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
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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
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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
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<1> California Department of Finance Demographic Research Unit
<2> Funders for Lesbian and Gay Issues, "Aging In Equity: LGBT
Elders in America," (2004).
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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
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<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.
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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
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Analysis Prepared by : Robert MacLaughlin / AGING & L.T.C. /
(916) 319-3990