BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: AB 1433
A
AUTHOR: Eng and Beall
B
VERSION: June 14, 2010
HEARING DATE: June 22, 2010
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FISCAL: Appropriations
4
3
CONSULTANT:
3
Park
SUBJECT
Continuing care contracts: temporary relocation
SUMMARY
Defines "residential temporary relocation" in the context
of continuing care contracts of residents who live in
continuing care retirement communities (CCRC). Establishes
related rights, requirements, and procedures.
ABSTRACT
Existing law:
1.Provides for the regulation by the Department of Social
Services (DSS) of activities relating to continuing care
contracts that govern care provided to elderly residents
in CCRCs for the duration of the resident's life or a
term in excess of one year.
2.Defines "permanent closure" of a CCRC as the voluntary or
involuntary termination or forfeiture of a provider's
certificate of authority or license or other action that
results in the permanent relocation of residents, except
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
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in the case of a natural disaster or other event out of
the provider's control.
3.Provides for notice to residents of a "permanent closure"
of a CCRC and regulates the permanent closure of CCRCs,
as specified below:
a. Requires that continuing care contracts include
provisions describing how the provider will proceed in
the event of a closure;
b. Requires CCRCs to provide written notice to DSS and
to the affected residents or designated
representatives of the affected residents 120 days
prior to the intended date of closure of a continuing
care retirement community;
c. Requires closure notices to include the intended
date of closure and the requirement of a relocation
plan;
d. Requires providers to offer a resident a choice of
specified placement options, the terms of which shall
not be less than the terms of the continuing care
contract between the resident and the provider as if
that contract had been fully performed;
e. Requires providers to, within 30 days of submitting
the relocation plan for a permanent closure, fund a
reserve, set up a trust fund, or secure a performance
bond to ensure fulfillment of costs associated with
the relocation, in an amount equal to or greater than
the estimated costs of relocating residents and
relocation options, funded with qualifying assets not
subject to any liens, judgments, garnishments or
creditor's claims;
f. Requires providers to submit monthly progress
reports to DSS detailing the progress and problems
associated with the closure until all affected
residents are relocated and all required payments are
made;
g. Requires DSS to monitor the implementation of the
closure and impose penalties if DSS determines that a
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
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provider is closing a facility in violation of the
permanent closure requirements or is doing so in a
manner that endangers the health or safety of
residents; and,
h. Prohibits the provider from displacing any resident
or to close the facility until the relocation plan has
been prepared and submitted to DSS and provided to the
affected residents, the affected residents'
representatives, and the local long-term care
ombudsman program.
This bill:
1.Defines a "residential temporary relocation" to mean the
relocation of one or more residents, except in the case
of a natural disaster that is out of the provider's
control, from one or more residential living units,
assisted living units, skilled nursing units, or a wing,
floor or entire CCRC due to a change of use or major
repairs or renovations.
2.Further defines "residential temporary relocation" to
mean a relocation that lasts for a period of at least
nine months but does not exceed 18 months without the
written agreement of the resident. Allows a provider to
extend the period of temporary closure for up to six
months, if that resident has agreed to the extension in
writing. Provides that the written agreement shall state
that by signing, the resident waives all rights to the
same relocation options offered in the case of permanent
closure for the period of the extension.
3.Requires a continuing care contract to state that the
resident has a right to terminate his or her contract
after 18 months of residential temporary relocation, and
that the contract have provisions related to monthly fee
and entrance fee refunds upon termination of the contract
for this reason.
4.Requires all providers to include in resident contracts
the procedures to be followed to ensure that temporary
relocations provide comparable levels of care, services,
and living accommodations as described in the resident's
contract.
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
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5.Requires a provider to notify the resident of the
impending relocation at least 60 days in advance of the
relocation, and requires a provider to meet with the
resident and, at the resident's request, family members
or other individuals at least 30 days in advance of the
transfer to discuss all aspects of the transfer.
Requires notice of this meeting to be provided in writing
and at least seven days in advance of the meeting and to
include the date of the transfer; the available
replacement unit or units and monthly fees; the time when
the resident will be able to inspect the replacement unit
or units; and the estimated date when the resident will
be able to return to his or her unit or may move to a
substitute permanent unit.
6.Requires a licensee to provide a unit in a facility,
agreed to by the resident, that most closely provides the
services, size, features, and amenities provided in the
unit being vacated, if accommodations are not available
at a CCRC operated by the provider within a 30-mile
radius. Provides that, if the provider has acted in good
faith and fair dealing in offering a particular unit to
the resident, the provider's duty under this section to
provide a temporary relocation unit has been satisfied,
and no alternative unit or units need be offered.
7.Requires the provider to arrange and pay for all moving
costs to the new facility and moving costs to the
reconstructed facility, if the resident returns, as well
as storage costs.
8.Provides that the resident shall only be required to pay
to the provider the monthly fee required in the
resident's contract, or the monthly fee in the new
facility, whichever is less. Requires the provider to
make payment to the facility at which the resident is
relocated.
9.Requires the provider to make available the services of a
licensed medical or geriatric professional to advise the
resident, the resident's representative, and the provider
regarding the relocation of the resident, upon request by
the resident or the resident's representative. Allows a
provider to place a reasonable limit on the cost of the
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
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services of the medical or geriatric professional.
10.Requires the provider to identify unique service and
care needs, if applicable, for a resident directly
affected by the temporary relocation. Requires the
unique services and care needs identified to be in
writing and become a part of the resident's plan of care.
11.Requires the provider to set forth specific procedures
for the resident to follow regarding relocation to the
unit vacated, the selection of a new unit, and timeframes
for making choices. Requires specified procedures for
returning the relocated resident when residential units
are ready for occupancy, including compliance with notice
requirements, and selection and characteristics of units.
12.Provides that if the relocation of a resident of a
continuing care retirement community will exceed 18
months, the resident will have all options that are
available in the case of permanent closure, unless there
is a written agreement between the affected resident and
the provider that the provider may extend the period of
temporary closure for up to six months.
FISCAL IMPACT
According to the Assembly Appropriations Committee analysis
of a prior version of the bill, costs associated with this
legislation would be minimal and absorbable within existing
resources. It is unclear whether recent amendments would
alter the fiscal analysis.
BACKGROUND AND DISCUSSION
Author's statement
The authors state that, currently, the Health & Safety Code
does not provide guidance to operators and residents of
CCRCs on how to appropriately handle temporary relocation
of residents, due to remodeling or reconstruction projects.
The authors state that this bill establishes notification
requirements, procedures for selecting temporary
accommodations, payment responsibilities for moving costs
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
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and monthly fees, procedures for returning to the
originally vacated unit, and contract cancellation
provisions if the relocation exceeds 18 months.
Continuing Care Retirement Communities (CCRCs)
CCRCs offer a long-term continuing care contract that
provides housing, residential services, and nursing care,
usually in one location, and usually for a resident's
lifetime. Most CCRCs provide three levels of care:
independent living, assisted living, and skilled nursing.
A resident may begin in the independent living setting and
move to a higher level of care as his or her care needs
change.
DSS licenses each CCRC as a "residential care facility for
the elderly." Two branches at DSS participate in the
regulation of CCRCs: the senior care program branch
monitors CCRCs for compliance with licensing laws and
regulations regarding buildings and grounds,
accommodations, care and supervision of residents, and
quality of service. The continuing care community branch
is responsible for reviewing and approving applications to
operate a CCRC and monitors the ongoing financial condition
of CCRC providers. If a skilled nursing facility is
operating on the CCRC campus, it must be licensed by the
Department of Public Health.
Legislative history
A prior bill, AB 407 (Beall and Eng), Chapter 442, Statutes
of 2009, established requirements for the permanent closure
of a CCRC. Prior to AB 407, while the law regulated the
establishment and operation of CCRCs, minimal regulations
governed a facility's closure. The authors of this bill
report that AB 407, as introduced, addressed both permanent
and temporary closures. Due to provider concerns over
prevailing economic conditions, however, AB 407 was amended
to address only permanent closures. The joint authors of
both AB 407 and this bill note that they and stakeholder
organizations representing CCRC providers and CCRC
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
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residents agreed to address residential temporary
relocations this year.
Arguments in support
Aging Services of California, the sponsor of this measure,
writes that this measure is a product of several months of
work with stakeholders and will establish new provisions in
the CCRC statutes that address temporary resident
relocations in CCRCs. Aging Services states that, while
most CCRC remodeling and renovation projects are executed
with minimal impact on residents, the Health & Safety Code
does not provide guidance to operators and residents of
CCRCs on how to handle temporary construction relocations
when disputes arise. The sponsor states that the bill will
provide equity and certainty to residents and providers
facing remodeling projects that require residents to
temporarily relocate from their homes or apartments during
construction. The sponsor believes that the bill strikes a
balance between the need of CCRCs to remain attractive to
future residents and protecting the rights of existing
residents.
Related/prior legislation
AB 407 (Beall and Eng), Chapter 442, Statutes of 2009,
established patient protection requirements on continuing
care retirement communities in the event of their closure.
AB 949 (Krekorian), Chapter 686, Statutes of 2007,
established procedures and duties for a residential care
facility for the elderly prior to transferring a resident
to another facility or living arrangement as a result of
forfeiture of a license or change of the use of the
facility.
PRIOR VOTES
Assembly Floor: 68 - 0
Assembly Appropriations:17 - 0
Assembly Human Services: 6 - 0
COMMENTS
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
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1.Opposition to prior version of the bill. The Department
of Social Services indicates that it opposed the prior
version of the bill and is currently evaluating whether
recent amendments remove its opposition.
2.Definition of temporary location. The bill defines a
residential temporary location as a relocation that lasts
for a period of at least nine months but does not exceed
18 months without the written agreement of the resident.
The authors may wish to address why the protections
afforded by this bill would be unnecessary for residents
who are relocated for a lesser period of time, such as
six months.
3.Authors' amendment. The authors propose to strike the
following language to simplify the requirement related to
the offering of a substitute unit.
(d) If accommodations are not available at a continuing
care retirement community operated by the provider within
a 30 mile radius, the licensee shall be required to
provide a unit in a facility, agreed to by the resident,
that most closely provides the services, size, features,
and amenities provided in the unit being vacated. If
the provider has acted in good faith and fair dealing in
offering a particular unit to the resident, the
provider's duty under this section to provide a temporary
relocation unit has been satisfied, and no alternative
unit or units need be offered.
4.Recommended committee amendments. Staff recommends the
following clarifying amendments:
a. Page 25:
15 (c) The provider shall meet with the
resident and, at the
16 resident's request, family members or other
individuals at least
17 30 days in advance of the transfer to discuss
all aspects of the
18 transfer , including, but not limited to, the
rights, requirements, and procedures outlined in this
section and section 1793.91 . Notice of this meeting
shall be provided in writing and
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
9
19 at least seven days in advance of the meeting
and shall include all
20 of the following information:
21 (1) The date of the transfer.
22 (2) The available replacement unit or units
and monthly fees.
23 (3) The time when the resident will be able
to inspect the
24 replacement unit or units.
25 (4) The estimated date when the resident
will be able to return
26 to his or her unit or may move to a substitute
permanent unit.
27 (d) If accommodations are not available at a
continuing care
28 retirement community operated by the provider
within a 30-mile
29 radius, the licensee provider shall be required
to provide a unit in a facility,
30 agreed to by the resident, that most closely
provides the services,
31 size, features, and amenities provided in the
unit being vacated.
32 If the provider has acted in good faith and fair
dealing in offering
33 a particular unit to the resident, the
provider's duty under this
34 section to provide a temporary relocation unit
has been satisfied,
35 and no alternative unit or units need be
offered.
b. Page 26:
16 1793.91. The provider shall set forth
specific procedures for
17 the resident to follow regarding relocation to
the originally unit vacated, the
18 selection of a new unit, and timeframes for
making choices.
19 Procedures for returning the relocated resident
when residential
20 units will be ready for occupancy shall include
all of the following:
21 (a) The provider shall provide the resident
STAFF ANALYSIS OF ASSEMBLY BILL 1433 (Eng and Beall)Page
10
at least 60 days
22 notice of the return to his or her unit or a
substitute permanent
23 unit, and subsequent notices 30 days and seven
days prior to the
24 return date.
25 (b) The resident shall have the right to
return to his or her
26 previously occupied unit or a unit comparable in
services, size,
27 features, and amenities to the originally unit
vacated, without payment of
28 any further entrance or accommodation fee. The
provider is not
29 required to guarantee a specific unit.
Assignment of units shall be
30 based upon the length of occupancy of returning
residents.
31 (c) If the relocation of a resident of a
continuing care retirement
32 community will exceed 18 months, the resident
will have all options
33 allowed by Section 1793.82, unless there is a
written agreement
34 between the affected resident and the provider
as described in
35 subdivision (d) (e) .
POSITIONS
Support: Aging Services of California (sponsor)
Oppose:Department of Social Services (prior version -
1/14/10).
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