BILL ANALYSIS
AB 528
Page 1
Date of Hearing: April 29, 2003
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Lois Wolk, Chair
AB 528 (Mullin) - As Introduced: March 27, 2003
SUBJECT : Alzheimer's disease: residential care facilities for
the elderly.
SUMMARY : This bill encourages Residential Care Facilities for
the Elderly (RCF-E's) to create programs and activities to
mitigate the effects of sundown syndrome. Specifically, this
bill :
1)Makes findings and declarations relating to Alzheimer's
disease and related disorders.
2)Defines "Sundown syndrome" as "recurring confusion and
increasing levels of agitation that coincide with the onset of
late afternoon and early evening."
3)Requires the State Department of Social Services (DSS) to
"encourage residential care facilities for the elderly that
serve Alzheimer's patients to create activities and programs
that are designed to decrease the effects of sundown syndrome
by creating more activities in the late afternoon and evening
hours."
EXISTING LAW :
1)Provides for the licensure and regulation of Residential Care
Facilities for the Elderly by the State Department of Social
Services (DSS).
2)Establishes the Alzheimer's Disease Program, administered by
the Department of Health Services (DHS), which oversees ten
Alzheimer's Disease Research Centers of California (ARDCC) at
university medical centers throughout California, for the
purpose of research into the causes, treatment, cures, coping
strategies, prevention, incidence, and prevalence of
Alzheimer's disease and related disorders.
3)Establishes the Alzheimer's Disease and Related Disorders
Research Fund, administered by DHS, and establishes a tax
check-off option on the State Income Tax return to permit
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Californians to make contributions.
FISCAL EFFECT : It is unlikely that the implementation of this
bill would result in new costs.
COMMENTS : According to the author, "There are more than 3,600
new RCFE's with 90,500 new beds that have opened in the last 19
years. Current laws regarding programs are very vague,
specifying only that residential care homes for the elderly must
provide activities. Too often the facilities define 'watching
television' as part of the activity program. This bill
encourages RCFE's to create programs for Alzheimer's patients to
help combat the effects of the 'sundown syndrome.'
'Sundown syndrome' is defined as a syndrome of recurring
confusion and increasing levels of agitation, which coincide
with the onset of late afternoon and early evening. It is
commonly associated with patients suffering from dementia,
commonly, Alzheimer's patients. While the exact cause of
sundown syndrome is not known, experts believe there are several
contributing factors. These include physical and mental
exhaustion (after a long day), and a shift in the 'internal body
clock' caused by the change from daylight to dark. Some people
with Alzheimer's disease have trouble sleeping at night, which
may contribute to their disorientation. Sundown syndrome can be
draining for the person with Alzheimer's disease and his or her
caregivers.
Various activities and programs can help decrease the effects of
sundown syndrome, including by making certain they receive
regular exercise. Frequent walks outdoors in the bright light
not only provides exercise, but it also exposes the patient to
much needed sunlight. Research has shown that patients sleep
better and longer if they receive adequate daily sunlight
exposure. Research has also found that many Alzheimer patients
have low blood levels of melatonin, so it is even more vital to
increase melatonin production by bright light exposure daily."
Prior legislation:
SB 639 (Ortiz) Chapter 692, Statutes of 2001 requires the Health
and Human Services Agency to develop a strategic plan from
improving access to mental health services by persons with
Alzheimer's disease and related disorders.
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AB 1347 (Pescetti) Chapter 339, Statutes of 2001, establishes
dementia-specific orientation and training program requirements
Skilled Nursing Facility (SNF) and Intermediate Care Facility
(ICF) staff.
SJR 37 (Romero) Res. Chapter 69, Statutes of 2002 memorializes
the President and Congress to enact legislation to address
Alzheimer's disease research and detection.
Is the phrase "Alzheimer's patient" the best way to describe
this population? The language of the bill is largely limited to
the phrases "Alzheimer's patient" or "Alzheimer's disease".
Many elderly people with dementia, however, receive a diagnosis
other than "Alzheimer's disease", but may benefit by
interventions encouraged by the bill. The Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)
defines dementia as the development of multiple cognitive
deficits that include memory impairment and cognitive
disturbances in specific areas of cognitive functioning which
are severe enough to cause impairment in social or occupational
functioning. "Dementia of the Alzheimer's type", as its name
implies, is one type of dementia that has specific neurological
features that can only be identified by biopsy or autopsy. For
this reason, the diagnosis of "Alzheimer's disease" is only made
after all other forms of dementia are ruled out.
How will this bill enhance the care of the elderly? Caring for
a person with Alzheimer's disease or other forms of dementia can
be a particularly distressful experience, especially when the
caregiver is confronted with agitated or anxious behaviors.
Unlike purely physiological ailments, dementia is experienced by
many as behaviors within a social context, which a caregiver may
react to with feelings of frustration, hurt, anger, or insult.
This bill encourages discussion of some behaviors associated
with Alzheimer's disease and other dementia in the context of
the disease itself. By framing the discussion in this manner,
and by exploring strategies that mitigate distressful behaviors,
caregivers can become better equipped to care for those with
dementia, and the elderly can benefit from such interventions.
Suggested amendment : The author offers an amendment requesting
that it be accepted as a committee amendment:
The department shall encourage residential care facilities for
the elderly that serve Alzheimer's patients to create activities
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and programs that are designed to decrease the effects of
sundown syndrome by creating more activities in the late
afternoon and evening hours. including, but not limited to,
increasing outdoor activities in appropriate weather conditions.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State County and Municipal Employees
(AFSCME)
Opposition
California Association of Homes & Services for the Aging (CAHSA)
Analysis Prepared by : John Boisa / HUM. S. / (916) 319-2089