BILL ANALYSIS �
SB 911
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SENATE THIRD READING
SB 911 (Block)
As Amended August 22, 2014
Majority vote
SENATE VOTE :25-11
HUMAN SERVICES 6-1 AGING 5-0
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|Ayes:|Stone, Maienschein, |Ayes:|Yamada, Brown, Daly, |
| |Ammiano, | |Gray, Levine |
| |Ian Calderon, Garcia, | | |
| |Lowenthal | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Grove | | |
| | | | |
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APPROPRIATIONS 12-0
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|Ayes:|Gatto, Bocanegra, | | |
| |Bradford, | | |
| |Ian Calderon, Campos, | | |
| |Eggman, Gomez, Holden, | | |
| |Pan, Quirk, | | |
| |Ridley-Thomas, Weber | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Increases training requirements for licensees and
staff of Residential Care Facilities for the Elderly (RCFE).
Specifically, this bill :
1)Increases the number of hours of instruction for RCFE licensee
certification training from 40 hours to 80 hours, which
includes increasing the number of hours of classroom
instruction from 40 to 60 hours, and adds nonpharmacologic,
person-centered approaches to dementia care; resident
admission, retention and assessment procedures; and resident
rights to the list of items covered in the RCFE licensee
certification training program.
2)Increases the continuing education requirement for
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administrators from 20 hours to at least 40 hours during each
two-year certification period.
3)Increases the number of hours of instruction for RCFE staff
certification training from 10 hours to 40 hours, which
includes a requirement that 24 hours be conducted in a
classroom setting, and adds 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 instruction related to the special
needs of persons with Alzheimer's disease and dementia,
including nonpharmacologic person-centered approaches to
dementia care, to staff training requirements.
4)Provides that no RCFE licensee, or officer or employee of the
licensee, may discriminate or retaliate against any person on
the basis, or for the reason that, the person dialed or called
911, and provides that any violation of this prohibition shall
result in a civil penalty, as specified.
5)Requires a RCFE that accepts or retains a resident with a
prohibited health condition, as specified, shall ensure that
the resident receives home health or hospice services
sufficient in scope and hours to ensure that the resident
receives medical care as prescribed by the resident's
physician and contained in the resident's service plan. Makes
RCFEs violating this provision subject to a civil penalty, as
specified.
6)Requires a RCFE that accepts or retains a resident with a
restricted health condition, as specified, to ensure that the
resident receives 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. Makes RCFEs violating this provision subject to
a civil penalty, as specified.
7)Defines an "appropriately skilled professional" as an
individual who has training and is licensed to perform the
necessary medical procedures prescribed by a physician, which
includes but is not limited to a registered nurse, licensed
vocational nurse, physical therapist, occupational therapist,
or respiratory therapist who may be employed by a home health
agency (HHA), the resident, or a facility, and who are
currently licensed in this state.
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8)Requires the Department of Social Services (DSS) to develop
jointly with the California Department of Aging requirements
for a uniform core of knowledge for the required initial
certification and continuing education for administrators, and
their designated substitutes, and for recertification of
administrators of RCFEs, as specified. Requires this training
to be developed in consultation with individuals or
organizations with specific expertise in RCFEs or assisted
living services, or by an outside source with expertise in
residential care facilities for the elderly or assisted living
services.
9)States legislative findings that the quality of services
provided to residents of RCFEs is dependent upon the training
and skills of staff and that the current training requirements
for staff of RCFEs are insufficient to meet the range of care
needs of the residents of those facilities.
10)Requires DSS to adopt regulations to require staff members of
residential care facilities for the elderly who assist
residents with personal activities of daily living to receive
appropriate training, as specified.
11)Requires staff who assist residents with prescription
medication management in a RCFE with more than 16 persons to
complete 16 hours of hands-on-training, instead of 16 hours,
of initial training related to medication management, as
specified. For RCFEs providing care to 15 or fewer persons,
requires staff to complete 10 hours, instead of six hours, of
initial training.
12)Adds new training requirements for RCFE staff at facilities
serving residents with postural supports, restricted health
conditions or who receive hospice services to include four
hours of training prior to providing direct care to residents
on the care, supervision, and special needs of those
residents, and four hours annually thereafter of in-service
training on the subject of serving those residents.
13)Delays implementation of this bill until January 1, 2016.
14)Double joints the bill to AB 1570 (Chesbro) of the current
legislative session.
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FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)2015-16 costs in the range of $280,000 (General Fund),
includes onetime and ongoing, for the DSS to add training
topics, certify vendors, revise the CCL Evaluator Manual,
revise regulations, consult with specified groups to update
the uniform core of knowledge for RCFE administrators and
training for direct care staff, and to review training
programs and applications.
2)Ongoing costs in the range of $250,000 (General Fund) for DSS
to review administrator certification training programs and
certification applications. This assumes approximately 3,500
reviews annually at 3.75 hours per review.
3)Unknown, but likely significant, ongoing increase in training
costs to employees and/or facilities to meet the enhanced
initial and continuing education training requirements
imposed.
COMMENTS :
Background: 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.
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,<1> and continued to grow 16 percent between 2001 and
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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.
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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 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 June 2, 2014, there are 7,587 licensed
RCFEs in California with a capacity to serve 176,891 residents.
RCFE licensee and administrator requirements: California
statute differentiates between administrators and facility
licensees, who often are the business owners and may be property
owners and administrators 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," which
includes providing an 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 must 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 an administrator are both
required to undergo 40 hours of classroom instruction in order
to be certified. 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, for administrators, in
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<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
<4> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
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order 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" 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 advertises or promotes special care, special
programming, or a special environment for persons with dementia
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
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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 or seven days after employment or
licensure.<5>
Adequacy and relevance of existing training and certification
requirements: Nearly 25 years have passed since existing RCFE
licensing and certification requirements have been changed. The
last noted change was in AB 1615 (Hannigan), Chapter 848,
Statutes of 1991, which required prospective licensees to
undergo an orientation training prior to commencing the licensee
certification process. Additionally, there are no requirements
that licensees or administrators have a college degree or
professional license, and staff are only required to be 18 years
of age regardless of whether they have a high school diploma.
The staff training requirements pale in comparison to those of
many service related positions that do not provide direct care
to the infirm, elderly or disabled. In its 2013 special report,
Residential Care in California: Unsafe, Unregulated, and
Unaccountable, California Advocates for Nursing Home Reform
wrote that even a manicurist "must have 400 hours of training
and pass a state exam."
The existing training requirements and methods by which RCFE
personnel access and meet their ongoing training needs is also
antiquated. Currently, RCFE licensees and administrators are
required to undergo 40 hours of training and complete a written
exam. However, as noted by DSS, "currently, no proctoring
protocol exists, resulting in no statewide uniformity on how the
exams are administered. This lack of consistency and guidance
results in errors and can ultimately result in candidates
getting certified who may not meet the minimum
qualifications."<6>
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
FN: 0005210
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<5> Section 87411(f) of Title 22, California Code of
Regulations.
<6> 2014-15 Budget Change Proposal #CCLD-2; Department of Social
Services; Social Services and Licensing. 2014-15 Budget. Page
12.
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