BILL ANALYSIS Ó
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Date of Hearing: May 5, 2015
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Cheryl Brown, Chair
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Brown - As Amended April 27, 2015
SUBJECT: California Task Force on Family Caregiving
SUMMARY: Establish the California Task Force on Family
Caregiving to meet monthly and report to the Legislature interim
findings by January 1 of 2017 and final findings by January 1 of
2018 on issues relative to the challenges faced by family
caregivers and opportunities to improve caregiver support and to
review the current network and the services and supports
available to caregivers. Specifically, this bill:
1)Identifies caregivers as people who provide a wide range of
assistance to those with chronic disabling needs, such as the
elderly;
2)Declares that three-quarters of older people living in a
community setting rely solely upon unpaid caregiving;
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3)Describes the lack of comprehensive resources describing
services for the state's 5.8 million caregivers who provide
3.9 million hours of care estimated to be worth about $ 47
billion;
4)Describes the value of family support as a key-driver in
permitting an individual to choose a home setting, including
70% of those with Alzheimer's disease, though the physical,
emotional and financial costs can be substantial, as some 59%
of informal caregivers are employed;
5)Describes that variations of strategies undertaken by families
based upon ethnic or cultural origin may provide clues to
untapped strategies and resources which could relieve
caregiver stress;
6)Describes the critical need for state leadership to compile
inventories of resources available, identify access barriers,
and to coordinate consistent access using the most efficient
and up-to-date technologies; and,
7)Calls for a 20-member task force of experts to meet monthly,
without compensation, under open-meeting standards, consult
with stake-holders, partner with the California Commission on
Aging, and report to the Legislature and the Governor by
January 1, 2017, and
January 1, 2018.
EXISTING LAW:
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1)Establishes the Older Californians Act (OCA) and assures older
adults have equal access to programs and services provided
through the OCA regardless of physical or mental disabilities,
language barriers, cultural or social isolation, including
that caused by actual or perceived racial and ethnic status,
including, but not limited to, African-American, Hispanic,
American Indian, and Asian American, ancestry, national
origin, religion, sex, gender identity, marital status,
familial status, sexual orientation, or by association with a
person or persons with one or more of these actual or
perceived characteristics, that restrict an individual's
ability to perform normal daily tasks or that threaten his or
her capacity to live independently.
2)Establishes the California Department of Aging (CDA) to
provide leadership to the area agencies on aging in developing
systems of home-and community-based services that maintain
individuals in their own homes or least restrictive, homelike
environments.
3)Establishes 33 area agencies on aging to receive federal,
state, and local funds to contract with local organizations
for service to seniors. There are 33 area agencies on aging
designated by the CDA as the local Planning Services Agencies.
4)Establishes the Title IIIE program, also known as the National
Family Caregiver Support Program (NFCSP), established in 2000,
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to coordinate local community-service systems for assisting
caregivers of seniors. Services are available to family and
other unpaid caregivers supporting older individuals, as well
as grandparents and older relatives caring for children. Each
Area Agency on Aging (AAA) is responsible for determining the
array of services, including caregiver information, assistance
in gaining access to services, counseling and training
support, temporary respite, and limited supplemental services
to complement the care provided by caregivers. Services are
provided directly by AAA staff, or through partnerships with
other public or private agencies.
5)Establishes Caregiver Resource Centers to deliver services to
and advocate for caregivers of cognitively impaired adults, by
offering specialized information on chronic and disabling
conditions and diseases, aging, caregiving issues, community
resources and family consultation. Professional staff work
with families and caregivers to provide support, alleviate
stress, examine options, and enable them to make decisions
related to the care, respite, and counseling in legal and
financial aid.
FISCAL EFFECT: Unknown, likely negligible given that no state
funds are allowed to be used to conduct the activities of the
task force.
COMMENTS:
Author's Statement: "This Assembly Concurrent Resolution is
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relevant to California's current need to have a current and
up-to-date status of existing caregiver programs. Caregivers
come from a wide range of economic, social, racial and ethnic
backgrounds. Research by the AARP Public Policy Institute
indicates that 27% of caregivers have no additional assistance
from family members, a healthcare professional or a home health
aide. Only 31% report having been visited by a healthcare
professional in the home. For many families in the midst of
caregiving, there is deep worry and concern about the quality of
care and quality of life of the relative for whom they are
providing care. Many caregivers do not know who to call or
where to go to get the right kind of affordable help when they
need it. This resolution will bring together a council of
California's best and brightest minds in the field of caregiving
to focus and determine the priorities and strategies that
California caregivers need - caregivers who struggle everyday -
invisible to most of us as they place their own lives aside to
meet the needs of another. ACR 38 provides family caregivers,
their loved ones and our State invaluable data and information
as we move forward in addressing family caregiving issues."
Discussion: After the veto of AB 1744 last year, Assemblymember
Brown, a caregiver herself, resolved to see the establishment of
a broadly recognized essential strategy to advance and secure
adequate support and recognition of caregivers within the
state's developing patch-work of services and supports for the
corresponding expanding population of older people and those who
care for them.
Families are the major provider of long-term care, but research
has shown that caregiving exacts a heavy emotional, physical and
financial toll. Many caregivers who work and provide care
experience conflicts between their responsibilities. Twenty two
percent of caregivers are assisting two individuals, while eight
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percent are caring for three or more. Almost half of all
caregivers are over age 50, making them more vulnerable to a
decline in their own health, and one-third describe their own
health as fair to poor.
Women make up the majority of the unpaid caregiver workforce,
often interrupting work careers to take on the burden of caring
for a relative. Caregiving women face uncertain economic
futures due to breaks from employment and the corresponding
reductions to retirement plans and the Social Security system.
At a Joint Hearing of Assembly Committees on Aging and Long-Term
Care and the Assembly Committee on Human Services in 2011, the
committees heard testimony about caregiving in California.
Given the demographics confronting California, it would come as
no surprise that most people will become a caregiver at some
point during their lives. According to the Family Caregiver
Alliance, "?caregivers are daughters, wives, husbands, sons,
grandchildren, nieces, nephews, partners and friends. While
some people receive care from paid caregivers, most rely on
unpaid assistance from families, friends and neighbors." The
National Alliance on Caregiving and AARP report "Caregiving in
the United States, 2009," estimates 31.2% of households in the
U.S. had at least one person who served as an unpaid family
caregiver during the course of the year. At any one time the
report estimates 37.3 million people are providing care; 66% are
women and 34% are men. The typical family caregiver is a 49
year-old woman caring for her widowed 69 year-old mother who
does not live with her. She is married and employed. 1.4
million children ages 8 to 18 provide care for an adult
relative; 72% are caring for a parent or grandparent; and 64%
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live in the same household as their care recipient. The same
report estimates the number of caregivers in California at any
given time at 4.0 million, with an estimated 5.88 million people
serving as caregivers during the course of a year.
What is Caregiving: Caregivers can be paid or unpaid.
Caregivers support the needs of dependent individuals in a
variety of ways, performing a range of tasks, including
companionship, light house-keeping, meal preparation, and
personal care tasks. More complex and sensitive tasks include
money management, medication management, communicating with
health professionals, and coordinating care. The Family
Caregiver Alliance finds that many family members and friends do
not consider such assistance and care "caregiving" - they are
just doing what comes naturally to them: taking care of someone
they love. But that care may be required for months or years,
and may take an emotional, physical and financial toll on
caregiving families. Given impending demographic realities that
point to a rapid expansion of the 65+ population underway,
maximizing the support of informal caregivers, if better
understood, may be a mechanism that could insulate the state
from costs.
The value of the services family caregivers provide for "free,"
when caring, was estimated to be $450 billion in 2009. The
estimated value of unpaid care in California is $47 billion,
accounting for over 3.8 billion hours of care at $12.17, the
average caregiver wage in 2009. On the personal side, long term
caregiving has significant financial consequences for
caregivers, particularly for women. Informal caregivers
personally lose about $659,139 over a lifetime: $25,494 in
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Social Security benefits; $67,202 in pension benefits; and
$566,443 in forgone wages. Caregivers face the loss of income
of the care recipient, loss of their own income if they reduce
their work hours or leave their jobs, loss of employer-based
medical benefits, shrinking of savings to pay caregiving costs,
and a threat to their retirement income due to fewer
contributions to pensions and other retirement vehicles.
A 2012 report issued by the California Commission on Aging
(CCoA) noted that the state faces serious caregiver challenges
in today's economic climate. As budgets are cut at the state
level, state policies are moving rapidly toward providing more
services to frail elders in the home, according to the report,
entitled "Celebrating Caregiving in California." The CCoA
cautioned that policymakers must weigh the value of protecting
the interest of family caregivers against the cost of
institutionalization.
Previous Legislation:
AB 1744 (Brown) Vetoed by the Governor required the California
Department of Aging, upon securing $200,000 in non-state funds
from private sources for purposes of implementing the bill, to
convene a blue-ribbon panel, comprised of at least 13 members,
as specified, to make legislative recommendations to improve
services for unpaid and family caregivers in California, as
provided. The bill would have required the committee to prepare
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a report of its findings and recommendations and provide it to
the Legislature on or before July 1, 2016.
Governor's Veto Message:
To the Members of the California State Assembly:
I am returning Assembly Bill 1744 without my
signature.
The bill would require the California Department
of Aging to establish and support a 13-member
blue ribbon task force on unpaid family
caregiving, using only non-state funds from
private sources.
The California State Plan on Aging, the
California Plan for Alzheimer's Disease, the
significant reports and action plans developed by
the 33 Area Agencies on Aging, the Alzheimer's
Association, the AARP and so many others have
produced ample evidence for knowledgeable and
caring people to recommend ways to improve
support for family caregivers.
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Establishing another task force in state law
simply isn't necessary.
Sincerely,
Edmund G. Brown Jr.
AB 753 (Lowenthal) Chapter 708, Statutes of 2013 requires the
Department of Health Care Services to contract directly with
nonprofit caregiver resource centers (CRCs) to provide direct
services to caregivers of cognitively impaired adults, including
specialized information, family consultation, respite care,
short-term counseling, and support groups.
SB 491 (Alquist) Chapter 339, Statutes of 2008 required the
California Department of Public Health to establish an
Alzheimer's Disease and Related Disorders Advisory Committee,
appoint members, and develop recommendations about various
policy issues related to Alzheimer's disease.
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REGISTERED SUPPORT / OPPOSITION:
Support
American Association of Retired Persons (AARP) - Sponsor
Association of California Caregiver Resource Centers -
Co-Sponsor
California Commission on Aging - Co-Sponsor
California Senior Legislature - Co-Sponsor
Congress of California Seniors
National Association of Social Workers, California Chapter
(NASW-CA)
United Domestic Workers of America (UDW)
Opposition
None on file.
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Analysis Prepared by:Robert MacLaughlin / AGING & L.T.C. / (916)
319-3990