BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1377
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|AUTHOR: |Nguyen |
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|VERSION: |March 28, 2016 |
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|HEARING DATE: |April 6, 2016 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Cognitively impaired adults: caregiver resource
centers
SUMMARY : Appropriates $3.3 million from the General Fund each fiscal
year beginning with the 2016-17 fiscal year to the Department of
Health Care Services for Caregiver Resource Centers (CRCs) for
purpose of providing respite care. Permits CRC services to be
provided both in-person and through the use of remote
technologies, including but not limited to, web-based services,
mobile applications, and telephone messaging services.
Existing law:
1)Requires the director of DHCS to maintain or enter into
contracts directly with nonprofit CRCs to provide direct
services to caregivers throughout the state in the existing
geographic service areas.
2)Requires CRCs to deliver services to and advocate for
caregivers of cognitively impaired adults, as established in
the CRC Operations Manual. Requires CRC services to include,
but not be limited to, all of the following:
a) Specialized information on chronic and
disabling conditions and diseases, aging, caregiving
issues, and community resources;
b) Family consultation to provide support,
alleviate stress, examine options, and enable them to
make decisions related to the care of cognitively
impaired adults, including an assessment of caregiver
needs, short- and long-term care planning, and ongoing
consultation;
c) Family consultation to provide support,
alleviate stress, examine options, and enable them to
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make decisions related to the care of cognitively
impaired adults, including an assessment of caregiver
needs, short- and long-term care planning, and ongoing
consultation;
d) Respite care;
e) Short-term counseling;
f) Support groups;
g) Legal and financial consultation, including
professional legal assistance or referrals to
professional legal assistance, that can help
caregivers with a variety of issues, including estate
planning, trusts, wills, conservatorships, and durable
powers of attorney; and,
h) Education and training of caregivers and
community professionals on a variety of topics related
to caregiving.
3)Defines "respite care" as substitute care or supervision in
support of the caregiver for the purposes of providing relief
from the stresses of providing constant care and so as to
enable the caregiver to pursue a normal routine and
responsibilities. Allows respite care to be provided in the
home or in an out-of-home setting, such as day care centers or
short-term placements in inpatient facilities.
This bill:
1)Appropriates $3.3 million from the General Fund each fiscal
year beginning with the 2016-17 fiscal year, to DHCS for
allocation to CRCs for allocation to the CRCS for purpose of
providing respite care.
2)Permits CRC services to be provided both in-person and through
the use of remote technologies, including but not limited to,
web-based services, mobile applications, and telephone
messaging services in order to advance consumer choice in
service delivery and expand service in rural areas.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1)Author's statement. According to the author, an estimated 58%
of Californians juggle work in the labor force with unpaid
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work as a family caregiver. When it becomes difficult to
juggle caregiving with work and other family responsibilities,
many employed caregivers make changes such as arriving to work
late or leaving early. Sometimes they also have to quit work
in order to provide care to a family member at home. According
to data from AARP, approximately 4.5 million family caregivers
in California provide care to an adult with limitations in
daily activities. The economic value of the 3.85 million hours
of unpaid labor provided by these California caregivers is
approximately $47 billion. This is equivalent to 1.25 times
total Medi-Cal spending. One-third of all California
households contain at least one caregiver who provides 20+
unpaid hours a week. Respite care provides caregivers a
temporary rest from caregiving, while the person who is being
cared for continues to receive assistance in a safe
environment. Respite supports and strengthens a caregiver's
ability to stay healthy. Respite care can be provided as
in-home care, adult day care, residential, and transportation
services to relieve the caregiver from the stresses of
constant care provision. Currently there are over 5,000
caregivers on wait lists for respite.
2)CRCs. CRCs provide a single point-of-entry network for
caregivers focusing on providing services to families whose
loved ones are suffering from Alzheimer's disease, stroke,
Huntington's disease, Parkinson's disease, traumatic brain
injury, and other chronic or degenerative cognitive disorders
that affect adults. There are eleven CRCs statewide that
provide information, education, respite care, and emotional
support services to California families that are caregivers in
an effort to help those families provide long-term care at
home to those suffering from chronic or degenerative cognitive
disorders.
CRCs were overseen by the Department of Mental Health (DMH)
from FY 2000-01 through 2011-12, when oversight transitioned
to DHCS. In 2000-01, funding for CRCs was $12.2 million. This
amount was reduced to $11.7 million in 2001-02, to $11.4
million in 2007-08, and to $10.5 million in 2008-09. In
2009-10, funding was reduced to $2.9 million. That funding
level remained the same until it was increased by $2 million
(to $4.9 million) in the 2015-16 Budget. The funding
reductions from CRCs have resulted in reduction of CRC
services, staffing and service locations.
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Amounts appropriated to CRCs are not for a specific CRC
service (such as respite care) as DHCS indicates CRCs are
allocated a fixed total budget amount and have the ability to
establish their budget across available services as needed,
with approval from DHCS.
DHCS indicates CRC services are not only delivered in person
and, depending on the service, there are a variety of service
delivery methods. For example, services may be delivered
in-person, on-line, telephonic, educational events,
interactive webinars, and Skype or Facetime. DHCS indicates
CRCs are not prevented from using technology to provide
services, and that the operations manual does not specify that
services have to be delivered in person. DHCS indicates that,
given the geography of the state and the many rural areas that
the CRCs serve, the use of technology to deliver services is
often the preferred mode of service delivery.
3)Prior legislation. AB 1467 (Budget Committee, Chapter 23,
Statutes of 2012) transferred the CRC program from the (DMH)
to DHCS, due to the elimination of DMH in the 2012 Budget.
4)Support. Supporters of this bill include senior and caregiver
representatives, who argue that CRCs are the lead agency in
California that exclusively serve and support unpaid family
caregivers through respite and counseling services. Supporters
state that CRC funding was cut 74% in 2009 and respite
services were nearly eliminated. Supporters argue CRCs are a
vital safety net for family caregivers carving for a loved one
with Alzheimer's disease, Parkinson's, traumatic brain injury,
stroke or related dementia, and not providing respite care
services will force people into more expensive services.
5)Policy comment. This bill codifies the current practice of
CRCs providing services through alternative use of remote
technologies. While nearly most CRC services are able to be
delivered in this manner, this bill also includes respite care
within the services that can be delivered through remote
technology when respite care would not be delivered in this
manner. Staff recommends the authorization for the use of
remote technology in providing CRC services exclude respite
care, as follows:
(d) CRC services may be provided both in-person and, except
for respite care services, through the use of remote
technologies, including, but not limited to, web-based
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services, mobile applications, and telephone messaging
services, in order to advance consumer choice in service
delivery and to expand service in rural areas.
SUPPORT AND OPPOSITION :
Support: AALL In-Home Services
AARP
ALS (Amyotrophic Lateral Sclerosis) Association Golden
West Chapter
Alzheimer's Association Chapters in California
Alzheimer's Association, Greater Sacramento
Amador Senior Center
Association of California Caregiver Resource Centers
Belmont Village Senior Living - Cardiff
California Advocates for Nursing Home Reform
California Association of Public Authorities
California Caregiver Resource Centers
Central Coast Home Health & Hospice
Comfort Keepers
Del Oro Caregiver Resource Center
Family Service Agency
Health Projects Center
Help4HD International Incorporated
Inland Caregiver Resource Center
Law Offices of Canela M. Cavada
LeadingAge California
Medi-Cal Regulation Specialists
Multipurpose Senior Services Program Site Association
Senior Care Solutions
Stephens Law Group
Support for Home
TRI Commercial, Inc.
UC San Diego Shiley-Marcos Alzheimer's Disease
Research Center
United Domestic Workers of America-AFSCME Local
3930/AFL-CIO
Windward Life Care
Oppose: None received
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