BILL ANALYSIS
AB 762
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Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Bonnie Lowenthal, Chair
AB 762 (Lowenthal) - As Amended: April 13, 2009
SUBJECT : Residential care facilities for the elderly:
admission.
SUMMARY : Narrows the definition of "bedridden" residents for
residential care facilities for the elderly (RCFEs).
Specifically, this bill :
1)Redefines "bedridden" to mean a resident who requires turning
and repositioning in bed, except in facilities with
appropriate and sufficient care staff, mechanical devices if
necessary, and safety precautions, as determined by the
California Department of Social Services (DSS) director in
regulations.
2)Excludes residents who may require verbal or physical
assistance in transferring to and from bed but are then able
to move either independently or with the use of an assistive
device from the definition of "bedridden".
EXISTING LAW
1)Establishes the California Residential Care Facilities for the
Elderly Act which includes licensing, regulations,
administration, levels of care, and other provisions of law
governing RCFEs.
2)Defines a RCFE as a housing arrangement chosen voluntarily by
a person 60 years of age and over, or their authorized
representative, where varying levels and intensities of care
and supervision, protective supervision, or personal care are
provided.
3)Establishes DSS as the oversight entity for RCFEs.
4)Requires a prospective applicant for licensure as an RCFE to
secure and maintain fire clearance approval from the local
fire enforcement agency or the State Fire Marshal.
5)Requires each RCFE to provide at least the following basic
services:
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a) Care and supervision;
b) Assistance with instrumental activities of daily living
to meet the needs of residents;
c) Helping residents gain access to appropriate supportive
services in the community;
d) Being aware of the resident's general whereabouts,
although the resident may travel independently in the
community;
e) Monitoring the activities of the residents while they
are under the supervision of the facility to ensure their
general health, safety, and well-being; and,
f) Encouraging the residents to maintain and develop their
maximum functional ability through participation in planned
activities.
6)Prohibits an RCFE from admitting or retaining a resident if
any of the following apply:
a) The resident requires 24-hour, skilled nursing or
intermediate care; or,
b) The resident is bedridden, other than for a temporary
illness or for recovery from surgery.
7)Defines "bedridden" as either requiring assistance in turning
and repositioning in bed, or being unable to independently
transfer to and from bed, except in facilities with
appropriate and sufficient staff, mechanical devices if
necessary, and safety precautions as determined by DSS.
8)Allows a bedridden individual to be admitted to, and remain
in, a RCFE if the facility secures and maintains an
appropriate fire clearance. A fire clearance will be issued
to a facility in which a bedridden individual resides if the
fire safety requirements are met, or alternative methods of
protection are approved.
9)Allows a facility to retain a bedridden resident beyond 14
days if all of the following requirements are satisfied:
a) The facility notifies DSS in writing regarding the
temporary illness or recovery from surgery;
b) The facility submits to DSS, the notification, and a
physician and surgeon's written statement to the effect
that the resident's illness or recovery is of a temporary
nature. The statement must contain an estimated date upon
which the illness or recovery will end or upon which the
resident will no longer be confined to a bed;
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c) DSS determines that the health and safety of the
resident is adequately protected in the facility and that
the transfer to a higher level of care is not necessary;
and,
d) Allowing the resident to remain at the RCFE does not
expand the scope of care and supervision of a RCFE.
10)Requires every facility admitting or retaining a bedridden
resident to notify the local fire authority within 48 hours of
the resident's admission or retention of the estimated length
of time the resident will retain his or her bedridden status
in the facility.
FISCAL EFFECT : Unknown.
COMMENTS :
RCFEs offer assisted living services in both large and small
settings and can range in size from six beds or less to over 100
beds. These facilities provide care and assistance to older
adults and adults with disabilities in areas such as medication
management, food service, bathing, and grooming - they do not
provide skilled nursing care. For many residents, the care and
support provided by the RCFE is enough to keep the individual
from needing nursing home care. This bill does not expand RCFE
services to include skilled nursing care.
The existing definition of "bedridden" covers not only those who
are truly bedridden and confined to bed and unable to
reposition, but also residents who need help in and out of bed
but are then able to move around the community with the use of a
walker or wheelchair. This "bedridden" definition includes
residents with dementia since they might need verbal reminders
to get out of bed, but can then walk without assistance.
Proponents argue that the broad definition of "bedridden" can
result in the unnecessary transfer of residents to more
expensive institutional care when they could easily remain at
the RCFE with minimal assistance.
RCFEs are currently allowed to admit and retain "bedridden"
residents provided the facility meets certain criteria,
including fire safety precautions. This bill does not expand
the admission or retention criteria, nor does it relax existing
standards for fire safety, care, or staffing.
Prior to 2001, individuals who required assistance repositioning
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in bed (permanently bedridden) were prohibited in RCFEs.
Residents who needed assistance in transferring in and out of
bed, but could then move around the facility independently were
allowed, but required a "non-ambulatory" fire clearance.
However, SB 1896 (Ortiz), Chapter 817, Statutes of 2000, changed
the definition of "bedridden" to mean either requiring
assistance in turning and repositioning in bed, or being unable
to independently transfer to and from bed, except in facilities
with appropriate and sufficient care staff and other
precautions. While the primary focus of the bill was community
care facilities serving children and developmentally-disabled
adults, it also included RCFEs. The changes in SB 1896 allowed
permanently bedridden individuals to reside in an RCFE and
grouped both categories (permanently bedridden and
non-ambulatory) under one definition of "bedridden". RCFEs that
admit a "bedridden" individual, whether the resident is only in
need of assistance in transferring or unable to reposition in
bed, must have a "bedridden" fire clearance.
According to the California Assisted Living Association,
throughout the 1990's and early 2000's, assisted living
residents who required assistance transferring out of bed and
then were able to walk independently or with assistance of a
cane or walker were considered "non-ambulatory" and required a
"non-ambulatory" fire clearance. A change in statute and
subsequent change in interpretation now has these residents
classified as "bedridden". This bill will amend the currently
overly broad statutory definition of "bedridden" and eliminate
confusion and prevent unnecessary evictions or premature
relocation to institutional care.
RCFEs that serve bedridden individuals already meet strict
requirements for the health and safety of their residents.
According to the author, state law should clearly allow
individuals to remain in the least restrictive setting for as
long as possible. By narrowing the definition, this bill will
clarify existing law and regulations and allow RCFE residents
who need a little help in and out of bed to remain in their
homes.
Previous Legislation:
AB 749 (Berg) of 2007 would have provided an exemption for
hospice residents who were bedridden. AB 749 was amended in the
Senate to become AB 749 (Wolk), Chapter 477, Statutes of 2008,
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which required RCFEs to have an emergency plan that includes
specific provisions and is available, upon request, to residents
onsite and available to local emergency responders.
SB 1896 (Ortiz), Chapter 817, Statutes of 2000, revised the
definition of "bedridden" to mean either requiring assistance in
turning and repositioning in bed, or being unable to
independently transfer to and from bed, except in facilities
with appropriate and sufficient care staff and other
precautions. SB 1896 also expressly allowed a bedridden person
to be admitted to, and remain in, an RCFE that secures and
maintains an appropriate fire clearance.
REGISTERED SUPPORT / OPPOSITION :
Support
California Assisted Living Association (CALA) - sponsor
California Association for Adult Day Services (CAADS)
Aging Services of California
Alzheimer's Association, California Council
Association of Board and Care Homes, Inc.
Bello Villetta RCFE
Board and Care Owners Association
California Hospice and Palliative Care Association (CHAPCA)
Hill Partnership, Inc.
Professional Fiduciary Association of California (PFAC)
Royal Garden Board and Care
Quartz Garden
6 individuals
Opposition
None on file.
Analysis Prepared by : Allison Ruff / AGING & L.T.C. / (916)
319-3990