BILL ANALYSIS �
AB 973
Page 1
Date of Hearing: May 8, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 973 (Quirk-Silva) - As Amended: April 25, 2013
Policy Committee: HealthVote:12-6
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires the Department of Public Health (DPH) to use
specified funds from the state and federal Health Facilities
Citation Penalty Accounts to contract with a nonprofit
organization that meets specified criteria to promote culture
change and person-centered care in long-term care (LTC)
facilities.
FISCAL EFFECT
1)Costs of up to $150,000 from the State Health Facilities
Citation Penalties Account (State Account) for the general
promotion of culture change and person-centered care.
2)Costs of up to $250,000 from the Federal Health Facilities
Citation Penalties Account (Federal Account) for projects
directed by the federal government, including the promotion of
person-centered care and culture change.
3)This bill contains an appropriation by changing the
disbursement of funds in the State Account from legislative
appropriation to continuous appropriation.
COMMENTS
1)Rationale . The California Culture Change Coalition is
sponsoring this bill to promote the values and practices of
culture change in long-term care (LTC). Nearly all states are
working on pragmatic ways to encourage nursing homes to adopt
these values. According to the coalition, additional funding
is needed to sustain these efforts and the funding is
imperative in California in particular, because it is a large,
AB 973
Page 2
geographically and culturally diverse state with over 1,200
nursing homes, all of which are in need of funds to enhance
the quality of life for those who live in them. Additional
supporters include the Alzheimer's Association, Congress of
California Seniors, and California Association of Health
Facilities.
2)Culture change . According to the Commonwealth Fund, the
culture change movement is intended to empower LTC facilities
to move from institutional care to individualized care.
Proponents of culture change do not recommend a specific model
or set of practices. Instead, they support principles
governing resident care practices; organizational and human
resource practices; and the design of the physical facility.
According to these principles, an ideal culture change
facility would feature the following elements:
a) Resident direction. Residents should be offered choices
and encouraged to make their own decision about personal
issues like what to wear or when to go to bed.
b) Home-like atmosphere. Practices and structures should
be more homelike and less institutional. For instance,
larger nursing units with 40 or more residents would be
replaced with smaller households of 10 to 15 residents.
Residents would have access to refrigerators for snacks,
and overhead public address systems would be eliminated.
c) Consistent assignment leading to closer relationships.
To foster strong bonds, the same nurse should always
provide care to a resident so the nurse is able to observe
both the resident's personal and medical needs over time.
d) Staff empowerment. Staff should have the authority, and
the necessary training, to respond on their own to
residents' needs. The use of care teams should also be
encouraged.
e) Collaborative decision-making. The traditional
management hierarchy should be flattened, with frontline
staff given the authority to make decisions regarding
residents' care.
f) Quality improvement processes. Culture change should be
AB 973
Page 3
treated as an ongoing process of overall performance
improvement, not just as a superficial change or provision
of amenities.
According to the California HealthCare Foundation (CHCF),
recent literature shows that nursing homes embracing culture
change have improved quality outcomes and offer preliminary
evidence of positive business impacts. However, CHCF
indicates California has lagged behind other states in
implementing culture change.
1)Penalty Accounts . Under existing law, funds in the state and
federal penalty accounts must be used, upon appropriation by
the Legislature, in accordance with state and federal law for
the protection of health or property of residents of LTC
facilities, including, but not limited to, relocation if a
facility closes, maintenance pending deficiency corrections,
reimbursement to residence for personal funds lost, and
support for the LTC Ombudsman Program. As of September 2012,
the state penalty account had a balance of over $11 million.
2)Opposition . California Advocates for Nursing Home Reform
(CANHR) objects to diverting funds from the state and federal
penalty accounts to pay for culture change. CANHR argues if
skilled nursing facilities were truly interested in culture
change, they would fund it on their own. CANHR supports
culture change practices in nursing homes, including
consistent staffing, reduction of psychotropic drugs, and
patient-centered care, but asserts it is not appropriate to
use funds paid by facilities with serious violations of the
law to provide those same facilities with culture change
services.
Disability Rights California is also opposed to this bill.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081