BILL ANALYSIS �
AB 2044
Page A
ASSEMBLY THIRD READING
AB 2044 (Rodriguez)
As Amended April 21, 2014
Majority vote
HUMAN SERVICES 6-0 APPROPRIATIONS 13-0
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|Ayes:|Stone, Maienschein, |Ayes:|Gatto, Bocanegra, |
| |Ammiano, | |Bradford, |
| |Ian Calderon, Garcia, | |Ian Calderon, Campos, |
| |Hall | |Eggman, Gomez, Holden, |
| | | |Linder, Pan, Quirk, |
| | | |Ridley-Thomas, Weber |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Places additional staffing and health and safety
requirements on residential care facilities for the elderly
(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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Minor and absorbable costs to the Department of Social
Services (DSS) to modify their training regulations.
AB 2044
Page B
2)Unknown costs to facility owners or licensees to meet the
increased health and safety requirements and ensure adequate
staffing levels.
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
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.
Growing demand: Over the past 30 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,<1> and
continued to grow by 16% between 2001 and 2010.<2> Nationwide,
states reported 1.2 million beds in licensed RCFEs in 2010.<3>
In 2010, the national Centers for Disease Control and Prevention
reported that 40% of RCFE residents needed help with three or
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<1> 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.
<2> 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
<3> "Assisted Living and Residential Care in the States in
2010," Mollica, Robert, AARP Public Policy Institute
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more activities of daily living and three-fourths of residents
had at least two of the 10 most common chronic conditions.<4>
According to DSS, as of March 5, 2014, there are 7,589 licensed
RCFEs in California with a capacity to serve 176,317 residents.
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,"<5> 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.
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"<6> 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
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<4> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
<5> Health and Safety Code Section 1569.15
<6> Health and Safety Code Section 1569.625(b)
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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"<7> are required to undergo an additional six hours of
training on providing care to persons with dementia. Staff also
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.<8>
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 Health and Safety
Code Section 1569.618, which has not been amended since its
creation 25 years ago by SB 1166 (Mello), Chapter 1115, Statutes
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<7> Health and Safety Code Section 1569.626
<8> Section 87411(f) of Title 22, California Code of
Regulations.
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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.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
FN: 0003490