BILL ANALYSIS Ó
AB 918
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Date of Hearing: April 7, 2015
ASSEMBLY COMMITTEE ON HEALTH
Mark Stone Rob Bonta, Chair
AB 918
Mark Stone - As Amended April 6, 2015
SUBJECT: Health and care facilities: seclusion and behavioral
restraints.
SUMMARY: Requires specified community facilities to report to
the appropriate and designated agency each death or serious
injury of a person occurring during, or related to, the use of
seclusion or behavioral restraints. Specifically, this bill:
1)Requires the following types of facilities to report each
death or serious injury of a person occurring during, or
related to, the use of seclusion or behavioral restraints:
a) Intermediate care facilities (ICF);
b) Intermediate care facilities/developmentally
disabled-nursing (ICF-DDN);
c) Intermediate care facilities for the developmentally
disabled (ICF-DD);
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d) Intermediate care facilities/developmentally
disabled-habilitative (ICF-DDH);
e) Group homes;
f) Adult residential facilities; and,
g) Mental health rehabilitation centers.
2)Requires the Secretary of the California Health and Human
Services Agency (CHHSA), or his or her designee, to establish
on or before January 1, 2017, a system of mandatory,
consistent, timely and publically accessible data collection
regarding the use of seclusion and behavioral restraints.
3)Requires data collected to include the following information:
a) The number of deaths that occur while persons are in
seclusion or behavioral restraints or where it is
reasonable to assume that a death was proximately related
to the use of seclusions or behavioral restraints;
b) The number of serious injuries sustained by persons
while in seclusion or subject to behavioral restraints;
c) The number of serious injuries sustained by staff, that
occur during the use of seclusion or behavioral restraints;
d) The number of incidents of seclusion;
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e) The number of incidents of use of behavioral restraints;
f) The duration of time spent per incident in seclusion;
g) The duration of time spent per incident subject to
behavioral restraints; and,
h) The number of times an involuntary emergency medication
is used to control behavior, as defined by the Department
of State Hospitals.
EXISTING LAW:
1)Requires the following types of facilities to report each
death or serious injury of a person occurring during, or
related to, the use of seclusion or behavioral restraints:
a) Psychiatric units of general acute care hospitals;
b) Acute psychiatric hospitals;
c) Psychiatric health facilities;
d) Crisis stabilization units;
e) Community treatment facilities;
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f) Group homes;
g) Skilled nursing facilities (SNFs);
h) ICFs;
i) Community care facilities; and,
j) Mental health rehabilitation centers.
2)Does not require the above entities to fulfill the above
reporting requirements if adequate resources are not
available.
3)Defines "ICF" as a health facility that provides inpatient
care to ambulatory or nonambulatory patients who have
recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of
continuous skilled nursing care.
4)Defines "ICF-DDN" as a facility with a capacity of four to 15
beds that provides 24-hour personal care, developmental
services, and nursing supervision for persons with
developmental disabilities who have intermittent recurring
needs for skilled nursing care but have been certified by a
physician and surgeon as not requiring continuous skilled
nursing care. The facility shall serve medically fragile
persons with developmental disabilities or who demonstrate
significant developmental delay that may lead to a
developmental disability if not treated.
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5)Defines "ICF-DD" as a facility that provides 24-hour personal
care, habilitation, developmental, and supportive health
services to persons with developmental disabilities whose
primary need is for developmental services and who have a
recurring but intermittent need for skilled nursing services.
6)Defines "ICF-DDH" as a facility with a capacity of four to 15
beds that provides 24-hour personal care, habilitation,
developmental, and supportive health services to 15 or fewer
persons with developmental disabilities who have intermittent
recurring needs for nursing services, but have been certified
by a physician and surgeon as not requiring availability of
continuous skilled nursing care.
7)Defines "group home" as a residential facility that provides
24-hour care and supervision to children, delivered at least
in part by staff employed by the licensee in a structured
environment. Limits the care and supervision provided by a
group home to be nonmedical, except as otherwise permitted by
law.
8)Defines "residential facility" as any family home, group care
facility, or similar facility determined by the director, for
24-hour nonmedical care of persons in need of personal
services, supervision, or assistance essential for sustaining
the activities of daily living or for the protection of the
individual.
FISCAL EFFECT: None.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, while existing
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law protects individuals with developmental disorders in
developmental centers (DCs) from unreported use of seclusions
and restraint, the populations in these facilities are
changing. State facilities are beginning to close and more
people are living in community facilities. The author states
that this move can be heralded as an important and beneficial
move for those with developmental disabilities, but it also
leaves them vulnerable to the use of seclusion and behavioral
restraint as tactics to control behavior.
The author also states that the Legislature has made findings
and declarations indicating that the use of seclusions and
restraints is not a treatment nor does it positively change
behavior. When the state first implemented reporting and
publishing requirements, most individuals were living in DCs.
However, now California is moving individuals to community
facilities, where no such requirement exists. According to
the author, California must protect these vulnerable
individuals, give consumers more information when choosing a
facility, and allow the government and the designated
protection and advocacy agency, Disability Rights California
(DRC), the ability to compare the use of seclusion and
restraint across facilities.
2)BACKGROUND.
a) Lanterman Act. The Department of Developmental Services
(DDS) is responsible under the Lanterman Developmental
Disabilities Services Act of 1969 (Lanterman Act) for
ensuring that approximately 280,000 individuals with
developmental disabilities receive the services and support
they require to lead more independent and productive lives
and to make choices and decisions about their lives.
The Lanterman Act defines a developmental disability as a
"substantial disability" that starts before age 18 and is
expected to continue indefinitely. The developmental
disabilities for which an individual may be eligible to receive
services under the Lanterman Act include: cerebral palsy;,
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epilepsy; autism, intellectual disabilities; and, other
conditions closely related to intellectual disabilities that
require similar treatment (such as a traumatic brain injury).
b) DCs. California provides services and support to
individuals with developmental disabilities in two ways.
The vast majorities of people live in their families' homes
or other community settings and receive state-funded
services that are coordinated by one of 21 non-profit
corporations known as regional centers (RCs). More than
99% of DDS consumers receive services in this way under the
Community Services Program. These consumers live with
their parents or other relatives, in their own houses or
apartments, or in residential facilities or group homes
designed to meet their needs. A smaller number of
individuals, or less than 1% of the DDS caseload, live in
three state-operated DCs and one state-operated community
facility. DDS operates three DCs: Fairview (Orange
County); Porterville (Tulare County); and, Sonoma (Sonoma
County). Among other services, Porterville also provides
secure treatment services. A fourth DC, Lanterman,
transitioned its last resident into community living on
December 23, 2014. Services at all facilities involve the
provision of active treatment through residential and day
programs on a 24-hour basis, including appropriate medical
and dental care, health maintenance activities, and
assistance with activities of daily living, training,
education, and employment.
c) Population Transitions. During a period of recent
budget deficits, the Legislature enacted numerous DDS
budget reductions and cost savings measures to yield
General Fund savings. The 2012-13 budget imposed a
moratorium on admissions to DCs except for individuals
involved in the criminal justice system, and consumers in
an acute crisis needing short-term stabilization. The high
costs to maintain and staff these facilities, coupled with
an emphasis on transitioning individuals back into their
community, have led to the closure and/or restructuring of
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many DCs. The moratorium on DC admission as well as the
need for the availability of services in the community have
led to a shift in spending from the DCs to the community
services programs. The 2015-16 budget reflects this
change, as the budget for DCs has decreased and the
Community Services budget has increased.
3)SUPPORT. DRC, the sponsors of the bill, write that current
law requires state and non-public facilities to collect and
publicly report the use of seclusion and behavioral
restraints. When the law was enacted, the Department of State
Hospitals and DDS immediately implemented their data
collection and public data reporting. This requirement was not
implemented for non-public facilities. Therefore, there is no
publicly accessible data regarding the use of these
interventions in most of the facilities where they are used.
The sponsor goes on to state that the populations served in
state facilities has changed. Residents in DCs are moving
from large state facilities and into smaller community
facilities. Family members and advocates are concerned about
the unknown and unreported use of behavioral restraint and
seclusion; dangerous practices that often result in serious
injuries, even death. The concern continues to grow as
individuals with behavioral challenges migrate from DCs where
there is public reporting and accountability to isolated
community settings where there is no public accountability
regarding as to the use of seclusion and behavioral restraint.
People with disabilities should live in the community with
appropriate services and supports; and there should be
appropriate oversight of community facilities that use
dangerous restraint and seclusion practices.
The National Association of Social Workers (NASW) writes that
through previous legislation, the state has attempted to
reduce or eliminate the use of seclusion or behavior
restraints at state facilities. Efforts have also been made to
make the data on the use of seclusion and restraints available
to the public. Currently, these laws do not apply to community
facilities. NASW argues this bill will require information
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about deaths or serious injury available to the protection and
advocacy agency designated by the Governor. Deaths or serious
injury cannot go unnoticed. Those with the most expertise in
protecting this vulnerable population should have access to
information that could prevent additional tragedies.
4)PREVIOUS LEGISLATION. SB 130 (Chesbro), Chapter 750, Statutes
of 2003, made a number of changes to state law regarding the
use of seclusion and restraints in a variety of residential
facilities, including psychiatric hospitals, DCs, skilled
nursing facilities and foster care group homes.
REGISTERED SUPPORT / OPPOSITION:
Support
Disability Rights California (sponsor)
California Long-Term Care Ombudsman Association
National Association of Social Workers, California Chapter
The Alliance Supporting People with Intellectual and
Developmental Disabilities
Opposition
None on file.
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Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097