BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: SB 982
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|Author: |McGuire |
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|Version: |March 28, 2016 |Hearing |April 12, 2016 |
| | |Date: | |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Mareva Brown |
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Subject: State Department of Developmental Services: Sonoma
State Hospital
SUMMARY
This bill requires the Department of Developmental Services
(DDS) to develop and conduct a three-year longitudinal study, as
specified, between 2017 and 2020 to assess the quality of life
and outcomes of residents that relocate from the Sonoma
Developmental Center as a result of the closure of that center.
The bill specifies the contents of the study, including
assessments of the residents before they leave the center and at
one-year and two-year intervals after they relocate. It requires
DDS to submit interim and final reports to the Legislature, as
specified.
ABSTRACT
Existing law:
1) Establishes the Lanterman Developmental Disabilities
Services Act, which declares California's responsibility
for providing an array of services and supports to meet the
needs of each person with developmental disabilities in the
least restrictive environment, regardless of age or degree
of disability, and to support their integration into the
mainstream life of the community. (WIC 4500, et seq.)
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2) Establishes the jurisdiction of DDS over state
developmental centers, including Sonoma, Fairview and
Porterville developmental centers and the responsibility of
each facility to create bylaws and rules, as specified.
(WIC 4440)
3) Requires DDS to submit a detailed plan to the
Legislature when it proposes closure of a developmental
center no 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 4474.1.
(a))
4) Establishes a system of nonprofit regional centers to
provide fixed points of contact in the community for all
persons with developmental disabilities and their families,
to coordinate services and supports best suited to them
throughout their lifetime. (WIC 4620)
5) Requires DDS to implement an improved, unified quality
assessment system, and expresses Legislative intent that
this system will ensure the well-being of consumers, taking
into account their informed and expressed choices. Requires
DDS with its stakeholders to identify a valid and reliable
quality assurance instrument, as specified, and to contract
with an entity with experience in tracking outcomes and
developing data systems. (WIC 4571)
6) Requires DDS, in consultation with the contractor, to
establish the methodology by which the quality assurance
instrument shall be administered, including, but not
limited to, how often and to whom the quality assurance
will be administered, and the design of a stratified,
random sample among the entire population of consumers
served by regional centers. Requires the contractor to
provide aggregate information for regional centers and the
state as a whole. (WIC 4571 (e))
This bill:
1) Adds a new section, WIC 4474.12, requiring DDS to
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develop and conduct a three-year longitudinal study to
assess the quality of life and outcomes of developmental
center residents that relocate from the Sonoma State
Hospital as a result of the closure of that center.
Specifies that the study shall be conducted over the course
of the 2017-18 through 2019-20, inclusive, fiscal years.
7) Requires the study to do all of the following:
a. Measure the residents' quality of life, their
satisfaction with services, the degree to which the
residents achieve their goals, such as independence,
and other dimensions as determined by the department.
b. Include assessments of the residents before
they leave the center and at one-year and two-year
intervals after they relocate from the center.
c. Track the residential locations of the former
residents of the center for purposes of conducting the
one-year and two-year post relocation reassessments.
d. Include a written report that does all of the
following:
i. Summarizes the findings based on
the data collected.
ii. Provides recommendations regarding
how the closure could have been conducted in a
manner that better served the needs of the
residents and their families.
iii. Specifies any community-based
services for former residents that need to be
improved.
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8) Requires DDS to maintain and update the addresses of,
and contact information for, former residents of the center
who relocated as a result of the closure of the center.
9) Requires DDS to ensure, to the extent permitted by law,
that researchers conducting the study have access to data
and other information necessary to conduct the study,
including the addresses of, and contact information for,
former residents of the center who relocated due to the
closure of the center.
10) Requires DDS to submit interim reports to the
Legislature regarding the study at the end of the first and
second years of the study, and to submit the study to the
Legislature upon its completion, as specified.
11) Sunsets the study on January 1, 2021.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
This bill requires DDS to develop and conduct a three-year
longitudinal study to assess the quality of life and outcomes of
developmental center residents that relocate from the Sonoma
Developmental Center as a result of the closure of that center.
According to the author, the longitudinal study would be modeled
after study conducted as part of the Stockton Developmental
Center closure which measured residents' quality of life,
satisfaction with services, and other factors before the
individual left the developmental center and one and two years
after they had moved. Additionally, developmental center
residents and their family members were asked to assess how well
the closure was handled and to make recommendations for how the
process could be improved, the author states.
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The author states that requiring a comprehensive longitudinal
study would ensure families that their loved ones are receiving
quality care, enable the state to learn from and correct any
challenges that may arise from the transition and would be a
transparency and accountability mechanism. The author further
states, "Although there are currently tracking mechanisms, given
the fact that there will NO LONGER be any developmental centers
to fall back on if a resident has challenges in the community, a
comprehensive longitudinal study should be required."
Developmental Centers
DDS operates three state developmental centers - Sonoma,
Fairview and Porterville developmental centers - and one
smaller, 55-bed facility in Cathedral City that is often used as
a step-down placement for individuals with developmental
disabilities and challenging behavioral needs. Each
developmental center has three levels of care - a skilled
nursing facility, an intermediate care facility for individuals
with intellectual disabilities (ICF/IID), and a few beds in a
general acute care hospital.
In April of 2015, the Administration submitted a proposed plan
of closure for the Sonoma Developmental Center. This plan is
currently under review of legislative budget committees and must
be approved prior to implementation. On April 1, 2016, the
Administration submitted proposed closure plans for Fairview
Developmental Center and the general treatment program at
Porterville Developmental Center. These plans must also be
approved by the Legislature.
The developmental centers once were considered the placement of
preference for individuals with significant needs. At its peak
in 1968, the developmental center system housed more than 13,400
individuals in seven facilities. Of the three remaining
facilities, the oldest is Sonoma Developmental Center (1891) and
the newest is Fairview Developmental Center (1959). Since then a
series of federal and state legal decisions began the movement
to provide services for individuals with developmental
disabilities in their communities.
As of March 30, 2016, the four state-run facilities collectively
served 1,005 individuals with significant physical or behavioral
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developmental disabilities. Of these, 204 individuals were in
the secure treatment program at Porterville Developmental
Center, and 158 were in the general treatment program. Another
237 individuals lived at Fairview Developmental Center and 359
were at Sonoma. The remaining 47 were at Canyon Springs, a
smaller state-run facility in Riverside County, which is not
slated for closure.
Licensing and Certification concerns
In January 2013, four of the 10 ICF units at Sonoma DC were
withdrawn from federal certification by DDS, in response to
notice that the federal government was moving to decertify, and
defund, the entire group of ICF units at the facility. These
actions came on the heels of widely reported revelations of
multiple instances of abuse, neglect, and other lapses in
caregiving at the institution. In March 2013, DDS entered into a
Program Improvement Plan agreement with the state Department of
Public Health (DPH), which was accepted by the federal Centers
for Medicare and Medicaid Services (CMS). As a condition of the
Program Improvement Plan, DDS contracted with an outside
consultant, the Delmarva Foundation, to conduct a root cause
analysis of the problems at Sonoma DC, and to develop an action
plan to ensure compliance with federal and state licensing and
certification requirements. On October 31, 2013, the DPH
accepted the Sonoma DC action plan which included the opening of
a new ICF unit, 118.5 new staff positions, three new wheelchair
transport vehicles, and extensive staff training.
The Administration assumed these corrective actions would result
in the restoration of certification and federal funding by July
1, 2014. However, this did not occur. A survey of the seven
certified ICF units at Sonoma DC in May 2014 resulted in their
decertification. Over the next 14 months, while CMS and the
Administration negotiated terms of a settlement. On June 30,
2015, DDS entered into a settlement agreement with CMS to extend
the final termination date for the remaining ICF residences to
July 1, 2016 with the potential for one or more extensions,
while DDS must continue program improvement activities.
Concurrent with these activities is the planned closure of the
developmental center.
Similar concerns and CMS findings followed at the other two
developmental centers and on April 1, 2016, DDS revealed plans
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for closure of Fairview Developmental Center and the general
treatment area at Porterville DC. An agreement with CMS is
anticipated to follow within several weeks.
Community based services
California's 21 nonprofit regional centers are part of a system
of care for individuals with developmental disabilities overseen
by DDS. DDS is responsible for coordinating care and providing
services for nearly 290,000 people who receive services and
supports to live in their communities, as of March 2016.
Regional centers provide diagnosis and assessment of eligibility
and case managers help to plan, access, coordinate and monitor
the services and supports that are needed because of an
individual's developmental disability. Services for consumers
are determined through an individual program plan (IPP).
Quality Assessments
DDS has used a variety of quality assessment measurements,
beginning in 1993 with the Coffelt settlement Quality Tracking
Project, which focused on individuals who were placed in the
community from a developmental center as a result of the
lawsuit. According to DDS, The study assessed consumer and
family satisfaction, case management activities, independence,
productivity, integration, choice and self-determination,
service delivery patterns, health, safety, psychoactive
medication usage, qualities of home settings, and costs of
services. Using six different research designs and more than
4000 visits, the survey ultimately was reported in 19 separate
reports and found that movers had improvements in self-care
abilities, social behaviors, opportunities for choice making and
consumer satisfaction, among other domains. Negative outcomes
included fewer individuals with paid jobs and making less money
than they did in the DCs. Use of sedatives and psychotropic
medications had increased.
As part of the plan to close Stockton Developmental Center, DDS
agreed to complete a three-year longitudinal study in three
phases to track consumer outcomes and the quality of life of
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individuals upon its closure in 1996. An interagency agreement
was reached with California State University, Sacramento (CSUS)
to conduct the study.
In 1997, responding to parent concerns, the Legislature codified
the state's responsibility to track and evaluate the well-being
of individuals moving from DCs, (SB 391, Chapter 294, Statutes
of 1997). The obligation was fulfilled by a variety of contracts
with researchers. In 2009, as part of the budget process, this
section of statute was deleted and replaced by language
directing DDS to complete a single survey, the Quality
Assessment Project, (WIC 4571) which was intended to provide
more appropriate information for CMS in seeking renewal of the
Home and Community Based Services (HCBS) Waiver, which provides
substantial matching funding for community programs. To satisfy
this requirement, DDS chose to use the National Core Indicator
survey.
National Core Indicator survey
The National Core Indicators (NCI) is a collaborative effort
between the National Association of State Directors of
Developmental Disabilities Services (NASDDDS) and the Human
Services Research Institute (HSRI). The program began in 1997
to support NASDDDS member agencies to gather a standard set of
performance and outcome measures that can be used to track their
own performance over time, to compare results across states, and
to establish national benchmarks. Indicators address key areas
of concern including employment, rights, service planning,
community inclusion, choice, and health and safety, including
loneliness. In California, the NCI Quality Assessment Project
operates on a three year cycle, alternating data collection
between three distinct groups of people serviced by regional
centers: adult consumers, guardians and family members and
family members of children who receive services.
DDS also is conducting a longitudinal study to better understand
the experience among movers and their families during the first
two years post transition into the community. This longitudinal
study will survey the first 100 people transitioning from a
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developmental center into the community and their families
beginning in January 2016. Study participants will be surveyed
at 3 months, 6 months, 1 year, and 2 years post transition using
the NCI survey tools.
Related legislation:
AB 9 (Evans, Chapter 9, 4th Extraordinary Session) established a
requirement in statute for DDS to track outcomes of consumers in
the system.
COMMENTS
The author may want to consider aligning the language of this
bill more closely with the language of the prior statutorily
required movers study, in order to ensure consistency in
outcomes and greater chances of comparability. Staff also
recommends broadening the scope to all three DCs that are slated
for closure and removing the sunset date to capture more robust
data. Specifically, staff recommends the following amendments:
WIC 4474.12. (a) To ensure that persons with developmental
disabilities who are moved from developmental centers to the
community are receiving necessary services and supports, the
department shall develop and conduct a three-year contract with
an independent agency or organization for a longitudinal study,
commencing July 1, 2017, to assess the quality of life and
outcomes of developmental center residents that relocate from
the Sonoma State Hospital Developmental Center, Fairview
Developmental Center and the general treatment area of
Porterville Developmental Center as a result of the closure of
that those center s . The study shall be conducted over the course
of the 2017-18 through 2019-20, inclusive, fiscal years.
(b) The contractor shall be experienced in all of the following:
1) Designing valid tracking instruments
2) Tracking the quality of community programs, including
outcome-based measures such as health and safety, quality
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of life, integration, choice and consumer satisfaction.
3) Tracking the quality and appropriateness of community
placements for persons moving from large institutions into
community settings.
4) Developing data systems
5) Data analysis and report preparation
(c)The contractor shall measure consumer and family satisfaction
with services provided, including case management and quality of
life, including but not limited to health and safety,
independence, productivity, integration, opportunities for
choice and delivery of needed services.
1) The contractor shall meet with each person,
and the person's family, legal guardian or
conservator, when appropriate, no less than once a
year to discuss quality of life and observe the
person's services and supports.
2) In cases where the consumer is not capable of
communicating his or her responses and where there is
no family member, guardian or conservator involved,
the contractor shall meet with no less than two
persons familiar with the consumer. Additionally, the
contractor shall interview staff and friends who know
the consumer best and review records, as appropriate.
(d) The contract may be satisfied by the same contractor used by
DDS to implement the quality assurance instrument pursuant to
WIC 4571, if appropriate.
(b) The study conducted pursuant to this section shall do all
of the following:
(1) Measure the residents' quality of life, their satisfaction
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with services, the degree to which the residents achieve their
goals, such as independence, and other dimensions as determined
by the department.
(2) Include assessments of the residents before they leave the
center and at one-year and two-year intervals after they
relocate from the center.
(3) Track the residential locations of the former residents of
the center for purposes of conducting the one-year and two-year
postrelocation reassessments.
(4) Include a written report that does all of the following:
(A) Summarizes the findings based on the data collected.
(B) Provides recommendations regarding how the closure could
have been conducted in a manner that better served the needs of
the residents and their families.
(C) Specifies any community-based services for former residents
that need to be improved.
(c) (e) (1) For purposes of conducting the study, the department
shall maintain and update the addresses of, and contact
information for, former residents of the center who relocated as
a result of the closure of the center.
(2) The department shall ensure, to the extent permitted by law,
that researchers conducting the study have access to data and
other information necessary to conduct the study, including the
addresses of, and contact information for, former residents of
the center who relocated due to the closure of the center.
(d) (f) The department shall submit interim reports to the
Legislature regarding the study at the end of the first and
second years of the study, in accordance with the requirements
of Section 9795 of the Government Code. Upon the completion of
the study, the department shall submit the study to the
Legislature, in accordance with the requirements of Section 9795
of the Government Code.
(e) This section shall remain in effect only until January 1,
2021, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2021, deletes or
extends that date.
>
POSITIONS
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Support:
Parent Hospital Association
Sonoma County Board of Supervisors
Sonoma Land Trust
California Association of Psychiatric Technicians
Oppose:
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