BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: SB 911
S
AUTHOR: Block
B
VERSION: March 27, 2014
HEARING DATE: April 8, 2014
9
FISCAL: Yes
1
1
CONSULTANT: Sara Rogers
SUBJECT
Residential Care Facilities for the Elderly
SUMMARY
This bill increases the number of hours of classroom
instruction, and adds to the uniform core of knowledge,
that licensees and administrators of Residential Care
Facilities for the Elderly (RCFEs) must meet for initial
certification and continuing education training. This bill
increases the training requirements for facility staff that
assist residents with personal activities, as specified,
and adds topics that shall be included in the training.
Additionally, this bill requires facilities that accept or
retain residents with restricted or prohibited health
conditions to employ a registered nurse on a full-time or
part-time basis and to provide for a registered nurse to be
on call 24 hours per day.
ABSTRACT
Existing Law:
1.Establishes the Residential Care Facilities for the
Continued---
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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Elderly Act which provides for the California Department
of Social Services (CDSS) to license and regulate RCFEs
as a separate category within the existing residential
care licensing structure of CDSS. (HSC 1569 et seq.)
2.Requires applicants for an RCFE license to file an
application including a criminal record clearance,
employment history, character references, evidence of
certification, and disclosure of previous service in
other RCFEs, outpatient health clinics, health facilities
(including hospitals, skilled nursing facilities or
intermediate face facilities), or a community care
facility, among other requirements. (HSC 1569.15)
3.Requires a license applicant and an RCFE administrator to
successfully complete a certification program approved by
the department, which shall include a minimum of 40 hours
of classroom instruction including a uniform core of
knowledge, as specified. (HSC 1569.23 and HSC 1569.616)
4.Provides that RCFE administrator certification shall be
valid for two years and that recertification shall
require 40 hours of continuing education. Through
regulation provides that an applicant for licensure shall
meet the requirements for initial certification of
administrators. (HSC 1569.616 (f), Title 22 CCR 87155 and
87406)
5.Provides that the initial certification of administrators
shall include successful completion of a
department-approved program, passage of a written test
administered by the department within 60 days, and a
criminal records clearance. (Title 22 CCR 87406)
6.Requires CDSS to develop requirements for a uniform core
of knowledge for the initial certification and continuing
education requirements for licensees, administrators and
staff of RCFEs. Provides that this knowledge base shall
include basic understanding of the psychosocial and
physical care needs of elderly persons. (HSC 1569.62)
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7.Provides that RCFE staff members who assist residents
with activities of daily living shall receive at least 10
hours of initial training within the first four weeks of
employment and at least four hours annually thereafter.
(HSC 1569.625 and Title 22 CCE 87411)
8.Requires CDSS to develop a uniform assessment tool to be
used by all RCFEs in identifying resident needs for
service and assistance with daily living. (HSC 1569.62)
9.Requires facility personnel to be sufficient in numbers
and competent to provide the services necessary to meet
resident needs. Provides that the department may require
any facility to provide additional staff whenever if
determines through documentation that the needs of the
particular residents, the extent of services provided, or
the physical arrangements of the facility require
additional staff. (Title 22 CCE 87411)
This bill:
1.Requires RCFE licensee certification to consist of 100
hours of training, up from the current 40-hour
requirement, of which 80 hours shall be classroom
instruction. Additionally, expands the uniform core of
knowledge to address use of psychotropic drugs,
nonpharmacologic approaches to dementia care and the
importance of residents' rights training.
2.Requires RCFE administrator initial certification
training to include 100 hours of in training and 60 hours
of continuing education for recertification.
Additionally, expands the uniform core of knowledge to
address use of psychotropic drugs, nonpharmacologic
approaches to dementia care and the importance of
residents' rights training.
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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3.Adds to the CDSS requirement to develop regulations for
licensee and administrator certification and testing the
additional participation of stakeholder groups and the
requirement to review the test annually and update it as
necessary to reflect changes in law and regulations.
4.Prohibits a licensee, or officer or employee of the
licensee from discriminating or retaliating against an
RCFE resident or employee, on the basis, or for the
reason that the person dialed or called 911.
5.Requires an RCFE that accepts or retains residents with
prohibited health conditions, as defined by the
department, to ensure that residents receive home health
or hospice services sufficient in scope and hours to
ensure that residents receive medical care as prescribed
by the resident's physician and contained in the
resident's service plan.
6.Requires an RCFE that accepts or retains residents with
restricted health conditions, as defined by the
department, to ensure that residents receive medical care
as prescribed by the resident's physician and contained
in the resident's service plan by appropriately skilled
professionals acting within their scope of practice.
7.Defines appropriately skilled professional to mean an
individual who has training and is licensed to perform
the necessary medical procedures prescribed by a
physician. Specifies that this includes, but is not
limited to, a registered nurse, licensed vocational
nurse, physical therapist, occupational therapist, or
respiratory therapist, as defined.
8.Provides that failure to meet or arrange to meet the
needs of residents who require specialized health
services, or failure to notify the physician of a
resident's illness or injury that poses a danger of death
or serious bodily harm is a licensing violation and
subject to civil penalty pursuant, as specified.
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9.Requires CDSS to develop a uniform resident assessment
tool to be used by all residential care facilities for
the elderly. The assessment tool shall, in lay terms,
help to identify resident needs for service and
assistance with activities of daily living.
10.Requires staff who assist residents with activities of
daily living to receive 40 hours of training within the
first four weeks of employment, an increase from the
existing 10-hour requirement. Requires that 24 of them be
completed prior to the provision of direct care, and
requires staff to receive an additional 20 hours of
continuing training annually. Requires the training to be
developed in consultation with individuals or
organizations with specific expertise in RCFE or assisted
living services.
11.Expands the staff training curriculum to address the
use, misuse, and interaction of drugs commonly used by
the elderly, the adverse effects of psychotropic drugs
for use in controlling the behavior of persons with
dementia and nonpharmacologic person-centered approaches
to dementia care.
12.Exempts certified nurse assistants with valid
certification from the staff training requirements,
except that exempted CNAs shall receive eight hours of
training on resident characteristics, resident records
and facility practices and procedures.
13.Permits CDSS to develop a certification training program
with a standardized test for RCFE staff.
14.Requires facilities that advertise or promote special
care, special programming or a special environment for
persons with dementia to provide to staff 15 hours of
resident care orientation (increased from six hours)
prior to providing direct care to residents, and removes
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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the requirement that the requirement that the training
must be provided within the first four weeks of
employment.
15.Requires RCFEs that advertise or promote care for
persons with dementia to increase in-service training
requirements from eight to 12 hours annually.
16.Requires RCFEs with 16 or more residents to increase
training for staff who assist residents with the
self-administration of medications from 16 to 32 hours.
Of these hours, increases from eight to 12, the number of
hours of hands-on shadow training to be completed prior
to assisting residents with medications and increases
from eight to 20 hours other training or instruction, to
be completed within the first four weeks of employment
(increased from two weeks).
17.Requires RCFEs with 15 or fewer residents to increase
training for staff who assist residents with the
self-administration of medications from six to 16 hours.
Of these hours, increases, from two to eight, the number
of hours of hands-on shadow training to be completed
prior to assisting residents with medications and from
four to eight hours other training or instruction, to be
completed within the first two weeks of employment.
18.Further increases the annual number of continuing
training hours, from four to eight, of in-service
training on medication-related issues for employees who
assist residents with self-administration of medications.
19.Increases the training curriculum for staff assisting
with the self-administration of medication to include and
explanation of adverse effects of psychotropic drugs for
use in controlling the behavior of persons with dementia
and the increased risk of death when elderly residents
with dementia are given anti-psychotic medications.
20.Adds new training requirements for staff working in
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facilities that serve residents with postural supports,
restricted health conditions, or hospice services as
follows:
15 hours on the care, supervision, and special
needs of those residents prior to providing direct
care.
12 hours thereafter of in-service training per
year.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, California's RCFE law is more than
20 years old and has not been updated to reflect changes in
medical and industry practices in caring for the elderly.
The author states that RCFEs now serve more residents with
serious health problems and higher levels of dementia who
previously would have been treated in nursing homes and
that, as a result, the lack of qualifications and training
required of administrators and direct care staff are
inadequate to meet the residents' needs for care and
supervision.
The author cites a series of in-depth investigative reports
from the San Diego Union Tribune which found that hundreds
of seniors have suffered broken bones, deadly bedsores and
sexual assaults in San Diego alone. The articles cite
repeated incidents in which facility staff failed to
contact the residents' physicians or call 911 following
serious injuries, often related to falls or severe
bedsores.
Residential Care Facilities for the Elderly
Within California's continuum of long term care, situated
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between in-home care and skilled nursing facilities, is the
RCFE, also commonly called Assisted Living, Board and Care,
or Residential Care. There are approximately 8,000 Assisted
Living, Board and Care, and Continuing Care Retirement
homes that are licensed as RCFEs in California. These
residences are designed to provide homelike housing options
to seniors and other adults who need some help with
activities of daily living, such as cooking, bathing, or
getting dressed, but otherwise do not need continuous,
24-hour assistance or nursing care. Increasingly residents
are entering RCFEs with significant health needs including
diabetes, bedsores, or require the use of oxygen tanks,
catheters, colostomies or ileostomies.
The RCFE licensure category includes facilities with as few
as six beds to those with hundreds of residents, whose
needs may vary widely. Typically, the smaller facilities
are homes in residential neighborhoods while the larger
facilities resemble apartment complexes with structured
activities for their residents. Residents may reside in
their own apartment, or may share a bedroom. Generally,
residents are free to leave the facility if they choose,
and may entertain guests, and otherwise maintain a high
level of independence. Facilities licensed to serve
residents with dementia or Alzheimer's disease, also known
as "memory care units" may maintain a secure perimeter.
Licensee and Administrator training requirements
Existing law requires prospective licensees and facility
administrators to complete a certification program approved
by the department consisting of 40 hours of classroom
instruction. Statute requires that the curriculum for both
include:
Laws, regulations, policies and procedural
standards that impact RCFE operations, including
residents personal rights (8 hours);
Business operations (3 hours);
Management and supervision of staff (3 hours);
Psychosocial need of elderly residents (5 hours);
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Physical needs for elderly residents (5 hours);
Community and support services (2 hours);
Use, misuse and interaction of drugs commonly used
by the elderly (5 hours);
Resident admission, retention, and assessment
procedures (5 hours);
Care of residents with Alzheimer's Disease and
other dementias (4 hours)
This bill requires a total of 100 hours of initial
instruction as well as 60 hours annually of continuing
education instruction and would expand the curriculum to
additionally include:
Adverse effects of psychotropic drugs for use in
controlling behavior of persons with dementia;
Nonpharmacologic, person centered approaches to
dementia care;
Residents rights and residents rights and the
importance of ongoing training for staff to ensure
residents rights.
Typically, the 40-hour requirements are met through private
vendors who have been approved by CDSS to conduct these
trainings. The courses are generally scheduled as four,
consecutive 10-hour-day trainings, costing approximately
$200 to $300. Following the training, prospective
administrators are required to pass a 40-question test
administered by the Department that has not been changed
since its initial release. Approximately 500 individuals
take the exam every month. Reportedly, the several versions
of the test are available online to be studied in advance
and few individuals fail the exam. Licensees must only pass
their initial certification and are not required to
maintain a current certification which expires after two
years. Additionally, corporate owners of a facility, who
are not the official licensee, are not themselves required
to be licensed or have any training despite having
financial and managerial control over the facilities they
manage.
Restricted or Prohibited Health Conditions
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California law provides that RCFEs may accept or retain
persons who are capable of administering their own
medications (or need only be reminded due to forgetfulness
or assisted due to physical limitations), who receive
medical care outside the facility or from a visiting nurse,
persons with mild temporary emotional disturbance,
forgetfulness, irritability, wandering, confusion, or
inability to manage money, or persons who are bedridden
(provided fire clearance requirements are met). (Title 22
CCR 87455)
California statute prohibits RCFEs from accepting residents
who require 24-hour skilled nursing or intermediate care.
Additionally, regulation prohibits RCFEs from accepting
residents who depend on others to perform all activities of
daily living, residents whose primary need for care and
supervision results from an ongoing behavior caused by a
mental disorder<1> and prohibits the acceptance of
residents with certain medical conditions including stage 3
or 4 pressure sores, gastronomy care, naso-gastric tubes,
staph infections or other serious infections, and
tracheotomies.<2>
RCFEs may accept residents who are permanently bedridden if
the facilities meet requirements pertaining to sufficiency
and training of staff, availability of appropriate
equipment or devices and obtain the proper fire
clearances.<3> Regulations require that RCFES that accept
bedridden residents must include a statement of how the
facility intends to meet those residents' overall health,
safety and care needs in the facility Plan of Operation.
This plan must include how the facility will meet the needs
-------------------------
<1> Title 22 CCR 87455
<2> Title 22 CCR 87615
<3> CCL Information Release 2007-04
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of bedridden residents with dementia, or those who are
terminally ill. In addition, each bedridden resident's
record must include documentation to demonstrate the
facility is meeting the needs of individual residents,
staff must receive training specific to care of bedridden
residents, and the facility's register of residents much
include information related to bedridden residents.<4>
Regulation permits a licensee to submit a written exception
request for prohibited and or restricted health conditions,
and CDSS states that it evaluates every exception request
to ensure that the resident's physician has determined that
it remains an appropriate placement for the resident and
that the facility is equipped to address the medical needs
of the resident. CDSS provides facilities that intend to
serve hospice patients with facility-wide hospice waivers
instead of approving case-by-case exceptions determined by
individual LPAs.
Residents with "restricted health conditions," which
otherwise fall short of a prohibited condition or hospice
care, may be cared for in an RCFE by "appropriately skilled
staff" either through home health agencies or by hired
medical staff. Any medical care provided in this manner
must be provided consistent with the medical practitioner's
scope of practice. Regulation defines "Appropriately
Skilled Professional" to mean:
"[A]n individual that has training and is licensed to
perform the necessary medical procedures prescribed by
a physician. This includes but is not limited to the
following: Registered Nurse (RN), Licensed Vocational
Nurse (LVN), Physical Therapist (PT), Occupational
Therapist (OT) and Respiratory Therapist (RT). These
professionals may include, but are not limited to,
those persons employed by a home health agency, the
resident, or facilities and who are currently licensed
in California."
----------------------
<4> Title 22 CCR 87606 (f)
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RCFEs are prohibited from permitting facility staff from
administering injections, or from forcing or camouflaging
medications and staff may assist with the
self-administration of medications only when the
medications have been prescribed by the resident's
physician. If a resident's physician states in writing that
the resident is unable to determine his/her need for PRN
(as needed) medication and is unable to communicate
symptoms clearly then facility staff is only permitted to
assist in the self-administration of medications after
having contacted the resident's physician. The physician
must be contacted prior to each dose being administered,
and this information must be recorded in the patient's
record, along with the date and time that the medication
was taken.<5>
Facilities are additionally permitted to accept and retain
residents with health conditions that require incidental
medical services that may be provided through a licensed
home health agency. In such instances, the facility is
required to provide the care and supervision to the
residents and the facility and home health agency must
agree in writing on the responsibilities of each party. The
licensee must inform the home health agency of any duties
that facility staff members are prohibited from
performing.<6>
Staffing requirements
-------------------------
<5> Title 22 CCR 87465
<6> Title 22 CCR 87609
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Existing law requires facility personnel to be sufficient
in numbers and competent to provide the services necessary
to meet resident needs. The department may require a
facility to provide additional staff whenever it determines
that the needs of the particular residents, the extent of
services provided, or the physical arrangements of the
facility require additional staff. Additionally,
regulations require RCFEs to ensure that the resident is
cared for in accordance with the physician's orders and
that the resident's medical needs are met. Facility staff
members are required to have the knowledge and skills to
respond to problems and to contact the physician,
appropriately skilled professional or vendor as
necessary.<7>
Residents are required to have a preadmission appraisal
performed and documented that includes an evaluation of the
resident's functional, mental and social needs, in order to
determine the level of care and supervision that each
resident requires. Additionally, residents must have a
medical assessment completed that must be signed by a
physician, made within the last year and kept on file. The
functional assessment is required to determine the
prospective resident's ability to perform detailed
activities of daily living including bathing, dressing,
grooming, continence, eating and physical condition.
Additionally facilities are required to complete a needs
and services appraisal/plan to determine the amount of
supervision that is necessary.<8>
Placement agencies (defined to include county welfare,
social service or mental health departments, county public
guardians, hospital discharge planners or coordinators
public or private agencies providing placement or referral
services, conservators and regional centers) who are
engaged in finding homes or other places for the placement
-------------------------
<7> Title 22 CCR 87411 and 87611
<8> Title 22 CCR 87458, 87459 and 87461 and LIC forms 602A,
603, 603A, 604A and 625
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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of elderly persons for temporary or permanent care are
required to report to the department any situation in which
a facility has insufficient personnel or incompetent
personnel on duty.
Regulations additionally require facilities to have and
maintain a current, written definitive plan of operation
that is required to be submitted to the licensing agency
with their application.<9> The plan includes, among other
things, a statement of admission policies and procedures
for accepting residents as well as the staffing plan,
qualifications and duties. Additionally, facilities are
required to submit a written report to the licensing agency
and the resident's responsible person when certain
incidents occur that may impact the health and safety of
residents.<10>
Staff training requirements
Existing law permits CDSS to adopt regulations to require
RCFE staff members who assist residents with activities of
daily living to receive ten hours of training. Statute and
regulation provide that this training shall include:<11>
The aging process and physical limitations and
special needs of the elderly (at least two hours).
Importance and techniques of personal care
services, including bathing, grooming, dressing,
feeding, toileting and universal precautions (at least
three hours).
Residents rights as specified in Title 22 CCR
87468.
-----------------------
<9> Title 22 CCR 87208
<10> Title 22 CCR 87211
<11> HSC 1569.625 and Title 22 CCR 87411
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Policies and procedures regarding medications,
including knowledge to safely assist with
self-administered prescribed medications (at least two
hours).
Psychosocial needs of the elderly, such as
recreation, companionship, independence, etc.
Recognizing signs and symptoms of dementia.
This bill would require staff to receive 40 hours of
training within the first four weeks of employment, with 24
of them to be provided prior to the provision of direct
care, and would require staff to receive an additional 20
hours of continuing training annually. The curriculum of
the training is expanded under this bill to include:
The use, misuse, and interaction of drugs commonly
used by the elderly, and the adverse effects of
psychotropic drugs for use in controlling the behavior
of persons with dementia.
The special needs of persons with Alzheimer disease
and dementia, including nonpharmacologic
person-centered approaches to dementia care.
This bill would exempt certified nurse assistants (CNAs)
with valid certification from these requirements except
that exempted CNAs would still be required to receive eight
hours of training on resident characteristics, resident
records and facility practices and procedures.
Additionally, this bill requires additional hours of staff
training for staff that assist in the self-administration
of medication, staff that work in facilities advertising
special care for residents with dementia, as well as staff
members that serve residents with postural supports, have
restricted health conditions, or are receiving hospice
services. In total, in facilities serving these residents,
staff would be required to complete the following training
schedule:
------------------------------------------------------------
| |
|Overall requirements: 40 hours total; 24 prior to |
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|providing care; and 20 annually |
|Dementia care: 15 hours total prior to |
|providing care; and 12 annually |
|Medication Assistance: |
| Large facilities - 32 hours total; 12 prior to |
|providing care; and 8 annually |
| Small facilities - 16 hours total; 8 prior to |
|providing care; and 8 annually |
|Postural, Restricted, Hospice: 15 hours total prior to |
|providing care; and 12 annually |
| |
------------------------------------------------------------
Through regulation, existing law provides that all training
shall be conducted by a person who is knowledgeable in a
relevant subject area of the training and who has one of
the following:
a four year degree or graduate degree as well as
two years of experience;
a license to work as a health care provider;
at least two years of experience in California as
an RCFE administrator with a record of administering
facilities with substantial compliance.
This bill would require that the training shall be
developed in consultation with individuals or organization
with specific expertise in RCFE or assisted living
services, or by an outside source with such expertise.
Use of anti-psychotic medications in Assisted Living
Recent research suggests that between 35% and 53% of
assisted living residents receive one or more psychotropic
medications.<12> Numerous studies document that older
adults are particularly susceptible vulnerable to adverse
-------------------------
-------------------------
<12> Smith M, Buckwalter KC, Hyunwook K, Ellingrod V,
Schultz SK. Dementia-specific assisted living: Clinical
factors and psychotropic medication use. Journal of the
American Psychiatric Nurses Association. 2008;14:39-49
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effects of psychotropic medications.<13> Those older than
age 70 are 3.5 times more likely than younger individuals
to be admitted to the hospital due to adverse drug
reactions associated with psychotropic medications.
Additionally, the risk for adverse reactions increases
dramatically with the number of medications used and with
increasing age.<14>
In 2012, the Centers for Medicare and Medicaid Services
(CMS) launched the National Partnership to Improve Dementia
Care and Reduce Unnecessary Antipsychotic Drug Use in
Nursing Homes. A recent memorandum submitted to CMS state
surveyor agency directors, citing numerous peer reviewed
academic studies, states that:
The problematic use of medications, such as
antipsychotics, is part of a larger, growing concern.
This concern is that nursing homes and other settings
(i.e. hospitals, ambulatory care) may use medications
as a "quick fix" for behavioral symptoms or as a
substitute for a holistic approach that involves a
thorough assessment of underlying causes of behaviors
and individualized, person-centered interventions?
When antipsychotic medications are used without an
adequate rationale, or for the purpose of limiting or
controlling behavior of an unidentified cause, there
is little chance that they will be effective. In
addition, they commonly cause complications such as
movement disorders, falls, hip fractures,
cerebrovascular adverse events (cerebrovascular
accidents and transient ischemic events) and increased
----------------------
----------------------
<13> Lindsey, Pamela. Psychotropic Medication Use among
Older Adults: What All Nurses Need to Know. Journal of
Gerontol Nursing. Sep 2009; 35(9): 28-38
<14> Brooks JO, Hoblyn JC. Neurocognitive costs and
benefits of psychotropic medications in older adults.
Journal of Geriatric Psychiatry and Neurology.
2007;20:199-214
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risk of death. <15>
Additionally, the memorandum cites a Food and Drug
Administration (FDA) public health advisory which found
that elderly patients with dementia-related psychosis
treated with second generation antipsychotic drugs are at a
1.6-1.7 fold increased risk of death compared to
placebo.<16> According to the FDA, the specific causes of
these deaths were largely either due to heart related
events (e.g., heart failure, sudden death) or infections
(mostly pneumonia). The FDA notes that none of the
antipsychotic drugs have been approved for the treatment of
behavioral disorders in patients with dementia and has
required drug manufactures to include a boxed warning in
their labeling.
In setting standards for use of these medications in
nursing homes, CMS has put forward a series of dementia
care principles that attempts to foster a person centered
approach to care better ensures the judicial use of
pharmalogical approaches to dementia care, that they are
clinically indicated and gradually reduced in an effort to
discontinue the drugs over time. Although this CMS guidance
is directed specifically toward nursing homes, its findings
and subsequent policy approaches are substantially relevant
to assisted living facilities which presumably serve a
similar demographic of residents who are potentially less
acute than those of nursing homes.
Governor's Budget Proposal
-------------------------
<15> S&C: 13-35-NH
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certific
ation/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-L
etter-13-35.pdf
<16> FDA Public Health Advisory: Deaths with Antipsychotics
in Elderly Patients with Behavioral Disturbances.
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInfo
rmationforPatientsandProviders/DrugSafetyInformationforHeath
careProfessionals/PublicHealthAdvisories/ucm053171.htm
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As part of the Governor's 2014-2015 proposed budget the
Administration has put forth a Budget Change Proposal that
intends to address some of the policy issues that this bill
also seeks to address. The Administration does not propose
to increase the training hours or curriculum for licensees,
administrators or staff of RCFEs. Instead, the proposal
seeks to strengthen the administrator certification process
by adding three new positions that would enhance current
testing policies and procedures establish statewide
uniformity in the administration of the test and update the
exams themselves. Additionally, the Administration proposes
to hire a nurse practitioner position to assist with the
development of regulatory policies related to medical care
in RCFEs as well as a mental health populations unit to
provide technical assistance to enforcement staff.
Prior/Related Legislation
Current legislation
SB 894 (Corbett) Would expand numerous requirements for
RCFE licensees in the event of a temporary license
suspension or license revocation. Additionally, would
expand the responsibilities of CDSS in overseeing a
temporary suspension or revocation of an RCFE license and
in protecting the health and safety of affected residents.
SB 895 (Corbett) Would require CDSS to conduct annual
unannounced comprehensive inspections for all facilities,
requires CDSS to verify compliance following deficiencies
within 10 days, and requires results of inspections to be
available on the CDSS website.
SB 1153 (Leno) Would permit CDSS to order a suspension of
new admissions for an RCFE when the facility has violated
applicable laws and regulations that present a direct risk
to the health and safety or residents, is not providing
adequate care and supervision, has been cited for
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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subsequent violations of the same law within 12 months, or
has failed to pay existing fines.
SB 1382 (Block) Would increase the annual licensure fees by
30 percent and would make related findings and
declarations.
AB 1571 (Eggman) Would increase disclosure requirements for
RCFE licensee applicants and require applicant information
to be cross referenced with the State Department of Public
Health. Would require, by 2015, CDSS to create an online
inquiry system posting detailed information about RCFE
facilities including complaints, deficiencies and
enforcement actions resulting in fines. In subsequent
years, would require CDSS to post additional information,
as specified.
AB 1572 (Eggman) Would require RCFEs, at the request of two
or more residents, to assist the residents in establishing
and maintaining a single resident council, as specified,
and requires the facility to interact with the council in
specified ways.
AB 1523 (Atkins and Weber) Would require RCFEs to maintain
liability insurance covering injury to residents and guests
in the amount of $1 million per occurrence and $3 million
annually.
AB 1436 (Waldron) Would require the results of all reports
of inspections, evaluations or consultations and lists of
deficiencies to be posted on the departments Internet Web
site.
AB 1454 (Calderon) Would require all licensed community
care facilities, RCFEs, and child day care centers to be
subject to an annual unannounced visits visit by CDSS.
AB 1570 (Chesbro) Would increase the certification training
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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requirements for RCFE administrators, increases training
requirements for RCFE staff that care for residents, and
increases training requirements for staff providing
dementia care.
AB 1554 (Skinner) Would make various changes to existing
RCFE complaint procedures including require the department
to make an onsite inspection within 24 hours of a complaint
alleging abuse, neglect or a threat of imminent danger.
Additionally would require the department to complete its
investigation within 90 days of receiving a complaint.
Would permit a complainant to file an appeal of
departmental findings.
AB 1899 (Brown) Would make a person whose license is
revoked or forfeited for abandonment of the facility
ineligible for reinstatement of the license for a period of
10 years following the revocation or forfeiture.
Additionally would require CDSS to establish and maintain a
telephone hotline and an Internet Web site dedicated to
receiving complaints.
AB 2171 (Wieckowski) Would establish specified RCFE
resident's rights and require facilities to inform
residents of these rights as specified.
AB 2044 (Rodriguez) Would require every licensed
residential care facility to be subject to an annual
unannounced visit by the department, as prescribed.
Additionally would require complaints to be inspected
within 3 days if the complaint involves alleged abuse or
serious neglect, or within 10 days for all other complaints
and would require investigations to be completed within 30
days. Would provide a complainant with the right to request
an informal conference and subsequent appeal, as specified.
Also would require certain staff to be present in the
facility for specified times.
Prior legislation
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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AB 313 (Monning, Chapter 365, Statutes of 2011) Requires
each RCFE to provide residents, their responsible party,
and the local long-term care ombudsman with a 10 day
written notice when CDSS commences proceedings to suspend
or revoke its license, or a criminal action relating to
health or safety of the residents is brought against the
facility, and makes other changes related to these actions.
AB 2066 (Monning, Chapter 643 Statutes of 2012) Requires
RCFEs to provide a 60 day written notice to residents or
the responsible person within 24 following receipt of CDSSs
order of revocation. Permits the licensee to secure an
alternative manager, as specified. Requires RCFEs to refund
all or a portion of preadmission fees to residents
transferring as the result of a license revocation, as
specified.
SB 897 (Leno, Chapter 376, Statutes of 2011) Requires
licensed residential care facilities for the elderly
(RCFEs) to notify CDSS, the state's Long-Term Care
Ombudsman and the facility's residents when the property is
subject to foreclosure or certain other events occur due to
financial distress.
AB 419 (Mitchell, 2011) Would have required every community
care facility licensed by CDSS to be inspected unannounced
at least once per year using research based, field tested
inspection protocols, as specified. This bill died in the
Assembly Appropriations Committee.
Comments:
The California Association for Health Services at Home and
the California Assisted Living Association raise a concern
that this bill may permit an RCFE to oversee or direct the
care of a home health or hospice agency that is caring for
a resident that has a prohibited health condition. The
author states that the intent of the bill is for a facility
to ensure that it has the capacity to safely care for a
resident with a prohibited condition, and not to permit the
facility to directly oversee the care of the licensed
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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agency.
Staff recommends the author continue working with these
organizations to clarify the intent of the bill.
Provisions of this bill are substantially similar to AB
1570 (Chesbro) but have different requirements in terms of
the number of hours of training and the scope of the
training.
Staff recommends the author work with sponsor and author of
AB 1570 to seek to address these differences.
POSITIONS
Support: Hazel's Army (co-sponsor)
Stand Up for Rosie (co-sponsor)
AFSCME
California Advocates for Nursing Home Reform
California Assisted Living Association
California Continuing Care Residents
Association
California Senior Legislature
Catholic Charities Diocese of Stockton
Consumer Attorneys of California
Consumer Federation of California
County of San Diego
Elder Law and Advocacy
Jewish Family service of Los Angeles
Johnson Moore Trial Lawyers
Long-Term Care Ombudsman of Ventura County
Office of the State Long-Term Care Ombudsman
Ombudsman & HICAP Services of Northern
California
Ombudsman Services of Contra Costa
Valentine Law Group
202 individuals
Oppose: Angel Care Community Services, Inc.
California Assisted Living Association
(unless amended)
California Assoc. for Health Services at
Home (unless amended)
STAFF ANALYSIS OF SENATE BILL 911 (Block)
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California Association of Health Facilities
(unless amended)
California Right To Life Committee, Inc.
Leading Age California (unless amended)
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