BILL ANALYSIS �
AB 2044
Page A
Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 2044 (Rodriguez) - As Amended: April 21, 2014
SUBJECT : Residential Care Facilities for the Elderly (RCFE)
SUMMARY : Places additional staffing and health and safety
requirements on a RCFE. Specifically, this bill :
1)Requires that at least one administrator, facility manager, or
other person designated by the administrator who is at least
21 years of age are on the premises of a RCFE at all times.
2)Clarifies the requirement that RCFEs employ a sufficient
number of staff to meet the needs of its residents as provided
in their service agreements and to ensure the health, safety,
comfort, and supervision of residents.
3)Requires that at least one staff member with a certification
in cardiopulmonary resuscitation (CPR) and first aid training
is on duty at all times.
4)Clarifies that RCFEs must be clean, safe, sanitary, and in
good repair at all times for the safety and well-being of
residents, staff, and visitors, as specified.
EXISTING LAW
1)Establishes the California RCFE Act, which requires facilities
that provide personal care and supervision, protective
supervision or health related services for persons 60 years of
age or older who voluntarily choose to reside in that facility
to be licensed by the California Department of Social
Services' (DSS) Community Care Licensing Division (CCLD).
(H&S Code 1569 and 1569.1)
2)Requires a RCFE administrator to be at least 21 years of age,
have a valid RCFE administrator certificate, as specified, and
hold a high school diploma or pass a general educational
development (GED) test, as specified. (H&S Code 1569.613).
3)Requires RCFE licensee applicants to successfully complete a
certification program approved by DSS, consisting of a minimum
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of 40 hours of classroom instruction, as specified, and
passage of a written test. (H&S Code 1569.23)
4)Requires RCFE licensees, administrators, facility managers and
staff to undergo a criminal background check and clearance
prior to operation or employment. (H&S Code 1569.17)
5)Requires RCFE administrator certification to consist of 40
hours of classroom instruction, for it to be renewed every two
years, and makes issuance of the renewal conditional upon the
administrator to submit documentation of completion of 40
hours of continuing education, which shall include eight hours
of training on providing care to residents with dementia, as
specified. (H&S Code 1596.616(f))
6)Permits a RCFE administrator to designate a "facility
manager;" defined as a person on the premises with the
authority and responsibility necessary to manage and control
the day-to-day operation of a RCFE and supervise residents.
(H&S Code 1596.618)
7)Requires RCFE staff to undergo ten hours of training within
the first four weeks of employment and four hours annually
thereafter, as specified. (H&S Code 1569.625)
8)Requires staff providing care to receive appropriate training
in first aid, as specified. (�87411(c)(1) of Title 22, CCR)
9)Requires RCFE staff to undergo an additional six hours of
training on providing care to residents with dementia within
the first four weeks of employment and eight hours of
in-service training on dementia care annually thereafter.
(H&S Code 1569.626)
FISCAL EFFECT : Unknown
COMMENTS :
Background : It is the intent of the Legislature, in
establishing the RCFE Act, to help provide a system of
residential care to allow older persons to be able to
voluntarily live independently in a homelike environment instead
of being forced to live in an institutionalized facility, such
as a nursing home, or having to move between medical and
nonmedical environments. RCFEs, commonly referred to as
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assisted living facilities, are licensed retirement residential
homes and board and care homes that accommodate and provide
services to meet the varying, and at times, fluctuating health
care needs of individuals who are 60 years of age and over, and
persons under the age of 60 with compatible needs. Licensed by
DSS' Community Care Licensing Division (CCLD), they can range in
size from residential homes with six or less beds to more formal
residential facilities with 100 beds or more.
There is also no uniform common care model; rather the types of
assistive services can vary widely, which can include differing
levels of personal care and protective supervision, based upon
the needs of the resident.
If a resident needs medical care in his or her residence in
order to maintain an independent lifestyle, incidental medical
services are permitted to be provided by a licensed or otherwise
approved external provider, such as a home healthcare agency
(HHA), which is licensed by the California Department of Public
Health. Additionally, some RCFEs, upon approval of DSS and
after having met specified orientation and training
requirements, may provide assistive memory care services to
individuals with dementia or Alzheimer's disease.
Existing regulations also lay out the circumstances under which
an individual may be allowed to reside in RCFEs. Specifically,
they include persons:<1>
Capable of administering their own medications;
Receiving medical care and treatment outside the
facility or who are receiving needed medical care from a
visiting nurse;
Who because of forgetfulness or physical limitations
need only be reminded or to be assisted to take medication
usually prescribed for self-administration;
With problems including, but not limited to,
forgetfulness, wandering, confusion, irritability, and
inability to manage money;
With mild temporary emotional disturbance resulting from
--------------------------
<1> Section 87455(b) of Title 22, California Code of
Regulations.
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personal loss or change in living arrangement;
Who are temporarily bedridden, as specified; and
Who are under 60 years of age whose needs are compatible
with other residents in care, if they require the same
amount of care and supervision as do the other residents in
the facility.
Regulations also provide specific prohibitions on individuals
who are allowed to reside in a RCFE, which includes whether the
resident has active communicable tuberculosis, requires 24-hour
skilled nursing or intermediate care, has an ongoing behavioral
or mental disorder, or has dementia, unless he or she is
otherwise permitted to be cared for in a RCFE by CCLD.<2>
Growing demand : Over the past thirty years, the demand for
RCFEs has grown substantially. Although RCFEs have been
generally available, they experienced explosive growth in the
1990s, more than doubling the number of beds between 1990 and
2002,<3> and continued to grow by 16 percent between 2001 and
2010.<4> Nationwide, states reported 1.2 million beds in
licensed RCFEs in 2010.<5> In 2010, the national Centers for
Disease Control reported that 40% of RCFE residents needed help
with three or more activities of daily living and three-fourths
of residents had at least two of the 10 most common chronic
conditions.<6>
According to DSS, as of March 5, 2014 there are 7,589 licensed
RCFEs in California with a capacity to serve 176,317 residents.
---------------------------
<2> Section 87455(c) of Title 22, California Code of
Regulations.
<3> Flores and Newcomer, "Monitoring Quality of Care in
Residential Care for the Elderly: The Information Challenge".
Journal of Aging and Social Policy, 21:225-242, 2009.
<4> SCAN Foundation. "Long Term Care Fundamentals: Residential
Care Facilities for the Elderly." March 2011.
http://thescanfoundation.org/sites/thescanfoundation.org/files/LT
C_Fundamental_7_0.pdf
<5> "Assisted Living and Residential Care in the States in
2010," Mollica, Robert, AARP Public Policy Institute
<6> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
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RCFE licensee and administrator requirements : California
statute differentiates between facility licensees, who often are
the business owners and may be property owners and
administrators who are charged with overseeing the quality of
the day-to-day operations and are generally required to be
present at the facility during normal working hours. However,
initial training and certification requirements for licensees
and administrators are similar.
At minimum, in order to be eligible to apply for a RCFE license,
a person must be at least 21 years of age, pass a criminal
background check and have a high school diploma or pass a GED
test. A prospective licensee must then provide evidence that he
or she is of "reputable and responsible character,"<7> which
includes providing their employment history and character
references. A prospective licensee must also document that he
or she has sufficient financial resources to maintain the
standard of care required by law and disclose any prior role as
an administrator or licensee of another community care facility,
including whether any disciplinary action was taken against him
or her.
Regarding training, a licensee and administrator are both
required to undergo 40 hours of classroom instruction in order
to be certified. This training covers relevant laws and
regulations and core competencies as follows:
Laws, regulations, and policies and procedural standards
that impact the operations of residential care facilities
for the elderly;
Business operations;
Management and supervision of staff;
Psychosocial needs of the elderly;
Community and support services;
Physical needs for elderly persons;
Use, misuse, and interaction of medication commonly used
by the elderly;
--------------------------
<7> Health and Safety Code 1569.15
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Resident admission, retention, and assessment
procedures;
Training focused specifically on serving clients with
dementia; and
Cultural competency and sensitivity in issues relating
to the underserved aging lesbian, gay, bisexual, and
transgender community.
Once completed, licensees and administrators must pass a written
exam administered by CCLD, and once they are certified,
licensees and administrators must renew their certification
every two years. However, in order for administrators to have
their certification renewed, they must have participated in at
least 40 hours of continuing education. The continuing
education hours are required to include at least eight hours of
education on providing dementia care, and no more than half of
the hours of continuing education can be completed through
online courses.
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"<8> 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 "advertise(s) or promote(s) special care, special
programming, or a special environment for persons with
dementia"<9> are required to undergo an additional six hours of
training on providing care to persons with dementia. Staff also
---------------------------
<8> Health and Safety Code 1569.625(b)
<9> Health and Safety Code 1569.626
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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.
All personnel, including the licensee, administrator and staff,
are required to undergo and receive a criminal background
clearance, and must demonstrate they are of good health, which
means they must be physically and mentally capable of performing
assigned tasks. In order to ensure that all personnel are of
good health, they are required to undergo a health screening not
more than six months prior to, or seven days after, employment
or licensure.<10>
Need for this bill : This measure seeks to increase the skill
set and personnel requirements for RCFEs by requiring at least
one staff person who is at least 21 years of age is on the
premises at all times and that he or she is certified in CPR and
first aid. It also provides additional clarification as to the
duties and roles of staff in providing for the health and safety
of residents. In doing so, the bill amends Section 1569.618 of
the Health and Safety code, which has not been amended since its
creation 25 years ago by SB 1166 (Mello) Chapter 1115, Statutes
of 1989. Under this section, an administrator is permitted to
appoint a facility manager, who would serve in his or her place
when the administrator is not on the premises of the RCFE. It
also permits the licensee, administrator and facility manager to
be the same person.
Although SB 1166 implemented many recommendations from a January
1989 Little Hoover Commission Report, which found severe
deficiencies in the state's oversight of RCFEs, its legislative
history is limited, especially in regards to the establishment
of Section 1569.618. As a result it is difficult to ascertain
why this section was established, but its function allows a
staff person to be appointed a facility manager while the
---------------------------
<10> Section 87411(f) of Title 22, California Code of
Regulations.
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administrator is absent from the facility. It can be presumed
that the purpose of this section is to allow a RCFE to ensure
there is a lead staff person on duty at all times through the
appointment of a staff person to serve as a facility manager.
However, it does not require a staff person serving as a
facility manager to have any additional training or necessary
skill set, yet it expects this person to have the "authority and
responsibility necessary to manage and control the day-to-day
operation of a residential care facility for the elderly and
supervise the clients." In practice, a facility manager is more
often appointed in larger facilities that have the need of a
staff person to serve in a supervisorial role during graveyard
shifts.
POLICY CONSIDERATIONS:
Although this bill gives further clarification to the
responsibilities and required expertise, e.g. CPR and first aid,
of RCFE staff, it does not specifically address whether a
facility manager should be required rather than permitted to
manage a facility in the absence of an administrator for larger
RCFEs. If a facility manager was required to be appointed, then
additional training and possible certification requirements
should be considered.
Should the Committee choose to pass this measure, it should
encourage the author to work with DSS and RCFE advocacy
organizations, including industry and resident based advocacy
organizations, to determine whether the bill should further
clarify whether to require the appointment of a facility manager
in a large facility. If so, the bill should include additional
language establishing a minimum level of training and
certification for a facility manager.
REGISTERED SUPPORT / OPPOSITION :
Support
California Advocates for Nursing Home Reform (CANHR)
California Long-Term Care Ombudsman Association (CLTCOA)
Long-Term Care Ombudsman Services, San Luis Obispo County
National Association of Social Workers, CA Chapter (NASW-CA)
Opposition
AB 2044
Page I
None on file.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089