BILL ANALYSIS �
SB 1228
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Date of Hearing: August 8, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 1228 (Alquist) - As Amended: May 29, 2012
Policy Committee: HealthVote:12-7
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill establishes "small house skilled nursing facility"
(small-house SNF) as a new subcategory of skilled nursing
facilities for purposes of state licensure on or after January
1, 2014. Specifically, this bill:
1)Specifies certain licensure requirements a small-house SNF
must meet, including a number of facility requirements such as
a homelike environment, semi-private rooms, ample natural
light, and living and kitchen areas.
2)Requires the small-house SNF to comply with all state laws and
regulations that govern SNFs, except to the extent that those
laws and regulations are inconsistent with the provisions of
this bill.
3)Authorizes the California Department of Public Health (CDPH)
and the Office of Statewide Health Planning and Development
(OSHPD) to waive certain regulations that apply to SNFs in
order to allow small-house SNFs to operate
4)Requires they consult with stakeholders, consider
peer-reviewed research, and consider other states' experience
in development of regulations and standards specific to
small-house SNFs.
5)Defines "versatile worker" as a certified nursing assistant
(CNA) who provides personal care, socialization, activity aide
services, meal preparation services, and laundry and
housekeeping services
6)Requires the small-house SNF to use versatile workers for
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purposes of resident care, and requires training and
demonstration of proficiency for versatile workers and other
small-house SNF staff.
FISCAL EFFECT
1)Costs of at least $200,000 per year for at least two years
(fee-supported special fund) to CDPH to consult with
stakeholders and develop regulations specific to small-house
SNFs.
2)Minor one-time costs to OSHPD to adapt building standards for
small-house SNFs.
3)Any ongoing costs for licensure and inspection of small-house
SNFs will be supported by fee revenue from licensed
facilities. Total staff costs may or may not increase as a
result of this bill as compared to the status quo. It is
unknown whether streamlining licensure for the small-house SNF
model will lead to an increase in the total number of nursing
home beds and commensurate state staff costs. Nursing home
licensure fees collected by CDPH are currently $312 per bed.
COMMENTS
1)Rationale . According to the author, small-house SNFs provide a
homelike environment, and are an important development in
long-term care options that many consumers, family, and staff
prefer to traditional institutional settings. The author
states that they also deliver better clinical outcomes, more
direct-care time, and greater resident engagement at the same
operating cost as traditional nursing homes.
The author states small-house SNFs are difficult to develop in
California under current state requirements, and California's
current statutory and regulatory framework did not anticipate
this significant innovation. She indicates one California
nursing home provider has been working for three years to
implement the Green House model, a small-house SNF model that
has been extensively studied and replicated, but the provider
has experienced significant delays and added costs because it
does not fit well with California's current law.
2)Background . The Green House concept is an innovative model for
residential long-term care that involves a restructuring of
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the philosophy of care, architecture, and organizational
structure normally associated with long-term care.
Green House -style SNFs are generally self-contained private
residences, and offer each of 10-12 residents a private
bedroom and bathroom. They also contain a common space,
including a living area, kitchen, and single dining table.
Specially trained CNAs work in teams to provide direct care,
and other health care professionals also work in a team-based
setting in partnership with direct care staff. According to
the author, Green House homes are currently operating in 21
states.
Preliminary studies have suggested that care in Green
House-model SNFs may lead to small improvements in certain
outcomes, such as more direct care time per day in Green House
models as compared to similar residents in traditional nursing
homes. Studies are ongoing to attempt to tease out whether
Green House offer better care than traditional nursing homes
and, if so, which specific elements and practices are making
the difference.
3)Support . This bill is sponsored by NCB Capital Impact, which
has established The Green House Project, funded by the Robert
Wood Johnson Foundation, to help spur replication of The Green
House concept. It is supported by the California Association
of Health Facilities, the trade group of SNFs.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081