BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 911|
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THIRD READING
Bill No: SB 911
Author: Block (D), et al.
Amended: 5/27/14
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 3-2, 4/8/14
AYES: Liu, DeSaulnier, Hancock
NOES: Berryhill, Wyland
SENATE APPROPRIATIONS COMMITTEE : 5-2, 5/23/14
AYES: De León, Hill, Lara, Padilla, Steinberg
NOES: Walters, Gaines
SUBJECT : Residential care facilities for the elderly
SOURCE : Hazels Army
Stand Up for Rosie
DIGEST : This bill increases the initial and continuing
education training requirements for licensees, administrators,
and direct care staff of residential care facilities for the
elderly (RCFEs), as specified. Prohibits discrimination or
retaliation in any manner against a resident or employee for
calling 911. Implements these provisions on January 1, 2016,
and makes other technical changes.
ANALYSIS :
Existing Law:
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1. Establishes the RCFE Act which provides for DSS of Social
Services (DSS) to license and regulate RCFEs as a separate
category within the existing residential care licensing
structure of DSS.
2. Requires applicants for an RCFE license to file an
application including a criminal record clearance, employment
history, character references, evidence of certification, and
disclosure of previous service in other RCFEs, outpatient
health clinics, health facilities (including hospitals,
skilled nursing facilities [SNFs] or intermediate face
facilities), or a community care facility, among other
requirements.
3. Requires a license applicant and an RCFE administrator to
successfully complete a certification program approved by
DSS, which includes a minimum of 40 hours of classroom
instruction including a uniform core of knowledge, as
specified.
4. Provides that RCFE administrator certification be valid for
two years and that recertification requires 40 hours of
continuing education. Requires an applicant for licensure to
meet the requirements for initial certification of
administrators.
5. Provides that the initial certification of administrators
includes successful completion of a DSS-approved program,
passage of a written test administered by DSS within 60 days,
and a criminal records clearance.
6. Requires DSS to develop requirements for a uniform core of
knowledge for the initial certification and continuing
education requirements for licensees, administrators and
staff of RCFEs. Provides that this knowledge base includes
basic understanding of the psychosocial and physical care
needs of elderly persons.
7. Provides that RCFE staff members who assist residents with
activities of daily living shall receive at least 10 hours of
initial training within the first four weeks of employment
and at least four hours annually thereafter.
8. Requires DSS to develop a uniform assessment tool to be used
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by all RCFEs in identifying resident needs for service and
assistance with daily living.
9. Requires facility personnel to be sufficient in numbers and
competent to provide the services necessary to meet resident
needs. Permits DSS to require any facility to provide
additional staff whenever if determines through documentation
that the needs of the particular residents, the extent of
services provided, or the physical arrangements of the
facility require additional staff.
This bill:
1. Expands both the initial and ongoing training requirements
for RCFE licensees, administrators, and staff, as specified.
2. Deletes the existing requirement of 40 hours of classroom
instruction for RCFE licensee certification training programs
and replaces it with 100 hours of required training, 80 hours
of which are to consist of classroom instruction.
3. Increases continuing education training requirement for
administrators from 20 hours to at least 60 hours during each
two-year certification period.
4. Adds the following components to the list of items required
to be covered in the RCFE licensee certification training
program: adverse effects of psychotropic drugs for use in
controlling the behavior of persons with dementia,
non-pharmacologic, person-centered approaches to dementia
care, and residents' rights.
5. Requires the participation of "other stakeholder groups" in
the development of regulations of certification program
content, testing, process for approving programs, and
criteria to be used for authorizing individuals or
organizations to conduct certification programs. Further,
requires DSS to review the test annually and update as
necessary to reflect changes in law and regulations.
6. Prohibits a licensee, or officer or employee of the licensee,
from discriminating or retaliating in any manner against a
resident or employee of the facility, on the basis or for the
reason that the person, employee, or any other person dialed
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or called 911.
7. Eliminates the current 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 within the first four
weeks of employment, at least 24 hours of which must be
completed prior to providing direct care to residents, and 20
hours annually thereafter.
8. Requires DSS to establish the subject matter required for the
staff training and develop the training in consultation with
individuals or organizations with specific expertise in RCFE
or assisted living services, or by an outside source with
expertise, as specified.
9. Expands RCFE staff training components to include the use,
misuse, and interaction of drugs commonly used by the
elderly, the adverse effects of psychotropic drugs for use in
controlling the behavior of persons with dementia, and the
special needs of persons with Alzheimer's disease and
dementia, including non-pharmacologic person-centered
approaches to dementia care.
10.Increases training requirements for RCFE staff at facilities
that provide special care from six hours to 15 hours of
resident care, and requires all 15 hours to be completed
prior to providing direct care to residents. Also increases
in-service training from eight hours to 12 hours on the
subject of providing care and supervision to residents with
dementia.
11.Requires an RCFE that accepts or retains residents with
prohibited health conditions or restricted health conditions,
as specified, to ensure that residents receive care as
prescribed by the resident's physician and contained in the
resident's service plan.
12.Requires staff in RCFEs providing care to more than 16
persons to complete 32 hours, instead of 16 hours, of initial
training, as specified. Requires staff in RCFEs providing
care to 15 or fewer persons to complete 16 hours, instead of
six hours, of initial training, as specified.
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13.Adds new training requirements for RCFE staff at facilities
serving residents with postural supports, restricted health
conditions or who receive hospice services to include (a) 15
hours of training prior to providing direct care to residents
on the care, supervision, and special needs of those
residents, and (2) 12 hours annually thereafter of in-service
training on the subject of serving those residents.
14.Implements these provisions on January 1, 2016, and makes
other technical changes.
Background
Residential Care Facilities for the Elderly . Within
California's continuum of long term care, situated between
in-home care and skilled nursing facilities, is the RCFE, also
commonly called Assisted Living, Board and Care, or Residential
Care. 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 seniors and other adults 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. Increasingly
residents are entering RCFEs with significant health needs
including diabetes, bedsores, or require the use of oxygen
tanks, catheters, colostomies or ileostomies.
The RCFE licensure category includes facilities with as few as
six beds to those with hundreds of residents, whose needs may
vary widely. Typically, the smaller facilities are homes in
residential neighborhoods while the larger facilities resemble
apartment complexes with structured activities for their
residents. Residents may reside in their own apartment, or may
share a bedroom. Generally, residents are free to leave the
facility if they choose, and may entertain guests, and otherwise
maintain a high level of independence. Facilities licensed to
serve residents with dementia or Alzheimer's disease, also known
as "memory care units" may maintain a secure perimeter.
Licensee and Administrator training requirements . Existing law
requires prospective licensees and facility administrators to
complete a certification program approved by DSS consisting of
40 hours of classroom instruction.
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Typically, the 40-hour requirements are met through private
vendors who have been approved by DSS to conduct these
trainings. The courses are generally scheduled as four,
consecutive 10-hour-day trainings, costing approximately $200 to
$300. Following the training, prospective administrators are
required to pass a 40-question test administered by DSS that has
not been changed since its initial release. Approximately 500
individuals take the exam every month. Licensees must only pass
their initial certification and are not required to maintain a
current certification which expires after two years.
Additionally, corporate owners of a facility, who are not the
official licensee, are not required to be licensed or have any
training despite having financial and managerial control over
the facilities they manage.
Restricted or Prohibited Health Conditions . California law
provides that RCFEs may accept or retain persons who are capable
of administering their own medications, who receive medical care
outside the facility or from a visiting nurse, persons with mild
temporary emotional disturbance, forgetfulness, irritability,
wandering, confusion, or inability to manage money, or persons
who are bedridden (provided fire clearance requirements are
met).
California statute prohibits RCFEs from accepting residents who
require 24-hour skilled nursing or intermediate care.
Additionally, regulation prohibits RCFEs from accepting
residents who depend on others to perform all activities of
daily living, residents whose primary need for care and
supervision results from an ongoing behavior caused by a mental
disorder and prohibits the acceptance of residents with certain
medical conditions including stage three or four pressure sores,
gastronomy care, naso-gastric tubes, staph infections or other
serious infections, and tracheotomies.
RCFEs may accept residents who are permanently bedridden if the
facilities meet requirements pertaining to sufficiency and
training of staff, availability of appropriate equipment or
devices and obtain the proper fire clearances. Regulations
require that RCFES that accept bedridden residents must include
a statement of how the facility intends to meet those residents'
overall health, safety and care needs in the facility Plan of
Operation. This plan must include how the facility will meet
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the needs of bedridden residents with dementia, or those who are
terminally ill. In addition, each bedridden resident's record
must include documentation to demonstrate the facility is
meeting the needs of individual residents, staff must receive
training specific to care of bedridden residents, and the
facility's register of residents much include information
related to bedridden residents.
Residents with "restricted health conditions," which otherwise
fall short of a prohibited condition or hospice care, may be
cared for in an RCFE by "appropriately skilled staff" either
through home health agencies or by hired medical staff. Any
medical care provided in this manner must be provided consistent
with the medical practitioner's scope of practice.
RCFEs are prohibited from permitting facility staff from
administering injections, or from forcing or camouflaging
medications and staff may assist with the self-administration of
medications only when the medications have been prescribed by
the resident's physician.
Facilities are additionally permitted to accept and retain
residents with health conditions that require incidental medical
services that may be provided through a licensed home health
agency. In such instances, the facility is required to provide
the care and supervision to the residents and the facility and
home health agency must agree in writing on the responsibilities
of each party. The licensee must inform the home health agency
of any duties that facility staff members are prohibited from
performing.
Staffing requirements . Existing law requires facility personnel
to be sufficient in numbers and competent to provide the
services necessary to meet resident needs. DSS may require a
facility to provide additional staff whenever it determines that
the needs of the particular residents, the extent of services
provided, or the physical arrangements of the facility require
additional staff. Additionally, regulations require RCFEs to
ensure that the resident is cared for in accordance with the
physician's orders and that the resident's medical needs are
met.
Residents are required to have a preadmission appraisal
performed and documented that includes an evaluation of the
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resident's functional, mental and social needs, in order to
determine the level of care and supervision that each resident
requires. Additionally, residents must have a medical
assessment completed that must be signed by a physician, made
within the last year and kept on file.
Placement agencies who are engaged in finding homes or other
places for the placement of elderly persons for temporary or
permanent care are required to report to DSS any situation in
which a facility has insufficient personnel or incompetent
personnel on duty.
Regulations additionally require facilities to have and maintain
a current, written definitive plan of operation that is required
to be submitted to the licensing agency with their application.
Facilities are required to submit a written report to the
licensing agency and the resident's responsible person when
certain incidents occur that may impact the health and safety of
residents.
Prior legislation
AB 313 (Monning, Chapter 365, Statutes of 2011), requires each
RCFE to provide residents, their responsible party, and the
local long-term care ombudsman with a 10 day written notice when
DSS commences proceedings to suspend or revoke its license, or a
criminal action relating to health or safety of the residents is
brought against the facility, and makes other changes related to
these actions.
AB 2066 (Monning, Chapter 643 Statutes of 2012), requires RCFEs
to provide a 60 day written notice to residents or the
responsible person within 24 following receipt of DSSs order of
revocation. Permits the licensee to secure an alternative
manager, as specified. Requires RCFEs to refund all or a
portion of preadmission fees to residents transferring as the
result of a license revocation, as specified.
SB 897 (Leno, Chapter 376, Statutes of 2011), requires licensed
RCFEs to notify DSS, the state's Long-Term Care Ombudsman and
the facility's residents when the property is subject to
foreclosure or certain other events occur due to financial
distress.
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AB 419 (Mitchell, 2011), would have required every community
care facility licensed by DSS to be inspected unannounced at
least once per year using research based, field tested
inspection protocols, as specified. The bill died in the
Assembly Appropriations Committee.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Significant one-time costs potentially in excess of $500,000
(General Fund) for DSS to revise regulations and consult with
specified groups to update the uniform core of knowledge for
RCFE administrators and training for direct care staff.
No new costs to the Department of Aging to continue existing
efforts of collaboration with the DSS in development of
training curriculum and a resident assessment tool.
Significant ongoing increase in training costs to employees
and/or facilities to meet the enhanced initial and continuing
education training requirements imposed.
Potential minor non-reimbursable local enforcement costs for
violations of any of the provisions of this bill.
SUPPORT : (Verified 5/23/14)
Hazel's Army (co-source)
Stand Up for Rosie (co-source)
AFSCME
California Advocates for Nursing Home Reform
California Continuing Care Residents Association
California Senior Legislature
Catholic Charities Diocese of Stockton
Consumer Attorneys of California
Consumer Federation of California
County of San Diego
Elder Law and Advocacy
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Jewish Family Service of Los Angeles
Johnson Moore Trial Lawyers
Long-Term Care Ombudsman of Ventura County
Office of the State Long-Term Care Ombudsman
Ombudsman & HICAP Services of Northern California
Ombudsman Services of Contra Costa
Valentine Law Group
OPPOSITION : (Verified 5/23/14)
Angel Care Community Services, Inc.
California Assisted Living Association
California Assoc. for Health Services at Home (unless amended)
California Association of Health Facilities (unless amended)
California Right To Life Committee, Inc.
Leading Age California (unless amended)
ARGUMENTS IN SUPPORT : According to the author's office,
California's RCFE law is more than 20 years old and has not been
updated to reflect changes in medical and industry practices in
caring for the elderly. The author's office states that RCFEs
now serves more residents with serious health problems and
higher levels of dementia who previously would have been treated
in nursing homes and that, as a result, the lack of
qualifications and training required of administrators and
direct care staff are inadequate to meet the residents' needs
for care and supervision.
The author's office cites a series of in-depth investigative
reports from the San Diego Union Tribune which found that
hundreds of seniors have suffered broken bones, deadly bedsores
and sexual assaults in San Diego alone. The articles cite
repeated incidents in which facility staff failed to contact the
residents' physicians or call 911 following serious injuries,
often related to falls or severe bedsores.
JL:d 5/27/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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