          A., Erosheva, E. A., Hoy-Ellis, C. P., Goldsen, J., Petry, H.  
          (2011). The Aging and Health Report: Disparities and Resilience  
          among Lesbian, Gay, Bisexual, and Transgender Older Adults.  
          Seattle: Institute for Multigenerational Health.









                                                                  AB 663
                                                                  Page E
            purview to include training to residential care facilities for  
            the elderly and the Ombudsman.  However, the author may wish  
            to accept an amendment to modernize some of the terms used to  
            describe underserved or underrepresented communities.

             Recommended Amendment #1:
           
            In 15621 (c)(1)(J) replace the word "or" with the word "and";  
            and replace the word "minority" with "underserved"


          This bill passed out of Assembly Human Services on April 16th  
          with a vote of 5-2.


          
           RELATED LEGISLATION:

          AB 2920 (Chapter 829, Statutes of 2006)  Requires the California  
          Department of Aging (CDA) to ensure equal access to programs and  
          services funded through the Older Americans Act, and that all  
          programs administered by CDA and the Area Agencies on Aging  
          account for the needs of lesbian, gay, bisexual, and transgender  
          (LGBT) elders.
           
          AB 1729 (Chapter 550, Statues of 2008)  Requires Registered  
          Nurses, Certified Nurse Assistants, Licensed Vocational Nurses,  
          and physicians working within a skilled nursing facility or  
          congregate living facility to participate in training provided  
          by the Department of Public Health focused on eliminating  
          homophobia.
           
          REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          Equality California (EQCA) - Sponsor

          California Assisted Living Association (CALA)


           Opposition 
           
          None on file.
           









                                                                 AB 663
                                                                  Page F
          Analysis Prepared by  :    Robert MacLaughlin / AGING & L.T.C. /  
          (916) 319-3990