BILL ANALYSIS Ó
AB 753
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Date of Hearing: April 23, 2013
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
AB 753 (Lowenthal) - As Amended: April 18, 2013
SUBJECT : Cognitively impaired adults: caregiver resource
centers
SUMMARY : Repeals and recasts statutes related to the system of
caregiver resource centers (CRCs) and the recent transfer of the
program from the former Department of Mental Health (DMH) to the
Department of Health Care Services (DHCS) pursuant to the FY
2012-13 budget trailer bill provisions (AB 1467 Chapter 23,
Statutes of 2012). Specifically, this bill :
1)Repeals outdated statutes authorizing CRCs within the former
DMH, and creates the Comprehensive Act for Families and
Caregivers of Cognitively Impaired Adults.
2)Makes a number of legislative findings and declarations
regarding CRCs, including that:
a) Families caring for loved ones with cognitive
impairments face significant challenges to
maintaining physical and mental health due to burdens
associated with caregiving;
b) CRCSs advocate for family caregivers;
c) CRCs use evidence based practices to improve health
outcomes for caregivers and the people for whom they care;
d) CRC services help families avoid or delay nursing home
placement resulting in significant savings in health care
costs to families, as well as government individuals and
communities;
e) CRC's help the state's economy by assisting and
supporting families care for a loved one;
and,
f) The state shall support family caregivers taking care of
adults living with cognitive impairments by funding and
implementing caregiver resource centers.
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3)Establishes various definitions for purposes of the program,
for "Caregiver," "Cognitive Impairment," ''Cognitively
Impaired adult," among others.
4)Requires the director of the DHCS to:
a) Maintain contracts with 11 CRCS;
b) Maintain a CRC Operations Manual that define CRC
procedures, and identifies CRC duties, responsibilities;
and,
c) Seek funding for CRCs from federal and private
resources.
5)Requires agencies designated as CRCs to include on their
governing boards or advisory bodies, or both, representatives
that reflect the ethnic and socioeconomic character of the
area and people served, and establishes criteria to be used
when selecting a resource center, including:
a) Fiscal stability, and sound financial management,
including fundraising competencies;
b) The ability to build community support for the
agency; and,
c) The ability to deliver services to, and advocate for,
the needs of caregivers of cognitively impaired adults,
including consultations, respite, counseling, support
groups, legal and financial consultation, education, and
training.
6)Establishes services that must be delivered by CRCs based upon
available resources and the needs of the community, including
consultations, respite, counseling, support groups, legal and
financial consultation, education, and training.
7)Declares that recipients of services may be required to
contribute to defray the cost of services received.
8)Requires CRCs to submit progress reports on activities, as
required by the director of DHCS;
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9)Authorizes the director of DHCS to enter into exclusive or
nonexclusive contracts on a bid or negotiated basis and to
amend existing contracts to provide or arrange for services
provided under this bill.
10)Includes an urgency clause to make the provisions of this
bill take effect immediately.
EXISTING LAW establishes the Comprehensive Act for Families and
Caregivers of Brain-Impaired Adults, previously administered by
DMH, to contract with a Statewide Resources Consultant to
coordinate a statewide system of CRCs to serve caregivers of
adults with Alzheimer's disease, stroke, Parkinson's, traumatic
brain injury, and other adult-onset cognitive disorders.
AB 753 intends to continue the existing resource centers
FISCAL EFFECT : Unknown
1)PURPOSE : The Association of California CRCs has sponsored AB
753 to update CRC statutes for the first time in 30 years. By
doing, AB 753 recasts obsolete code sections reflecting the
program's transition from the former Department of Mental
Health to the Department of Health Care Services.
There are eleven Caregiver Resource Centers:
a) Bay Area CRC/ Family Caregiver Alliance, serving
Alameda, Contra Costa, Marin, San Francisco, San Mateo and
Santa Clara Counties;
b) Redwood CRC serving Del Norte, Humboldt, Lake,
Mendocino, Napa, Solano and Sonoma Counties;
c) Los Angeles CRC, serving Los Angeles County;
d) Inland CRC, serving Inyo, Mono, Riverside and San
Bernardino Counties;
e) Del Oro CRC, serving Alpine, Amador, Calaveras, Colusa,
El Dorado, Nevada, Placer, Sacramento, San Joaquin, Sierra,
Sutter, Yolo and Yuba Counties;
f) Southern CRC, serving San Diego and Imperial Counties;
g) Coast CRC, serving San Luis Obispo, Santa Barbara and
Ventura Counties;
h) Mountain CRC, serving Butte, Glenn, Lassen, Modoc,
Plumas, Shasta, Siskiyou, Tehama and Trinity Counties;
i) Valley CRC, serving Fresno, Kern, Kings, Madera,
Mariposa, Merced, Stanislaus, Tulare and Tuolumne Counties;
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j) Del Mar CRC, serving Monterey, San Benito and Santa Cruz
Counties; and,
aa) CRC of Orange County, serving Orange County.
1)CAREGIVING IN CALIFORNIA : California is home to the largest
number of seniors in the nation and their numbers are
expanding at a pace unprecedented in history. The California
Department of Finance's Demographic Research Unit estimates
that California's 65+ population will have grown 44 percent
between 2010 and 2020 (from 4.4 million to 6.35 million). By
2030 the 65+ population will reach nearly 9 million people.
The ratio of 65+ people will grow from about one in ten people
today, to one in five by 2035. Though women comprise roughly
half of the general population, by age 65 their proportion
increases to about 57%. By age 85, women outnumber men
two-to-one.
2)WHO ARE CAREGIVERS : Given the demographics confronting
California, it would come as no surprise that most people will
become a caregiver at some point during their lives. Who are
caregivers? According to the Family Caregiver Alliance, the
short answer is: Most of us, at some point in our lives.
"Caregivers are daughters, wives, husbands, sons,
grandchildren, nieces, nephews, partners and friends. While
some people receive care from paid caregivers, most rely on
unpaid assistance from families, friends and neighbors."
The National Alliance on Caregiving and AARP report "Caregiving
in the United States, 2009," estimates:
a) 31.2% of households in the U.S. had at least one person
who served as an unpaid family caregiver during the course
of the year.
b) At any one time the report estimates 37.3 million people
are providing care.
c) 66% are women and 34% are men.
d) The typical family caregiver is a 49-year-old woman
caring for her widowed 69-year-old mother who does not live
with her -- she is married and employed.
e) 1.4 million children ages 8 to 18 provide care for an
adult relative;
f) 72% are caring for a parent or grandparent; and
g) 64% live in the same household as their care recipient.
The same report estimates the number of caregivers in California
at any given time at 4.0 million, with an estimated 5.88 million
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people serving as caregivers during the course of a year.
1)WHAT IS CAREGIVING : Caregivers can be paid or unpaid.
Caregivers support the needs of dependent individuals in a
variety of ways, performing a range of tasks, including
companionship, light house-keeping, meal preparation, and
personal care tasks. More complex and sensitive tasks include
money management, medication management, communicating with
health professionals, and coordinating care. The Family
Caregiver Alliance (FCA) finds that many family members and
friends do not consider such assistance and care
"caregiving"-they are just doing what comes naturally to them:
taking care of someone they love. But that care may be
required for months or years, and may take an emotional,
physical and financial toll on caregiving families.
2)HISTORY : CRC were first authorized under legislation when
Governor Deukmejian signed AB 2913 in 1984. The
"Comprehensive Act for Family Caregivers of Brain-Impaired
Adults" established 11 regional agencies known as Caregiver
Resource Centers under the Department of Mental Health. CRCs
were legislatively mandated to assist families who provide
care for loved ones with Alzheimer's Disease, stroke,
Parkinson's, Huntington's Disease, Traumatic Brain Injury
(TBI), Multiple Sclerosis and other brain disorders acquired
after the age of 18. The CRC system was the first of its kind
in the nation and was looked to as a model for the development
of similar services now available in all 50 states.
CRCs emerged as the brain-child of research carried out by the
FCA, a San Francisco based resource and research center where
the study of family-centered care for older adults developed
into a special expertise in creating and replicating family
caregiver support programs, and translating research to
promote policy change.
CRC Services are somewhat unique. Unlike most publicly
supported services and programs, CRC services are not means
tested. They are not intended to address the needs of the
disabled family member who is being cared for directly -- but
instead directed to the caregiver, in order to support and
preserve the informal family caregiving relationship. The
public value lies in extending the caregiving relationship
through respite, counseling and other supports to caregivers.
Doing so assures caregivers endure the unremitting demands of
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caregiving and delays institutionalization, the likelihood of
imminent impoverishment, and other debilitating conditions
that caregivers are known experience, which could lead to a
dependency upon public social resources.
3)FUNDING : Funding for CRCs has been reduced by 74% since 2009.
As a result of these budget reductions, all CRCs maintain
waiting lists for various services; the CRC serving the Los
Angeles area has a waiting list of over 900 people for respite
services alone.
When the CRC program was under the authority of DMH, the FCA,
the original CRC, was selected to serve as the Statewide
Resources Consultant. In this capacity, FCA assisted in
statewide program development, data analysis, reporting
functions, and technical assistance.
The Governor's 2012-13 Budget proposed to eliminate all
funding for CRCs. In rejecting this proposal, the Legislature
noted that CRCs are a valuable component of the state's
overall safety net that allows caregivers to continue
providing long-term care in homes, thereby enabling many
disabled Californians to continue living in the community
rather than in nursing facilities, hospitals, or
institutionalized settings, at costs that typically exceed
most individual or family savings, leading to impoverishment,
and ultimately, dependency upon public social services.
According to a recent joint informational hearing of this
committee and the Assembly Human Services Committee, the value
of the services family caregivers provide for "free," when
caring, was estimated to be $450 billion in 2009. The
estimated value of unpaid care in California is $47 billion,
accounting for over 3.8 billion hours of care at $12.17, the
average caregiver wage in 2009. On the personal side,
long-term caregiving has significant financial consequences
for caregivers, particularly for women. Informal caregivers
personally lose about $659,139 over a lifetime: $25,494 in
Social Security benefits; $67,202 in pension benefits; and
$566,443 in forgone wages. Caregivers face the loss of income
of the care recipient, loss of their own income if they reduce
their work hours or leave their jobs, loss of employer-based
medical benefits, shrinking of savings to pay caregiving
costs, and a threat to their retirement income due to fewer
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contributions to pensions and other retirement vehicles<1>.
4)SUPPORT : Several individual CRCs note in support that
dedicated families, not institutions, provide most of the
long-term care for loved ones with cognitive impairments,
often at great physical, emotional, and financial sacrifice.
They state that this bill ensures that the state continues to
support and fund these programs that give caregivers a place
to turn for services. The Peninsula Stroke Association writes
in support that the small investment the state makes in CRCs
results in large monetary savings over the long-term by
preventing or delaying the placement of adults with cognitive
impairments in nursing homes or hospitals.
This bill passed out of Assembly Health with a vote of 19-0 with
a recommendation to consent.
REGISTERED SUPPORT / OPPOSITION :
Support
Alzheimer's Association
Association of California Caregiver Resource Centers (CRC)
California Association for Health Services at Home (CAHSAH)
Coast Caregiver Resource Centers
Del Oro caregiver Resource Center
Family Caregiver Alliance
Health Projects Center's Del Mar CRC
Inland Caregiver Resource Center
Multipurpose Senior Services Program Site Association (MSA)
Orange County Caregiver Resource Center
Peninsula Stroke Association
Redwood Caregiver Resource Center
Southern Caregiver Resource Center
Traumatic Brain Injury Services of California
Valley Caregiver Resource Centers
Opposition
None on file.
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<1> Valuing the Invaluable: 2011 Update: The Growing
Contributions and Costs of Family Caregiving, Lynn Feinberg,
Susan C. Reinhard, Ari Houser, and Rita Choula, AARP Public
Policy Institute
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Analysis Prepared by : Robert MacLaughlin / AGING & L.T.C. /
(916) 319-3990