BILL ANALYSIS                                                                                                                                                                                                    Ó






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                                   THIRD READING 


          Bill No:  AB 1526
          Author:   Committee on Aging and Long-Term Care
          IntroducedIntroduced3/16/15  
          Vote:     21  

           SENATE HEALTH COMMITTEE:  8-0, 7/1/15
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,  
            Pan, Roth
           NO VOTE RECORDED:  Wolk

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 8/27/15
           AYES:  Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen

           ASSEMBLY FLOOR:  79-0, 6/1/15 - See last page for vote

           SUBJECT:   Behavioral Risk Factor Surveillance System survey:  
                     caregiver module


          SOURCE:    Alzheimers Association


          DIGEST:  This bill requires 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 for five years, beginning on January  
          1, 2016, unless another act extends before that time.  


          ANALYSIS: 

          Existing law:









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          1)Establishes, under state law, the Department of Public Health  
            (DPH) to produce and disseminate data to inform and evaluate  
            public health status, strategies and programs.

          2)Authorizes, under federal law, the Centers for Disease Control  
            and Prevention (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 Behavioral Risk Factor Surveillance System  
            (BRFSS) survey.

          This bill:

          1)States legislative intent that informal caregivers in  
            California contribute billions of dollars' worth of unpaid  
            care to people with disabilities and chronic conditions, and  
            that public health staff seek to know how many caregivers  
            there are, the types of care they provide, and a the amount of  
            care they give in an effort to understand caregivers' needs,  
            which will allow decision makers to support caregivers and  
            recipients.  


          2)Requires DPH to include CDC's Caregiver Module in the annual  
            BRFSS survey beginning January 1, 2016, and until January 1,  
            2021.


          Comments  
           
          1)Author's statement.  According to the author, an important point  
            that bears repeating over and over again is that 1,000 people in  
            California turn 65 each day for the next 14 years.  This reality  
            will transform our state, resulting in a diverse and vibrant  
            population where one-in-five people are 65 or older.   
            Corresponding with change will be an increase in the number of  
            disabilities, and the corresponding reliance upon others for  
            support and care.  Family caregivers know first-hand the  
            financial, emotional and physical demands associated with placing  
            one's life aside in order to care for loved one.  Today, more than  
            one-in-six American workers cares for an elderly or disabled  
            family member.  These extraordinary individuals sacrifice their  
            own health, their emotional well-being, and in many cases, their  
            financial security to fill the gaps in our fragile system of  







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            long-term services and supports.  Combined, caregivers contribute  
            $450 billion in economic value to our nation's economy and they  
            save Medicare, Medi-Cal, In-Home Supportive Services and other  
            public programs scarce government dollars. This bill calls for a  
            statewide survey of caregiver burden to help us understand and  
            support this population, as their contributions are vital in their  
            homes, communities and to society.  



          2)Caregiving. According to the Family Caregiving Alliance,  
            informal caregiving is any help provided to an older,  
            chronically ill, or disabled family member, neighbor, or  
            friend. Caregiving can include buying groceries, cooking,  
            cleaning, driving someone to the doctor, or helping someone  
            get dressed, take a shower, or take medication. A 2013 study  
            by the Pew Research Center states that 39% of adults in the  
            U.S. are caregivers, and a report by MetLife states that 10  
            million caregivers over 50 who care for their parents lose an  
            estimated $3 trillion in lost wages, pensions, retirement  
            funds and benefits. The AARP states that researchers have long  
            known that caregiving can have deleterious mental health  
            effects and serious health consequences for caregivers, with  
            17% of caregivers feeling their health has become generally  
            worse as a result of their caregiving responsibilities.





          3)BRFSS.  According to DPH, BRFSS is a national ongoing  
            telephone survey whereby participating states and U.S.  
            territories utilize a standardized survey research  
            methodology.  BRFSS surveys randomly selected adults to  
            collect information on a wide variety of health-related  
            behaviors such as obesity, immunization, AIDS, tobacco use,  
            access to care, diabetes, physical activity, diet, cancer  
            screening, and emerging health issues that have significant  
            impacts on society, such as asthma and the flu vaccine. DPH,  
            in collaboration with CDC, has conducted BRFSS since 1984.  
            BRFSS is the main source of data in California for monitoring  
            at least half of the leading health indicators established by  
            the Healthy People 2020 Objectives.  Many programs within DPH,  
            local health departments, the American Cancer Society,  







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            universities, and other nonprofit organizations use the data  
            collected by BRFSS.  BRFSS allows for trend analysis and  
            direct comparison to the nation and other states. Data are not  
            only used for research, but also for planning of programs,  
            program evaluation, and resource allocation.





          4)BRFSS structure.  The BRFSS questionnaire is divided into  
            three parts:  the core component; optional modules; and,  
            state-added questions.  The core component includes queries  
            about current health-related perceptions, conditions, and  
            behaviors such as health 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 topics such as excess sun exposure,  
            cancer survivorship, mental illness, and stigma. States can  
            also add their own questions outside of the optional CDC  
            modules. According to CPD, there are currently 12 programs  
            within DPH participating in BRFSS, adding a total of 131  
            questions to the survey. In 2014, nine programs participated,  
            adding 141 questions to the survey.  DPH programs that have  
            consistently participated on an annual basis include, but are  
            not limited to:  Nutrition Education Obesity and Prevention  
            Branch, California Tobacco Control Branch, Chronic Disease  
            Control Branch Diabetes Program, Immunization Branch,  
            Childhood Lead Poisoning Prevention Branch, Chronic Disease  
            Surveillance and Research Branch's Comprehensive Cancer  
            Control Program, Environmental Health Investigations Branch,  
            and the Office of Health Equity.  

          5)Optional caregiver module.  The BRFSS Caregiver Module  
            contains nine questions regarding caregiving, including the  
            caregiver's relationship to the recipient, the amount of time  
            care has been provided, the number of hours per week the  
            caregiver provides assistance, that nature of the care, the  
            condition from which the recipient suffers, and support  
            services needed by the caregiver.  

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No








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          According to the Senate Appropriations Committee, annual costs  
          of $150,000 per year to expand the existing survey to include  
          the optional caregiving module (General Fund). DPH indicates  
          that it costs $7,500 per additional question to expand the  
          existing survey, including the costs to conduct phone interviews  
          and compile responses.


          SUPPORT:   (Verified8/28/15)


          Alzheimer's Association (source)
          Association of California Caregiver Resource Centers
          California Commission on Aging
          Justice in Aging
          Mental Health America of California


          OPPOSITION:   (Verified8/28/15)


          California Department of Public Health

          ARGUMENTS IN SUPPORT:  The Alzheimer's Association, the sponsor  
          of this bill, states that an efficient and effective  
          infrastructure to support caregivers requires high-level,  
          evidence-based data such as the BRFSS. As California's  
          population ages and demographics shift, the pool of available  
          family caregivers 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 also states that greater data on the scope of caregiving  
          within California will help the state better prepare support  
          systems for caregivers in the future.


          A coalition of supporters including the Association of  
          California Caregiver Resource Centers, Mental Health America,  
          and Justice in Aging state that 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.  They assert that  
          California's economy relies on informal caregivers to share the  
          cost of health and human service programs, yet there is no  







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          formal mechanism to effectively evaluate the impact of  
          caregiving statewide. 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.




          ARGUMENTS IN OPPOSITION:     The California Department of Public  
          Health states that this bill is unnecessary because other  
          Modules have been added to BRFSS without a legislative mandate.  
          DPH also states that funding for additional question is required  
          from departmental programs, agencies, or stakeholder groups, and  
          that this bill does not address the costs associated with the  
          survey, nor does it identify funding.

          ASSEMBLY FLOOR:  79-0, 6/1/15
          AYES:  Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,  
            Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,  
            Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,  
            Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina  
            Garcia, Eduardo Garcia, Gatto, Gomez, Gonzalez, Gordon, Gray,  
            Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones,  
            Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low,  
            Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin,  
            Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,  
            Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,  
            Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,  
            Wilk, Williams, Wood, Atkins
          NO VOTE RECORDED:  Gipson

          Prepared by:Shannon Muir / HEALTH / 
          8/31/15 12:47:46


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