BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 177|
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THIRD READING
Bill No: SB 177
Author: Strickland (R), et al.
Amended: 5/25/11
Vote: 21
SENATE HEALTH COMMITTEE : 7-0, 04/13/11
AYES: Hernandez, Strickland, Alquist, Anderson, De Le�n,
DeSaulnier, Rubio
NO VOTE RECORDED: Blakeslee, Wolk
SENATE APPROPRIATIONS COMMITTEE : 9-0, 05/23/11
AYES: Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley,
Price, Runner, Steinberg
SUBJECT : Congregate living health facilities
SOURCE : Visiting Nurse & Hospice Care
DIGEST : This bill raises the bed limit from 12 to 25 for
congregate living health facilities that serve terminally
ill patients in Santa Barbara County.
ANALYSIS : Existing law:
1.Provides for the licensure and regulation of health
facilities, including hospitals, skilled nursing
facilities, and congregate living health facilities
(CLHFs).
2.Defines a CLHF as a residential home with a capacity of
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no more than 12 beds, that provides inpatient care,
medical supervision, 24-hour skilled nursing and
supportive care, and other services to persons who meet
one of the following:
A. Persons who are mentally alert who have physical
disabilities, who may be ventilator dependent;
B. Persons who have a diagnosis of terminal illness,
or life-threatening illness, or both, as defined; or
C. Persons who are catastrophically and severely
disabled, as defined.
1.Provides, notwithstanding the 12-bed limit, that a CLHF
that is operated by a city and county may have 59 beds,
and provides that a CLHF that is not operated by a city
and county that serves persons who have a diagnosis of
terminal illness or life-threatening illness, or both,
that is located in a county of 500,000 or more persons,
may have not more than 25 beds.
2.Provides that the primary need of CLHF residents shall be
for skilled nursing care on a recurring, intermittent,
extended, or continuous basis, and provides that this
care is generally less intense than that provided in
general acute care hospitals but more intense than that
provided in skilled nursing facilities.
3.Provides for the licensure and regulation by the
Department of Public Health of persons or agencies that
provide hospice services in a person's home or other care
setting, defined as a specialized form of
interdisciplinary health care that is designed to provide
palliative care, alleviate the physical, emotional,
social, and spiritual discomforts of an individual
diagnosed with a terminal illness, and provide supportive
care to the primary caregiver and the family.
This bill raises the bed limit from 12 to 25 for congregate
living health facilities that serve terminally ill patients
in Santa Barbara County.
Background
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In order to provide options for providing care to
chronically ill patients outside of hospitals, CLHFs were
established as a category of licensed health facilities in
1986. CLHFs were initially limited to having no more than
six beds and were limited to serving mentally alert,
physically disabled residents, who can be
ventilator-dependent. In 1988, a second category of CLHFs
was authorized to provide 24-hour inpatient care to
terminally ill patients. These facilities were allowed to
have 25 beds in counties which have a population of 500,000
or more persons. In 1989, a third category of CLHFs was
established, to serve persons who are catastrophically and
severely disabled, which were allowed to have 12 beds in
counties with more than 500,000 persons. In 2005,
legislation was enacted which raised the bed-size limit for
CLHFs in all counties to 12 beds, while retaining the
higher 25-bed limit for CLHFs serving terminally ill
patients in counties with more than 500,000 persons.
The impetus for the 1988 legislation establishing the new
CLHF category for terminally ill patients, with a bed limit
of 25 in counties with over 500,000 persons, was to enable
a proposed 25-bed hospice facility serving persons with
AIDS, which was proposed to be operated by Barlow Hospital
in Los Angeles, to be licensed as a CLHF.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Major Provisions 2011-12 2012-13
2013-14 Fund
Increased CLHF-B
potentially minor to significant costs General/*
capacity Federal
Cost avoidance
potentially minor to significant cost avoidance**
General/*
Federal
*Medi-Cal costs shared 50 percent General Fund, 50 percent
federal funds.
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SUPPORT : (Verified 5/25/11)
Visiting Nurse & Hospice Care (source)
All Saints-by-the Sea Episcopal Church
Alliance for Living and Dying Well
Alzheimer's Association, California Central Coast Chapter
American Dream Concepts
The Beatitude Society
Brown & Brown Insurance
California Association for Health Services at Home
California Hospital Association
California Hospice and Palliative Care Association
California Transplant Donor Network
CenCal Health
City of Goleta
Community Hospice
Cottage Health System
Council on Alcoholism and Drug Abuse
County of Santa Barbara Board of Supervisors
Dream Foundation
Frank Schipper Construction Co.
Friendship Center
Grace House
Hospice of Santa Barbara, Inc.
Hospice of the East Bay
Hospice of the Foothills
Hutton Parker Foundation
Livingston Memorial Visiting Nurse Association
Maravilla
Orfalea Foundations
PMSM Architects
Santa Barbara Cancer Center
Santa Barbara County Medical Society
Santa Barbara Neighborhood Clinics
Santa Barbara Region Chamber of Commerce
Santa Barbara Village
Sharon Kennedy Estate Management
Sharp Hospice Care
St. Francis Foundation
United Way of Santa Barbara County
Visiting Nurse Association of the Inland Counties
Vista Del Monte Retirement Community
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OPPOSITION : (Verified 5/25/11)
California Nurses Association
ARGUMENTS IN SUPPORT : VNHC states that as the only
licensed hospice inpatient facility in Santa Barbara
County, Serenity House has struggled to meet demands for
end-of-life beds. Between 2008 and 2009, Serenity House
saw a 71 percent increase in the number of patients served
and has a growing waiting list due to the lack of available
beds for end of life patients. VNHC states that based on
current population projections, the number of people over
the age of 65 in Santa Barbara County will increase by 24
percent by 2050. While VNHC acknowledges that it made an
error in assuming it would be able to build an 18-bed
facility, because it believed that a waiver or exception
process existed to allow it to operate at the higher
bed-size, VNHC states that the need for additional
end-of-life beds continues to be critical in Santa Barbara
County and this bill will enable it to meet these needs and
continue providing compassionate care to persons at the end
of life.
ARGUMENTS IN OPPOSITION : The California Nurses
Association (CNA) objects to the fact that the one CLFH
facility that would benefit from the bed limit change in SB
177 was built outside of existing bed limits that apply to
CLHFs, and that the administrators of Serenity House did
not abide by state law when planning and constructing the
facility. CNA argues that it is not appropriate to make an
accommodation for this one facility. CNA further questions
whether the building standards for the Serenity House
facility have been correctly applied and would be
sufficient to keep patients and staff safe. CNA notes that
the type of patients that can reside in a CLHF include
persons who are catastrophically and severely
neurologically disabled, and urges the committee to gain a
fuller understanding of why the Office of Statewide Health
Planning and Development reversed its claim of jurisdiction
over the building standards for the facility.
CTW:nl 5/25/11 Senate Floor Analyses
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SUPPORT/OPPOSITION: SEE ABOVE
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