BILL ANALYSIS Ó
SENATE COMMITTEE ON GOVERNMENTAL ORGANIZATION
Senator Isadore Hall, III
Chair
2015 - 2016 Regular
Bill No: SB 547 Hearing Date: 4/14/2015
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|Author: |Liu |
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|Version: |2/26/2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant:|Arthur Terzakis |
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SUBJECT: Long-term care: Assistant Secretary of Aging and
Long-Term Care: Department of Community Living
DIGEST: This bill establishes the Department of Community
Living (DCL) within the Health and Human Services Agency to
serve as the single state-level contact on issues of aging and
long-term care. Additionally, this bill creates an Assistant
Secretary of Aging and Long-Term Care Coordination position
within the agency with specified duties and responsibilities.
ANALYSIS:
Existing law:
1)Establishes the California Health and Human Services Agency
consisting of the Departments of Aging, Child Support
Services, Community Services and Development, Developmental
Services, Health Care Services, Managed Health Care, Public
Health, Rehabilitation, Social Services, and State Hospitals.
2)Sets forth legislative findings and declarations regarding
long-term care services, including that consumers of those
services experience great differences in service levels,
eligibility criteria, and service availability that often
result in inappropriate and expensive care that is not
responsive to individual needs. Those findings and
declarations also state that the laws governing long-term care
facilities have established an uncoordinated array of
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long-term care services that are funded and administered by a
state structure that lacks necessary integration and focus.
This bill:
1)Establishes the Department of Community Living (DCL) within
the Health and Human Services Agency and creates an Assistant
Secretary of Aging and Long-Term Care Coordination position
within the agency, to be appointed by the Governor and
confirmed by the Senate.
2)Stipulates that the DCL shall be aligned, to the extent
practicable, with the federal Administration for Community
Living and shall serve as the single state-level contact on
issues of aging and long-term care, oversee statewide
long-term care service delivery, promote coordinated long-term
care service delivery and access to home and community-based
services at the local and regional levels, and provide
leadership and information to local agencies on best
practices.
3)Also, provides that the DCL shall serve as the organizational
unit designated to oversee all long-term care programs in the
state and to consolidate all long-term care administered
throughout all departments of the agency, including programs
serving older adults and persons with disabilities.
4)Stipulates that the Assistant Secretary shall serve as liaison
to the federal Administration for Community Living and be
responsible for ensuring that the state maximizes the use of
federal funding opportunities. Also, requires the Assistant
Secretary to do all of the following:
a) Consolidate data and programs pertaining to long-term
care from all departments and programs within the agency;
b) Coordinate and direct the establishment of the DCL and
lead the development and implementation of a statewide
long-term care strategic plan;
c) Oversee and coordinate the integration of health care
and long-term care services;
d) Facilitate the coordination of long-term care services
at the local level and work with rural and urban
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communities to identify infrastructure capacity issues and
lead in the development of access standards for home and
community-based services; and,
e) Report annually to the legislative policy and fiscal
committees regarding the status of long-term care in the
state, the level of state spending on long-term care
programs, the amount of federal funding received, progress
in improving the range of services, and recommendations to
enhance the overall coordination and delivery of long-term
care services.
5)Additionally, requires the Assistant Secretary to develop a
system wide long-term care plan that establishes the state's
priorities, maximizes the use of limited resources, engages a
range of stakeholders who need long-term care services and
incorporates clear benchmarks and timelines for achieving the
goals set forth in the plan.
6)Furthermore, stipulates that the plan shall do all of the
following:
a) Address the expansion of managed care in Coordinated
Care Initiative counties, as defined, and the changes to,
and differences in, access to health care for older and
disabled adults throughout the state and development of a
strategy for integrating the health care system statewide.
b) Provide a review and an analysis of existing programs,
services, and deficiencies as well as a plan of action for
a support network for unpaid family caregivers in this
state and consideration of employment-related policies and
proposals to improve the support network.
c) Include an analysis of workforce needs, including the
training and education requirements of a long-term care
workforce and a strategy for aligning the available
resources to meet those needs.
d) Provide directives for ensuring that the system screens
individuals prior to placement in a "nursing home" or
similar long-term care facility to avoid unnecessary
admissions and examine how a preadmission screening program
may be integrated into a managed care system and also
include a discussion of best practices in other states.
SB 547 (Liu) Page 4 of ?
e) Contain a strategy for developing a public/private
partnership to raise awareness of, and engagement in,
long-term care planning.
f) Identify how to educate long-term care consumers and
providers, the legal system, and the public about "safe"
advance directives, limited conservatorships, and
affordable access to conservators.
g) Address end-of-life planning issues and improvements to
end-of-life care and examine model programs in various
cities and counties and consider how to expand local and
state-level innovations designed to address the challenges
related to long-term care services delivery.
Background
Purpose of SB 547: According to the author's office, Senator
Liu, Chair of the Senate Select Committee on Aging and Long-Term
Care, led a comprehensive effort in 2014 to identify the
structural, policy, and administrative changes necessary to
realize an "ideal" long-term care delivery system and develop
recommendations and a strategy to achieve that vision. This
measure represents certain recommendations contained in the
Select Committee's report titled, "A Shattered System: Reforming
Long-Term Care in California." The full report addresses
challenges in the current system that fall into eight issue
areas and contains an overall strategy for creating a
sustainable, efficient continuum of care for this and future
generations of aging and disabled adults.
One of the issue areas identified by the Select Committee
involves "state leadership" - specifically, the Select Committee
found that "California's fragmented organizational structure
leaves the state with a leadership vacuum that complicates any
effort to undertake comprehensive long-term care reform. Rather
than develop a vision and overall strategic plan for long-term
care system transformation, the state has adopted a piecemeal
and reactive approach to change."
The Report's suggested recommendation with respect to this issue
area is as follows: "Reform the state-level administrative
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structure by naming a Long-Term Care leader (a Czar) to organize
system-wide planning activities and establishing a Department of
Community Living with the Health and Human Services Agency. The
Department, in collaboration with other agencies and departments
with relevant responsibilities, should develop a state Long-Term
Care Plan to guide the priorities and implementation of aging
and long-term care investments, policies, and programs
statewide."
California's Aging Population: According to information
provided by the Senate Select Committee on Aging and Long-Term
Care, California's aging population is growing rapidly and also
becoming more racially and culturally diverse. The population
of individuals over age 65 will increase by 27% for young
retirees (aged 65-74) and 10% for mature retirees (aged 75-84)
by the year 2017. In addition, the number of adults with
disabilities in California is expected to grow by approximately
20% in the next 20 years.
Alzheimer's disease and other dementias are on the rise and
projected to affect an estimated 1.1 million Californians by
2030. Aging disproportionately impacts women; though women
comprise roughly half of the population overall, by age 65 the
proportion of women to men increases to almost six out of ten,
and in the 85+ group, women outnumber men nearly two to one.
Moreover, because women's life expectancy is longer than men's,
women are more likely to outlive their resources and slip into
poverty.
These demographic realities constitute a social and moral
imperative to plan thoughtfully for the aging of our population.
At stake is the ability to age with dignity, choice, and
independence for two key groups: older adults and people with
disabilities who depend upon a system of long-term care (LTC) to
remain as independent as possible. Unfortunately, California is
not prepared to meet this demographic imperative.
A person-centered, culturally responsive LTC system would enable
individuals to receive services in the most affordable,
home-like settings available. California was once a leader in
providing services to support the full integration of older
adults and persons with disabilities into community life. Over
the past several years, however, the LTC system has been
adversely impacted by system fragmentation, a lack of usable
data, poor planning, unaddressed workforce issues, capacity
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issues, and of course devastating budget cuts during the
recession.
Staff Comments:
Suggested technical amendment - On page 3, line 6, after the
word "Senate" add the following: "Committee on Rules"
Prior/Related Legislation
SB 128 (Monning), 2015-16 Session. Among other things, would
enact the End of Life Option Act authorizing an adult who meets
certain qualifications, and who has been determined by his or
her attending physician to be suffering from a terminal illness,
as defined, to make a request for medication prescribed pursuant
to these provisions for the purpose of ending his or her life.
Also, would establish the procedures for making these requests.
(Pending in Senate Appropriations Committee)
AB 2014 (Berg) 2005-06 Session. Would have established a new,
single department, known as the California Department of Adult
and Aging Services, for the purpose of coordinating and
promoting those programs that support adults who are aging or
disabled so that they may remain in their homes and communities
for as long as practicably possible. (Held in Senate Human
Services Committee)
FISCAL EFFECT: Appropriation: No Fiscal
Com.: Yes Local: No
SUPPORT:
California Alzheimer's Association
California Association of Area Agencies on Aging
California Collaborative for Long Term Services and Supports
California Commission on Aging
California Foundation for Independent Living Centers
Congress of California Seniors
Justice in Aging
LeadingAge California
Service Employees International Union (SEIU) United Long Term
Care Workers
State Independent Living Council
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OPPOSITION:
California Association of Public Authorities for In-Home
Supportive Services
ARGUMENTS IN SUPPORT: Writing in support of SB 547, the
California Retired Teachers Association states that "fractured
oversight and the complexity of the administrative 'spider web'
have been ongoing issues of discussion in recent years,
especially with heightened interest in improving the system of
long-term care. For example, nursing homes are overseen by the
Department of Public Health, while residential care facilities
for the elderly are under the jurisdiction of the Department of
Social Services. As our population ages and requires more
nuanced and specialized care, the artificial bifurcation of
programs within the Administration is illogical and burdensome
to navigate for seniors, their families, and caregivers.
Additionally, lack of coordination between state departments has
created a system with compromised transparency and
accountability, meaning that bad actors regulated by one
department may subsequently be licensed to run programs under
the banner of a second department."
The California Retired Teachers Association believes that SB 547
will improve the likelihood that community-based services will
meet the needs of seniors, reducing hospitalizations and
institutional placements and ultimately improving their health
and well-being.
ARGUMENTS IN OPPOSITION: Writing in opposition to SB 547, the
California Association of Public Authorities (CAPA) has
expressed concern about the bill's potential impact on the
In-Home Support Services (IHSS) program. CAPA points out that
the IHSS program provides personal care and domestic services to
aged, blind or disabled individuals in their own homes. The
purpose of the program is to allow these individuals to live
safely at home rather than in costly and less desirable
out-of-home placement facilities. The California Department of
Social Services (CDSS) has lead responsibility for the
administration of the IHSS program.
CAPA notes that the IHSS program has undergone extensive changes
in the past few years and that one of the most significant
undertakings has been implementation of the Coordinated Care
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Initiative (CCI) which was created to improve care for
California seniors and persons with disabilities who are dually
eligible for both Medi-Cal and Medicare. CAPA states that even
though this is a difficult population to serve its members have
had a great deal of "customer" satisfaction with CDSS. CAPA
emphasizes that CDSS has displayed a cooperative and thorough
manner of providing assistance. CAPA believes that in light of
the fact that CDSS has several other major projects underway
that impact Public Authorities, the state-level reorganization
of the Health and Human Services Agency called for in SB 547 is
not well timed for IHSS consumers or providers.
DUAL REFERRAL: Senate Health Committee