BILL ANALYSIS �
SB 1382
Page A
SENATE THIRD READING
SB 1382 (Block)
As Amended June 24, 2014
Majority vote
SENATE VOTE :23-8
HUMAN SERVICES 6-1
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|Ayes:|Stone, Maienschein, | | |
| |Ammiano, | | |
| |Ian Calderon, Garcia, | | |
| |Lowenthal | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Grove | | |
| | | | |
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SUMMARY : Increases Residential Care Facilities for the Elderly
(RCFE) licensing fees by 20%.
FISCAL EFFECT : None. This bill has been keyed non-fiscal by
the Legislative Counsel.
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 Department of
Social Services (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
SB 1382
Page B
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.
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% between 2001 and 2010.<2>
Nationwide, states reported 1.2 million beds in licensed RCFEs
in 2010.<3> That same year, 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.
Financial Structure: More than 90% of RCFE licenses in
California are held by for-profit providers, the majority of
which have six or fewer beds. Most residents pay privately or
with long-term care insurance since there is very little public
funding available through Medi-Cal, Supplemental Security
Income/State Supplemental Payment Program (SSI/SSP) or Medicare,
and fees can range from $1,500 to more than $8,000 per month.
Very few beds are available to seniors who use their entire
SSI/SSP checks to pay rent. In 2013, the maximum SSI/SSP grant
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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
<4> "Residents Living in Residential Care Facilities: United
States, 2010, Caffrey, Christine, et al., US Centers for
Disease Control, April 2012
SB 1382
Page C
was $866.40. Residents who rely solely on Social Security
Income may have a maximum payment of $2,642 per month in
2014,<5> although that amount varies widely based on the
recipient's prior income while working.
As a result, low-income seniors and middle-income seniors who do
not have long term care insurance are largely unable to afford
to reside in a RCFE. Most low-income seniors may receive
services through In Home Supportive Services or a skilled
nursing facility if they are Medi-Cal eligible. A small number
of Medi-Cal patients who are eligible for nursing home care may
be placed in an RCFE through the state's Assisted Living Waiver,
which began in 2006. According to state data, 172 RCFEs
currently participate in the waiver program benefitting 2,200
residents. There are an additional 3,700 slots available.
Increasingly, complex corporate mergers and acquisitions have
meant that many RCFEs are owned by national corporate chains
that control more than one facility. Administrators employed by
these chains may also oversee multiple facilities. This
development has led to regulatory challenges since CCLD
citations and other licensing reports are facility specific, and
management problems common to multiple RCFEs with the same owner
may easily go unnoticed.
Need for the bill: Stating the need for the bill, the author
states:
Recent scrutiny of RCFEs has sparked multiple
legislative changes to address deficiencies and
improve regulation and supervision of assisted living
facilities in order to better protect our seniors.
Among these proposals is the need to inspect RCFEs
every year instead of every five years, require more
training of direct care staff and administrators, and
require the Community Care Licensing division, charged
with investigating complaints, to begin investigating
certain complaints within 24 hours and to complete
these investigations within 30 days.
These important changes that will help uplift the
entire RCFE system cost money and the Department of
Social Services is barely keeping up with its current
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<5> http://www.ssa.gov/pressoffice/factsheets/colafacts2014.pdf
SB 1382
Page D
regulatory programs. Increasing the RCFE licensing
fees by a moderate 30% will improve the department's
oversight and regulation and allow for new measures to
be fully implemented.
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
FN: 0004089