BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 753
AUTHOR: Lowenthal
AMENDED: June 18, 2013
HEARING DATE: July 3, 2013
CONSULTANT: Robinson-Taylor
SUBJECT : Cognitively impaired adults: caregiver resource
centers.
SUMMARY : Repeals and recasts statutes related to the system of
caregiver resource centers to conform with the transfer of the
program from the former Department of Mental Health to the
Department of Health Care Services.
Existing law:
1.Establishes the Comprehensive Act for Families and Caregivers
of Brain-Impaired Adults, previously administered by the
former Department of Mental Health (DMH), to contract with a
Statewide Resources Consultant to coordinate a statewide
system of caregiver resource centers (CRCs) to serve
caregivers of adults with Alzheimer's disease, stroke,
Parkinson's, traumatic brain injury, and other adult-onset
cognitive disorders.
2.Transfer the CRC program from DMH to Department of Healthcare
Services (DHCS), due to the elimination of DMH in the 2012
Budget.
This bill:
1.Repeals existing law governing CRCs under the jurisdiction of
DMH and enacts the Comprehensive Act for Families and
Caregivers of Cognitively Impaired Adults.
2.Makes a number of legislative findings and declarations
regarding the value and role of CRCs and expresses intent to
support family caregivers taking care of adults living with
cognitive impairment by funding and implementing the
California CRCs.
3.Establishes various definitions for purposes of this bill,
including that "caregiver" means any unpaid family member or
individual who assumes responsibility for the care of a person
whose cognitive impairment has occurred after 18 years of age.
Continued---
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Defines "respite care" as substitute care or supervision in
support of the caregiver for the purposes of providing relief
from the stresses of providing constant care and so as to
enable the caregiver to pursue a normal routine and
responsibilities. Specifies that "respite care" may be
provided in the home or in an out-of-home setting, such as day
care centers or short-term placements in inpatient facilities.
4.Requires the Director of the DHCS to take the following
actions with respect to CRCs:
a. Maintain or enter into contracts directly with
CRCs to provide direct services to caregivers
throughout the state in the existing geographic
service areas; and,
b. Maintain or require CRCs to maintain a CRC
Operations Manual that defines CRC services and
procedures and identifies CRC duties and
responsibilities.
5.Permits the Director of DHCS to enter into any contracts under
this bill on a bid or non-bid basis and exempts such contracts
from existing law related to public contracting code.
6.Requires agencies designated as CRCs by the Director of DHCS
to include in their governing or advisory boards, or both,
persons who represent the ethnic and socioeconomic character
of the area served and the client groups served in the
geographic area. Specifies the criteria that must be used in
selecting CRCs.
7.Requires CRCs to deliver services to, and advocate for,
caregivers of cognitively-impaired adults in accordance with
the CRC Operations Manual and specifies the range of services
CRCs must provide.
8.Requires that each of the services provided to be determined
by local needs and resources.
9.Provides that persons receiving services pursuant to this bill
may be required to contribute to the cost of services
depending upon their ability to pay, but not to exceed the
actual cost.
10.Requires each CRC to submit progress reports with specified
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information on its activities to the Director of DHCS.
11.Includes an urgency clause to make the provisions of this
bill take effect immediately.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis, this bill will result in negligible state
costs.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Aging and Long Term Care: 7- 0
Assembly Appropriations: 17- 0
Assembly Floor: 70- 0
COMMENTS :
1.Author's statement. Currently, there are 11 CRCs in
California. CRCs help families and caregivers of adults
affected by chronic health conditions. These debilitating
disorders include Alzheimer's or dementia, cerebrovascular
diseases such as stroke or aneurysm, degenerative diseases
which cause both physical and cognitive impairment, brain
injury or tumor, and many others. Each CRC offers a full
complement of family services designed to assist caregivers.
The services are free or low cost and include advice and
assistance on caregiving, family consultation and care
planning, respite care or in-home support, education and
training, legal and financial consultations, short-term
counseling, and access to support groups. CRCs were
administered through DMH. When DMH was eliminated in 2012,
CRCs were transferred to DHCS. This bill makes technical
changes to the terminology used in code to reflect the shift
in medical terminology used in current diagnoses. This bill
also restores a bid exemption that was accidently removed in
the transfer from DMH to the DHCS.
2.CRCs. The CRC system was created pursuant to AB 2913 (Agnos),
Chapter 1658, Statutes of 1984, to provide a single point of
entry to long-term care services available to caregiving
families in 11 major geographic regions throughout California.
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 were
legislatively mandated to assist families who provide care for
loved ones with Alzheimer's disease, stroke, Parkinson's,
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Huntington's disease, Traumatic Brain Injury, Multiple
Sclerosis and other brain disorders acquired after the age of
18. Unlike most publicly supported services and programs, CRC
services 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. This helps
caregivers endure the demands of caregiving and other
debilitating conditions that caregivers are known to
experience.
3.CRC Funding. Individuals pay for CRC services on a sliding
scale basis. Funding for CRCs has been reduced by 74 percent
since 2009 and went from a high of $11.5 million in 2008 to
$2.9 million today. As a result of these budget reductions,
all 11 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.
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. According to the Budget
Committees, keeping people at home leads to substantial
savings for the state in reduced institutional care costs.
The Legislative Analyst's Office also commented that
eliminating funding for CRCs seemed at odds with the
Administration's efforts to provide better coordinated care
for seniors and persons with disabilities in order to reduce
fragmentation in the state's long-term care services
continuum.
4.Prior legislation.
a. AB 1467 (Committee on Budget), Chapter 23, Statutes of
2012 transfers the CRC program from DMH to DHCS, due to
the elimination of DMH in the 2012 Budget; and,
b. AB 2913 (Agnos), Chapter 1658, Statutes of 1984
created the CRC system.
5.Support. The Association of California Caregiver Resource
Centers writes in support that dedicated families - not
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institutions - provide most of the long-term care in the
United States to loved ones suffering from debilitation health
conditions, often at great physical, emotional and financial
sacrifice. For nearly three decades, the11 CRCs have supplied
information, education, respite and emotional support to
California families. The California Association for Health
Services at Home writes that such services play a vital role
in allowing families to keep their loved ones at home and in
the community. Sponsors are pleased to update the governing
statutes to be more reflective of the current practices of
this vital community-based program.
SUPPORT AND OPPOSITION :
Support: Association of California Caregiver Resource Centers
(Sponsor)
Alzheimer's Association
The Arc and United Cerebral Palsy California
Collaboration
Association of California Caregiver Resource Centers
California Association for Health Service at Home
Coast Caregiver Resource Center
Del Mar Caregiver Resource Center
Del Oro Caregiver Resource Center
Los Angeles Caregiver Resource Center
Family Caregiver Alliance
Inland Caregiver Resource Center
Caregiver Resource Center - Orange County
Peninsula Stroke Association
Redwood Caregiver Resource Center
Southern Caregiver Resource Center
Traumatic Brain Injury Services of California
Valley Caregiver Resource Center
Oppose: None received
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