BILL ANALYSIS �
AB 1744
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Date of Hearing: April 1, 2014
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
AB 1744 (Brown) - As Amended: March 20, 2014
SUBJECT : Older Californians Act; Blue Ribbon Committee on
Family Caregiving.
SUMMARY : Establishes the California Caregiver Act of 2014.
Specifically, this bill :
1) Makes legislative findings and declarations as follows:
a. That 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.
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.
c. Rising demand and shrinking families that provide
caregiving support suggest that California needs a
comprehensive person-and family-centered policy for
long-term services and support 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.
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.
e. Family support is a key driver to remain 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 support
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.
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.
h. In 2009, 59% 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.
i. Nationally, 46% 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.
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% of these caregivers reported that they
trained themselves to perform medication management.
aa. Only 31% of caregivers reported being visited at home by
a health care professional. In addition, 27% of caregivers
report that they have no additional assistance from a
family member, health care professional, or home health
aide.
bb. 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.
cc. 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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dd. Families do not know who to call or where to go to get
the right kind of affordable help when they need it.
ee. 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.
ff. 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.
gg. 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.
hh. There is an immense need for caregiving resources and
services as California's population ages and as California
becomes increasingly diverse.
1)Directs the California Department of Aging to convene a
blue-ribbon panel on family caregiving and long-term services
and supports, chaired jointly by the Director of the
Department of Aging (or his or her designee) and the AARP;
made up of 12 individuals who serve at the pleasure of the
director and the AARP. Except for all decisions regarding the
expenditure of state funds, decisions of the body would be
joint decisions.
Membership :
a. One member shall have experience in the field of
academic research on caregiving;
b. One member shall be a family caregiver of an adult with
a chronic or disabling condition;
c. One member shall be a representative of the mental
health community;
d. One member shall be a representative of the Family
Caregiver Resource Centers;
e. One member shall be a representative of the National
Alzheimer's Association;
f. One member shall be a representative of an organization
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that provides community-based adult services;
g. One member shall be a representative of an organization
that provides an adult day program;
h. One member shall be a representative of an organization
that provides services to caregivers;
i. One member shall be a representative of an unpaid or
family or family caregiver consumer organization;
j. One member shall be a culturally and linguistically
diverse caregiver;
aa. One member shall be an adult with a chronic or disabling
condition who receives care from an unpaid caregiver or
family member.
1)The Blue Ribbon Panel would be required to :
a. Review current policies and practices of state, local
and community programs available to caregivers of adults
with chronic disabling conditions, and consider how the
needs of family caregivers should be assessed and addressed
so that they may avoid overburdening themselves, and remain
in their caregiving role.
b. Consider other state plans, including State Olmstead
plan, the Long-Range Strategic Plan on Aging, the State
Plan for Alzheimer's disease, and the State Plan on Aging.
c. Compile and inventory resources available to family
caregivers.
d. Determine gaps in services to family caregivers and
identify barriers to participation in current programs.
e. Consider cultural and linguistic factors that impact
caregivers and care recipients who are from diverse
backgrounds.
f. Consult with a broad range of stakeholders, including
but not limited to people diagnosed with Alzheimer's,
adults with disabling and 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.
g. Solicit testimony on the needs of family caregivers
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including the designation of caregivers, training, respite
services, medical leave policies, delegation of tasks to
non-medical aides, and other policies.
h. Identify best practice in other states.
i. Explore expanding those best practices in caregiving
programs to populations that are not currently targeted.
j. Develop at least three legislative recommendations to
improve the provisions of services for unpaid and family
caregivers in California to address the following:
i. Community-based support for California's
diverse populations of caregivers for adults with
chronic or disabling conditions;
ii. Choices for care and residence for persons
with Alzheimer's disease and their families;
iii. The family caregiving "competencies" of health
care professionals.
aa. Prepare a report to the legislature on or before July of
2016 in digital format.
bb. Provide ongoing advice and assistance to the department
and the legislature as to the needs of unpaid and relative
caregivers.
1)Members shall serve without compensation but shall receive
reimbursement for travel and other expenses incurred in the
performance of their official duties, and meet publicly
every-other month.
EXISTING LAW:
1)Establishes the Older Californians Act (OCA) and assures older
adults have equal access to programs and services provided
through the OCA regardless of physical or mental disabilities,
language barriers, cultural or social isolation, including
that caused by actual or perceived racial and ethnic status,
including, but not limited to, African-American, Hispanic,
American Indian, and Asian American, ancestry, national
origin, religion, sex, gender identity, marital status,
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familial status, sexual orientation, or by association with a
person or persons with one or more of these actual or
perceived characteristics, that restrict an individual's
ability to perform normal daily tasks or that threaten his or
her capacity to live independently.
2)Establishes the California Department of Aging (CDA) 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.
3)Establishes 33 area agencies on aging to receive federal,
state, and local funds to contract with local organizations
for service to seniors. There are 33 area agencies on aging
designated by the CDA as the local Planning Services Agencies
4)Establishes the Title IIIE program, also known as the National
Family Caregiver Support Program (NFCSP), established in 2000,
to coordinate local community-service systems for assisting
caregivers of seniors. Services are available to family and
other unpaid caregivers supporting older individuals, as well
as grandparents and older relatives caring for children. Each
AAA is responsible for determining the array of services,
including caregiver information, assistance in gaining access
to services, counseling and training support, temporary
respite, and limited supplemental services to complement the
care provided by caregivers. Services are provided directly by
AAA staff, or through partnerships with other public or
private agencies.
5)Establishes Caregiver Resource Centers to deliver services to
and advocate for caregivers of cognitively impaired adults, by
offering specialized information on chronic and disabling
conditions and diseases, aging, caregiving issues, community
resources and family consultation. Professional staff work
with families and caregivers to provide support, alleviate
stress, examine options, and enable them to make decisions
related to the care, respite, and counseling in legal and
financial aid.
FISCAL EFFECT : Unknown
COMMENTS :
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Author's Statement : "This bill is relevant to California's
current need, through a collaborative joint study committee, to
inventory, assess and report on the status of existing caregiver
programs. Caregivers come from a wide range of economic,
social, racial and ethnic backgrounds. Research by the AARP
Public Policy Institute indicates that 27% of caregivers have no
additional assistance from family members, a healthcare
professional or a home health aide. Only 31% report having been
visited by a healthcare professional in the home. For many
families in the midst of caregiving, there is deep worry and
concern about the quality of care and quality of life of the
relative for whom they are providing care. Many caregivers do
not know who to call or where to go to get the right kind of
affordable help when they need it. This bill will provide
family caregivers, their loved ones and our State invaluable
data and information as we move forward in addressing family
caregiving and long-term support service issues."
Background : Families are the major provider of long-term care,
but research has shown that caregiving exacts a heavy emotional,
physical and financial toll. Many caregivers who work and
provide care experience conflicts between their
responsibilities. Twenty two percent of caregivers are assisting
two individuals, while eight percent are caring for three or
more. Almost half of all caregivers are over age 50, making them
more vulnerable to a decline in their own health, and one-third
describe their own health as fair to poor.
Women make up the majority of the unpaid caregiver workforce,
often interrupting work careers to take on the burden of caring
for a relative. Caregiving women face uncertain economic
futures due to breaks from employment and the corresponding
reductions to retirement plans and the Social Security system.
At a joint Hearing of Assembly Committees on Aging and Long-Term
Care and the Assembly Committee on Human Services in 2011, the
committees heard testimony about caregiving in California.
Given the demographics confronting California, it would come as
no surprise that most people will become a caregiver at some
point during their lives. According to the Family Caregiver
Alliance, caregivers are daughters, wives, husbands, sons,
grandchildren, nieces, nephews, partners and friends. While
some people receive care from paid caregivers, most rely on
unpaid assistance from families, friends and neighbors. The
National Alliance on Caregiving and AARP report "Caregiving in
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the United States, 2009," estimates 31.2% of households in the
U.S. had at least one person who served as an unpaid family
caregiver during the course of the year. At any one time the
report estimates 37.3 million people are providing care; 66% are
women and 34% are men. The typical family caregiver is a 49
year-old woman caring for her widowed 69 year-old mother who
does not live with her. She is married and employed. 1.4
million children ages 8 to 18 provide care for an adult
relative; 72% are caring for a parent or grandparent; and 64%
live in the same household as their care recipient. The same
report estimates the number of caregivers in California at any
given time at 4.0 million, with an estimated 5.88 million people
serving as caregivers during the course of a year.
What is Caregiving : Caregivers can be paid or unpaid.
Caregivers support the needs of dependent individuals in a
variety of ways, performing a range of tasks, including
companionship, light house-keeping, meal preparation, and
personal care tasks. More complex and sensitive tasks include
money management, medication management, communicating with
health professionals, and coordinating care. The Family
Caregiver Alliance finds that many family members and friends do
not consider such assistance and care "caregiving" - they are
just doing what comes naturally to them: taking care of someone
they love. But that care may be required for months or years,
and may take an emotional, physical and financial toll on
caregiving families.
The value of the services family caregivers provide for "free,"
when caring, was estimated to be $450 billion in 2009. The
estimated value of unpaid care in California is $47 billion,
accounting for over 3.8 billion hours of care at $12.17, the
average caregiver wage in 2009. On the personal side, long term
caregiving has significant financial consequences for
caregivers, particularly for women. Informal caregivers
personally lose about $659,139 over a lifetime: $25,494 in
Social Security benefits; $67,202 in pension benefits; and
$566,443 in forgone wages. Caregivers face the loss of income
of the care recipient, loss of their own income if they reduce
their work hours or leave their jobs, loss of employer-based
medical benefits, shrinking of savings to pay caregiving costs,
and a threat to their retirement income due to fewer
contributions to pensions and other retirement vehicles.
Discussion :
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AB 1744 would amend the Older Californians Act to require the
California Department of Aging to convene a joint Blue Ribbon
Task Force on family caregiving, and long-term supports and
services. The proposed Blue Ribbon Task Force committee would
be co-chaired by the AARP and the director of the CDA. The Task
force's joint study mandates would be multi-faceted:
1)To consult a range of stakeholders, including people living
with Alzheimer's disease, people living with chronic and
disabling conditions, family caregiver, service providers,
researchers, formal caregivers, Caregiver Resource Centers,
and the California Commission on Aging, among others.
2)To solicit testimony on the needs of family caregivers,
including the designation of caregivers, training, respite
services, medical leave policies, delegation of tasks to
non-medical aides, and other policies.
3)To identify best practices in California as well as other
states, and explore ways to replicate them, and expand them to
populations not currently served.
The Blue Ribbon Panel would prepare a report to the Legislature
by July 1, 2016 and provide ongoing advice to the department and
the legislature.
Questions :
1. Is it the intent of the author to compel the panel to
produce three legislative initiatives separate from the
report that is due to the legislature on July 1, 2016?
2. Given the broad cultural representation of people in
California, besides reviewing best practices within the
state of California and other states, does it serve the
residents of the state to assess best practices developed
in other countries as well?
Proposed Amendments :
Amendment #1:
On Page 2, line 34, replace "3,850,000" with "3,850,000,000"
Amendment #2:
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On page 4, lines 20-28, amend as follows:
9104. (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 elected by the members
of the blue-ribbon panel. of AARP California, except that all
All decisions regarding the expenditure of state funds shall be
made by the department representative. The panel shall serve at
the pleasure of the department and be comprised of at least 12
members , each of whom shall be representative of at least one of
the following: who shall serve at the pleasure of the
department, and AARP, and shall include all of the following:
Amendment #3: On Page 5, line 5, amend as follows:
(10) One representative with experience and knowledge of the
specific needs of culturally and linguistically diverse
caregivers, and the specific challenges of delivering services
to family caregivers challenged by cultural or linguistic
barriers. caregiver.
REGISTERED SUPPORT / OPPOSITION :
Support :
American Association of Retired Persons (AARP) California
(Sponsor)
Alzheimer's Association
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
California Assisted Living Association (CALA)
California Association for Health Services at Home (CAHSAH) -
Support if Amended
California Association of Area Agencies on Aging (C4A)
California Caregiver Resource Centers
California Commission on Aging
Congress of California Seniors
Family Caregiver Alliance
Pacific Clinics
United Domestic Workers of America (UDW) AFSCME Local 3930
Opposition :
None on file.
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Analysis Prepared by : Robert MacLaughlin / AGING & L.T.C. /
(916) 319-3990