Amended in Assembly March 20, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 1744

Introduced by Assembly Member Brown

(Principal coauthor: Assembly Member Atkins)

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(Coauthor: Assembly Member Yamada)

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February 14, 2014

An act to begin delete amend Section 9100 of end delete begin insert add Section 9104 to end insert the Welfare and Institutions Code, relating to aging.

LEGISLATIVE COUNSEL’S DIGEST

AB 1744, as amended, Brown. California Department of Aging.

The Mello-Granlund Older Californians Act creates the California Department of Aging to provide leadership to the area agencies on aging in developing systems of home- and community-based services that maintain individuals in their own homes or least restrictive homelike environments. Existing law requires the department, in accomplishing its mission, to consider available data and population trends in developing programs and policies, collaborate with area agencies on aging, the California Commission on Aging, and other state and local agencies.

This bill would require the department to convene a begin delete joint study committee on family caregiving and long-term support services end delete begin insert blue-ribbon panel, comprised of at least 12 members, as specified, to make legislative recommendations to improve services for unpaid and family caregivers in California end insert , as provided. The bill would require the committee to prepare a report of its findings begin insert and recommendations end insert and provide it to the Legislature on or before July 1, 2016. begin insert The bill would make related findings and declarations. end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert This act shall be known, and may be cited, as the
California Caregiver Act of 2014. end insert

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begin insert SEC. 2. end insert   

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The Legislature finds and declares all of the following:

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(a) A caregiver can be any relative, partner, friend, or neighbor
who has a significant relationship with, and who provides a broad
range of assistance to, an older person or an adult with a chronic
or disabling condition.

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(b) At present, there is no complete inventory of caregiving
programs available to Californians performing unpaid caregiving
services for an aging or disabled family member, friend, or
neighbor.

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(c) Rising demand and shrinking families to provide caregiving
support suggest that California needs a comprehensive person-
and family-centered policy for long-term services and supports
systems that would better serve the needs of older persons with
disabilities, support family and friends in their caregiving roles,
and promote greater efficiencies in public spending.

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(d) California ranked 30th out of 50 states and the District of
Columbia on the 2011 State Long-Term Services and Supports
Scorecard sponsored by the SCAN Foundation, American
Association of Retired Persons (AARP), and the Commonwealth
Fund.

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(e) Family support is a key driver in remaining in one’s home
and community, but it comes at substantial costs to the caregivers,
their families, and to society. If family caregivers were no longer
available, the economic cost to California’s health care and
long-term services and supports systems would increase
astronomically.

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(f) In 2009, approximately 4 million family caregivers in
California provided care to an adult with limitations in daily
activities at any given point in time, and over 5.8 million provided
care at some time during the year.

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(g) In 2009, California’s family caregivers provided an
estimated 3,850,000 hours of unpaid labor caring for their loved
ones. The estimated economic value of their unpaid contributions
was approximately $47 billion.

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(h) In 2009, 59 percent of all family caregivers were employed
full or part time. Family caregivers typically spend 20 hours a
week caring for a family member who needs help with bathing,
dressing, and other kinds of personal care, as well as household
tasks such as shopping and managing finances.

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(i) Nationally, 46 percent of family caregivers performed
medical or nursing tasks for care recipients with multiple chronic
physical and cognitive conditions. More than three-quarters of
family caregivers who provided medical or nursing tasks were
managing medications, including administering intravenous fluids
and injections.

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(j) Almost one-half of family caregivers were administering five
to nine prescription medications a day, and one in five was helping
with 10 or more prescription medications a day. Yet, 61 percent
of these caregivers reported that they trained themselves to perform
medication management.

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(k) Only 31 percent of caregivers reported being visited at home
by a health care professional. In addition, 27 percent of caregivers
report that they have no additional assistance from a family
member, health care professional, or home health aide.

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(l) Nationally, more than 8 in 10 caregivers are over the age of
50. Family caregivers are aging and are increasingly from diverse,
social, racial, ethnic, and political backgrounds.

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(m) For many families in the midst of caregiving, there is deep
worry and concern about the quality of care and quality of life.

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(n) Families do not know who to call or where to go to get the
right kind of affordable help when they need it.

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(o) In just 13 years, as the baby boomers age into their 80s, the
decline in the caregiver support ratio is projected to shift from a
slow decline to a free fall in California.

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(p) To avoid bankrupting our health and social service systems
serving the elderly and persons with disabilities, it is imperative
that California prepare by identifying strategies that will promote
appropriate, person-centered services for families struggling with
providing care to a family member.

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(q) It is in the interest of the state to better serve the
approximately 4,000,000 families statewide who are currently
struggling to care for an aging or disabled family member, many
of whom are also in the workforce.

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(r) There is an immense need for caregiving resources and
services. As California’s population ages and as California
becomes increasingly diverse, it is also in the interest of the state
to adequately serve the following emerging caregiver populations:

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(1) Caregivers from the Black, Latino, Asian American, and
Pacific Islander communities.

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(2) Families of individuals with developmental disabilities.

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(3) Persons who cannot access or are not eligible for existing
caregiver support programs.

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(4) Non-English speakers, and ethnically and racially diverse
populations that need caregiving programs to be provided in a
culturally and linguistically appropriate manner.

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(5) Those in the lesbian, gay, bisexual, and transgender
community.

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(6) Rural residents.

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begin insert SEC. 3. end insert   

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begin insert Section 9104 is added to the end insert begin insert Welfare and Institutions
Code end insert begin insert , to read: end insert

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begin insert 9104. end insert   

(a) The department shall convene a blue-ribbon panel
on family caregiving and long-term services and supports. The
panel shall be jointly chaired by the director of the department or
his or her designee and a representative of AARP California,
except that all decisions regarding the expenditure of state funds
shall be made by the department representative. The panel shall
be comprised of at least 12 members who shall serve at the
pleasure of the department and AARP, and shall include all of the
following:

(1) One person with experience in the field of academic research
on caregiving.

(2) One family caregiver for an adult with a chronic or disabling
condition.

(3) One representative of the mental health community.

(4) One representative of the California caregiver resource
centers.

(5) One representative of the national Alzheimer’s Association.

(6) One representative of an organization that provides
community-based adult services.

(7) One representative of an organization that provides an adult
day program.

(8) One representative of an organization that provides services
to caregivers.

(9) One representative of an unpaid or family caregiver
consumer organization.

(10) One culturally and linguistically diverse caregiver.

(11) One adult with a chronic or disabling condition who
receives care from an unpaid caregiver or family member.

(b) The blue-ribbon panel shall do all of the following:

(1) Review the current policies and practices of state, local, and
community programs available to caregivers of adults with chronic
or disabling conditions, and consider how the needs of family
caregivers should be assessed and addressed so that they can
continue in their caregiving role without being overburdened.

(2) Consider the recommendations of other state plans,
including, but not limited to, the Olmstead Plan, the Long-Range
Strategic Plan on Aging, the State Plan for Alzheimer’s Disease,
and the State Plan on Aging.

(3) Compile an inventory of the resources available to family
caregivers.

(4) Determine gaps in services to family caregivers and identify
barriers to participation in current programs.

(5) Consider cultural and linguistic factors that impact
caregivers and care recipients who are from diverse populations.

(6) Consult with a broad range of stakeholders, including, but
not limited to, people diagnosed with Alzheimer’s disease, adults
with disabling or chronic conditions, family caregivers,
community-based and institutional providers, caregiving
researchers and academicians, formal caregivers, the Caregiver
Resource Centers, the California Commission on Aging, and other
state entities.

(7) Solicit testimony on the needs of family caregivers, including
the designation of caregivers, training, respite services, medical
leave policies, delegation of tasks to nonmedical aides, and other
policies.

(8) Identify best practices both in California and in other states.

(9) Explore expanding those best practices in caregiving
programs to populations that are not currently targeted.

(10) Develop at least three legislative recommendations to
improve the provision of services for unpaid and family caregivers
in California. These recommendations shall address all of the
following:

(A) Community-based support for California’s diverse
population of caregivers for adults with chronic or disabling
conditions.

(B) Choices for care and residence for persons with Alzheimer’s
disease and their families.

(C) The family caregiving competence of health care
professionals.

(11) Prepare and provide to the Legislature a report of its
findings and recommendations on or before July 1, 2016.

(12) Provide ongoing advice and assistance to the department
and the Legislature as to the needs and priorities of unpaid and
relative caregivers.

(c) (1) Members shall serve without compensation, but shall
receive reimbursement for travel and other necessary expenses
actually incurred in the performance of their official duties.

(2) The panel shall meet on a bimonthly basis.

(3) All meetings of the panel shall be open to the public and
adequate notice shall be provided in accordance with the
Bagley-Keene Open Meeting Act (Article 9 (commencing with
Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of
the Government Code).

(d) (1) The requirement for submitting a report imposed under
paragraph (11) of subdivision (b) is inoperative on July 1, 2020,
pursuant to Section 10231.5 of the Government Code.

(2) A report to be submitted pursuant to paragraph (11) of
subdivision (b) shall be submitted in compliance with Section 9795
of the Government Code.

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SECTION 1.  

Section 9100 of the Welfare and Institutions Code
is amended to read:

9100.  

(a) There is in the California Health and Human Services
Agency, the California Department of Aging.

(b) The department’s mission shall be to provide leadership to
the area agencies on aging in developing systems of home- and
community-based services that maintain individuals in their own
homes or least restrictive homelike environments.

(c) (1) In fulfilling its mission, the department shall develop
minimum standards for service delivery to ensure that its programs
meet consumer needs, operate in a cost-effective manner, and
preserve the independence and dignity of aging Californians. In
accomplishing its mission, the department shall consider available
data and population trends in developing programs and policies,
collaborate with area agencies on aging, the commission, and other
state and local agencies, and consider the views of advocates,
consumers and their families, and service providers.

(2) The department shall report the Elder Economic Security
Standard Index data for each service area in its state plan and use
it as a reference when making decisions about allocating its existing
resources, but only if the Elder Economic Security Standard Index
is updated and made available to the department, and if the
available public data used to calculate each Elder Economic
Security Standard Index data element is calculated and updated
for each California county and made available to the department
in a format that displays each county’s specific data.

(d) (1) The department shall convene a joint study committee
on family caregiving and long-term support services. The
committee shall be jointly chaired by a representative of the
department and a representative of AARP California, except that
all decisions regarding the expenditure of state funds shall be made
by the department representative. The committee shall be
comprised of at least five members, of which at least one shall be
a representative of an area agency on aging advisory council. The
committee shall do all of the following:

(A) Identify policies, resources, and programs available for
family caregivers and encourage additional innovative and creative
means to support family caregivers to continue to provide needed
in-home support for older adults.

(B) Compile an inventory of the resources available to family
caregivers.

(C) Solicit testimony on the needs of family caregivers including
the designation of caregivers, training, respite services, medical
leave policies, delegation of tasks to nonmedical aids and other
policies.

(D) Prepare and provide to the Legislature a report of its findings
on or before July 1, 2016.

(2) The requirement for submitting a report imposed under
paragraph (1) is inoperative on July 1, 2020, pursuant to Section
10231.5 of the Government Code.

(3) A report to be submitted pursuant to paragraph (1) shall be
submitted in compliance with Section 9795 of the Government
Code.

(e) The minimum standards for the department programs shall
ensure that the system meets all of the following requirements:

(1) Have the flexibility to respond to the needs of individuals
and their families and caregivers.

(2) Provide for consumer choice and self-determination.

(3) Enable consumers to be involved in designing and
monitoring the system.

(4) Be equally accessible to diverse populations regardless of
income, consistent with state and federal law.

(5) Have consistent statewide policy, with local control and
implementation.

(6) Include preventive services and home- and community-based
support.

(7) Have cost containment and fiscal incentives consistent with
the delivery of appropriate services at the appropriate level.

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