BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 911|
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UNFINISHED BUSINESS
Bill No: SB 911
Author: Block (D), et al.
Amended: 8/22/14
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
SENATE FLOOR : 25-11, 5/28/14
AYES: Beall, Block, Corbett, Correa, De León, DeSaulnier,
Evans, Galgiani, Hancock, Hernandez, Hill, Hueso, Jackson,
Lara, Leno, Lieu, Liu, Mitchell, Monning, Padilla, Pavley,
Roth, Steinberg, Torres, Wolk
NOES: Anderson, Berryhill, Fuller, Gaines, Huff, Knight,
Morrell, Nielsen, Vidak, Walters, Wyland
NO VOTE RECORDED: Calderon, Cannella, Wright, Yee
ASSEMBLY FLOOR : 68-6, 8/27/14 - See last page for vote
SUBJECT : Residential Care Facilities For The Elderly
SOURCE : California Advocates for Nursing Home Reform
Hazels Army
Stand Up for Rosie
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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.
Assembly Amendments add co-authors; make technical changes; and
add double-jointing language to AB 1570 (Chesbro) to avoid
chaptering conflicts.
ANALYSIS :
Existing Law:
1. Establishes the RCFE Act which provides for the Department 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,
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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
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. Increases the number of hours of instruction for RCFE
licensee certification training from 40 hours to 80 hours,
which includes increasing the number of hours of classroom
instruction from 40 to 60 hours, and adds nonpharmacologic,
person-centered approaches to dementia care; resident
admission, retention and assessment procedures; and resident
rights to the list of items covered in the RCFE licensee
certification training program.
2. Increases the continuing education requirement for
administrators from 20 hours to at least 40 hours during each
two-year certification period.
3. Increases the number of hours of instruction for RCFE staff
certification training from 10 hours to 40 hours, which
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includes a requirement that 24 hours be conducted in a
classroom setting, and adds 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 instruction related to the special
needs of persons with Alzheimer's disease and dementia,
including nonpharmacologic person-centered approaches to
dementia care, to staff training requirements.
4. Provides that no RCFE licensee, or officer or employee of the
licensee, may discriminate or retaliate against any person on
the basis, or for the reason that, the person dialed or
called 911, and provides that any violation of this
prohibition shall result in a civil penalty, as specified.
5. Requires a RCFE that accepts or retains a resident with a
prohibited health condition, as specified, shall ensure that
the resident receives home health or hospice services
sufficient in scope and hours to ensure that the resident
receives medical care as prescribed by the resident's
physician and contained in the resident's service plan.
Makes RCFEs violating this provision subject to a civil
penalty, as specified.
6. Requires a RCFE that accepts or retains a resident with a
restricted health condition, as specified, to ensure that the
resident receives medical care as prescribed by the
resident's physician and contained in the resident's service
plan by appropriately skilled professionals acting within
their scope of practice. Makes RCFEs violating this
provision subject to a civil penalty, as specified.
7. Defines an "appropriately skilled professional" as an
individual who has training and is licensed to perform the
necessary medical procedures prescribed by a physician, which
includes but is not limited to a registered nurse, licensed
vocational nurse, physical therapist, occupational therapist,
or respiratory therapist who may be employed by a home health
agency, the resident, or a facility, and who are currently
licensed in this state.
8. Requires DSS to develop jointly with the Department of Aging
requirements for a uniform core of knowledge for the required
initial certification and continuing education for
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administrators, and their designated substitutes, and for
recertification of administrators of RCFEs, as specified.
Requires this training to be developed in consultation with
individuals or organizations with specific expertise in RCFEs
or assisted living services, or by an outside source with
expertise in RCFEs or assisted living services.
9. States legislative findings that the quality of services
provided to residents of RCFEs is dependent upon the training
and skills of staff and that the current training
requirements for staff of RCFEs are insufficient to meet the
range of care needs of the residents of those facilities.
10.Requires DSS to adopt regulations to require staff members of
RCFEs who assist residents with personal activities of daily
living to receive appropriate training, as specified.
11.Requires staff who assist residents with prescription
medication management in a RCFE with more than 16 persons to
complete 16 hours of hands-on-training, instead of 16 hours,
of initial training related to medication management, as
specified. For RCFEs providing care to 15 or fewer persons,
requires staff to complete 10 hours, instead of six hours, of
initial training.
12.Adds new training requirements for RCFE staff at facilities
serving residents with postural supports, restricted health
conditions or who receive hospice services to include four
hours of training prior to providing direct care to residents
on the care, supervision, and special needs of those
residents, and four hours annually thereafter of in-service
training on the subject of serving those residents.
13.Delays implementation of this bill until January 1, 2016.
14.Contains double-jointing language with AB 1570 (Chesbro) of
the current legislative session.
Comments
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
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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 is 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.
Background
RCFEs, commonly referred to as assisted living facilities, are
licensed retirement residential homes and board 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 DSS' Community Care Licensing
Division, they can range in size from residential homes with six
or less beds to more formal residential facilities with 100 beds
or more.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Assembly Appropriations Committee:
2015-16 costs in the range of $280,000 (General Fund),
includes onetime and ongoing, for the DSS to add training
topics, certify vendors, revise the CCL Evaluator Manual,
revise regulations, consult with specified groups to update
the uniform core of knowledge for RCFE administrators and
training for direct care staff, and to review training
programs and applications.
Ongoing costs in the range of $250,000 (General Fund) for DSS
to review administrator certification training programs and
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certification applications. This assumes approximately 3,500
reviews annually at 3.75 hours per review.
Unknown, but likely significant, ongoing increase in training
costs to employees and/or facilities to meet the enhanced
initial and continuing education training requirements
imposed.
SUPPORT : (Verified 8/27/14)
California Advocates for Nursing Home Reform (co-source)
Stand Up for Rosie (co-source)
Hazel's Army (co-source)
AARP
AFSCME, AFL-CIO
Alliance on Aging of Monterey County
Assisted Living Consumer Alliance
California Assisted Living Association
California Association of Public Authorities
California Continuing Care Residents Association
California Long-Term Care Ombudsman Association
California Senior Legislature
Catholic Charities Diocese of Stockton
Consumer Attorneys of California
Consumer Federation of California
Contra Costa Advisor Council on Aging
County of San Diego
Elder Abuse Task Force of Santa Clara County
Elder Law and Advocacy
Leading Age California
Long Term Care Ombudsman
Long Term Ombudsman Services of San Luis Obispo County
National Association of Social Workers, CA Chapter
National Consumer Voice for Quality Long-Term Care
Ombudsman Services of Contra Costa
Stanislaus Long Term Care Ombudsman
Valentine Law Group
Ventura County Ombudsman
OPPOSITION : (Verified 8/27/14)
Community Residential Care Association of California
ARGUMENTS IN SUPPORT : AARP writes in support that this bill
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is a vital legislative improvement that will allow California to
achieve one of AARP's highest priorities: replacing California's
current disjointed and dysfunctional system with a comprehensive
and coherent system of long-term services and supports,
including reform of the current system of RCFEs.
ARGUMENTS IN OPPOSITION : The United Association of California
Careproviders opposes this bill stating that it mandates
increased initial training for RCFE administrators and licensees
which would impose additional financial burden on small RCFEs.
ASSEMBLY FLOOR : 68-6, 8/27/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bloom, Bocanegra,
Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon,
Campos, Chau, Chávez, Chesbro, Conway, Cooley, Dababneh,
Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier, Garcia,
Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray, Hall, Roger
Hernández, Holden, Jones, Jones-Sawyer, Levine, Linder,
Lowenthal, Maienschein, Medina, Mullin, Muratsuchi, Nazarian,
Nestande, Pan, Perea, John A. Pérez, V. Manuel Pérez, Quirk,
Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner,
Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, Atkins
NOES: Bigelow, Grove, Hagman, Mansoor, Olsen, Patterson
NO VOTE RECORDED: Donnelly, Beth Gaines, Harkey, Logue,
Melendez, Vacancy
JL:d 8/27/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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