BILL ANALYSIS Ó
AB 1526
Page 1
Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Bonta, 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: Requires the Department of Public Health (DPH) to
include the federal Centers for Disease Control and Prevention's
(CDC's) Caregiver Module in the annual Behavioral Risk Factor
Surveillance System (BRFSS) survey for five years, beginning on
January 1, 2016, unless another act extends before that time.
EXISTING LAW:
1)Establishes, under state law, DPH to carry out various duties
regarding public health programs.
2)Authorizes, under federal law, CDC to determine behaviors that
place the nation at risk for threats to public health, and
conduct state surveys to assess factors affecting the nation's
public health, such as the BRFSS survey.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
AB 1526
Page 2
1)PURPOSE OF THIS
BILL. The author states that California currently does not
have reliable, valid public health data regarding the burden
of caregiving. The author states there is a growing body of
evidence that reveals that providing care for a chronically
ill individual can have harmful physical, mental, and
emotional consequences for the caregiver. The author asserts
that accurately identifying, thoroughly analyzing, and
thoughtfully planning to address caregiver burden in
California will improve the health outcomes for the individual
in need and the caregiver, in addition to lowering the costs
of healthcare and social services. The author contends when
the state supports caregivers, it effectively also cares for
individuals affected by various diseases, such as Alzheimer's,
autism, cancer, and mental health disorders. The author
concludes that conducting the survey is necessary to better
assess the scope and extent of caregiving in California, and
subsequently develop the most effective infrastructure and
support for our state's caregivers.
2)BACKGROUND.
a) Caregivers in California. California is home to the
largest number of seniors in the nation and their numbers
continue to expand at a rapid rate. Many within this
population become dependent over time and require
additional care to perform daily tasks. Oftentimes family
members, friends, and others become caregivers to help
support the daily needs of dependent individuals. The
California Caregiver Alliance estimates that the value of
services family caregivers provide at no charge was
estimated to be $47 billion in California for 2009. The
state has established eleven Caregiver Resource Centers
throughout the state to help serve thousands of families
and caregivers of those with Alzheimer's disease, stroke,
Parkinson's disease, and other disorders. California was
the first state in the nation to establish a statewide
network of support organizations for caregivers; every
resident has access to a Caregiver Resource Center in their
area.
b) BRFSS. According to the CDC, the BRFSS is the nation's
premier system of health-related telephone surveys that
AB 1526
Page 3
collect state data about U.S. residents regarding their
health-related risk behaviors, chronic health conditions,
and use of preventive services. Established in 1984 with
15 states, BRFSS now collects data in all 50 states as well
as the District of Columbia and three U.S. territories.
BRFSS typically completes over 400,000 adult interviews
each year, making it the largest continuously conducted
health survey system in the world.
BRFSS collects state data about U.S. residents regarding their
health-related risk behaviors and events, chronic health
conditions, and use of preventive services. BRFSS also collects
data on important emerging health issues such as vaccine
shortage and influenza-like illness. Since September 2009,
federal, state, and local health agencies have used BRFSS to
monitor the prevalence rates of influenza-like illness to help
with pandemic planning. Interviewers administer the annual BRFSS
surveys continuously through the year.
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
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.
c) BRFSS structure. The BRFSS questionnaire is divided
into three parts: i) the core component; ii) optional
modules; and, iii) state-added questions. The core
component includes queries about current health-related
perceptions, conditions, and behaviors (e.g., health
AB 1526
Page 4
status, health care access, alcohol consumption, tobacco
use, disability, and HIV/AIDS risks), as well as
demographic questions. The optional modules contain sets
of questions on specific topics, such as excess sun
exposure, cancer survivorship, mental illness, and stigma,
which states elect to use on their questionnaires depending
on their individual needs. In 2013, 22 optional modules
were supported by the BRFSS; California chose to complete
the modules on Childhood Asthma Prevalence, Health Care
Access, and Random Child Selection. The state-added
questions are also optional for completion. Individual
states develop or acquire these questions and add them to
their BRFSS questionnaires. CDC neither edits nor evaluates
these questions.
d) Caregiver optional module. In 2009, the CDC offered the
Caregiver optional module as part of the BRFSS. The survey
contained nine questions to determine basic demographic
information about the individual receiving care; the
relationship of the caregiver to the individual; the length
of time the caregiver had been providing care; the major
health problem with the individual; in what areas the
individual needs the most assistance; the amount of time
per week the caregiver provides care; the difficulties
faced by the caregiver; and whether or not the individual
receiving care has experienced changes in thinking and
remembering. Illinois, Louisiana, and the District of
Columbia opted to use the Caregiver Module in 2009.
3)SUPPORT. The Alzheimer's Association, this sponsor of this
bill, states that prudent planning to create the most
efficient and effective infrastructure to support caregivers
requires high-level, evidence-based data such as the BRFSS
under the appropriate jurisdiction of DPH. The sponsor
asserts that as the state's population ages and demographics
shift, the pool of available family caregivers to assist
individuals is diminishing, and will significantly impact
public health programs such as Medi-Cal and other state and
federally funded health, education and human services. The
sponsor contends that greater data on the scope of caregiving
AB 1526
Page 5
within California will help the state better prepare support
systems for caregivers in the future.
The Association of California Caregiver Resource Centers
support the bill, stating California's health and human
service programs benefit from unpaid, informal caregivers who
provide direct services to family members and friends who need
assistance with activities of daily living. The support
asserts the state's economy relies on informal caregivers to
share the cost of health and human service programs, yet there
is no formal mechanism to effectively evaluate the impact of
caregiving statewide. Support concludes the inclusion of the
Caregiver Module within the 2016 BRFSS survey will help
collect reliable data for future use by the Legislature and
stakeholders on this important population.
4)RELATED LEGISLATION. ACR 38 (Brown) establishes the
California Task Force on Family Caregiving, to collaborate
with a broad range of stakeholders to examine resources
available to caregivers and make legislative recommendations
regarding the development of an Internet Website containing
resources for caregivers, the enhancement of outreach and
education efforts, and the development of a caregiver
screening and assessment tool. The task force would be
required to submit an interim report to the Legislature no
later than January 1, 2017, and a final report no later than
July 1, 2018.
5)PREVIOUS LEGISLATION. AB 1744 (Brown) of 2014 would have
required CDA, until January 1, 2018, to establish a
blue-ribbon task force comprised of at least 13 members to
make recommendations to improve services for unpaid and family
caregivers in California. AB 1744 was vetoed by the Governor.
The Governor's veto message stated the legislation was not
necessary because there is already ample data and evidence
from existing sources.
6)DOUBLE REFERRAL. This bill is double referred; it passed out
of the Assembly Committee on Aging and Long-term Care with a
vote of 6-0 on April 21, 2015.
AB 1526
Page 6
REGISTERED SUPPORT / OPPOSITION:
Support
Alzheimer's Association (sponsor)
Association of California Caregiver Resource Centers
Opposition
None on file.
Analysis Prepared
by: An-Chi Tsou / HEALTH / (916) 319-2097