BILL ANALYSIS Ó
AB 1526
Page 1
Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Cheryl Brown, Chair
AB 1526
(Committee on Aging and Long-Term Care) - As Introduced March
16, 2015
SUBJECT: Behavioral Risk Factor Surveillance System survey:
caregiver module
SUMMARY: Directs the Department of Public Health (DPH),
beginning January 1, 2016, to include the federal Centers for
Disease Control and Prevention's Caregiver Module in the annual
Behavioral Risk Factor Surveillance System survey.
Specifically, this bill: Finds and declares:
1)That caregiving represents challenges for public health.
2)Finds that though there are positive and negative health
outcomes associated with caregiving, informal caregivers in
California are frequently overlooked as a component of the
health care system though they contribute billions of dollars'
worth of unpaid care to people with disabilities and chronic
conditions.
3)Public health staff, agencies and researchers are working to
understand caregivers needs.
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4)Public health staff, agencies and researchers seek to answer
questions about the number of caregivers there are, the types
of care they provide, the amount of care they provide and for
how long.
5)Understanding caregiving allows the state, and decision makers
to understand the impact of caregiving, plan for services to
support caregivers and care recipients, and to provide
interventions.
6)Directs the Department of Public health to include the Federal
Centers for Disease Control and Prevention's Caregiver Module
in the annual Behavioral Risk Factor Surveillance System
survey.
EXISTING LAW:
1) Federal law authorizes the Centers for Disease Control
(CDC) which conducts annual surveys to assess behaviors
that places humans at risk for diseases and/or other health
conditions, including the Behavioral Risk Factor
Surveillance System (BRFSS).
2) State law establishes the Department of Public Health
which is dedicated to optimizing the health and well-being
of the people in California.
Background:
Author's Statement: "Accurately identifying, thoroughly
analyzing, and thoughtfully planning to address caregiver burden
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in California will improve health outcomes for both the person
needing care and the caregiver, as well as lower public health
and social service costs. Caregivers are a key ally to
delivering health services and long-term services and supports
to disabled adults and older Californians. We have a unique
opportunity today to incorporate questions on California's
extensive BRFSS survey to examine caregiving in our state. From
this simple survey, we can learn more about California
caregivers and their needs. When we support caregivers, we
support individuals affected by Alzheimer's disease, autism,
cancer, diabetes, heart disease, mental health and substance
abuse too. We can't afford to wait for a crisis and then embark
on planning. We have the desire and the ability now to take the
first step, measuring caregiver burden in California with the
expertise of our own Department of Public Health through an
existing BRFSS survey tool with a CDC approved question. The
pieces are all in place to move forward. For minimal cost we
can better plan to meets the growing needs of caregivers through
the Caregiver Module."
BRFSS: The Behavioral Risk Factor Surveillance System (BRFSS) is
a cross-sectional telephone survey that state health departments
conduct monthly over landline telephones and cellular telephones
with a standardized questionnaire and technical and
methodological assistance from CDC. BRFSS is used to collect
prevalence data among adult U.S. residents regarding their risk
behaviors and preventive health practices that can affect their
health status. Respondent data are forwarded to CDC to be
aggregated for each state, returned with standard tabulations,
and published at year's end by each state. In 2011, more than
500,000 interviews were conducted in the states, the District of
Columbia, and participating U.S. territories and other
geographic areas.
By collecting behavioral health risk data at the state and local
level, BRFSS has become a powerful tool for targeting and
building health promotion activities. As a result, BRFSS users
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have increasingly demanded more data and asked for more
questions on the survey. Currently, there is a wide sponsorship
of the BRFSS survey, including most divisions in the CDC
National Center for Chronic Disease Prevention and Health
Promotion; other CDC centers; and federal agencies, such as the
Health Resources and Services Administration, Administration on
Aging, Department of Veterans Affairs, and Substance Abuse and
Mental Health Services Administration.
BFRSS Caregiver Module: Beginning in 2009, a special set of 10
questions have been available to examine various aspects of
caregiving, referred to as the "Caregiver Module." The
questions allow states to determine who is a caregiver; the
relationship between the caregiver and the care recipient; the
average hours of caregiving per week; the most difficult problem
facing the caregiver; the age and gender of the care recipient;
the types of assistance needed by the care recipient; the major
health problem, long-term illness, or disability of the care
recipient; the duration of caregiving; and whether the person
has had more difficulty with thinking or remembering in the past
year. The responses from the caregiver module are then paired
with information from the main BRFSS questionnaire, which allow
for additional information about the health and well-being of
caregivers.
Caregiving: California is home to the largest number of seniors
in the nation and their numbers are expanding at a pace
unprecedented in history. The California Department of
Finance's Demographic Research Unit estimates that California's
65+ population will have grown 43 percent between 2010 and 2020
(from 4.4 million to 6.35 million). By 2030 the 65+ population
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will reach nearly 9 million people. The ratio of 65+ people
will grow from about one in ten people today, to one in five by
2040. Though women comprise roughly half of the general
population, by age 65 their proportion increases to about 57
percent. By age 85, women outnumber men two-to-one.
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."
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.
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
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term caregiving has significant financial consequences for
caregivers, particularly for women. Informal caregivers
personally lose about $659,139 over a lifetime: $25,494 in
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.
FISCAL EFFECT: This measure has not been analyzed by a fiscal
committee.
REGISTERED SUPPORT / OPPOSITION:
Support
Alzheimer's Association
Opposition
None on file.
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Analysis Prepared by:Robert MacLaughlin / AGING & L.T.C. / (916)
319-3990