BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: SB 639
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|Author: |Stone |
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|Version: |February 27, 2015 |Hearing |April 28, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Mareva Brown |
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Subject: Developmental centers: closure
SUMMARY
This bill requires the Department of Developmental Services
(DDS) to submit a plan to the Legislature by April 1, 2016, to
close the Sonoma and Fairview developmental centers no later
than December 31, 2018, except as specifed. The bill requires a
plan for using both properties to benefit the developmentally
disabled community on an ongoing basis, and requires the state
to estimate potential revenues that may be generated from
different options for use of the properties. Additionally, this
bill includes codified Legislative intent that DDS minimize the
expenditure of state funds related to any developmental center
residential units that are decertified for failure to meet
federal or state health and safety laws or regulations, or that
receive notification from a state or federal regulator that they
are at risk of decertification. It also includes codified
Legislative intent that funds previously used to operate
developmental centers instead be shifted to support
community-based services for individuals with developmental
disabilities.
ABSTRACT
Existing law:
1) Establishes the California Department of Developmental
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Services (DDS) as the agency that oversees the state's
developmental centers, and specifies the duties of the
department and developmental center employees. (WIC 4400 et
seq.)
2) Defines a "developmental disability" as a disability
that originates before the age of 18, continues, or can be
expected to continue, indefinitely, and constitutes a
substantial disability. (WIC 4512)
3) Requires that when DDS proposes the closure of a state
developmental center, the department shall be required to
submit a detailed plan to the Legislature not later than
April 1 immediately prior to the fiscal year in which the
plan is to be implemented, and as a part of the Governor's
proposed budget. (WIC 4471 (a))
4) Requires that prior to submission of the plan to the
Legislature, DDS must solicit input from the State Council
on Developmental Disabilities, the Association of Regional
Center Agencies, the protection and advocacy agency
specified in Section 4901, the local area board on
developmental disabilities, the local regional center,
consumers living in the developmental center, parents,
family members, guardians, and conservators of persons
living in the developmental centers or their representative
organizations, persons with developmental disabilities
living in the community, developmental center employees and
employee organizations, community care providers, the
affected city and county governments, and business and
civic organizations, as may be recommended by local state
Senate and Assembly representatives. (WIC 4474.1 (c))
5) Requires that prior to the submission of the plan to the
Legislature, DDS must confer with the county in which the
developmental center is located, the regional centers
served by the developmental center, and other state
departments using similar occupational classifications, to
develop a program for the placement of staff of the
developmental center planned for closure in other
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developmental centers, as positions become vacant, or in
similar positions in programs operated by, or through
contract with, the county, regional centers, or other state
departments. (WIC 4474.1 (d))
6) Requires that prior to submission of the plan to the
Legislature, the department shall hold at least one public
hearing in the community in which the developmental center
is located, with public comment from that hearing
summarized in the plan. (WIC 4474.1 (e))
7) Requires that the plan submitted to the Legislature
include all of the following:
a) A description of the land and buildings affected.
b) A description of existing lease arrangements at the
developmental center.
c) The impact on residents and their families.
d) Anticipated alternative placements for residents.
e) The impact on regional center services.
f) Where services will be obtained that, upon closure of
the developmental center, will no longer be provided
by that facility.
g) Potential job opportunities for developmental center
employees and other efforts made to mitigate the
effect of the closure on employees.
h) The fiscal impact of the closure.
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i) The time frame in which closure will be accomplished.
(WIC 4474.1 (f))
This bill:
1) States various uncodified Legislative findings and
declarations about the developmental center system,
including the intent of the Legislature to carry out the
principles reflected in a 2014 task force report on the
future of the Developmental Centers. Includes the assertion
that in the four- and five-year closure processes of prior
developmental centers, while care and caution were
essential to ensure that residents found suitable housing
and services in their communities, these facilities took
more time than necessary to achieve these goals.
2) Requires DDS to submit a plan to the Legislature by
April 1, 2016, to close the Sonoma and Fairview
developmental centers which meets the requirements for
closure established in statute. (WIC 4474.1)
3) Requires the closure plan to result in closure of both
Sonoma and Fairview developmental centers no later than
December 31, 2018. If the department concludes that it is
not feasible to close both developmental centers by that
date, the plan shall provide a detailed rationale for that
conclusion and a revised date for closure of each of the
two centers. Requires the revised date to be no later than
December 21, 2019.
4) Requires a plan to reduce developmental center staff in
an efficient manner that facilitates shifting funds from
developmental center options to community services, as
warranted by the transition of the developmental center
population to the community.
5) Requires a plan for using the properties occupied by the
two developmental centers to benefit the developmentally
disabled community on an ongoing basis.
6) Requires DDS to work with the Department of General
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Services to estimate potential revenues that may be
generated from different options for use of the properties,
as specified, and including but not limited to:
a. Providing ongoing revenues to support
community-based services through lease or rental
agreements between DDS and private entities, local
governments or other state departments.
b. Developing community-based, integrated housing
resources for use by individuals with developmental
disabilities in a manner similar to the Harbor Village
development located adjacent to the Fairview
Developmental Center.
c. Other proposals for commercial development
that would provide ongoing revenues to the state for
purposes of supporting community-based services for
individuals with developmental disabilities.
7) States codified Legislative intent that DDS minimize the
expenditure of state funds related to any developmental
center residential units that are decertified for failure
to meet federal or state health and safety laws or
regulations, or that receive notification from a state or
federal regulator that they are at risk of decertification
for failure to meet those laws or regulations.
8) States codified Legislative intent that DDS make moving
residents of decertified units, or units at risk of federal
or state decertification, a priority for movement into a
community-based residence with appropriate community
supports and services, as specified.
9) States codified Legislative intent that funds previously
used to operate developmental centers instead be shifted to
support community-based services for individuals with
developmental disabilities.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
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Purpose of the bill:
The author states that the vision to create fulfilling lives for
this population launched in 1969 through the Lanterman
Developmental Disabilities Services Act, "which envisioned a
system in which individuals with DD could maximize their
potential and control over their own lives by living in
communities of their choosing. While the vast majority of the
DD individuals do live in community settings, roughly 1,100
continue to languish in archaic developmental centers (DCs),
which do not fulfill the Lanterman Act's vision," the author
states.
According to the author, the developmenetal center system is
plagued with resident health and safety problems, as indicated
in reports by journalists and inspections by the state
Department of Public Health. Sonoma Developmental Center lost
its federal certification in 2012 due to significant health and
safety violations, which not only harmed residents but also
resulted in the loss of millions of dollars annually in federal
funds, the author states. Other DCs are also facing the
possibility of decertification based on violations of federal
health and safety standards. Additionally, the author states,
the three DCs consume a disproportionate share of state
spending, receiving more than $563 million for 2014-15, or
$504,000 for each DC resident.
Developmental disabilities
A developmental disability is defined as a severe and chronic
disability that is attributable to a mental or physical
impairment that begins before age 18 and is expected to continue
indefinitely. These disabilities include mental retardation,
cerebral palsy, autism, epilepsy, and other similar conditions.
Infants and toddlers (age 0 to 36 months) may also be eligible
for some developmental services if they are at risk of having
developmental disabilities or if they have a developmental
delay.
Developmental Centers
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DDS operates three Developmental Centers and one smaller
state-operated community facility, Canyon Springs, that together
care for 1,100 consumers across the state. These DCs are part of
a larger system of developmental services overseen by DDS, which
also includes services and supports for approximately 280,000
people who live in their communities.
The first DC opened in 1888, and residents with developmental
disabilities initially shared the state hospitals with patients
diagnosed with mental illness. Eventually, those populations
were separated into different facilities. For many years, the
state hospitals were the only alternative available to families
of children with intellectual and developmental disabilities who
were unable to be cared for at home. Over time, community
services and supports for individuals with developmental
disabilities became the programs of choice and the resident
population dropped in the DCs from a high of 13,400 in 1968,
with thousands more on a waiting list for admission, to 1,109
residents as of April 22, 2015. At its peak, the state had eight
developmental centers, each of which was designed to accommodate
between 2,500 and 3,500 individuals.
California's closure last year of the Lanterman Developmental
Center in Pomona was preceded by four other closures in the past
two decades. In 1995, the state shuttered the Stockton State
Hospital. In 1997, the state closed Camarillo State Hospital,
which had housed clients with both mental illness and
developmental disabilities. In 2009, DDS closed Agnews
Developmental Center, and a year later, in 2010, Sierra Vista, a
state-operated community facility, was closed. Of the three
remaining DCs, Sonoma has the largest population, with 408
residents, and Fairview had 281 residents as of April 22.
Sonoma Developmental Center
Sonoma Developmental Center is the oldest facility in California
that was established specifically to serve the needs of
individuals with developmental disabilities. The facility was
opened on November 24, 1891 and in 1909 was renamed the
California Home for the Care and Training of the Feeble Minded.
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Later, it became the Sonoma State Hospital and eventually,
Sonoma DC. The facility is in Eldridge, between the towns of
Glen Ellen and Sonoma, on approximately 1,000 acres of land that
is bisected by Highway 12.
Sonoma DC includes a campus with residential cottages, a
campground, store, post office, petting farm, swimming pool and
other recreational facilities for the residents. It sits in the
midst of a wildlife corridor that open space advocates and
others have pledged to protect from development and adjacent to
Jack London State Park which features equestrian trails, camping
facilities, lakes and historic buildings.
Fairview Developmental Center
Fairview Developmental Center in Costa Mesa is the newest of the
state's developmental centers officially opening on January 5,
1959. It originally occupied 752 acres, and had an initial bed
capacity of 2,622 and was intended to house some 4,125
residents. The actual population peaked in 1967 at 2,700 and
much of the original land was transferred in 1979 to the city of
Costa Mesa. The population on March 25, 2015 was 281.
The campus is surrounded on three sides by a 36-hole golf course
built on land that was sold to the city. Facilities include a
swimming pool, work activity center, auditorium, park, small
animal farm, recreational campsite, and library. According to
the DDS website, services include training in daily living,
vocational, leisure, academic, communication, mobility,
socialization, and community skills and are provided both on
campus and in community settings. On the northern portion of the
Fairview campus are the Harbor Village Apartments, a 568-unit
residential rental project. Harbor Village was initially
developed in the late 1980s to provide housing for employees and
consumers of Fairview Developmental Center, but tenants now
include the local community, staff and consumers of Fairview DC,
as well as other DDS consumers. A second housing project,
Shannon's Mountain, is being discussed to be built on the
Fairview Property.
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Federal involvement
On July 3, 2012, licensing staff from the California Department
of Public Health (CDPH) conducted an annual survey of Sonoma DC
to assess whether the facility was in compliance with state
licensing regulations, as well as to conduct, by proxy, a
federal licensing review by the Centers on Medicaid and Medicare
Services (CMS). Officials detailed in a 250-page report numerous
violations which amounted to lapses in six of the eight
categories required for continued federal funding. Among the
findings were that Sonoma DC's management failed to take actions
that identified and resolved problems of a systemic nature,
failed to ensure adequate facility staffing, failed to provide
active treatment, failed to provide appropriate health care
services and several other key categories. The team also
identified four situations that posed immediate jeopardy to the
health and safety of patients at the facility including 11
clients with injuries that resembled burns from a stun gun, a
finding that also prompted a criminal investigation.
In January 2013, four of the 11 Intermediate Care Facility (ICF)
units at Sonoma DC were withdrawn from federal certification by
DDS, in response to notice that the federal government was
moving to decertify the full group of ICF units. The loss of
certification has cost the state $1.4 million per month in
federal funds. In May 2014, Sonoma participated in a
recertification survey for the seven remaining ICF units, but
was unsuccessful. DDS also was unsuccessful in an appeal. While
CMS has officially decertified all 11 ICF units now at Sonoma,
it has extended the date that the state loses federal funding
from October 2014 to April 2015 to, now, May 7, 2015. The loss
of federal funding is approximately $43 million annually for all
eleven ICF units.
Subsequent to Sonoma's federal survey in 2013, Fairview and
Porterville Developmental Centers' ICF units were found by DPH
to be out of compliance with federal certification requirements
generally related to clients' health, safety, and rights. Both
developmental centers created program improvement plans, which
were approved by DPH, and continue to implement structural
changes in order to meet federal certification requirements and
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to retain federal Medicaid funding. Both facilities were
recently surveyed, but results have not been made public for
Fairview's survey.
DC Task Force
On January 13, 2014, California's Health and Human Services
Secretary Diana Dooley released a 59-page "Plan for the Future
of Developmental Centers in California." The Plan was developed
pursuant to trailer bill language adopted in 2013 that required
the Secretary to submit to the Legislature a master plan for the
future of DCs by November 15, 2013, and to submit to the
Legislature by January 10, 2014 the Administration's plans to
meet the service needs of all current residents of the DCs.
The task force included a broad representation of stakeholders
including a resident of Sonoma DC, family members, regional
center directors, providers, labor representatives, consumer
advocates, legislators, and DDS and Agency staff. While noting
that some family members and union representatives on the task
force qualified their support for the plan to clarify that they
do not support any implication that the centers be closed, the
plan provides six consensus recommendations:
1) More community style homes/facilities should be
developed to serve individuals with enduring and complex
medical needs using existing models of care.
2) For individuals with challenging behaviors and support
needs, the state should operate at least two acute crisis
facilities and small transitional facilities. The state
should develop a new "Senate Bill (SB) 962 like" model that
would provide a higher level of behavioral services.
Funding should be made available so that regional centers
can expand mobile crisis response teams, crisis hotlines,
day programs, short-term crisis homes, new-model behavioral
homes, and supported living services for those
transitioning to their own homes.
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3) For individuals who have been involved in the criminal
justice system, the state should continue to operate the
Porterville DC's Secure Treatment Program and the
transitional program at Canyon Springs Community Facility.
Alternatives to the Porterville DC Secure Treatment Program
also should be explored.
4) The development of a workable health resource center
model should be explored, to address the complex health
needs of DC residents who transition to community homes.
5) The state should enter into public/private partnerships
to provide integrated community services on existing state
lands, where appropriate. Also, consideration should be
given to repurposing existing buildings on DC property for
developing service models identified in Recommendations 1
through 4.
6) Another task force should be convened to address how to
make the community system stronger.
DDS and the Health and Human Services agency have begun
implementing some of the recommendations, including initiating a
Developmental Services Task Force which began meeting last fall
to focus the community system. That task force is ongoing.
Crisis units
One issue that emerged from the Future of the DC task force was
the desire to have crisis units in both Northern and Southern
California. The 2014-15 budget included funding for establishing
acute crisis units at Fairview and Sonoma developmental centers
to operate as a placement of last resort for consumers living in
the community who are found to be a danger to themselves or
others and who are in need of short-term crisis stabilization
services. While Fairview's crisis unit has been functioning for
several years, the crisis unit at Sonoma Developmental Center is
in the process of opening.
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Positions
Support
The bill's sponsor, the California Disability Services
Association, writes in support that "these institutions hold
hundreds of individuals who have counterparts in the community
living lives with greater independence, opportunity, and choice
than is possible in a developmental center. Members of CDSA
have served many former residents of developmental centers, and
they have cast off the behaviors of anger and frustration,
expanded their capabilities, and developed a new enthusiasm for
life. The current residents of the developmental centers
deserve these same opportunities. CDSA also urges recognition of
the high cost of care in institutional settings. The average
cost for a developmental center resident now exceeds $500,000
per year; in the community, even individuals needing the highest
level of care can be served for half this amount. And many need
less intensive services, costing far less. The resources
devoted to developmental centers can be better invested in
helping the 280,000 individuals with developmental disabilities
served in the community."
Opposition
Theresa DeBell, a member of the DC Task Force and president of
the California Association of State Hospital Parent Councils for
the Retarded, writes in opposition to this bill that the task
force did not recommend closure of the DCs for specific reasons.
"The Task Force studied in great detail the needs of the current
DC residents, who are very medically fragile or who have complex
and challenging behaviors. The Task Force also reviewed the
current Developmental Disabilities System capacity to supply
those needs in the community setting. It was recognized that
currently there were not sufficient numbers or types of
specialized service models to care for many community clients
with complex needs, let alone the current DC residents. Their
recommendations focused on the development of services, on
'opportunity to define and manage the transition ? to integrated
and specialized services using the expertise and resources of
the DCs to benefit the consumers.' ? There is a process in place
for the transition of DC clients to a community setting. That
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process is IPP-driven, and includes a comprehensive assessment
and the judicious use of Community Placement Plan funding to
develop necessary services. The lessons of the past include
successful community transitions (most recently those of the
former Lanterman Developmental Center residents) and
unsuccessful ones (some of the quota-driven placements under the
Coffelt decision that resulted in increased community deaths
among the DC movers). SB 639, by mandating a time-driven
closure process, would be a large step away from the focus of
the Lanterman Act on the individual."
Related legislation:
SB 1344 (Evans, 2014) would have required the state to establish
the Sonoma Developmental Center as the center of last resort for
Northern California, and would have required DDS to confer and
cooperate with the County of Sonoma to develop a detailed action
plan, as specified, and to ensure the inclusion and
participation of certain community entities in planning the
action plan. Died in the Senate Appropriations Committee.
SB 1428 (Evans, 2014) would have required that, prior to the
development of any plan for the sale, lease, transfer, or major
change of use of any portion of the Sonoma DC, DDS and the
Department of General Services confer and cooperate with public
and private entities in the development of an improvement and
redevelopment plan for the center. The bill would authorize the
plan to contain specific elements for residences, the wildlife
habitat corridor and public recreational facilities. Died in the
Senate Appropriations Committee.
AB 2349 (Yamada, 2014), would have established the Office of
Community Care Coordination within DDS, located at Sonoma DC,
and would have required the office to develop a plan, on or
before January 1, 2016, that addresses, among other things, the
operation of at least two acute crisis clinics, as specified.
AB 89 (Budget and Fiscal Review, Chapter 25, Statutes of 2013)
required the Secretary of the Health and Human Services Agency
to submit a master plan for the future of DCs and subsequent
plan for individuals living in those centers.
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AB 1472 (Budget and Fiscal Review, Chapter 25, Statutes of 2012)
included a moratorium for new admissions to the DCs, with
limited exception, limitations on the use of locked mental
health facilities and out-of-state placements, and provisions to
strengthen the capacity of the community to serve individuals
with challenging needs including the creation of a statewide
Specialized Resource Service.
SB 410 (Thompson, Chapter 513, Statutes of 1995) established the
procedures for closing a developmental center.
COMMENTS
This bill proposes to close two troubled developmental centers
without addressing a number of critical issues.
Pending federal action
1.The timing of a Legislative mandate to close these two
developmental centers comes as word is pending from the
federal CMS about its plans for Sonoma Developmental Center.
While CMS has notified Sonoma that it has been decertified, it
has provided DDS with several extensions to the revocation of
federal funding, which may appear to indicate a pending
agreement between CMS and the state. Should there be a
federally required plan for Sonoma, that plan may dictate the
state's preferred course of action. This bill does not
consider whether a federal government's plan should alter the
scope or timing of the plan for Sonoma DC.
Abbreviated time line
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2.The time line laid out in this bill is significantly shorter
than previous closures. Statute requires that when DDS
proposes the closure of a state developmental center, the
department must be required to submit a detailed plan to the
Legislature not later than April 1 immediately prior to the
fiscal year in which the plan is to be implemented, and as a
part of the Governor's proposed budget. (WIC 4471 (a)) The
earliest that DDS could submit a plan to the Legislature would
be April 1, 2016, as the bill reflects. The plan would then be
eligible to be adopted in the 2016 budget. That would leave
the department two years to move approximately 700 of the
state's most difficult to serve individuals from two
developmental centers into community living situations.
Challenges not addressed
3.This bill does not acknowledge or propose to resolve any of
the identified challenges to transitioning residents of the
DCs to community settings, which include, but are not limited
to:
While about one-third of DC residents have
complex medical needs and are receiving nursing
facility-level care for multiple medical conditions,
the availability of "SB 962" homes to care for
individuals with these conditions does not meet
demand. The task force recommended targeting $25
million in community placement funding over three
years, however it is unclear that the state is on
track to meet that recommendation.
The task force recommended that the state
should operate 15-bed acute crisis facilities like the
program at Fairview DC at least in the Northern and
Southern part of the states. These facilities have now
been opened at Fairview and Sonoma DCs, and this
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bill's mandate would include closure of those
facilities.
A new model of home is needed to provide
intensive, wrap-around therapeutic behavioral services
to consumers who need a higher level of support than
currently exists in community placements. The task
force estimated 36 of these three-bed homes would be
needed "if it were determined that this level of care
was appropriate for those remaining in the DCs with
challenging behaviors." This model has yet to be
developed.
The task force recommended recognizing and
preserving existing DC speciality services such as the
shoe making shops at Sonoma and Fairview DCs, the
wheelchair specialty clinic at Sonoma DC and the
availability of medical professionals with vast
experience in serving idividuals with complex
developmental and medical needs. An often-cited
example is the need for sedation dentistry services,
which are scarce in the community.
DDS has maintained over the last two closure processes that no
DC should close until there was an appropriate placement for
each individual who moved, a person-centered approach. Agnews
Developmental Center's closure was announced with the Governor's
in January 2003, the plan was presented in January of 2005 and
the last consumer moved in March 2009. Lanterman's closure was
announced in January 2010, the plan was presented that April and
the last person moved in December 2014. In both of those
transitions, the state and Legislature created a number of new
services, such as homes to care for medically involved
residents, a clinic for movers to bridge needed medical and
dental treatment in their new homes, as well as other
innovations.
In the case of two other closures - at Stockton and Camarillo
Developmental Centers - emptying the DCs was much quicker - less
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than one year for each. However, in both of those cases, the
residents were moved en masse to other developmental centers.
That option does not exist any more.
POSITIONS
Support:
California Disability Services Association (Sponsor)
Disability Rights California
Futures Explored
Opposition:
California Association of State Hospital Parent
Councils for the Retarded
Parent Hospital Association
Sonoma County Board of Supervisors
Sonoma Land Trust
Union of American Physicians and Dentists
(UAPD/AFSCME)
VOR
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