BILL ANALYSIS �
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THIRD READING
Bill No: AB 1821
Author: Gordon (D), et al.
Amended: 6/17/14 in Senate
Vote: 21
SENATE VETERANS AFFAIRS COMMITTEE : 6-0, 6/24/14
AYES: Hueso, Knight, Correa, Lieu, Nielsen, Roth
NO VOTE RECORDED: Block
SENATE APPROPRIATIONS COMMITTEE : 5-0, 8/14/14
AYES: De Le�n, Hill, Lara, Padilla, Steinberg
NO VOTE RECORDED: Walters, Gaines
ASSEMBLY FLOOR : 78-0, 5/28/14 - See last page for vote
SUBJECT : Medical foster homes
SOURCE : Author
DIGEST : This bill establishes the Medical Foster Home (MFH)
Pilot Program and commencing June 1, 2015, and until January 1,
2018, authorizes a United States Department of Veterans Affairs
(VA) facility to establish a MFH that is not subject to
licensure or regulation as a residential care facility for the
elderly, a community care facility, or a residential care
facility for persons with chronic, life-threatening illnesses
provided that specified federal requirements are satisfied, the
VA facility establishing the home agrees to be subject to the
jurisdiction of the State Auditor, and the VA obtains criminal
background information for caregivers and specified individuals
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residing in the home.
ANALYSIS :
Existing federal law:
1.Establishes the VA, which is responsible for administering
various programs and services for the benefit of veterans.
Existing state law:
2.Provides for the licensure of residential care facilities for
the elderly by the Department of Social Services (DSS) under
the California Residential Care Facilities for the Elderly
(RCFE) Act.
3.Exempts specified facilities from DSS licensure, including
general acute care hospitals, clinics, and recovery houses for
individuals with drug or alcohol addiction.
4.Authorizes the State Auditor, upon the request by the Joint
Legislative Audit Committee (JLAC) and to the extent funding
is available, to audit a state or local governmental agency,
as defined, or any other publicly created entity.
This bill:
1.Authorizes - no sooner than June 1, 2015, and only until
January 1, 2018 - a pilot program in which the VA facility may
establish a MFH, which is not subject to licensure or
regulation under the RCFE Act provided that:
A. Specified federal requirements are satisfied;
B. The VA facility establishing the home agrees to be
subject to the jurisdiction of the State Auditor; and
C. The VA obtains criminal background information for
caregivers and specified individuals residing in the home.
1.States the Legislature's intent that the State Auditor,
through a request to the JLAC, conduct an audit evaluating the
program created by this bill no sooner than January 1, 2016,
as specified.
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Background
Residential Care Facilities for the Elderly . The Community Care
Licensing (CCL) division of DSS develops and enforces
regulations designed to protect the health and safety of
individuals in 24-hour residential care facilities and day care.
These facilities include child care centers, RCFEs, and foster
family homes and group homes.
The approximately 7,500 RCFEs in California are licensed to
provide housing and a range of supportive services, such as
assistance with activities of daily living, for up to 175,000
people annually.
Traditionally, RCFEs have been used as nonmedical placements for
individuals with less acute medical needs than those who qualify
for skilled nursing home placement, with some exceptions.
Nearly 80% of California's RCFEs are licensed for four to six
beds.
MFH Care and Elder Veterans . The federal VA oversees the MFH
program. According to the VA, MFHs are private homes in which a
trained caregiver provides services to a few individuals. Some,
but not all, residents are veterans. VA inspects and approves
all MFH, but does not actually provide or pay for the homes.
MFHs often serve as an alternative to a nursing home. It may be
appropriate for veterans, who require nursing home care but
prefer a non-institutional setting with fewer residents.
MFHs have a trained caregiver on duty 24/7. This caregiver can
help the Veteran carry out activities of daily living (e.g.,
bathing and getting dressed). The VA ensures that the caregiver
is well trained to provide VA planned care. While living in a
MFH, Veterans receive Home Based Primary Care services.
To be eligible for a MFH, a veteran must be enrolled in Home
Based Primary Care, which is a VA program through which health
care services are provided to veterans in their homes. Veterans
must pay for the MFH themselves or rely on other insurance. The
charge for a MFH is about $1500 to $3000 each month based on
income level and level of care required.
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Typical services provided to veterans by a MFH caregiver
include:
Help with your activities of daily living (e.g., bathing and
getting dressed);
Help in taking medications;
Some nursing assistance, if the caregiver is a registered
nurse;
All meals; and
Planned recreational and social activities.
Comments
According to the author's office, MFHs are home-based care
models for mostly older and medically frail veterans needing
assisted living care. MFHs provide 24-hour a day, 7-days a week
care for up to a maximum of three eligible veterans in a private
home. MFHs are currently operational at more than 83 sites in
39 states.
To qualify for the MFH program, a veteran must first be enrolled
in the VHA's Home Based Primary Care program. In this program
the veteran's medical care is provided by an interdisciplinary
team of physicians, nurses, aides, and others which are all
provided by the VHA. The private home, where the veteran is
placed, is also monitored closely by the VHA under strict
standards required of the caregivers. Families who volunteer to
participate in the MFH program must be approved by the VHA's
interdisciplinary team as well as submit income statements, and
train in CPR.
Additionally, the MFHs are routinely inspected by the VHA.
Veterans pay room and board in the MFH program; however, the
Veterans Benefits Administration's "Aid and Attendance" benefit
and Social Security benefits are generally anticipated to cover
these costs. MFHs are distinguished from other typical
residential care homes or facilities because a MFH caregiver is
required to reside in their own private home while providing
24-hour personal care and supervision to the veteran. The
veteran, in turn, receives their medical care through the VHA in
a highly regulated, yet independent, community-based setting.
Currently, the federal MFH program can only exist in California
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if operated as and under the RCFE Act. Unfortunately, that law
does not envision the MFH model under traditional assisted
living care such that all potential MFH caregivers would need to
have their personal home licensed, they would have to become a
Certified Administrator for RCFE, and they would also incur all
the costs associated with their training and licensure. This
creates a barrier for caregivers to open their home to a veteran
and limits the growth of the program in our state.
In addition, placements in existing RCFEs are not financially
feasible due to the three-veteran limitation, as most "board and
care" RCFEs have up to six residents residing in one location.
Therefore, the RCFE requirements impede California veterans from
having similar opportunities as veterans in other states who are
able to "age in place" with dignity and independence, in a
home-like environment with a loving and caring foster family.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee, State Auditor
costs of up to $200,000 (General Fund).
SUPPORT : (Verified 8/8/14)
AARP
AMVETS - Department of California
California Commission on Aging
California State Commanders Veterans Council
Leading Age California
Public Law Center - Operation Veterans Re-entry Unit
Veterans Caucus of the California Democratic Party
VFW - Department of California
Vietnam Veterans of America - California State Council
ASSEMBLY FLOOR : 78-0, 5/28/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell,
Gray, Grove, Hagman, Hall, Harkey, Roger Hern�ndez, Holden,
Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal,
Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi,
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Nazarian, Nestande, Olsen, Pan, Patterson, Perea, John A.
P�rez, V. Manuel P�rez, Quirk, Quirk-Silva, Rendon,
Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner,
Waldron, Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
NO VOTE RECORDED: Donnelly, Vacancy
AL:e 8/16/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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