BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: AB 762
A
AUTHOR: Lowenthal
B
VERSION: May 28, 2009
HEARING DATE: June 23, 2009
7
FISCAL: To Appropriations
6
2
CONSULTANT:
Hailey
SUBJECT
Residential care facilities for the elderly: admissions
SUMMARY
Clarifies the requirements for accepting or retaining a
resident in a residential care facility for the elderly
when that individual needs assistance transferring to and
from bed.
ABSTRACT
Current law
1)Establishes the California Residential Care Facilities
for the Elderly Act that includes licensing, regulations,
administration, levels of care, and other provisions of
law governing residential care facilities for the elderly
(RCFEs).
2)Defines an 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.
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 762 (Lowenthal) Page
2
3)Establishes the State Department of Social Services (DSS)
as the entity that licenses RCFEs and enforces health and
safety regulations.
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:
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 either 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, unless
the RCFE obtains an appropriate fire clearance.
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, an RCFE if the facility secures and maintains
an appropriate fire clearance. A fire clearance will be
STAFF ANALYSIS OF ASSEMBLY BILL 762 (Lowenthal) Page
3
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;
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.
11)Defines "nonambulatory persons" as persons unable to
leave a building unassisted under emergency conditions.
This bill
1) Specifies that a resident of an RCFE who needs
assistance transferring to and from bed, but who does not
need assistance repositioning in bed, is "nonambulatory"
for purposes of a fire clearance.
FISCAL IMPACT
The Assembly Appropriations Committee finds no fiscal
impact on the Department of Social Services or on local
fire departments.
STAFF ANALYSIS OF ASSEMBLY BILL 762 (Lowenthal) Page
4
BACKGROUND AND DISCUSSION
Synopsis
This bill classifies residents needing assistance
transferring to and from bed as "nonambulatory" for the
purposes of a fire clearance for an RCFE, as long as the
person can turn or reposition themselves in bed without
assistance. The bill will clarify for local fire
inspectors and the State Fire Marshal what kind of fire
safety clearance a particular RCFE will need. Persons who
need help getting out of bed, but who are able to
reposition themselves, will be able to live in an RCFE if
it has a nonambulatory fire clearance. A person who needs
assistance repositioning himself or herself in bed will
continue to be classified as "bedridden." "Nonambulatory"
clearances are less restrictive than current requirements
for persons classified as "bedridden."
Residential care facilities for the elderly
RCFEs offer assisted living services in both large and
small settings and can range in size from six beds or fewer
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.
According to the author, for many residents, the care and
support provided by the RCFE is enough to keep the
individual from needing skilled nursing home care.
Can "bedridden" persons live in an RCFE?
Prior to 2001, individuals who required assistance
repositioning in bed were defined as permanently bedridden
and were prohibited from living in RCFEs. Residents who
needed assistance in transferring in and out of bed and who
could then move around the facility independently could
live in an RCFE if it received a "nonambulatory" fire
clearance.
In 2000, the Legislature fixed a problem that had occurred
in licensed residential facilities for children. SB 1896
(Ortiz, Chapter 817, Statutes of 2000) changed a definition
of "bedridden" to include those individuals who are able to
reposition themselves in bed; and the bill extended that
STAFF ANALYSIS OF ASSEMBLY BILL 762 (Lowenthal) Page
5
definition to all residential facilities licensed by DSS
including RCFEs. This change meant that RCFEs that
previously cared for "nonambulatory" residents needed to
meet stricter fire regulations, and thus a new problem
arose.
Although fire inspectors could still provide "nonambulatory
fire clearances," the author reports instances where an
inspector has ceased to distinguish between "nonambulatory"
and "bedridden" residents, resulting in threatened or
actual eviction of nonambulatory residents from RCFEs into
a skilled nursing facility setting. The author believes
that these transfers and evictions are unnecessary.
Various attempts to fix the new problem through regulation
and discussion have led to this bill as a proposed
statutory remedy.
Assembly votes
Floor 78-0
Appropriations 16-0
Aging and Long-Term Care 6-0
POSITIONS
Support: California Assisted Living Association
(sponsor)
Aging Services of California
Alzheimer's Association, California Council
Area 4 Agency on Aging
Area Agency on Aging of Lake & Mendocino
Association of Board and Care Homes, Inc.
Bello Villetta RCFE
Board and Care Owners Association
California Association for Adult Day
Services
California Commission on Aging
California Hospice and Palliative Care
Association
California Hospice and Palliative Care
Association
CalPACE
Community Residential Care Association of
California
STAFF ANALYSIS OF ASSEMBLY BILL 762 (Lowenthal) Page
6
Congress of California Seniors
Counties PSA 26
Hill Partnership, Inc.
Professional Fiduciary Association of
California
Quartz Garden
Royal Garden Board and Care
St. Paul Senior Homes & Services
6 Individuals
Oppose: None received
-- END --