BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 528
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          ASSEMBLY THIRD READING
          AB 528 (Mullin)
          As Amended May 1, 2003
          Majority vote 

           HUMAN SERVICES      5-0         APPROPRIATIONS      17-0        
           
           ----------------------------------------------------------------- 
          |Ayes:|Wolk, Dutra, Lieber,      |Ayes:|Steinberg, Berg,          |
          |     |Ridley-Thomas, Mullin     |     |Calderon, Montanez,       |
          |     |                          |     |Correa, Diaz, Firebaugh,  |
          |     |                          |     |Goldberg, Leno, Nation,   |
          |     |                          |     |Negrete McLeod, Nunez,    |
          |     |                          |     |Pavley, Ridley-Thomas,    |
          |     |                          |     |Simitian, Wiggins, Yee    |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Encourages Residential Care Facilities for the Elderly  
          (RCFEs) 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 RCFEs by 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  








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            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  
            Californians to make contributions.

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee Analysis, minor absorbable costs to DSS to request  
          that RCFEs emphasize or increase certain kinds of activities. 

           COMMENTS  :  According to the author, "'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."

           Enhancing the care of the elderly  :  Representatives of  
          caregivers support this bill, applauding the authors effort to  
          "provide better services for elders that reside in residential  
          care facilities."  Social workers practicing in this area note  
          that 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.

           
          Analysis Prepared by  :    John Boisa / HUM. S. / (916) 319-2089 








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