BILL ANALYSIS                                                                                                                                                                                                    Ó



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          ASSEMBLY THIRD READING
          AB 663 (Gomez)
          As Amended  April 29, 2013
          Majority vote 

           HUMAN SERVICES      5-2         AGING               5-2         
           
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          |Ayes:|Stone, Ammiano, Ian       |Ayes:|Yamada, Brown, Daly,      |
          |     |Calderon, Garcia, Hall    |     |Gray, Levine              |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Maienschein, Grove        |Nays:|Wagner, Grove             |
          |     |                          |     |                          |
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           APPROPRIATIONS      12-5                                        
           
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          |Ayes:|Gatto, Bocanegra,         |     |                          |
          |     |Bradford,                 |     |                          |
          |     |Ian Calderon, Campos,     |     |                          |
          |     |Eggman, Gomez, Hall,      |     |                          |
          |     |Rendon, Pan, Quirk, Weber |     |                          |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Harkey, Bigelow,          |     |                          |
          |     |Donnelly, Linder, Wagner  |     |                          |
          |     |                          |     |                          |
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           SUMMARY  :  Requires additional training for administrators of  
          adult community care facilities.  Specifically,  this bill  :  

          1)Requires administrators of adult residential facilities (ARF)  
            and residential care facilities for the elderly (RCFE) to  
            undergo additional training in cultural competency and  
            sensitivity in aging lesbian, gay, bisexual, and transgender  
            minority issues.

          2)Requires the Long-Term Care (LTC) Ombudsman to undergo  
            additional training in cultural competency and sensitivity in  
            aging lesbian, gay, bisexual, and transgender minority issues.

           FISCAL EFFECT  :  According to the Assembly Appropriations  








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          Committee, because the bill does not require an increase in the  
          overall number of hours of training, costs associated with this  
          legislation should be minor and absorbable within existing  
          resources. 

           COMMENTS :  

           Community Care Facilities Act (CCFA)  :  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, Community Care Facilities (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. 

          Under the CCFA, 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 Department of Social Services  
          (DSS)-approved certification program.  The instruction is  
          required to provide training on a uniform core of knowledge that  
          is necessary to operate a CCF. 

          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.   








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          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  
          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 country'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  








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          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 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.
           

          Analysis Prepared by  :    Chris Reefe / HUM. S. / (916) 319-2089 








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