BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 1570 (Chesbro) - Residential care facilities for the elderly:
training.
Amended: June 26, 2014 Policy Vote: Human Services 4-0
Urgency: No Mandate: Yes
Hearing Date: August 14, 2014
Consultant: Jolie Onodera
SUSPENSE FILE. AS AMENDED.
Bill Summary: AB 1570 would, effective January 1, 2016, increase
the training requirements for licensees and direct care staff of
residential care facilities for the elderly (RCFEs), as
specified.
Fiscal Impact (as approved on August 14, 2014):
Significant one-time and ongoing costs potentially in
excess of $350,000 (General Fund) for the Department of
Social Services (DSS) to develop and revise regulations,
review and approve certification programs, administer and
periodically revise the examination for RCFE licensees, and
establish the subject matter required for training for
direct care staff. These costs would be offset by the
increase in fee authority.
Significant increase in training costs to employees and/or
facilities to meet the enhanced initial and continuing
education training requirements imposed.
Potential minor non-reimbursable local enforcement costs
for misdemeanor violations of the provisions of the Act
pursuant to this measure.
Background: The Community Care Licensing Division (CCLD) of the
DSS administers the licensure and oversight of over 7,500
assisted living, board and care, and continuing care retirement
homes that are licensed as RCFEs in California. These residences
are designed to provide home-like environment housing options to
elderly residents who need assistance with activities of daily
living but otherwise do not require continuous, 24-hour
assistance or nursing care. The RCFE licensure category includes
facilities with as few as six beds to facilities with hundreds
of residents whose needs may vary widely.
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Over 20 years have passed since existing RCFE licensing
certification requirements have been changed. The last noted
revision was through the enactment of AB 1615 (Hannigan),
Chapter 848/1991, which required prospective licensees to
undergo an orientation training prior to commencing the licensee
certification process.
RCFE licensee/administrator requirements : Currently, licensees
and administrators of RCFEs are required to undergo 40 hours of
training and complete a written exam. However, as noted by the
DSS, "Currently, no proctoring protocol exists, resulting in no
statewide uniformity on how the exams are administered. This
lack of consistency and guidance results in errors and can
ultimately result in candidates getting certified who may not
meet the minimum qualifications."
Concerns have also been raised by advocates about the rigor and
relevance of the administrator exam. According to DSS,
approximately 500 people take the administrator certification
test each month. However, there is no requirement under law that
the exam reflects what is provided in the 40 hours of
administrator/licensee training required for completion prior to
taking the certification exam.
RCFE staff requirements : Licensees employ a wide range of staff
to provide day-to-day support and care for residents of RCFEs.
Although many employ individuals with specific expertise and
certifications, such as Licensed Vocational Nurses and Certified
Nursing Assistants, at minimum, staff who assist residents with
personal activities of daily living are required to be at least
18 years of age and undergo 10 hours of training within four
weeks of being employed by the RCFE and four hours of training
each year thereafter. The training is somewhat similar to that
required of licensees and administrators, but is limited to
covering the physical limitations and needs of the elderly, the
importance and techniques for personal care services, residents'
rights, policies and procedures regarding medications and the
psychosocial needs of the elderly.
There are also additional training requirements for staff who
work in RCFEs that "provide" dementia care or who assist
residents with managing their medication. Staff who work in a
RCFE that advertises or promotes special care, special
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programming, or a special environment for persons with dementia
are required to undergo an additional six hours of training on
providing care to persons with dementia. Staff also must
annually complete eight hours of continuing training on dementia
care. Training for staff who assist residents in the management
and self-administration of medication depends on the size of the
facility in which they work. For facilities with 16 or more
residents, staff must undergo 16 hours of training, and for
facilities with 15 or fewer residents, staff must complete six
hours of training on medication management. Both training
requirements must be completed within the first two weeks of
employment and conclude with an examination. Four hours of
annual continuing medication management training is required, as
well.
In response to recent health and safety issues discovered at
facilities licensed by the CCLD, the 2014 Budget Act includes
funding for a comprehensive plan to reform the CCLD program. The
Budget includes an increase of $7.5 million ($5.8 million
General Fund) and 71.5 positions to improve the timeliness of
investigations, ensure the CCLD inspects all facilities at least
once every five years, increase staff training, and establish
clear fiscal, program, and corporate accountability. The Budget
also increases licensing and application fees by 10 percent.
Proposed Law: This bill would expand both the initial and
ongoing training requirements for RCFE licensees and direct care
staff, as follows:
Revises the existing requirement of 40 hours of
classroom instruction for RCFE licensee certification
training programs and replaces it with 100 hours of
required training, 60 hours of which are to consist of
classroom instruction.
Requires a state-administered examination consisting of
no less than 100 questions, as specified.
Adds the following components to the list of items
required to be covered in the RCFE licensee certification
training program: adverse effects of psychotropic drugs for
use in controlling the behavior of persons with dementia,
non-pharmacologic, person-centered approaches to dementia
care, managing the physical environment, residents' rights,
cultural competency and sensitivity in issues relating to
the underserved, aging, lesbian, gay, bisexual, and
transgender (LGBT) community, postural supports,
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restricted health, and hospice care.
Requires the participation of "provider organizations"
(undefined) in the development of regulations of
certification program content, testing, process for
approving programs, and criteria to be used for authorizing
individuals or organizations to conduct certification
programs. Further, requires DSS to review the test annually
and update as necessary to reflect changes in law and
regulations.
Eliminates the requirement that a RCFE staff person must
undergo ten hours of training within the first four weeks
of employment and, instead, requires a RCFE staff person to
undergo 40 hours of training within the first four weeks of
employment, at least 24 hours of which must be completed
prior to providing direct care to residents, and 16 hours
shall be hands on training. An additional 20 hours annually
on dementia care, postural supports, restricted health
conditions, and hospice care shall be administered on the
job, in a classroom setting, or both.
Requires DSS to establish the subject matter required
for the staff training and develop the training in
consultation with provider organizations.
Expands RCFE staff training components to include the
use, misuse, and interaction of drugs commonly used by the
elderly, the adverse effects of psychotropic drugs for use
in controlling the behavior of persons with dementia, the
special needs of persons with Alzheimer's disease and
dementia, including non-pharmacologic person-centered
approaches to dementia care, and cultural competency and
sensitivity in issues relating to the underserved, aging,
and LGBT community.
Adds new training requirements for all RCFE direct care
staff to include 1) 12 hours of dementia care training
prior to providing direct care to residents on the care,
supervision, and special needs of those residents, and, 2)
8 hours annually of in-service training on the subject of
serving those residents.
Related Legislation: SB 911 (Block) 2014 would increase the
initial and continuing education training requirements for
licensees, administrators, and direct care staff of RCFEs, as
specified. In addition, this bill would prohibit discrimination
or retaliation in any manner against a resident or employee for
calling 911. This bill is pending hearing in the Assembly
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Committee on Appropriations.
The following bills regarding licensing and inspections at
community care facilities, and RCFEs specifically, have been
introduced this session:
SB 894 (Corbett) RCFEs: revocation of license.
SB 895 (Corbett) RCFEs: annual inspections.
SB 1153 (Leno) RCFEs: suspension of new admissions.
SB 1382 (Block) RCFEs: licensure fees.
AB 1436 (Waldron) RCFEs: internet posting of inspection reports.
AB 1454 (Calderon) care facilities: annual inspections.
AB 1523 (Atkins) RCFEs: liability insurance.
AB 1554 (Skinner) RCFEs: complaint procedures.
AB 1571 (Eggman) RCFEs: disclosure requirements.
AB 1572 (Eggman) RCFEs: single resident council.
AB 1899 (Brown) RCFEs: prohibitions on licensure reinstatement.
AB 2044 (Rodriguez) RCFEs: 24-hour presence of
administrator/staff.
AB 2171 (Wieckowski) RCFEs: residents' rights.
AB 2236 (Maienschein/Stone) RCFEs: civil penalties.
Staff Comments: The DSS would likely incur one-time and ongoing
costs potentially in excess of $350,000 (General Fund) to
develop and revise regulations, review and approve certification
programs, administer the examination for RCFE licensees, and
establish the subject matter required for training for direct
care staff. The DSS would also incur ongoing workload to review
the test annually and update as necessary to reflect changes in
law and regulations.
Additional regulations for RCFE staff training provisions would
also be adopted once DSS establishes the subject matter required
for staff training and develops the training in consultation
with provider organizations, as required under the provisions of
this bill.
Under existing law, any person who violates the California
Residential Care Facilities for the Elderly Act (Act), is guilty
of a misdemeanor and subject to civil penalties and suspension
or revocation of his or her license. To the extent the
provisions of this measure result in future violations of the
Act, local law enforcement agencies would incur non-reimbursable
local enforcement costs offset to a degree by fine revenue.
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Committee amendments:
Increase the fee authority for the certification exam
for licensees from $100 to up to $150.
Make other technical changes to direct care staff
training requirements.