BILL ANALYSIS �
SB 177
Page 1
Date of Hearing: June 21, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 177 (Strickland) - As Amended: May 25, 2011
SENATE VOTE : 33-0
SUBJECT : Congregate living health facilities.
SUMMARY : Increases the bed limit for congregate living health
facilities (CLHFs) that serve terminally ill patients in the
County of Santa Barbara. Specifically, this bill :
1)Permits a CLHF to have up to 25 beds if the CLHF is located in
the County of Santa Barbara.
2)Finds and declares that a special law is necessary and that a
general law cannot be made applicable within the meaning of
existing law because of the unique business climate
surrounding CLHFs in the County of Santa Barbara.
EXISTING LAW :
1)Provides for the licensure and regulation of health
facilities, including hospitals, skilled nursing facilities,
and CLHFs.
2)Defines a CLHF as a residential home with a capacity of 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) Are mentally alert, have physical disabilities and may
be ventilator dependent;
b) Have a diagnosis of terminal illness, or
life-threatening illness, or both, as defined; or,
c) Are catastrophically and severely disabled, as defined.
3)Permits a CLHF that is operated by a city and county to have
59 beds. Permits 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, to have not more than
25 beds.
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4)Requires the primary need of CLHF residents to 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.
5)Requires the Department of Public Health (DPH) to license and
regulate 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.
FISCAL EFFECT : According to the Senate Appropriations
Committee, this bill will increase CLHF capacity resulting in
potentially minor to significant costs to Medi-Cal, but could
also result in potentially minor to significant cost avoidance
depending on the costs associated with whether the individuals
receiving hospice Medi-Cal benefits select CHLF services versus
receiving similar services in a skilled nursing facility.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, Santa Barbara
County has only one licensed hospice facility, Serenity House,
a six-bed facility operated by Visiting Nurses and Hospice
Care of Santa Barbara (VNHC), the sponsor of this bill. The
author maintains that Serenity House has struggled to meet the
patient demand in the Santa Barbara community for many years
citing that between 2008 and 2009, Serenity Houses experienced
of a 71% increase in the number of patients served and also a
growing waiting list due to a lack of available beds for
end-of-life patients. The author argues that in recognition
of this critical need, local community members generously
contributed to the campaign to build a new 18-bed hospice
inpatient facility. The author states that without enactment
of this bill the Serenity House, which recently opened their
new 18-bed facility as a 12-bed facility in accordance with
existing law, will have to operate interminably as a 12-bed
facility. According to the author, this bill will allow the
six additional beds to become operative in January 2012 and
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thus provide more critical hospice-bed capacity in the Santa
Barbara region of the central coast.
2)CLHF's . CLHFs are residential-based care facilities that
provide inpatient care, medical supervision, 24-hour skilled
nursing and supportive care, and other services to one of
three categories of persons: 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; or, c) persons
who are catastrophically and severely disabled.
According DPH, 53 CLHFs are currently licensed in California to
provide services to these populations. Of these, 12 serve
terminally ill patients. CLHFs that serve terminally ill
patients are sometimes referred to as CLHF-Bs, which denotes
the subparagraph of the statute that refers to them.
Hospice services that are provided to terminally ill patients
and their families generally fall into four categories or
levels of care - routine home care, continuous home care,
inpatient respite care, and general inpatient care. Routine
home care and continuous home care services are generally
provided in the patient's home, which can include a licensed
health or residential care facility that they reside in.
CLHF-Bs can provide this level of care, when it is not
feasible for a patient to be cared for at home. When a
hospice patient needs an inpatient level of care, either to
provide respite to family members or due to a need for 24-hour
pain control and symptom management, hospice service providers
generally must arrange to place the patient in a licensed
health facility, such as a hospital, skilled nursing facility
or CLHF-B.
Several hospice service providers currently operate their own
facilities to accommodate hospice patients with these higher
levels of needs. One currently operates a special hospital in
San Diego with 24 beds, which is operating under a pilot
project that was established in 1980. Eleven hospice service
providers operate CLHF-Bs to serve patients who need inpatient
care.
3)SUPPORT . VNHC, the sponsors of this bill, writes in support
that, as the only licensed and inpatient hospice facility in
Santa Barbara County, Serenity House met the needs of the
community for many years, until it recently became clear that
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additional end-of-life beds were required to satisfy the
growing demands of Santa Barbara County's aging population.
VNHC maintains that in recognition of the critical need for
more beds, the organization broke ground on an expanded 18-bed
facility in 2009 following an ambitious capital fundraising
campaign. During the planning phase of the project, VNHC
explains, the number of beds that would be built was
determined by state population projections that indicated that
the number of people over the age of 65 in Santa Barbara
County will increase by 24% by the year 2050; compared to a
state average of 19.5%.
VNHC asserts that while they were aware of the CLHF 12-bed
population requirement, the organization was led to believe a
waiver existed to allow a state administrative approval for an
expanded facility. With that expectation, VNHC continued with
their plans to design and build 18 beds. VNHC explains that
they now know they relied on misinformation and a waiver is
not available. VNHC acknowledges their lack of due diligence
but argues that the need for additional end-of-life beds is
still a critical issue in the Santa Barbara community. This
bill, according to VNHC, will enable Serenity House to meet
the growing demands and continue their mission of providing
compassionate care to those in need.
4)RELATED LEGISLATION .
a) SB 135 (Ed Hern�ndez) creates a new health facility
licensing category, and requires DPH to develop regulations
for hospice facilities, as defined, and imposes various
requirements on these facilities. Provides that DPH may
use specified federal regulations as the basis for hospice
facility licensure until DPH adopts regulations.
b) SB 804 (Corbett) requires the Department of Health Care
Services to allow CLHFs, as defined, that solely provide
pediatric subacute care services and do not provide
Medicare services, to participate in the Medi-Cal subacute
care program.
5)PREVIOUS LEGISLATION .
a) AB 950 (Roger Hern�ndez) of 2009 was substantially
similar to SB 135. AB 950 was held under submission in the
Senate Appropriations Committee.
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b) AB 2523 (Nava) of 2009 would have increased the bed
limit for CLHF's in counties with fewer than 500,000
persons. AB 2523 died in the Senate Rules Committee.
c) SB 1164 (Corbett) of 2009 would have required the
definition of CLHF to include facilities that provide
services to children who have a diagnosis of a terminal or
life-threatening illness. SB 1164 was referred to Senate
Health Committee, hearing canceled at the request of the
author.
d) SB 666 (Aanestad), Chapter 443, Statutes of 2005,
increases the capacity of a CLHF from no more than six beds
to no more than 12 beds. SB 666 maintains an exception to
allow CLHFs which serve terminally ill patients and which
are located in counties with 500,000 or more persons to
have 25 beds.
e) AB 3535 (Wright), Chapter 1459, Statutes of 1986,
creates the CLHF licensure category, and defined a CLHF as
a residential home with a capacity of no more than six
beds, which provides inpatient care to mentally alert,
physically disabled residents, who may be ventilator
dependent.
f) AB 4536 (Polanco), Chapter 1478, Statutes of 1988,
creates a second category of CLHFs, to provide 24-hour
inpatient care to terminally ill patients. Permits these
facilities to have up to 25 beds in counties which have a
population of 500,000 or more.
g) AB 68 (Polanco), Chapter 1393, Statutes of 1989,
establishes a third category of CLHFs, to serve persons who
are catastrophically and severely disabled, which are
permitted to have 12 or less beds in counties with more
than 500,000 persons.
REGISTERED SUPPORT / OPPOSITION :
Support
Visiting Nurse & Hospice Care (sponsor)
All Saints-by-the Sea Episcopal Church
The Beatitude Society
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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
City of Santa Barbara
Community Home Health
Community Hospice
Cottage Health System
Council on Alcoholism and Drug Abuse
County of Santa Barbara Board of Supervisors
Frank Schipper Construction Co.
Grace House
Hospice of Santa Barbara, Inc.
Hospice of the East Bay
Hospice of the Foothills
Livingston Memorial Visiting Nurse Association
Orfalea Foundations
PMSM Architects
Santa Barbara Cancer Center
Santa Barbara Neighborhood Clinics
Santa Barbara Region Chamber of Commerce
Santa Barbara Village
Senior Living Consultants
Sharp Hospice Care
St. Francis Foundation
United Way of Santa Barbara County
Visiting Nurse & Hospice Care
Visiting Nurse Association of the Inland Counties
Vista Del Monte Retirement Community
Several Hundred Individuals
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097