BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 528|
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THIRD READING
Bill No: AB 528
Author: Mullin (D), et al
Amended: 8/19/03 in Senate
Vote: 21
SENATE HEALTH & HUMAN SERV. COMMITTEE : 7-3, 6/18/03
AYES: Ortiz, Chesbro, Escutia, Figueroa, Kuehl, Romero,
Vasconcellos
NOES: Aanestad, Ashburn, Battin
ABSENT/ABSTAINING/NOT VOTING: Alarcon, Florez, Vincent
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 49-25, 5/22/03 - See last page for vote
SUBJECT : Alzheimers disease: residential care
facilities for the elderly
SOURCE : California Senior Legislature
DIGEST : This bill encourages Residential Care Facilities
for the Elderly to create activities to mitigate the
effects of sundowning.
Senate Floor Amendments of 8/19/03 made several technical
changes, including the reference to "sundown syndrome"
throughout the bill is changed to "sundowning".
ANALYSIS :
Existing Law
CONTINUED
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1.Provides for the licensure and regulation of Residential
Care Facilities for the Elderly (RCFEs) by the State
Department of Social Services (DSS).
2.Establishes the Alzheimer's Disease Program, administered
by the State 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
Californians to make contributions.
This bill:
1.Makes findings and declarations relating to Alzheimer's
disease and related disorders, including:
A. 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.
B. 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 persons with Alzheimer's disease and
other forms of dementia, including activities
designed to decrease the effects of sundowning. With
less light, these individuals may lose visual clues
that help them compensate for their sensory
impairments.
2.Defines "sundowning" as a condition in which persons with
cognitive impairment experience recurring confusion,
disorientation and increasing levels of agitation that
coincide with the onset of late afternoon and early
evening.
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3.Specifies that RCFE's that serve residents with
Alzheimer's disease and other forms of dementia should
include information on sundowning as part of the training
for direct care staff, and should include in the plan of
operation a brief narrative description explaining
activities available for residents to decrease the
effects of sundowning, including, but not limited to,
increasing outdoor activities in appropriate weather
conditions.
Comments
Background . According to the author's office, sundowning
is defined as a condition 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. While the exact cause
of sundowning 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 condition can be draining for the person with
Alzheimer's disease and his or her caregivers.
The author's office asserts that various activities can
help to decrease the effects of sundowning, 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.
Prior Legislation
SB 639 (Ortiz), Chapter 692, Statutes of 2001 -- Requires
the Health and Human Services Agency to develop a strategic
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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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/19/03)
California Senior Legislature (source)
American Federation of State, County, and Municipal
Employees
Congress of California Seniors
Gray Panthers California
San Joaquin County Commission on Aging
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
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.
ASSEMBLY FLOOR :
AYES: Berg, Bermudez, Calderon, Canciamilla, Chan, Chavez,
Chu, Cohn, Corbett, Correa, Diaz, Dutra, Dymally,
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Firebaugh, Frommer, Goldberg, Hancock, Jerome Horton,
Jackson, Kehoe, Koretz, Laird, Leno, Levine, Lieber, Liu,
Longville, Lowenthal, Maldonado, Matthews, Montanez,
Mullin, Nakano, Nation, Negrete McLeod, Nunez, Oropeza,
Parra, Pavley, Reyes, Ridley-Thomas, Salinas, Simitian,
Steinberg, Vargas, Wiggins, Wolk, Yee, Wesson
NOES: Aghazarian, Benoit, Bogh, Campbell, Cogdill, Cox,
Dutton, Garcia, Harman, Haynes, Keene, La Malfa, La Suer,
Leslie, Maddox, Maze, McCarthy, Mountjoy, Nakanishi,
Pacheco, Plescia, Runner, Samuelian, Strickland, Wyland
CP:cm 8/20/03 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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