BILL ANALYSIS �
SB 1228
Page 1
SENATE THIRD READING
SB 1228 (Alquist)
As Amended August 20, 2012
Majority vote
SENATE VOTE :36-0
HEALTH 12-0 APPROPRIATIONS 16-0
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|Ayes:|Monning, Atkins, Eng, |Ayes:|Gatto, Harkey, |
| |Garrick, Gordon, Hayashi, | |Blumenfield, Bradford, |
| |Roger Hern�ndez, Bonnie | |Charles Calderon, Campos, |
| |Lowenthal, Mansoor, | |Davis, Fuentes, Hall, |
| |Mitchell, Nestande, Pan | |Hill, Cedillo, Mitchell, |
| | | |Nielsen, Norby, Solorio, |
| | | |Wagner |
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SUMMARY : Adds "small house skilled nursing facility" (SHSNF),
as defined, to the skilled nursing facility (SNF) category of
facilities licensed by the Department of Public Health (DPH),
and permits an SHSNF to be licensed by DPH beginning on January
1, 2014, if the SHSNF meets specified requirements.
Specifically, this bill :
1)Adds SHSNF, as defined, to the SNF category of facilities
licensed by DPH beginning on January 1, 2014, if the SHSNF
meets specified requirements.
2)Defines "home" as an apartment, home, or other similar unit
that serves 12 or fewer residents.
3)Defines "SHSNF" as an SNF that is licensed for the purposes of
providing skilled nursing care in a homelike,
non-institutional setting and is one of the following:
a) A stand-alone home;
b) A facility that consists of more than one home; or,
c) A distinct area within an existing SNF that otherwise
meets the definition of "home" referenced in 2) above, and
has been dedicated to the small house model, has distinct
entry, and has no through traffic of staff, residents, or
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visitors not affiliated with the household.
4)Defines "versatile worker," for purposes of SHSNF licensing
requirements, as a certified nursing assistant who provides
personal care, socialization, activity aide services, meal
preparation services, and laundry and housekeeping services.
Requires the SHSNF, to the extent permitted under federal law,
to utilize versatile workers for purposes of resident care.
5)Requires the SHSNF 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. Permits DPH or the Office of Statewide Health
Planning and Development (OSHPD) to waive one or more
regulations that conflict with the provisions of this bill in
order to permit SHSNFs to meet licensure requirements, if DPH
or OSHPD determines doing so will not jeopardize the health
and safety of a facility's residents. Requires DPH or OSHPD
to consider whether the practice contained in the provision
has been demonstrated safely in other states and requires them
to consider peer-reviewed research.
6)Requires the SHSNF, to the extent permitted under federal law,
to provide meals cooked on the premises of each home, and not
prepared in a central kitchen and transported to the home.
7)Requires the SHSNF to meet all federal and state direct-care
staffing requirements for SNFs. Requires all direct care
staff to be onsite, awake, and available within each home at
all times.
8)Requires SHSNFs to provide consistent staff assignments and
self-managed work teams of direct care staff. Requires
licensed nursing staff to direct the versatile workers in all
activities delegated under the licensed nurses' scope of
practice. A versatile worker may be supervised by nonclinical
staff at the discretion of the SHSNF.
9)Requires SHSNFs to provide training for all staff involved in
the operation of the home and be completed prior to initial
operation of the home, concerning the philosophy, operations,
and skills required to implement and maintain self-directed
care, self-managed work teams, a noninstitutional approach to
long-term care, safety and emergency skills, food handling and
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safety, and other elements necessary for the successful
operation of the home. Requires versatile workers and other
staff interacting with residents in the homes to demonstrate
proficiency in these areas as well as the facility's policies
and procedures, conflict resolution, and self-directed care
principles.
10)Requires replacement staff to undergo the training described
in 9) above, within six weeks of commencing employment with
the facility.
11)Exempts any staff members who are employed on a short-term,
temporary basis due to permanent staff illness or unexpected
absence from the training requirements set forth in 9) above.
12)Requires the SHSNF, to the extent permitted under federal
law, to consist of a home-like, rather than institutional,
environment having the following characteristics:
a) The home is accessible to disabled persons, and is
designed as a house, an apartment, or a distinct area
within an existing SNF that is similar to housing available
in the surrounding community, and that includes shared
areas that would only be commonly shared in a private home
or apartment;
b) The home does not, to the extent practicable, contain
institutional features, such as nursing stations,
medication carts, room numbers, and wall-mounted licenses
or certificates;
c) The home includes resident rooms that accommodate not
more than two residents per room. Homes are encouraged to
include private, single-occupancy bedrooms that are shared
only at the request of a resident to accommodate a spouse,
partner, family member, or friend, and that contain a full
private and accessible bathroom. Double occupancy rooms
contain a full private and accessible bathroom, and each
resident's bedroom area be visually separated from the
other by a full height wall or a permanently installed
sliding door, folding door, or partition that provide
visual and acoustic separation. Residents have direct use
of, and access to, an exterior window at all times;
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d) The home contains a living area where residents and
staff socialize, dine, and prepare food together that
provides, at a minimum, a living room seating area, a
dining area large enough to accommodate all residents and
at least two staff members, and a full kitchen that may be
utilized by residents;
e) The home contains ample natural light;
f) The home has built-in safety features to allow areas of
the facility to be accessible to residents during the
majority of the day and night;
g) The home provides access to secured outdoor space; and,
h) The home endeavors to create an aging in place
environment where long-stay residents may form permanent
homes with each other.
13)Requires the SHSNF to be certified to participate as a
provider of care either as a SNF under the federal Medicare
Program or as a nursing facility under the federal Medicaid
Program.
14)Requires DPH and OSHPD to consult with providers, employee
organizations, consumer advocates, and other interested
stakeholders including groups with demonstrated experience in
SHSNF operations, on the physical, operational, and other
aspects of SHSNFs.
15)Requires DPH to adopt regulations to implement this bill.
EXISTING LAW :
1)Provides for the licensure of health facilities, including
SNFs, by DPH.
2)Defines "SNF" as a health facility that provides skilled
nursing care and supportive care to patients whose primary
need is for availability of skilled nursing care on an
extended basis.
3)Requires OSHPD, under the Alfred E. Alquist Hospital
Facilities Seismic Safety Act, to assume responsibility for
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the enforcement of all building standards related to hospital
buildings, including SNFs.
EXISTING REGULATIONS :
1)Further define "SNF" as a facility providing 24-hour inpatient
care and, at a minimum, includes physician, skilled nursing,
dietary, and pharmaceutical services and an activity program.
2)Require each SNF licensed for 59 or fewer beds to have at
least one registered nurse or a licensed vocational nurse,
awake and on duty, in the facility at all times, day and
night.
3)Require each SNF to employ sufficient nursing staff to provide
a minimum of 3.2 nursing hours per patient day. Requires this
staffing ratio to only include direct caregivers, which is
defined to include registered nurses, licensed vocational
nurses, psychiatric technicians, or certified nurse
assistants, who are performing nursing services.
4)Specify that while all SNFs are required to maintain
compliance with licensing requirements, these requirements are
not to prohibit the use of alternate concepts, methods,
procedures, techniques, equipment, personnel qualifications,
or the conducting of pilot projects, as long as such
exceptions have prior written approval of DPH.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Costs of at least $200,000 per year for at least two years
(fee-supported special fund) to DPH to consult with
stakeholders and develop regulations specific to SHSNFs.
2)Minor one-time costs to OSHPD to adapt building standards for
SHSNFs.
3)Any ongoing costs for licensure and inspection of SHSNFs 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 SHSNF model will lead to an
increase in the total number of nursing home beds and
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commensurate state staff costs. Nursing home licensure fees
collected by DPH are currently $312 per bed.
COMMENTS : According to the author, SHSNFs implementing the core
practices outlined in this bill are an important development in
long-term care options that many consumers, family, and staff
prefer to traditional 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 asserts that this deep
culture change model of SHSNFs is proliferating in many states
and meets all federal nursing home certification requirements.
Unfortunately, these homes are difficult to develop in
California under current state requirements, and California's
current statutory and regulatory framework did not anticipate
this significant innovation.
According to the author, SHSNFs following the practices outlined
in this bill currently require multiple agency interpretations
and waivers to move forward in California. These
interpretations and waivers add a great deal of time and expense
to implementation - both for the provider organizations and the
state agencies involved. This additional time and expense
discourages their development and deprives California residents
of this important option.
The author states that this bill would create a new health
facility licensing category to assist the development of SHSNFs
implementing the core practices that research has shown to
reliably deliver improved satisfaction, quality, and cost
outcomes.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0005055