BILL ANALYSIS Ó
SENATE COMMITTEE ON VETERANS AFFAIRS
Senator Jim Nielsen, Chair
2015 - 2016 Regular
Bill No: SB 980 Hearing Date: 4/12/16
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|Author: |Nielsen |
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|Version: |2/10/16 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant:|Wade Teasdale |
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Subject: Veterans' homes
DESCRIPTION
Summary:
1)Requires the Department of Veterans Affairs (CalVet) (a) to
adopt statewide policies and procedures, by regulation, for
operation of the state veterans home system; (b) to establish
a quality of care assessment team; (c) to implement a
statewide electronic health records system; and (d) correct
and update outdated terminology and references within the
portion of the Military and Veterans Code (MVC) that governs
state veterans' homes.
Existing law:
1)Authorizes establishment and operation of the Veterans' Home
of California system.
2)Establishes the authority and responsibilities of CalVet in
administering the system.
3)Requires each on-site home administrator to adopt rules and
regulations for the administration of each home.
4)Defines criteria for admission to a veterans' home.
5)Requires that home members (residents) pay fees and charges as
determined by CalVet, subject to a specified fee schedule.
6)Authorizes CalVet to investigate a veteran's financial status
for admission purposes.
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7)Requires 100% of the monies received by a veterans' home from
veterans receiving federal aid to be placed to the credit of
the home to offset the costs of being in the home.
8)Requires that -- upon the death of a veteran in a home - any
monies not in excess of $3,000 held by the home for the
veteran to be paid to the home's Morale, Welfare, and
Recreation Fund, if no will or heir or other family member is
discovered.
9)Authorizes:
a) Married veteran home members to have their
non-veteran spouses domicile with them.
b) A resident spouse to continue residency after a
veteran spouse's death.
This bill:
1)Corrects and updates archaic and outdated terminology and
references within the portion of the MVC that governs state
veterans' homes.
2)Clarifies that the on-site home administrator to be the senior
executive appointed to oversee the operations of a veterans'
home.
3)Requires the Secretary of Veterans Affairs to adopt uniform
statewide policies and procedures, by regulation, for the
operation of the veterans' home system.
4)Requires CalVet to establish a quality of care assessment
team.
5)Requires the Secretary to implement a statewide electronic
health record system.
6)Requires the Secretary to annually report to the veterans
policy committees of the Legislature.
7)Requires that fees and charges be established by the
Secretary.
8)Requires the Secretary to adopt rules and regulations that
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apply to the homes and the criteria for admission.
9)Provides that a resident spouse who continues residency after
a veteran spouse's death to continue to pay all applicable
fees and comply with all department regulations.
10) Requires CalVet to determine the total worth of
any member's property or assets for purposes of admission,
including validating income levels for purposes of
establishing fees.
11) Provides that monies received by a veterans'
home from veterans who receive federal aid to be deposited
into the Federal Trust Fund, a continuously appropriated fund,
to be used for the operating costs of the home.
BACKGROUND
State Veterans Homes
The State of California provides veterans' homes to help provide
for the state's aged or disabled veterans to acknowledge the
service and tremendous sacrifices California veterans have made
on behalf of our nation.
CalVet's Veterans Homes Division provides rehabilitative,
residential medical care and services in a homelike environment
for aged and disabled veterans (and eligible veteran spouses)
residing in the State's eight veterans homes, which are located
in Barstow, Chula Vista, Fresno, Lancaster. Redding, Ventura,
West Los Angeles, and Yountville. As of mid-March 2016, a total
of 2,158 members resided in the homes.
Many of the homes were built in the last 10 years and the
state's laws and regulations governing the homes are not
standardized. Also, some policies and procedures are outdated
and need to be updated to reflect the level of care provided at
the homes.
Levels of Care
The eight campuses offer different combinations of the following
levels of care that generate increasing levels of cost:
1)Independent living/domiciliary care (Barstow, Chula Vista,
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Yountville):
This level of care is for residents able to perform activities
of daily living with, at most, minimal assistance. Non-nursing
employees provide limited supervision. Residents have access
to all of the Home's services, activities, and medical care.
Individuals can transfer to higher levels of care as needed.
Independent living is also referred to as Domiciliary by
CalVet and the USDVA.
2)Residential care/assisted living (All homes except Barstow):
Residential Care Facilities for the Elderly (RCFE) are
available for residents who require minimal assistance and
supervision with some activities of daily living. RCFE
services may include care by licensed nurses. In the future,
memory care programs may be established within the RCFEs.
3)Intermediate care (Barstow, Yountville):
This level is for residents who often require licensed nursing
assistance with medications and treatments, and generally
require unlicensed nursing assistance with several daily
living activities.
4)Skilled nursing care (Barstow, Chula Vista, Fresno, Redding,
West LA, Yountville)
This level of care provides 24-hour services of licensed
nurses and certified nursing assistants, and is more
comprehensive than intermediate care. Skilled nursing
residents have greater access to rehabilitation therapies,
nursing care, pharmacy management, structured activities and
clinical dietary services.
5)Memory care:
The Fresno, Redding, West LA and Yountville homes provide
memory care programs within their skilled nursing facilities.
6)Outpatient clinic:
In addition to the above levels of care, each home provides an
outpatient clinic to serve its members. The clinics provide
comprehensive multidisciplinary assessments as well as ongoing
primary care. The clinics address the veteran's routine care
needs and also will arrange visits with outside medical
specialists as necessary.
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Electronic Health Records
New technologies and financial incentives have resulted in
health care providers increasingly and actively using electronic
health records (EHR). An EHR is an electronic version of a
patient's medical history, which is maintained by the provider
over time, and may include all of the key administrative
clinical data relevant to that persons care under a particular
provider, including demographics, progress notes, problems,
medications, vital signs, past medical history, immunizations,
laboratory data and radiology reports The EHR automates access
to the information and has the potential to streamline clinician
workflow. The EHR also has the ability to support other
care-related activities directly or indirectly through various
interfaces, including evidence-based decision support, quality
management, and outcomes reporting.
In 2009, the President signed the American Recovery and
Reinvestment Act which included the establishment of the Office
of the National Coordinator for Health Information Technology to
facilitate and expand the use of health information technology
pursuant to national standards. Using electronic health record
systems is intended to reduce medical errors and increase
patient accessibility to personal medical information. However,
according to Privacy Rights Clearing House, 1263 data breaches
involving medical and healthcare providers have been made public
since 2005. Those breaches involved over 45 million records.
Accordingly, both the state and federal governments continue
enact measures to ensure the protection of patient medical
information, and closely monitor legislation involving EHRs.
COMMENT
Committee Comments :
1)This bill is double-referred to Senate Judiciary at that that
Committee's request. Judiciary staff says their interest is
exclusively in the EHR provisions.
2)The state veterans home system has expanded rapidly from three
homes to eight within the past decade. This has challenged
CalVet's departmental ability to ensure a standardized, high
quality of care in all the homes. New CalVet Secretary Vito
Imbasciani, a physician, has announced this as a priority
concern.
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3)According to CalVet, the dollar amounts in MVC Sec. 1035.3
have been unchanged since at least 1983, when that section was
amended last. They have not been adjusted for inflation nor
have they been adjusted to address increases in court and
administrative costs associated with collecting and disposing
of assets. In many cases the department has had to spend more
in court fees and administrative costs than what is actually
recovered from the assets. Additionally, since Sec. 1035.5
references Secs. 1035 through 1035.4 for disposal of assets
for residents admitted after January 1, 1984, the sections are
still relevant and need to be updated. This bill updates the
dollar amounts.
Related/Prior Legislation
SB 543 (Wolk, pending Assembly, 2016 ), with regard to the
Veterans Home of California system, creates a single system-wide
Morale, Welfare, and Recreation Fund (MWR Fund) that
consolidates existing and future MWR moneys generated by
individual veterans home campuses, and establishes procedures
and restrictions on the budgeting and spending of moneys in the
Fund.
SB 1410 (Wolk, Chapter 659, Statutes of 2014 ) requires
non-veteran spouses to pay the same fees and charges as paid by
veteran members of a veterans' home, as determined by CalVet,
and subjects them to the same prohibitions.
AB 1580 (Yamada, died Senate 3rd Reading, 2014 ) consolidates the
separate MWR Funds at each veterans home into a newly created
fund in the State Treasury.
SB 10 (Evans, Chapter 265, Statutes of 2011 ) provides for the
establishment of a Veteran's Home Allied Council for each
veterans home, and would additionally permit each council to
represent veterans who reside in that same home in matters
before the Legislature if each council, in the course of
providing that representation, complies with specified
requirements, as prescribed.
POSITIONS
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Sponsor:
AMVETS
CA Association of County Veterans Service Officers
Support:
California State Commanders Veteran Council
California Long-Term Care Ombudsman Association
Military Officers Association of America-CA Council of Chapters
Veterans of Foreign Wars- Department of CA
Vietnam Veterans of America-CA State Council
Oppose: None on file
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