BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Jim Beall, Chair
BILL NO: AB 1572
A
AUTHOR: Eggman
B
VERSION: April 8, 2014
HEARING DATE: June 10, 2014
1
FISCAL: Yes
5
7
CONSULTANT: Sara Rogers
2
SUBJECT
Residential Care Facilities for the Elderly: resident and
family councils
SUMMARY
This bill requires a Residential Care Facility for the
Elderly (RCFE) to assist residents in establishing and
maintaining a resident council at the request of two or
more residents, instead of at the request of a majority of
residents. Additionally, this bill requires facilities to
respond to resident council concerns in writing and to
promote the resident council as specified. This bill also
requires facilities to respond to concerns raised by family
councils and to include notice of the family council as
specified. This bill additionally requires facilities to
perform other specified actions pertaining to the resident
and family councils.
ABSTRACT
Existing law:
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1572 (Eggman)
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1.Establishes the Residential Care Facilities for the
Elderly Act, which provides for the California Department
of Social Services (CDSS) to license and regulate RCFEs
as a separate category within the existing community care
licensing structure of CDSS. (HSC 1569 et seq.)
2.Requires every licensed RCFE, at the request of a
majority of residents, to assist residents in
establishing and maintaining a resident-oriented facility
council composed of residents and family members. (HSC
1569.157)
3.Provides that a willful and repeated violation of the
above shall not constitute a misdemeanor offense but
shall be subject to other civil penalties established
pursuant to the RCFE Act. (HSC 1569.157)
4.Provides that an RCFE may not prohibit the formation of a
family council and requires the family council be
permitted to meet in a common room of the RCFE, be
provided with adequate space on a prominent bulletin
board. (HSC 1569.158)
5.Defines family council as a meeting of two or more family
members, friends, responsible parties or legal agents of
residents. (HSC 1569.158 (c))
This bill:
1.Requires RCFEs assist residents in establishing and
maintaining a single resident council at the facility at
the request of two or more residents and renames
"resident oriented facility council" as "resident
councils."
2.Provides that various non-resident stakeholders may
participate in resident council meetings and activities
STAFF ANALYSIS OF ASSEMBLY BILL 1572 (Eggman)
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at the invitation of the council.
3.Requires a facility to respond in writing to written
concerns or recommendations made by a resident council or
a family council within 14 days.
4.Establishes numerous rights of the resident council
including to meet independently with outside persons or
facility personnel and for members to be informed by the
facility about each resident's right to be interviewed as
part of the regulatory inspection process.
5.Requires an RCFE to promote the resident council by
informing residents, providing information regarding the
timing and location of meetings, and the resident
representative contact.
6.Requires an RCFE with 16 or more residents to appoint a
designated staff liaison to assist a resident council or
a family council, as specified.
7.Prohibits an RCFE from willfully interfering with the
formation of a resident or family council or its
participation in the regulatory inspection process, as
defined.
8.Provides that facility personnel may attend a family
council meeting only at the invitation of the council and
that upon request of the family council, a facility shall
share the name and contact information of the designated
representative of the family council with the long-term
care ombudsman program.
9.Requires facilities to provide notice regarding the
family council in routine mailings and to inform family
members and resident representatives identified on a new
or current resident's admissions agreement regarding the
family council; or if no family council exists, requires
STAFF ANALYSIS OF ASSEMBLY BILL 1572 (Eggman)
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the facility to provide written information to the family
or resident representative of their right to form a
council.
10.Prohibits an RCFE from willfully interfering with the
formation of a resident council or its participation in
the regulatory inspection process, as defined.
11.Provides that a violation of the facility requirements
pertaining to both resident councils and family councils
shall constitute a violation of resident's rights and
imposes a $250 daily civil penalty until the violation is
corrected.
FISCAL IMPACT
An Assembly Appropriations Analysis found stated there are
minor and absorbable one-time and ongoing enforcement costs
to CDSS and that civil penalty revenue is unknown but
likely to be minor.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, RCFEs currently are not required
to inform residents and their families or representatives
of their right to form resident and family councils. The
author further states that current law requiring a majority
of residents to request the formation of a resident council
is prohibitive to the creation of resident councils. The
author states that resident and family councils allow
concerns to be addressed through a formal body that is
tasked with representing the interests of the residents and
family members and those councils may be able to resolve
disputes without the involvement of Community Care
Licensing, thus saving the state money.
This bill is part of a broad package of legislation
sponsored by California Advocates for Nursing Home Reform
(CANHR) in response to recent instances of inadequate
regulatory oversight of RCFEs. A series of events has drawn
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attention to questions about the adequacy of CDSS oversight
and the state's ability to protect people who reside in
RCFEs.
In July 2013, ProPublica and Frontline reporters wrote
and produced a series of stories on Emeritus, the
nation's largest RCFE provider.<1> Featured in the
article was a woman who died after receiving poor care at
in a facility in Auburn, California. The series
documented chronic understaffing, a lack of required
assessments and substandard care.
Reports in September 2013, prompted by a consumer
watchdog group that had hand-culled through stacks of
documents in San Diego, revealed that more than two dozen
seniors had died in recent years in RCFEs under
questionable circumstances that went ignored or
unpunished by CCL.<2>
In late October 2013, 19 frail seniors were abandoned at
Valley Springs Manor in Castro Valley by the licensee and
all but two staff after the state began license
revocation proceedings. CDSS inspectors, noting the
facility had been abandoned, left the two unpaid service
staff to care for the abandoned residents with
insufficient food and medication, handing them a $3,800
citation before leaving for the weekend. The next day
sheriff's deputies and paramedics sent the patients to
local hospitals.
Residential Care Facilities for the Elderly
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<1>
http://www.propublica.org/article/life-and-death-in-assisted
-living-single
<2> "Care Home Deaths Show System Failures," San Diego
Union Tribune, Sept.7, 2013
STAFF ANALYSIS OF ASSEMBLY BILL 1572 (Eggman)
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There are approximately 8,000 Assisted Living, Board and
Care, and Continuing Care Retirement homes that are
licensed as RCFEs in California. These residences are
designed to provide homelike housing options to residents
who need some help with activities of daily living, such as
cooking, bathing, or getting dressed, but otherwise do not
need continuous, 24-hour assistance or nursing care. The
RCFE licensure category includes facilities with as few as
six beds to those with hundreds of residents, whose needs
may vary widely.
Regulatory Oversight
The Community Care Licensing (CCL) division of CDSS
provides the primary public oversight over the quality and
care provided in RCFE facilities. Prior to January 2004,
CCL conducted annual visits of all RCFEs and other licensed
facilities within its jurisdiction. However, as a result of
a series of budget cuts beginning in 2003, CCL began
inspecting facilities based on a random sample protocol.
Under this scenario, those facilities that warrant close
monitoring because of a poor history of compliance are
monitored annually, as well as facilities that are
federally required to be inspected annually. Typically,
this comprises about 10 percent of all facilities. Of the
remaining 90 percent, approximately 30 percent are randomly
selected for inspection each year. A five-year inspection
mandate was imposed with the intent to catch facilities
that are not randomly selected at least that often for
inspection.
A 2008 study published by the California Health Care
Foundation investigating the impact on the truncated
frequency of visits found that "routine visits were
replaced with significant increases in the number of
complaint and problem-driven visits" and that "the
monitoring of quality of care in RCFEs has become a
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complaint and problem driven process."<3>
COMMENTS
The bill's sponsor, California Advocates for Nursing Home
Reform (CANHR), states that resident councils and family
councils can positively influence the quality of care in
RCFEs by offering a forum to enhance communications with
facility staff and assist with identifying and addressing
facility problems. The author and sponsor additionally
state that while current law permits the formation of
resident and family councils, it does not encourage their
development, as there is no affirmative obligation for
facilities to inform potential participants or their right
to form, or the existence of a resident or family council,
nor any obligation to respond to concerns raised.
PRIOR VOTES
Assembly Aging and Long Term Care 7-0
Assembly Appropriations 16-1
Assembly Floor 72-1
POSITIONS
Support: California Long-Term Care Ombudsman
Association
County of San Diego
Oppose: None received.
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<3> Inspection Visits in Residential Care Facilities for
the Elderly. C. Flores, A. Bostrom, and R. Newcomer.
California Health Care Foundation, 2008.
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