BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 1572
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          Date of Hearing:  April 1, 2014

                   ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
                                Mariko Yamada, Chair
                    AB 1572 (Eggman) - As Amended:  March 24, 2014
           
          SUBJECT  :  Residential care facilities for the elderly (RCFE):  
          resident and family councils.

           SUMMARY  :  Amends Sections 1569.157 and 1569.158 of the Health  
          and Safety Code to up-date and modernize resident councils and  
          family councils.  Specifically,  this bill  :  

          1)Renames "resident-oriented facility councils" as "resident  
            councils."

          2)Clarifies that facility staff, a Long-Term Care Ombudsman  
            (LTCO) program representative, and other participation at  
            resident council activities is permissive, upon invitation of  
            the resident council.

          3)Requires facilities to consider written recommendations of the  
            resident council and respond within 14 calendar days, in  
            writing.

          4)Prohibits facility policies from limiting the right of  
            residents to meet independently with outside persons, or  
            facility personnel, as determined by the resident council.

          5)Requires facilities to orient resident council members of  
            their rights to participate in facility regulatory  
            inspections.

          6)Requires facilities to promote resident councils by informing  
            new and current residents that a resident council exists, the  
            meeting dates, time and place, and the resident contact.

          7)For facilities with 16 or more beds, a staff person shall be  
            designated to assist the resident council with meeting and  
            notification arrangements, and provide space to post resident  
            council information in a prominent place.

          8)If resident councils do not exist, the facility shall provide  
            notice to residents upon admission, of their right to form a  
            resident council, and receive a copy of the codes authorizing  








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            resident councils.  This information must also be provided to  
            the newly admitted residents family, friends or  
            representatives.

          9)Requires facilities to share contact information of the  
            resident representative of the resident council with the  
            Long-Term Care Ombudsman upon request, and with permission of  
            the resident council.

          10)Prohibits discrimination or retaliation, against any  
            individual as a result of their participation in the resident  
            council; refusing to publicize or provide space for resident  
            council meetings; failing to respond to written requests in a  
            timely manner; and establishes $250 dollar per day fine for  
            violations. 

          11)Requires facilities to post a copy of the state law related  
            to resident councils labeled "Rights of Resident Councils" in  
            a prominent place that is accessible to residents, families,  
            friends, or representatives.  

          12)Prohibits an RCFE from banning the formation of a family  
            council, or banning participants from meeting independently  
            with anyone, including facility personnel, during nonworking  
            hours.

          13)Requires access to common meeting space during mutually  
            agreed upon times, and shall be provided adequate space to  
            post meeting notices, minutes, information and newsletters.

          14)Declares family council meetings are private; personnel and  
            visitors may participate by invitation only.

          15)Declares facilities must consider the actions of family  
            councils, and must respond in writing, within 14 calendar days  
            of any action or inaction.

          16)Requires that when a family council exists, meeting notices  
            shall be included in routine mailings, and shall inform family  
            members, friends and representatives identified on the  
            admissions agreement during the admission process, the  
            existence of the family council, and name the family council  
            representative.

          17)Requires facilities to share the name and contact information  








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            of the family representative with the Long-Term Care  
            Ombudsman.

          18)If a facility has no family council, the facility shall  
            provide new residents, their family, friends and  
            representatives with information on their right to form a  
            family council.

          19)For facilities with 16 or more residents, facilities must  
            provide staff assistance in the form of a staff liaison to the  
            council, to respond to written requests that result from  
            family council meetings.  

          20)Establishes conditions for willful interference when a  
            facility interferes with the formation, maintenance, or  
            promotion of a family council, or for the family council's  
            participation in the inspection process, retaliation, refusing  
            to publicize meetings, or provide meeting space, or failure to  
            respond to written requests in a timely manner.

           EXISTING LAW  : 

          1)Establishes the California Community Care Facilities Act which  
            includes licensing and regulation provisions relative to adult  
            residential facilities, group homes, and RCFEs.

          2)Establishes that RCFEs will provide a model of non-medical  
            residential care for persons 60 years of age or over, and  
            permits RCFEs to provide varying levels and intensities of  
            care and supervision based on the resident's needs.

          3)Provides for the licensure and regulation of RCFEs by the  
            State Department of Social Services (DSS) and establishes the  
            requirements for licensure and license renewal, including  
            facilitating the formation of resident-oriented facility  
            councils, and allowing the formation of family councils.

          4)Requires every facility, at the request of a majority of the  
            residents, to assist with the formation of a resident-oriented  
            facility council composed of residents or family members, to  
            make recommendations to facility management to improve quality  
            of life, and strategies to enforce resident rights.

          5)Allows the formation of family councils when requested by a  
            member of a resident's family or responsible party, and grants  








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            the family council a private meeting room during agreed upon  
            times; allows family councils to meet privately with outside  
            persons, such as the Long-Term Care Ombudsman (LTCO) and other  
            nonprofit or government organizations, or with facility  
            personnel during nonworking hours.

          6)Requires facilities to grant family councils access to space  
            on bulletin boards to post and display agendas, meeting  
            notices, and newsletters.

          7)Declares that a willful or repeated violation of these  
            provisions is a misdemeanor punishable by a fine of up to  
            $1,000, imprisonment in county jail for up to 1 year, or both.

          8)Establishes the Long-Term Care Ombudsman Program, administered  
            pursuant to the Mello-Grandlund Long-Term Care Act of 1996, to  
            assist residents in the assertion of their civil and human  
            rights through the encouragement of community contact and  
            involvement.

           FISCAL EFFECT  :  Unknown

           COMMENTS  :  
           
          Author's Statement:  "This bill is a necessary step in protecting  
          elderly residents of residential care facilities for the elderly  
          (RCFE).  RCFEs have come under great scrutiny in California and  
          this bill is a proactive effort to prevent incidents from  
          occurring in facilities.  The promotion and establishment of  
          resident and family councils will encourage a collaborative  
          approach to addressing problems and concerns before they  
          endanger the health and safety of residents.  Consequently,  
          resident and family councils will enhance the quality of care in  
          these facilities and potentially save state resources."

           Background:  California's aged population is growing rapidly.   
          The state's 65+ population will reach 5 million people this  
          year.  By 2035, the state's population profile will consist of  
          one-in-five over age 65, a demographic shift expected to present  
          vexing problems for policy makers and governmental agencies  
          attempting to address care needs of this expanding and  
          diversifying population while the pool of those available to  
          give care remains flat.

          Residential care facilities for the elderly (RCFE) is a model of  








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          care overseen by the Department of Social Services.  RCFEs  
          provide care, supervision and assistance with activities of  
          daily living, such as bathing, dressing, ambulating, grooming,  
          and other personal activities. They may also provide incidental  
          medical services under special care plans.  Facilities provide  
          services to persons 60 years of age and over and persons under  
          60 with compatible needs.  RCFEs are also referred to as  
          assisted living facilities or board and care homes. Facilities  
          can range in size from six or fewer, to over 100 beds.   
          Residents in RCFEs require varying levels of personal care and  
          protective supervision.  Since RCFEs are non-medical facilities,  
          they are not required to have nurses or other health personnel  
          on staff.

           Growth in the number of RCFE Licensees:
           
           Fiscal Year:     # of Licenses
           FY 2000-2001      6,187     
          FY 2001-2002     6,204     
          FY 2002-2003      6,313     
          FY 2003-2004      6,491     
          FY 2004-2005     6,730     
          FY 2005-2006      6,992     
          FY 2006-2007      7,334     
          FY 2007-2008      7,707     
          FY 2008-2009      7,847     
          FY 2009-2010      7,822     
          FY 2010-2011      7,681     
          FY 2011-2012      7,695     
          *As of March 14, 2014 there were 7570 RCFEs operating in  
          California serving 176,026 residents.

          Recent media has captured the ramifications of the rapid  
          expansion, and diversification of the RCFE industry, as it  
          struggles to meet the housing and care needs of a growing aged  
          population, and the growing presence of more disabilities within  
          our communities.  

          In response, the Governor has proposed the following budget  
          initiatives to asst DSS with their oversight activities:

          1)Additional positions. The additional 71.5 positions to assist  
            in CCL enforcement activities including six special  
            investigator assistants, a nurse practitioner, five licensing  
            program managers,  and others;








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          2)Staff training and development for new field staff and  
            training for supervisors and managers by expanding the  
            Licensing Program Analyst academy, implementing ongoing  
            training, and strengthening the Administrator Certification  
            Section. 
          3)Recognizing the changing needs of clients in RCFEs, the  
            Governor's budget proposes that DSS will assist with policy  
            and practice development for medical and mental health  
            conditions in community facilities, by establishing medical  
            expertise resources.  Although CCL has no staff with medical  
            expertise, DSS licenses facilities that do allow for  
            incidental medical care. 
          4)Create a Mental Health Populations Unit which would provide  
            technical assistance to enforcement staff and licensees, as  
            well as to individuals who reside in facilities who have  
            increasing mental health care needs.
          5)Establish a Corporate Accountability Unit. With increased  
            applications for Residential  Care Facilities for the Elderly  
            and corporate mergers and acquisitions for facilities, the  
            additional attorney and associate governmental program analyst  
            would perform systemic noncompliance analysis and ensure  
            corrective actions; create management reports that identify  
            patterns and trends; make corrective action recommendations;  
            and, follow-up on corrective action plans to ensure that  
            licensees with poor compliance patterns do not support  
            operational expansions. 
          6)Increased civil penalties, because the current civil penalty  
            structure is related to a "per violation" event, the current  
            maximum civil penalty, even in response to serious injury or  
            death of a resident, is $150. 
          7)Establish a Temporary Manager and Receivership Process, to  
            appoint a temporary manager or receiver to act as the  
            provisional licensee, if DSS determines that residents of a  
            facility are likely to be in danger of serious injury or  
            death, and the immediate relocation of clients is not  
            feasible. 
          8)Specialized complaint hotline, a specialized and centralized  
            toll-free public complaint hotline, which can help acquire  
            better initial information, conduct consistent prioritization,  
            and dispatch incoming complaints to regional offices.
          9)Centralized application processing for Adult and Senior Care  
            facilities, which is expected to increase inspections of  
            licensed facilities to at least once every two years. 
          10)Establish a statewide Quality Assurance Unit to track  
            information statewide, including complaints, actions, or  








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            performance. It also does not provide aggregate data to review  
            and identify patterns. 
          11)Establish an Emergency Client/Resident Contingency Account to  
            be used at the discretion of the Director of DSS for the care  
            and relocation of clients and residents, when a facility's  
            license is revoked or temporarily suspended.

          As part of the rules and regulations governing an RCFE,  
          facilities must allow resident councils and family councils to  
          be convened. 

           FAMILY COUNCILS  :  
           The primary purpose of a family council is for families, as a  
          group, to influence the quality of residents' care. Whatever  
          affects the residents' lives is a proper concern of the family  
          council, whether it's the "look and feel" of the facility, the  
          day-to-day care, resident rights, or the activity program.   
          Family councils give a stake in the facility's administration,  
          and a mechanism for families to add value to the facility, and  
          the residents' quality of life.

          Family councils offer a forum to communicate with the facility  
          staff.  Facility staff is typically invited to specific meetings  
          at specific times to discuss specific concerns.  For example, if  
          concerns about dietary issues arise, the council may invite the  
          dietician to talk to the council, answer questions and address  
          these concerns.  Effective family councils provide a way to  
          resolve concerns before they rise to the level of an official  
          complaint.  Family council members benefit directly from sharing  
          information, support, and encouragement. By working together to  
          solve problems, families feel less isolated and powerless.


           RESIDENT COUNCILS  :  
           Resident councils are one method that assisted living  
          communities can use to continue delivering a high level of  
          quality care and services to residents.  Resident councils are  
          an avenue for open communication between the community's  
          management and its residents.  When resident councils exist,  
          they are often an extension of the activity program rather than  
          an independent group.  Resident councils offer an additional  
          forum for dialogue among residents, management and staff, which  
          opens communication in order that residents maintain a level of  
          control over their daily lives.  Resident councils are a place  
          for collaborative discussions about activities, dining services,  








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          housekeeping, and concerns with administration and staff.  Good  
          communications and good relationships is key for many people who  
          desire inclusion, and in many ways, can supplement state  
          oversight activities and can anticipate problems before they  
          become systemic issues.

           Previous Legislation
           
          AB 2262 (Lanterman, Lewis, and Brown, Ch. 1203, Stats. 1973)  
          established the 
          Community Care Facilities Act and provided a coordinated  
          comprehensive statewide service system of quality community care  
          for mentally ill, developmentally and physically disabled, and  
          children and adults who require care or services by a facility  
          or organization.  

          SB 185 (Mello, Ch. 1127, Stats. 1985) was enacted to provide for  
          the licensing, regulation, and operation of residential care  
          facilities for the elderly.  

          AB 3459 (Friedman, Ch. 1333, Stats. 1990) was enacted to provide  
          for the licensing, regulation, and operation of residential care  
          facilities for persons with a chronic, life-threatening illness.  
           

          AB 4319 (Mello, Ch. 692, Stats. 1988) authorized family councils  
          in residential care, and skilled nursing facilities.

          SB 1102 (Roberti, Ch. 466, Stats. 1989) allowed family councils  
          in residential care facilities for the elderly (RCFES).

           Recommended clean-up amendments:

          Amendment #1:

           On page 3, lines 7-12:

          7   of the facility .   and may include   F  amily members or  friends  
          of
           8   residents,   resident representatives,  advocates, or  
          long-term care
          9  ombudsman program representatives  ,   .   Facility   facility  staff  
          or others,
          10    including long-term care ombudsman program representatives,  
          11   may participate in resident council meetings and activities  








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          at the
          12    invitation of the resident council.

           Amendment #2:
           
          On page 4, line 2, strike "faculty" and replace with "facility"

           Amendment #3:

          On page 5, lines 19 and 20:

           Strike out: "Notwithstanding any other law," and start that  
          sentence at that point. 

           Amendment #4:
           
           On page 6, line 32:  

          Strike "and" and replace with "or"

           Amendment # 5:

          On page 7, lines 26 and 27: 
           
          Strike out: "Notwithstanding any other law," and start that  
          sentence at that point.

           REGISTERED SUPPORT / OPPOSITION  :  

           Support 
           
          California Advocates for Nursing Home Reform (CANHR)
          California Communities United Institute
          California Continuing Care Residents Association (CALCRA)
          California Long-Term Care Ombudsman Association
          California Senior Legislature
          Consumer Federation of California
          County of San Diego
          Elder Abuse Task Force of Santa Clara County
          Elder Law and Advocacy
          Jewish Family Service of Los Angeles
          Johnson Moore Trial Lawyers
          LeadingAge California-Support if Amended
          Long Term Care Services of Ventura County, Inc.
          National Association of Social Workers (NASW)-California Chapter








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          National Senior Citizens Law Center
          Ombudsman Services of Contra Costa
          State Long-Term Care Ombudsman
          Valentine Law Group
          Numerous individuals.

           Opposition 
           
          None on file.
           
          Analysis Prepared by  :    Robert MacLaughlin / AGING & L.T.C. /  
          (916) 319-3990