BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 2171 (Wieckowski) - Residential care facilities for the
elderly: bill of rights.
Amended: June 15, 2014 Policy Vote: Judiciary 5-2
Urgency: No Mandate: Yes
Hearing Date: August 4, 2014
Consultant: Jolie Onodera
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 2171 would establish a bill of rights for
residents of residential care facilities for the elderly (RCFE)
in order to strengthen a resident's right to make choices about
his or her care, treatment, and daily life in the facility. This
bill would authorize a private right of action by a current or
former resident against an RCFE for violations and authorize
specified damages, attorney's fees, costs, and injunctive
relief. This bill would provide for a three-year statute of
limitations from the date of discovery of the violation, and
would allow the RCFE to cure a violation before an action can be
filed.
Fiscal Impact:
Potentially significant cost pressure (General Fund*) on
trial courts under the new private right of action. There
are nearly 7,500 RCFE facilities and 145,000 licensed beds
in the state. Actual costs would be dependent on the number
and complexity of cases brought forward.
One-time costs to the Department of Social Services (DSS)
of about $250,000 (General Fund) to promulgate regulations
and review RCFE plans of operation to ensure compliance.
Potentially significant ongoing costs (General Fund) to the
DSS for enforcement of the mandatory assessment of penalties
for violations of rights defined in the bill.
Unknown, potential enforcement costs (General Fund) to the
Department of Justice (DOJ), offset to a degree by fine
revenue to the extent the Attorney General prosecutes cases.
Potential cost pressure (General Fund) to the California
Department of Veterans Affairs (CDVA) which operates seven
RCFEs within the state, to the extent this bill increases
litigation against CDVA facilities.
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*Trial Court Trust Fund
Background: The Community Care Licensing Division (CCLD) of the
DSS administers the licensure and oversight of over 7,500
assisted living, board and care, and continuing care retirement
homes that are licensed as RCFEs in California. These residences
are designed to provide home-like environment housing options to
elderly residents who need assistance with activities of daily
living but otherwise do not require continuous, 24-hour
assistance or nursing care. The RCFE licensure category includes
facilities with as few as six beds to facilities with hundreds
of residents whose needs may vary widely.
In response to health and safety issues discovered at facilities
licensed by the CCLD, the 2014 Budget Act includes a
comprehensive plan to reform the CCLD program. The Budget
includes an increase of $7.5 million ($5.8 million General Fund)
and 71.5 positions to improve the timeliness of investigations,
ensure the CCLD inspects all facilities at least once every five
years, increase staff training, and establish clear fiscal,
program, and corporate accountability. The Budget also increases
licensing and application fees by 10 percent.
Proposed Law: This bill would establish the "Resident's Bill of
Rights" for current and former RCFE residents, including a
statutory list of 29 enumerated rights, which would not diminish
a resident's constitutional rights or any other rights set forth
in other state or federal laws and regulations. The list
includes but is not limited to the following:
To be granted a reasonable level of personal privacy in
accommodations, medical treatment, personal care and
assistance, visits, communications, telephone
conversations, use of the internet, and meetings of
resident and family groups;
To confidential treatment of their records and personal
information and to approve their release, except as
authorized by law;
To be free from interference, coercion, discrimination,
and retaliation in exercising their rights;
To fully participate in planning their care, including
the right to attend and participate in meetings or
communications regarding the care and services, and to
involve persons of their choice in the planning process;
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the facility would be required to provide necessary
information and support to ensure that residents direct the
process to the maximum extent possible, and are enabled to
make informed decisions and choices;
To contact DSS, the long-term care ombudsman, or both,
regarding grievances against the facility, and the facility
would be required to post the telephone numbers and
addresses for the local offices of DSS and ombudsman
program, conspicuously in the facility foyer, lobby,
residents' activity room, or other location easily
accessible to residents;
To be fully informed, as evidenced by the resident's
written acknowledgement, prior to or at the time of
admission, of all rules governing residents' conduct and
responsibilities, and all rules established by a facility
would be required to be reasonable and not violate any
personal or lawful rights;
To receive in the admission agreement a comprehensive
description of the method for evaluating residents' service
needs and the fee schedule for the items and services
provided, and to receive written notice of any rate
increases;
To written notice of any room changes at least 30 days
in advance unless the request for a change is initiated by
a resident, required to fill a vacant bed, or necessary due
to an emergency;
To select their own physicians, pharmacies, privately
paid personal assistants, hospice agency, and health care
providers;
To be protected from involuntary transfers, discharges,
and evictions in violation of state laws and regulations -
facilities would be prohibited from involuntarily transfer
or eviction of residents for grounds other than those
specifically enumerated under state law or regulations, and
facilities would be required to comply with enumerated
eviction and relocation protections for residents.
Further, a facility would be required to provide 90 days'
notice to a resident prior to involuntarily transfer,
discharge, or eviction, and this bill would define
"involuntary" to mean a transfer, discharge, or eviction
that is initiated by the facility, not by the resident;
To have relatives and other individuals of the
resident's choosing visit at any time, subject to the
resident's right to withdraw consent;
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To receive written information on the right to establish
an advanced health care directive and, the facility's
written policies on honoring those directives;
To manage their financial affairs - the facility would
be prohibited from requiring residents to deposit their
personal funds with the facility. Further, a licensee and
employee of a facility would be prohibited from becoming or
acting as a representative payee for any payments made to a
resident, if the resident or the resident's representative
objects, and the licensee and employee of the facility
would be prohibited from serving as agent for a resident
under a power of attorney.
This bill would provide for the enforcement of the statutory
list of rights through a private right of action after the
facility has been given at least a 30-day period to remedy an
alleged violation. This bill authorizes the Attorney General to
prosecute an action for an injunction or civil damages, and
requires the DSS to assess civil penalties of up to $500 for
each violation of a right defined by this bill.
Related Legislation: The following bills regarding licensing and
inspections at community care facilities, and RCFEs
specifically, have been introduced this session:
SB 894 (Corbett) RCFEs: revocation of license.
SB 895 (Corbett) RCFEs: annual inspections.
SB 911 (Block) RCFEs: training.
SB 1153 (Leno) RCFEs: suspension of new admissions.
SB 1382 (Block) RCFEs: licensure fees.
AB 1436 (Waldron) RCFEs: internet posting of inspection reports.
AB 1454 (Calderon) Care facilities: annual inspections.
AB 1523 (Atkins) RCFEs: liability insurance.
AB 1554 (Skinner) RCFEs: complaint procedures.
AB 1570 (Chesbro) RCFEs: training.
AB 1571 (Eggman) RCFEs: disclosure requirements.
AB 1572 (Eggman) RCFEs: single resident council.
AB 1899 (Brown) RCFEs: prohibitions on licensure reinstatement.
AB 2044 (Rodriguez) RCFEs: 24-hour presence of
administrator/staff.
Staff Comments: The DSS would likely incur one-time costs
potentially in excess of $250,000 (General Fund) to promulgate
regulations and review RCFE plans of operation to ensure
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compliance with the provisions of this bill. The DSS would also
incur potentially significant ongoing costs (General Fund) for
enforcement of the mandatory assessment of penalties for
violations of rights defined in the bill.
The private right of action authorized in this measure could
potentially result in significant cost pressure (General Fund)
on trial courts. There are nearly 7,500 RCFE facilities and
145,000 licensed beds in the state. Actual costs would be
dependent on the number and complexity of cases brought forward.
As an example, should just one resident per 1,000 facilities
bring forth an action requiring one week of court time, at
$4,000 per court day, costs to the courts would exceed $1.4
million (General Fund). Enforcement costs to the DOJ associated
with cases prosecuted by the Attorney General would be dependent
on the number and complexity of cases handled by the AG in any
one year.
As the California Department of Veterans Affairs (CDVA) operates
seven RCFEs within the state, to the extent this bill increases
litigation against CDVA facilities would also create cost
pressure in terms of resources necessary to defend these cases.