BILL ANALYSIS Ó
AB 1570
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CONCURRENCE IN SENATE AMENDMENTS
AB 1570 (Chesbro)
As Amended August 21, 2014
Majority vote
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|ASSEMBLY: |79-0 |(May 28, 2014) |SENATE: |33-2 |(August 26, |
| | | | | |2014) |
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Original Committee Reference: HUM. S.
SUMMARY : Increases training requirements for licensees and
staff of Residential Care Facilities for the Elderly (RCFE).
Specifically, this bill :
1)Deletes the existing requirement of 40 hours of classroom
instruction for RCFE licensee certification training programs
and replaces it with 80 hours of required coursework, which
shall include at least 60 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
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undergo 20 hours of training, including six hours of training
on dementia care and four hours specific to postural supports,
restricted health conditions, and hospice care prior to
working independently with residents.
7)Requires the staff person training to include an additional 20
hours of hands-on training training, which shall include six
hours of training relating to dementia care, and permits the
20 hours of coursework training to utilize various methods of
instruction, as specified.
8)Requires staff to undergo 20 hours of annual training to
include eight hours of dementia care training and four hours
of postural supports, restricted health conditions, and
hospice care training, as specified.
9)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.
10)Expands the requirement to annually complete eight hours of
continuing education in dementia care to include all RCFE
staff.
11)Delays implementation of the bill until January 1, 2016.
The Senate amendments :
1)Delay implementation of the bill until January 1, 2016.
2)Reduce the increase in the number of training hours for staff
and the annual training requirements, as specified.
3)Include language to avoid chaptering out conflict with SB 911
(Block) of the current legislative session.
AS PASSED BY THE ASSEMBLY , this bill:
1)Deleted 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
included at least 40 hours of coursework to be attended in
person.
2)Added personal rights, management of antipsychotic medication,
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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)Clarified 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)Required the state-administered exam to be comprised of 100
questions and required the DSS to allow applicants to have
access to the RCFE Act, related regulations and the evaluator
manual during the exam.
5)Required DSS to annually review the exam and make changes, as
necessary, to reflect changes in statute and regulations, and
permitted DSS to solicit stakeholder input in the development
and review of test questions.
6)Eliminated 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)Required the staff person training to include 24 hours of
coursework training, which shall include 12 hours of training
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)Required 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)Expanded the requirement to annually complete eight hours of
continuing education in dementia care to include all RCFE
staff.
10)Delayed implementation of the bill until July 1, 2015.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
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1)Significant one-time and ongoing costs potentially in excess
of $350,000 (General Fund) for DSS to develop and revise
regulations, review and approve certification programs,
administer and periodically revise the examination for RCFE
licensees, and establish the subject matter required for
training for direct care staff. These costs would be offset
by the increase in fee authority.
2)Significant increase in training costs to employees and/or
facilities to meet the enhanced initial and continuing
education training requirements imposed.
3)Potential minor non-reimbursable local enforcement costs for
misdemeanor violations of the provisions of the RCFE Act
pursuant to this measure.
COMMENTS :
Background: 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 the 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.
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,<1> and continued to grow 16% between 2001 and 2010.<2>
Nationwide, states reported 1.2 million beds in licensed RCFEs
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<1>
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.
<2> 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
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in 2010.<3> 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.<4>
RCFE licensee and administrator requirements: California
statute differentiates between facility licensees, who often are
the business owners and may be property owners and
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,"<5> 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.
Once completed, licensees and administrators must pass a written
exam administered by CCLD. Once certified, licensees and
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
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<3> "Assisted Living and Residential Care in the States in
2010," Mollica, Robert, AARP Public Policy Institute
<4> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
<5> Health and Safety Code 1569.15
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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"<6> 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"<7> 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,
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
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<6> Health and Safety Code 1569.625(b)
<7> Health and Safety Code 1569.626
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licensure.<8>
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."<9>
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
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.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
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<8> Section 87411(f) of Title 22, California Code of
Regulations.
<9> 2014-15 Budget Change Proposal #CCLD-2; Department of Social
Services; Social Services and Licensing. 2014-15 Budget. Page
12.
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