BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 528
A
AUTHOR: Mullin
B
AMENDED: June 11, 2003
HEARING DATE: June 18, 2003
5
FISCAL: Appropriations
2
8
CONSULTANT:
Vazquez / sl
SUBJECT
Alzheimer's disease: residential care facilities for the
elderly
SUMMARY
This bill encourages Residential Care Facilities for the
Elderly (RCFEs) to create programs and activities to
mitigate the effects of sundown syndrome.
ABSTRACT
Existing law:
1.Provides for the licensure and regulation of RCFEs 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.
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 528 (Mullin) Page
2
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.
This bill:
1.Makes findings and declarations relating to Alzheimer's
disease and related disorders, including:
Alzheimer's disease and related disorders are
responsible for 50 percent of all nursing home
admissions and Alzheimer's disease is the fourth
leading cause of death in adults.
It is important to provide for the best quality of
life for those affected by this disease by providing
activities and programs that are adapted for the
unique needs of Alzheimer's patients, including
programs designed to decrease the effects of "sundown
syndrome."
1.Defines "sundown syndrome" as recurring confusion and
increasing levels of agitation that coincide with the
onset of late afternoon and early evening.
2.Requires DSS to encourage RCFEs that serve Alzheimer's
patients to create activities and programs that are
designed to decrease the effects of sundown syndrome,
including, but not limited to, increasing outdoor
activities in appropriate weather conditions.
FISCAL IMPACT
According to the Assembly Committee on Appropriations, the
measure imposes minor absorbable costs to DSS to request
that RCFEs emphasize or increase certain kinds of
activities.
BACKGROUND AND DISCUSSION
Background
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, particularly Alzheimer's patients.
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 528 (Mullin) Page
3
While the exact cause of sundown syndrome is not known,
experts believe there are several contributing factors,
including 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. This syndrome can
be draining for the person with Alzheimer's disease and his
or her caregivers.
The author asserts that various activities can help to
decrease the effects of sundown syndrome, including support
of activities that promote 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.
Arguments in support
Proponents applaud the author's 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
Continued---
many as behavior 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 these interventions.
Arguments in opposition
Opponents argue that the bill will raise costs to RCFEs
because it is requiring "encouragement" of activities and
programs in the late afternoon and evening hours, which
will necessitate additional staff time and payment. These
costs will be passed on to the residents, further limiting
the availability of residential assisting living to
seniors. The state Commission on Aging also writes in
opposition that the measure lacks research and supporting
evidence that these programs are appropriate care for
treatment of Alzheimer's.
Related legislation
SB 639 (Ortiz, Chapter 692, Statutes of 2001) requires the
Health and Human Services Agency to develop a strategic
plan for improving access to mental health services by
persons with Alzheimer's disease or related disorders.
AB 1753 (Romero, Chapter 434, Statutes of 2000) enacted the
Alzheimer's Training Act of 2000 and included provisions
that certain information for special features for persons
with dementia be included in an RCFE plan of operation and
that the plan be available to the public upon request.
PRIOR ACTIONS
Assembly Floor: 49 - 25 Pass
Assembly Appropriations: 17 - 0 Do Pass
Assembly Human Services: 5 - 0 Do Pass As Amended
POSITIONS
Support: California Senior Legislature (sponsor)
American Federation of State, County, and
Municipal Employees
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 528 (Mullin) Page
5
Congress of California Seniors
Gray Panthers California
San Joaquin County Commission on Aging
Oppose: California Association of Homes and Services for
the Aging
California Commission on Aging
-- END --