BILL ANALYSIS Ó
AB 1572
Page 1
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