BILL ANALYSIS Ó
AB 1570
Page A
Date of Hearing: April 8, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 1570 (Chesbro) - As Introduced: January 30, 2014
SUBJECT : Residential Care Facilities for the Elderly (RCFE).
SUMMARY : Increases training requirements for licensees and
staff of RCFEs. Specifically, this bill :
1)Deletes the existing requirement of 40 hours of classroom
instruction for RCFE licensee certification training programs
and replaces it with 100 hours of required coursework, which
shall include at least 40 hours of coursework that shall be
attended in person.
2)Adds personal rights, management of antipsychotic medication,
managing Alzheimer's disease and related dementias, and
managing the physical environment, including maintenance and
housekeeping to the list of items covered in the RCFE licensee
certification training program.
3)Clarifies that a RCFE licensee applicant is required to pass a
state-administered exam, rather than a written exam, in order
to become a RCFE licensee.
4)Requires the state-administered exam to be comprised of 100
questions and requires the Department of Social Services (DSS)
to allow applicants to have access to the RCFE Act, related
regulations and the evaluator manual during the exam.
5)Requires DSS to annually review the exam and make changes, as
necessary, to reflect changes in statute and regulations, and
permits DSS to solicit stakeholder input in the development
and review of test questions.
6)Eliminates the requirement that a RCFE staff person must
undergo ten hours of training within the first four weeks of
employment and, instead, requires a RCFE staff person to
undergo 40 hours of training prior to working independently
with residents.
7)Requires the staff person training to include 24 hours of
coursework training, which shall include 12 hours of training
AB 1570
Page B
relating to dementia care, as specified, and 16 hours of
hands-on training; and permits the 24 hours of coursework
training to utilize various methods of instruction, as
specified.
8)Requires DSS to establish regulations, in consultation with
provider organizations, to develop the staff person training
subject matter, which shall additionally include training on
dementia care and the misuse of antipsychotic medication.
9)Expands the requirement to annually complete eight hours of
continuing education in dementia care to include all RCFE
staff.
EXISTING LAW
1)Establishes the California RCFE Act, which requires facilities
that provide 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
to be licensed by the California Department of Social
Services' (DSS) Community Care Licensing Division (CCLD).
(H&S Code 1569 and 1569.1)
2)Requires RCFE licensee applicants to attend an orientation
given by the department which outlines the applicable rules
and regulations, and the scope and responsibility for
operation of a RCFE. (H&S Code 1569.235)
3)Requires a RCFE administrator to be at least 21 years of age,
have a valid RCFE administrator certificate, as specified, and
hold a high school diploma or pass a general educational
development (GED) test, as specified. (H&S Code 1569.613).
4)Requires RCFE licensee applicants to successfully complete a
certification program approved by DSS, consisting of a minimum
of 40 hours of classroom instruction, as specified, and
passage of a written test. (H&S Code 1569.23)
5)Requires DSS to authorize organizations, as specified, to
provide certificate and continuing education courses for RCFE
administrators. (H&S Code 1596.616(i))
6)Requires RCFE licensees, administrators, facility managers and
staff to undergo a criminal background check and clearance
AB 1570
Page C
prior to operation or employment. (H&S Code 1569.17)
7)Requires RCFE administrator certification to consist of 40
hours of classroom instruction, for it to be renewed every two
years, and makes issuance of the renewal conditional upon the
administrator to submit documentation of completion of 40
hours of continuing education, which shall include eight hours
of training on providing care to residents with dementia, as
specified. (H&S Code 1596.616(f))
8)Requires an RCFE administrator who holds a valid license as a
nursing home administrator, as specified, to comply with
required administrator training requirements, but exempts him
or her from having to take the written administrator test.
(H&S Code 1596.616)
9)Permits a RCFE administrator to designate a "facility
manager;" defined as a person on the premises with the
authority and responsibility necessary to manage and control
the day-to-day operation of a RCFE and supervise residents.
(H&S Code 1596.618)
10)Requires RCFE staff to undergo ten hours of training within
the first four weeks of employment and four hours annually
thereafter, as specified. (H&S Code 1569.625)
11)Requires RCFE staff to undergo an additional six hours of
training on providing care to residents with dementia within
the first four weeks of employment and eight hours of
in-service training on dementia care annually thereafter.
(H&S Code 1569.626)
12)Requires DSS to provide appropriate training to CCLD
licensing personnel, which includes 40 hours of pre-service
training, as specified, and 36 hours of annual training, as
specified. (H&S Code 1569.652)
FISCAL EFFECT : Unknown.
COMMENTS :
Background : It is the intent of the Legislature, in
establishing the RCFE Act, to help provide a system of
residential care to allow older persons be able to voluntarily
live independently in a homelike environment as opposed to being
AB 1570
Page D
forced to live in an institutionalized facility, such as a
nursing home, or having to move between medical and nonmedical
environments. RCFEs, commonly referred to as assisted living
facilities, are licensed retirement residential homes and board
and care homes that accommodate and provide services to meet the
varying, and at times, fluctuating health care needs of
individuals who are 60 years of age and over, and persons under
the age of 60 with compatible needs. Licensed by DSS' Community
Care Licensing Division (CCLD), they can range in size from
residential homes with six or less beds to more formal
residential facilities with 100 beds or more.
There is also no uniform common care model; rather the types of
assistive services can vary widely, which can include differing
levels of personal care and protective supervision, based upon
the needs of the resident.
If a resident needs medical care in his or her residence in
order to maintain an independent lifestyle, incidental medical
services are permitted to be provided by a licensed or otherwise
approved external provider, such as a home healthcare agency
(HHA), which is licensed by the California Department of Public.
Additionally, some RCFEs, upon approval of DSS and after having
met specified orientation and training requirements, may provide
assistive memory care services to individuals with dementia or
Alzheimer's disease.
Existing regulations also lay out the circumstances under which
an individual may be allowed to reside in RCFEs. Specifically,
they include persons:<1>
Capable of administering their own medications;
Receiving medical care and treatment outside the
facility or who are receiving needed medical care from a
visiting nurse;
Who because of forgetfulness or physical limitations
need only be reminded or to be assisted to take medication
usually prescribed for self-administration;
With problems including, but not limited to,
forgetfulness, wandering, confusion, irritability, and
inability to manage money;
With mild temporary emotional disturbance resulting from
personal loss or change in living arrangement;
--------------------------
<1> Section 87455(b) of Title 22, California Code of
Regulations.
AB 1570
Page E
Who are temporarily bedridden, as specified; and
Who are under 60 years of age whose needs are compatible
with other residents in care, if they require the same
amount of care and supervision as do the other residents in
the facility.
Regulations also provide specific prohibitions on individuals
who are allowed to reside in a RCFE, which includes whether the
resident has active communicable tuberculosis, requires 24-hour
skilled nursing or intermediate care, has an ongoing behavioral
or mental disorder, or has dementia, unless he or she is
otherwise permitted to be cared for in a RCFE by CCLD.<2>
Growing demand : Over the past thirty years, the demand for
RCFEs has grown substantially. Although RCFEs have been
generally available, they experienced explosive growth in the
1990s, more than doubling the number of beds between 1990 and
2002,<3> and continued to grow 16 percent between 2001 and
2010.<4> Nationwide, states reported 1.2 million beds in
licensed RCFEs in 2010.<5> In 2010, the national Centers for
Disease Control reported that 40% of RCFE residents needed help
with three or more activities of daily living and three-fourths
of residents had at least two of the 10 most common chronic
conditions.<6>
According to DSS, as of March 5, 2014 there are 7,589 licensed
RCFEs in California with a capacity to serve 176,317 residents.
RCFE licensee and administrator requirements : California
statute differentiates between facility licensees, who often are
the business owners and may be property owners and
---------------------------
<2> Section 87455(c) of Title 22, California Code of
Regulations.
<3> Flores and Newcomer, "Monitoring Quality of Care in
Residential Care for the Elderly: The Information Challenge".
Journal of Aging and Social Policy, 21:225-242, 2009.
<4> SCAN Foundation. "Long Term Care Fundamentals: Residential
Care Facilities for the Elderly." March 2011.
http://thescanfoundation.org/sites/thescanfoundation.org/files/LT
C_Fundamental_7_0.pdf
<5> "Assisted Living and Residential Care in the States in
2010," Mollica, Robert, AARP Public Policy Institute
<6> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
AB 1570
Page F
administrators who are charged with overseeing the quality of
the day-to-day operations and are generally required to be
present at the facility during normal working hours. However,
initial training and certification requirements for licensees
and administrators are similar.
At minimum, in order to be eligible to apply for a RCFE license,
a person must be at least 21 years of age, pass a criminal
background check and have a high school diploma or pass a GED
test. A prospective licensee must then provide evidence that he
or she is of "reputable and responsible character,"<7> which
includes providing their employment history and character
references. A prospective licensee must also document that he
or she has sufficient financial resources to maintain the
standard of care required by law and disclose any prior role as
an administrator or licensee of another community care facility,
including whether any disciplinary action was taken against him
or her.
Regarding training, a licensee and administrator are both
required to undergo 40 hours of classroom instruction in order
to be certified. This training covers relevant laws and
regulations and core competencies as follows:
Laws, regulations, and policies and procedural standards
that impact the operations of residential care facilities
for the elderly;
Business operations;
Management and supervision of staff;
Psychosocial needs of the elderly;
Community and support services;
Physical needs for elderly persons;
Use, misuse, and interaction of medication commonly used
by the elderly;
Resident admission, retention, and assessment
procedures;
Training focused specifically on serving clients with
dementia; and
Cultural competency and sensitivity in issues relating
to the underserved aging lesbian, gay, bisexual, and
transgender community.
Once completed, licensees and administrators must pass a written
exam administered by CCLD. Once certified, licensees and
---------------------------
<7> Health and Safety Code 1569.15
AB 1570
Page G
administrators must renew their certification every two years.
However, for administrators, in order to have their
certification renewed, they must have participated in at least
40 hours of continuing education. The continuing education
hours are required to include at least eight hours of education
on providing dementia care, and no more than half of the hours
of continuing education can be completed through online courses.
RCFE staff requirements : Licensees employ a wide range of staff
to provide day-to-day support and care for residents of RCFEs.
Although many employ individuals with specific expertise and
certifications, such as Licensed Vocational Nurses and Certified
Nursing Assistants, at minimum staff "who assist residents with
personal activities of daily living"<8> are required to be at
least 18 years of age and undergo 10 hours of training within
four weeks of being employed by the RCFE and four hours of
training each year thereafter. The training is somewhat similar
to that required of licensees and administrators, but is
limited to covering the physical limitations and needs of the
elderly, the importance and techniques for personal care
services, residents' rights, policies and procedures regarding
medications and the psychosocial needs of the elderly.
There are also additional training requirements for staff who
work in RCFEs that "provide" dementia care or who assist
residents with managing their medication. Staff who work in a
RCFE that "advertise(s) or promote(s) special care, special
programming, or a special environment for persons with
dementia"<9> are required to undergo an additional six hours of
training on providing care to persons with dementia. Staff also
must annually complete eight hours of continuing training on
dementia care. Training for staff who assist residents in the
management and self-administration of medication depends on the
size of the facility in which they work. For facilities with 16
or more residents, staff must undergo 16 hours of training, and
for facilities with 15 or fewer residents, staff must complete
six hours of training on medication management. Both training
requirements must be completed within the first two weeks of
employment and conclude with an examination. Four hours of
annual continuing medication management training is required, as
well.
All personnel, including the licensee, administrator and staff,
---------------------------
<8> Health and Safety Code 1569.625(b)
<9> Health and Safety Code 1569.626
AB 1570
Page H
are required to undergo and receive a criminal background
clearance, and must demonstrate they are of good health, which
means they must be physically and mentally capable of performing
assigned tasks. In order to ensure that all personnel are of
good health, they are required to undergo a health screening not
more than six months prior or seven days after employment or
licensure.<10>
Adequacy and relevancy of existing training and certification
requirements : Nearly 25 years have passed since existing RCFE
licensing certification requirements have been changed. The
last noted change was AB 1615 (Hannigan), Chapter 848, Statutes
of 1991, which required prospective licensees to undergo an
orientation training prior to commencing the licensee
certification process. Additionally, there are no requirements
that licensees or administrators to have a college degree or
professional license, and staff are only required to be 18 years
of age regardless of whether they have a high school diploma.
The staff training requirements pale in comparison to those of
many service related positions that do not provide direct care
to the infirm, elderly or disabled. In its 2013 special report,
"Residential Care in California: Unsafe, Unregulated, and
Unaccountable," California Advocates for Nursing Home Reform
wrote that even a manicurist "must have 400 hours of training
and pass a state exam."
The existing training requirements and methods by which RCFE
personnel access and meet their ongoing training needs is also
antiquated. Currently, a RCFE licensee and administrator are
required to undergo 40 hours of training and complete a written
exam. However, as noted by DSS, "currently, no proctoring
protocol exists, resulting in no statewide uniformity on how the
exams are administered. This lack of consistency and guidance
results in errors and can ultimately result in candidates
getting certified who may not meet the minimum
qualifications."<11>
Concerns have also been raised by advocates about the rigor and
relevance of the administrator exam. According to DSS,
approximately 500 people take the administrator certification
---------------------------
<10> Section 87411(f) of Title 22, California Code of
Regulations.
<11> 2014-15 Budget Change Proposal #CCLD-2; Department of
Social Services; Social Services and Licensing. 2014-15 Budget.
Page 12.
AB 1570
Page I
test each month. However, there is no requirement under law
that the exam reflects what is provided in the 40 hours of
administrator/licensee training required for completion prior to
taking the certification exam.
The Governor's 2014-15 CCLD budget proposal : In response to a
growing number of highly publicized incidents at licensed
community care facilities throughout the state, most notably the
abandonment of Valley Springs Manor, a licensed RCFE in Castro
Valley, CA, by its owner and licensee, the Governor has proposed
an increase of $7.5 million for CCLD. The proposal includes a
request to increase the number of administrative and inspection
analyst positions to:
"enhance health and safety outcomes for children and adults
in Community Care Facilities by ensuring a robust
enforcement program with a continued emphasis on increasing
visits to facilities, qualifications of facility
administrators, and civil penalties; updating facility
fees; establishing clear fiscal, program and corporate
accountability; developing necessary resources for
populations with medical and mental health needs; and
efficiently deploying staff and managers."<12>
Within the proposal, DSS acknowledges its responsibility to "see
that training provided properly prepares potential
administrators to safely operate facilities" and goes on to
state, in justifying their request for four additional staff,
that the requested funding is to "fully meet this responsibility
and to prevent the certification of unqualified administrators."
Although this proposal attempts to address over ten years of
budget reductions experienced by CCLD, it makes no mention of
additional training requirements for RCFE personnel, whether
increases in age qualifications or education should be
considered, or whether existing staff level requirements are
sufficient to meet the growing needs of California's aging
population.
Need for this bill : Stating the need for the bill, the author
writes:
"The current requirements for RCFE administrator and
-------------------------
<12> 2014-15 Budget Change Proposal #CCLD-2; Department of
Social Services; Social Services and Licensing. 2014-15 Budget.
Page 1.
AB 1570
Page J
caregiver training have not been revised in many years,
despite the changes in resident needs and despite higher
standards being imposed by some licensees themselves. This
has led to significant criticism and raised questions
regarding the quality and quantity of staff and
administrator training overall. In fact, the administrator
exam itself has come under fire for not having been updated
in many years to reflect changing laws and regulations.
[This bill] will increase the current requirements and
ensure that all RCFE administrators and direct care staff
have the appropriate level of training and that the
training covers the essential topics. This bill restores
integrity of the administrator exam itself by more than
doubling the number of questions and requiring that the
exam be updated on an annual basis to reflect new laws and
regulations."
POLICY CONSIDERATIONS:
Under current law, DSS is authorized to develop regulations
governing the selection of vendors of initial certification and
continuing education training programs. However, it lacks
specificity as to whether DSS conducts periodic evaluations of
these programs. As a result, many years could pass before a
vendor is reviewed and assessed as to the quality of its program
training.
Should the committee choose to pass this measure, it should
encourage the author to consider whether the bill should also
address the quality and rigor of initial certification and
continuing education training program vendors.
RECOMMENDED AMENDMENTS:
Current law does not require the administrators and licensees to
take exams that reflect the content required of their training.
Additionally, the bill does not specifically require DSS to
review and revise the administrator and licensee exam on a
regular periodic basis. This would allow DSS to make changes to
the exam to reflect changes in statute and/or regulations and
improve the test's rigor and questions on a more regular basis.
Specifically, staff recommends the following amendments:
Amendment #1 - On page 2, line 11 after "questions." insert:
AB 1570
Page K
The exam shall be reflective of the uniform core of knowledge
pursuant to subdivision (c).
Amendment #2 - On page 3, line 25, delete "shall review the exam
annually and update it as" delete line 26 and on page 27 delete
"regulations." and insert:
, no later than July 1, 2015 and every other year thereafter,
shall review and revise the exam to reflect changes in law and
regulations in order to ensure the rigor and quality of the
exam.
REGISTERED SUPPORT / OPPOSITION :
Support
LeadingAge California (Sponsor)
California Assisted Living Association (CALA)
California Commission on Aging
California Long-Term Care Ombudsman Association
Chancellor Health Care, Inc.
Long Term Care Ombudsman Services of San Luis Obispo County
National Association of Social Workers CA Chapter (NASW-CA)
Care and Compliance Group
be.group
Senior Living Facilities
Activecare at Rolling Hills Ranch
ActiveCare Living, Inc.
AlmaVia of Camarillo
Atherton Baptist Homes
Beach Homes
Belmont Village
Belmont Village Assisted Living of San Jose
Belmont Village Hollywood
Belmont Village of Encino
Belmont Village of Westwood
Belmont Village Rancho Palos Verdes
Belmont Village Sabre Springs
Belmont Village Senior Living
Belmont Village Sunnyvale
BridgePoint at Los Altos
Burlingame Villa
Byron Park
Byron Park
Capriana, Oakmont Senior Living Community
AB 1570
Page L
Casa de Santa Fe
Cedar Creek
Chancellor Place of Murieta
CiminoCare
Claremont Place
Courtyard Terrace
Cranbrook of Tustin
Cypress Court
Cypress Place Assisted Living
Cypress Place Superior Living
Drake Terrace
Easton Creek Villa
Elder Care Alliance
Emeral Court
Emeritus at Apple Valley
Emeritus at Casa Glendale
Emeritus at Casa Glendale
Emeritus at Chatsworth
Emeritus at Corona
Emeritus at Diablo Lodge
Emeritus at Folsom
Emeritus at Grand Terrace
Emeritus at Lassen House
Emeritus at Meadowlark
Emeritus at Orchard Park
Emeritus at Palm Springs
Emeritus at Roseville Gardens
Emeritus at Villa de Anza
Emeritus at Whittier
Emeritus of Alhambra
Emeritus Senior Living, CA Division
Emeritus, San Juan Capistrano
Eskaton Vallage Placerville
Fair Oaks Villa
Foothill Village
Fredericka Manor
Fredericka Manor
Front Porch
Garden Park Villas
Harbor View Chateau
Hollenbeck Palms
Huntington Terrace
Inn at the Park
Lakeside Park
Lantern Crest
AB 1570
Page M
Lodge at Paulin Creek
MBK Senior Living
Meadowbrook at Agoura Hills
Meadows at Country Place
Milestone Retirement, LLC
Mirage Inn
Mission Hills at Rancho Mirage
Murieta Gardens
Nohl Ranch Inn
Northstar Rancho Cordova
Oakdale of La Mesa
Oakmont of Carmichael
Palm Gardens
Palm Village Retirement Community
Paramount Court Senior Living
Paramount House Senior Living
Park Plaza
Park Terrace
Parson Group, Inc.
Ponte Palmero
Regency of Evergreen Valley
Regency Place
River Fountains of Lodi
Salem Lutheran Home
Sandi Flores Consulting Group, Inc.
Silverado Belmont Hills
Silverado Calabasas
Silverado Escondido
Silverado Senior Living - San Juan Capistrano
Silverado, Irvine
Stacie's Chalet Modesto Assisted Living
Stratford at Beyer Park
Summerhill Villa
Sunrise Assisted Living of Tustin
Sunrise at San Marino
Sunrise of Huntington Beach
Sunrise of La Costa
Sunrise of La Jolla
Sunrise of Mission Viejo
Sunrise of Sunnyvale
Sunrise of Westlake Village
Sunrise of Yorba Linda
Sunrise Senior Living
Sunrise Senior Living of Beverly Hills
Sunrise Senior Living of Oakland
AB 1570
Page N
The Arbors at Rancho Pensaquitos
The Carlisle
The Huntington
The Patrician
The Point at Rockridge
The Regency
The Strafford
Valencia Terrace
Villa Bonita
Vintage Burbank Senior Living
Vintage Cerritos
Vintage Coventry
Vintage Encino Hills
Vintage Golden Gate
Vintage Mission Viejo
Vintage Senior Living Bradford Square
Vintage Sierra Pointe
Vintage Simi Hills
Vista Village
Wesley Palms
Whittier Place
Windchime of Marin
Woodbridge Place
Opposition
California Right to Life Committee, Inc.
Community Residential Care Association of California
Consumer Advocates for RCFE Reform (CARR)
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089