BILL ANALYSIS Ó AB 2044 Page A CONCURRENCE IN SENATE AMENDMENTS AB 2044 (Rodriguez) As Amended August 21, 2014 Majority vote ----------------------------------------------------------------- |ASSEMBLY: |64-1 |(May 19, 2014) |SENATE: |33-0 |(August 25, | | | | | | |2014) | ----------------------------------------------------------------- Original Committee Reference: HUM. S. SUMMARY : Places additional staffing and health and safety requirements on residential care facilities for the elderly (RCFE). Specifically, this bill : 1)This bill would require that at least one administrator, facility manager, or designated substitute who is at least 21 years of age and has adequate qualifications, as specified, be on the premises of the facility 24 hours per day. 2)Requires RCFEs to employ, and the administrator to schedule, a sufficient number of staff members, as prescribed. 3)Requires RCFE staff training also include training on building and fire safety and how to appropriately respond to emergencies. 4)Requires that at least one staff member with a certification in cardiopulmonary resuscitation (CPR) and first aid training is on duty at all times and provides that this requirement may not be construed to require staff to provide CPR to a resident who has requested to forgo resuscitative measures, as specified. 5)Clarifies that RCFEs must be clean, safe, sanitary, and in good repair at all times for the safety and well-being of residents, staff, and visitors, as specified. FISCAL EFFECT : According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs. The Senate amendments : 1)Clarify that an individual appointed by the administrator to AB 2044 Page B serve in the capacity of the administrator shall have the necessary qualifications to serve that role. 2)Clarify that staff are not required to provide CPR to a resident who has requested to forgo resuscitative measures, as specified. 3)Require that at least one administrator, facility manager, or designated substitute who is at least 21 years of age and has adequate qualifications, as specified, be on the premises of the facility 24 hours per day. 4)Require RCFEs to employ, and the administrator to schedule, a sufficient number of staff members, as prescribed. 5)Require RCFE staff training also include training on building and fire safety and how to appropriately respond to emergencies. 6)Makes chaptering out amendments to avoid conflict with AB 1570 (Chesbro) of the current legislative session. AS PASSED BY THE ASSEMBLY , this bill: 1)Required that at least one administrator, facility manager, or other person designated to serve in the capacity of the administrator are on the premises of a RCFE at all times. 2)Clarified the requirement that RCFEs employ a sufficient number of staff to meet the needs of its residents as provided in their service agreements and to ensure the health, safety, comfort, and supervision of residents. 3)Required that at least one staff member with a certification in CPR and first aid training is on duty at all times, as specified. 4)Clarified that RCFEs must be clean, safe, sanitary, and in good repair at all times for the safety and well-being of residents, staff, and visitors, as specified. COMMENTS : Background: RCFEs, commonly referred to as assisted living facilities, are licensed retirement residential homes and board AB 2044 Page C 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 Department of Social Services' (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. Growing demand: Over the past 30 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 by 16% between 2001 and 2010.<2> Nationwide, states reported 1.2 million beds in licensed RCFEs in 2010.<3> In 2010, the national Centers for Disease Control and Prevention 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> According to DSS, as of June 2, 2014, there are 7,587 licensed RCFEs in California with a capacity to serve 176,891 residents. 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, --------------------------- <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 <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 AB 2044 Page D 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 general educational development 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. 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"<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. 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 to, or seven days after, employment or licensure.<7> --------------------------- <5> Health and Safety Code Section 1569.15 <6> Health and Safety Code Section 1569.625(b) <7> Section 87411(f) of Title 22, California Code of Regulations. AB 2044 Page E Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089 FN: 0005463