BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Jim Beall, Chair
BILL NO: AB 1744
A
AUTHOR: Brown
B
VERSION: May 23, 2014
HEARING DATE: June 24, 2014
1
FISCAL: Yes
7
4
CONSULTANT: Mareva Brown
4
SUBJECT
California Department of Aging
SUMMARY
This bill would require the department, upon securing
$200,000 in nonstate funds from private sources for
purposes of implementing the bill, to convene a blue-ribbon
panel, comprised of at least 13 members, as specified, to
make legislative recommendations to improve services for
unpaid and family caregivers in California, as provided.
The bill would require the committee to prepare a report of
its findings and recommendations and provide it to the
Legislature on or before July 1, 2016.
ABSTRACT
Existing law:
1) Establishes the Mello-Granlund Older Californians
Act, that reflects the policy mandates and directives
of the Older Americans Act of 1965 (42 USC Chapter 35,
Sec. 3001), and sets forth the state's commitment to
its older population and other populations served by
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the programs administered by the California Department
of Aging. (WIC 9000 et seq.)
2) Establishes the California Department of Aging
(CDA) with the mission 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. (WIC 9100)
3) Permits CDA to accept gifts and grants from any
source, public or private, to assist it in the
performance of its functions, and these gifts and
grants shall operate to augment any appropriation made
for the support of the department. (WIC 9107)
4) Establishes the California Commission on Aging,
with 25 appointees, as designated, and staggered
three-year terms, and tasks the commission with
duties, including, but not limited to the following:
a. Serve as the principal advocate body in
the state on behalf of older individuals,
including, but not limited to, advisory
participation in the consideration of all
legislation and regulations made by state and
federal departments and agencies relating to
programs and services that affect older
individuals.
b. Participate with the department in
training workshops for community, regional and
statewide senior advocates, to help older
individuals understand legislative, regulatory,
and program implementation processes.
c. Prepare, publish, and disseminate
information, findings, and recommendations
regarding the well-being of older individuals.
d. Actively participate and advise the
department in the development and preparation of
the State Plan on Aging, conduct public hearings
on the State Plan on Aging, review and comment on
the state plan, and monitor the progress of the
plan's implementation.
e. Meet at least six times annually in
order to study problems of older individuals and
STAFF ANALYSIS OF ASSEMBLY BILL 1744 (Brown)
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present findings and make recommendations.
f. Hold hearings throughout the state, that
may include conducting an annual statewide
hearing inviting all departments administering
programs affecting seniors, in order to gather
information and advise the Governor, Legislature,
department, and agencies on all levels of
government regarding solutions to problems
confronting older individuals and the most
effective use of existing resources and available
services for individuals.
g. Hire an executive director and, within
budgetary limits, such staff as may be necessary
for the commission to fulfill its duties.
h. Develop, in cooperation with the
department, a method for the selection of
delegates to the statewide legislative meeting of
senior advocates. (WIC 9200 et seq.)
5) Permits the commission on aging to accept gifts and
grants from any source, public or private, to assist
it in the performance of its functions. Requires that
any gifts and grants shall augment any appropriation
made for the support of the commission and requires
that CDA serve as the fiscal agent for the accounting
of the gifts and grants and that no gifts or grants
shall be used for the operation by the commission of
direct service programs that would conflict with the
department's duties and functions as described by law.
(WIC 9203)
6) Establishes caregiver resource centers within
mental health statutes to support families and other
caregivers who care for adults with cognitive
impairments, including those suffering from strokes,
traumatic brain injuries. (WIC 4632)
This bill:
1) Names this bill the California Caregiver Act of
2014.
2) Makes 18 different Legislative findings and
declarations, including but not limited to:
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a. 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.
b. 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 to better serve the needs of
older persons with disabilities, support family
and friends in their caregiving roles, and
promote greater efficiencies in public spending.
c. In 2009, approximately 4 million family
caregivers in California provided an estimated
3.85 billion hours of unpaid labor to 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.
d. 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.
3) Requires the Department of Aging to 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 panel.
4) Requires that formation of the blue-ribbon panel be
contingent upon securing $200,000 of nonstate funds
from private sources for the purpose of implementing
this section.
5) Requires that each of the 13-panel members
represent one or more of the following categories:
a. A person with experience in the field of
academic research on caregiving.
b. A family caregiver for an adult with a
chronic or disabling condition.
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c. A representative of the mental health
community.
d. A representative of the California
caregiver resource centers.
e. A representative of the national
Alzheimer's Association.
f. A representative of an organization that
provides community-based adult services.
g. A representative of an organization that
provides an adult day program.
h. A representative of an organization that
provides services to caregivers.
i. A representative of an unpaid or family
caregiver consumer organization.
j. A representative with expertise in and
knowledge of the specific needs of culturally and
linguistically diverse caregivers and the unique
challenges of delivering services to family
caregivers who face cultural or linguistic
barriers.
aa. An adult with a chronic or disabling
condition who receives care from an unpaid
caregiver or family member.
bb. A director or designated representative
of an area agency on aging.
6) Requires the panel 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.
7) Requires the panel 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
8) Requires the panel compile an inventory of the
resources available to family caregivers, determine
gaps in services to family caregivers and identify
barriers to participation in current programs, and
consider cultural and linguistic factors that impact
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caregivers and care recipients who are from diverse
populations.
9) Requires the panel to consult with a broad range of
stakeholders, including 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.
10) Requires the panel to 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.
11) Requires the panel to identify best practices both
in California and in other states, and explore
expanding those best practices in caregiving programs
to populations that are not currently targeted.
12) Requires the panel to prepare a report of its
findings and at least three legislative
recommendations to improve the provision of services
for unpaid and family caregivers in California and to
submit that report to the Legislature on or before
July 1, 2016. The recommendations must 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.
13) Sunsets the requirement for submitting the report
on July 1, 2020.
14) Provides that panel members shall serve without
compensation, but shall receive reimbursement for
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travel and other necessary expenses actually incurred
in the performance of their official duties.
15) Requires the panel to meet on a bimonthly basis.
16) Requires all meetings of the panel to be open to
the public and adequate notice shall be provided in
accordance with the Bagley-Keene Open Meeting Act, as
specified.
FISCAL IMPACT
An analysis by the Assembly Committee on Appropriations
projected one-time GF costs to the Department of Aging to
support the study and report in the low hundreds of
thousands of dollars and minor ongoing GF costs, likely
under $50,000, to provide staff support and travel
reimbursement for panel activities.
BACKGROUND AND DISCUSSION
Purpose of the bill:
The bill requires the blue ribbon panel to identify
policies, resources and programs available for family
caregivers and prepare and provide a report of its findings
and recommendations to the Legislature by July 1, 2016. The
author cites research on the 4 million California family
caregivers of adults with limitations in daily activities
that estimates the economic value of their unpaid
contributions is approximately $47 billion annually.
By 2026, 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 significant drop, the author
writes. In 2010, the caregiver support ratio in California
was 7.7 potential caregivers for every person in the
high-risk years of 80-plus. By 2030, the ratio is projected
to decline sharply to 3.9 caregivers available to every 1
person who requires assistance with daily activities and to
2.7 to 1 in 2050, according to the author.
According to the author, California must get its arms
around what we currently have, explore the gaps in
services, hear from stakeholders on their needs and
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problems with access, and begin to expand our current best
practice offerings, grapple with communicating and
assisting our many diverse communities working tirelessly
to aid their loved ones, while also better-publicizing the
excellent programs we already do have. This bill requires
the California Department of Aging, upon securing $200,000
from private sources for the purpose of implementing this
activity, to convene a blue ribbon panel on family
caregiving and long-term support services. This bill will
provide family caregivers and our state invaluable data and
information as we move forward in addressing family
caregiving and long-term support service issues. The
author states that this bill was modeled after AB 491
(Alquist), which established the Alzheimer's advisory
committee within the Department of Public Health.
Aging population
Nationally, according to the U.S. Administration on Aging
(AoA), 40 million adults were aged 65 or older in 2009, the
latest year for which data is available, or about one in
every eight Americans. By 2030, the AoA calculated, there
will be about 72.1 million older persons, more than twice
their number in 2000. People aged 65 or older represented
12.4% of the population in the year 2000 but are expected
to grow to be 19% of the population by 2030.<1>
According to data on the Department of Aging website,
California's aging population has one of the nation's
fastest growth rates among the elderly. In California, the
elderly population is expected to grow more than twice as
fast as the total population and this growth will vary by
region.
Family caregivers
A 2011 report issued by the AARP Public Policy Institute
noted that about 42 million family caregivers in the United
States provided care to an adult with limitations in daily
activities in 2009, and nearly 62 million provided care at
some point during the year. The estimated economic value of
their unpaid contributions was approximately $450 billion
in 2009, according to the report, based on an average of
18.4 hours of care per week at an average value of $11.16
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<1> http://www.aoa.gov/Aging_Statistics/
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per hour.
According to data from the Centers for Disease Control
website, unpaid caregivers provided an estimated 90 percent
of the long-term care in 2008. The typical caregiver is a
46 year old woman with some college experience who provides
more than 20 hours of care each week to her mother. Just
over half of caregivers who said their health had gotten
worse due to caregiving also said the decline in their
health has affected their ability to provide care.
According to the AARP survey, "Valuing the Invaluable," one
in five women reported that caregiving strains their
household finances and that 42 percent of caregivers spend
more than $5,000 a year on caregiving expenses. However,
one of the more significant impacts on caregiving is the
emotional and physical toll on caregivers.
"An extensive body of research finds that
providing care to a chronically ill family member
or close friend can have profound negative
effects on the caregiver's own physical and
psychological health, increase social isolation
and adversely impact quality of life and
well-being. More than two-thirds of family
caregivers responding to an online survey said
that caring for a loved one was their number one
source of stress, ahead of the economic downturn
and other family health problems."
Caregiver resource centers
Every year, California's nonprofit Caregiver Resource
Centers serve more than 14,000 families and caregivers of
adults affected by chronic and debilitating health
conditions including dementia, Alzheimer's disease,
cerebrovascular diseases (such as stroke or aneurysms),
degenerative diseases such as Parkinson's, Huntington's and
multiple sclerosis, or traumatic brain injury among many
others.<2>
A 2012 report issued by the California Commission on Aging
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<2>
https://caregiver.org/californias-caregiver-resource-centers
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noted that the state faces serious caregiver challenges in
today's economic climate. As budgets are cut at the state
level, state policies are moving rapidly toward providing
more services to frail elders in the home, according to the
report, entitled "Celebrating Caregiving in California."
The Commission cautioned that policymakers must weigh the
value of protecting the interest of family caregivers
against the cost of institutionalization.
Related legislation
AB 753 (Lowenthal) Chapter 708, Statutes of 2013 requires
the Department of Health Care Services to contract directly
with nonprofit caregiver resource centers (CRCs) to provide
direct services to caregivers of cognitively impaired
adults, including specialized information, family
consultation, respite care, short-term counseling, and
support groups.
AB 491 (Alquist) Chapter 339, Statutes of 2008 requires the
California Department of Public Health to establish an
Alzheimer's Disease and Related Disorders Advisory
Committee, appoint members, and develop recommendations
about various policy issues related to Alzheimer's disease.
COMMENTS
1. While this bill raises valid concerns around the
issues of family caregivers, it leaves unanswered many
elemental questions. Staff recommends that before
being heard in the next committee, the author define
the following aspects of the bill:
Who is responsible for appointing members of the
panel
Duration of their terms
Consider permitting the panel to choose a chair and
vice chair, rather than having co-chairs with one of
them being statutorily designated
1. Additionally, staff recommends the author consider
whether to focus of the blue ribbon panel directly on
relative caregivers rather than including other
long-term care policies, as the title of the panel
suggests.
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2. Staff further recommends the author consider
reducing the number of findings and declarations to
eliminate a substantial amount of data that is
time-specific.
3. Finally, staff suggests the author consider
revising the following legislative recommendation to
broaden its scope: (B) Choices for care and residence
for persons with Alzheimer's disease and their
families.
4. Additionally, the author states that she plans to
amend the bill before it is heard in the next
committee to clarify in Section 3 that the department
is not responsible for raising the private funding,
but that it will simply create the panel once it is in
receipt of the funds.
PRIOR VOTES
Assembly Floor 76 - 0
Assembly Appropriations 14 - 3
Assembly Aging and Long Term Care 7 - 0
POSITIONS
Support: AARP (Sponsor)
Alzheimer's Association
Area 4 Agency on Aging
Association of California Caregiver Resource
Centers
California Assisted Living Association
California Association for Adult Day
Services
California Association of Area Agencies on
Aging
California Commission on Aging
California Senior Legislature
Congress of California Seniors
Family Caregiver Alliance/National Center on
Caregiving
SEIU California
UDW/AFSCME Local 3930
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Oppose: None received.
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