BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 749|
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THIRD READING
Bill No: AB 749
Author: Berg (D), et al
Amended: 6/18/07 in Senate
Vote: 27 - Urgency
SENATE HUMAN SERVICES COMMITTEE : 4-0, 6/12/07
AYES: Alquist, Harman, Cogdill, Yee
NO VOTE RECORDED: Romero
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 72-0, 5/10/07 (Consent) - See last page
for vote
SUBJECT : Residential care facilities for the elderly:
hospice care
patients
SOURCE : California Assisted Living Association
DIGEST : This bill allows a residential care facility for
the elderly to admit or retain as a resident a person who
is a hospice patient.
ANALYSIS :
Existing law:
1. Establishes the California Residential Care Facilities
for the Elderly Act, which includes licensing,
CONTINUED
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regulations, administration, levels of care, and other
provisions of law governing residential care facilities
for the elderly (RCFEs), and establishes the Department
of Social Services (DSS) as the oversight entity for
RCFEs.
2. Defines an RCFE as a housing arrangement chosen
voluntarily by a person 60 years of age and over, or
their authorized representative, where varying levels
and intensities of care and supervision, protective
supervision, or personal care are provided.
3. Requires a prospective applicant for licensure as an
RCFE to secure and maintain fire clearance approval from
the local fire enforcement agency or the State Fire
Marshal.
4. Prohibits an RCFE from admitting or retaining a resident
if any of the following apply:
A. The resident requires 24-hour, skilled nursing or
intermediate care.
B. The resident is bedridden, other than for a
temporary illness or for recovery from surgery.
5. Defines "bedridden" as either requiring assistance in
turning and repositioning in bed, or being unable to
transfer independently to and from bed, except in
facilities with appropriate and sufficient staff,
mechanical devices if necessary, and safety precautions
as determined by DSS.
6. Allows a bedridden individual to be admitted to, and
remain in, an RCFE if the facility secures and maintains
an appropriate fire clearance. A fire clearance will
be issued to a facility in which a bedridden individual
resides if the fire safety requirements are met, or
alternative methods of protection are approved.
7. Allows a facility to retain a bedridden resident beyond
14 days if all of the following requirements are
satisfied:
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A. The facility notifies DSS in writing regarding the
temporary illness or recovery from surgery and
submits to DSS a physician and surgeon's written
statement to the effect that the resident's illness
or recovery is of a temporary nature.
B. DSS determines that the health and safety of the
resident is adequately protected in the facility and
that the transfer to a higher level of care is not
necessary.
C. Allowing the resident to remain at the RCFE does
not expand the scope of care and supervision of a
RCFE.
8. Requires every facility admitting or retaining a
bedridden resident to notify the local fire authority
within 48 hours of the resident's admission or retention
of the estimated length of time the resident will retain
his/her bedridden status in the facility.
9. Permits an RCFE to obtain a waiver from DSS for the
purpose of allowing a resident who has been diagnosed as
terminally ill by his or her physician and surgeon to
remain in the facility, or allowing a person who has
been diagnosed as terminally ill to become a resident of
the facility if that person is already receiving
licensed hospice services and would continue to receive
hospice services without disruption if he/she became a
resident when all the following conditions are met:
A. The facility, in the judgment of DSS, has the
ability to provide care and supervision appropriate
to meet the needs of the terminally ill individual.
B. The hospice has agreed to design and provide care,
services, and necessary medical intervention related
to the terminal illness.
C. An agreement has been executed between the
facility and the hospice regarding the care plan for
the terminally ill individual.
D. The RCFE has obtained the agreement of those
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residents who share the same room with the terminally
ill individual to allow hospice caregivers into their
residence.
10.Specifies that at any time the licensed hospice, the
RCFE, or the terminally ill resident determines that the
resident's condition has changed so that continued
residence in the facility will pose a threat to the
health and safety to the terminally ill resident or any
other resident, the RCFE may initiate procedures for a
transfer.
11.Specifies that a facility that has obtained a hospice
waiver does not need to call emergency response at the
time of life-threatening emergency if the hospice agency
is notified and the following are met:
A. The resident has completed an advance directive
requesting to forego resuscitative measures.
B. The facility has documented that facility staff
have received training from the hospice agency on the
expected course of the resident's illness and the
symptoms of impending death.
This bill:
1. States that it is the intent of the Legislature to
remove cumbersome regulatory obstacles to the placement
of hospice patients in residential care facilities for
the elderly to ensure that bedridden, terminally ill
individuals avoid unnecessary institutionalization.
2. Allows a residential care facility for the elderly to
admit or retain an individual receiving hospice care to
the facility beyond the 14-day period allowed for
bedridden individuals regardless of the hospice
patient's nonambulatory or bedridden condition.
Background
RCFEs offer assisted living services in both large and
small settings that range in size from six or fewer beds to
more than 100 beds. These facilities provide care and
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assistance to older adults and to adults with disabilities
in areas such as medication management, food service,
bathing, and grooming. For many residents, the care and
support provided by an RCFE is enough to keep the
individual from needing nursing home care.
Hospice is end-of-life care that provides comfort and
support to terminally ill individuals as well as to their
families. The goal of hospice is to make an individual
comfortable and to relieve his or her symptoms and pain for
the length of their illness. To receive hospice care, the
individual must receive a referral from a physician stating
that if the person's disease follows its normal course,
death may be expected within six months.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 6/26/07)
California Assisted Living Association (source)
Aging Services of California
American Federation of State, County and Municipal
Employees
Alzheimer's Association
California Alliance for Retired Americans
California Advocates for Nursing Home Reform
California Association for Health Services at Home
California Commission on Aging
Gray Panthers California
Protection and Advocacy, Inc.
ARGUMENTS IN SUPPORT : Proponents state that there is
serious conflict and confusion within DSS's licensing
regulations, RCFE statute, and State Fire Marshal
application of building codes. The conflicts and confusion
result in the possible relocation of RCFE residents to
skilled nursing facilities when those individuals reach the
point of being bedridden. While the Office of the State
Fire Marshal, DSS, and advocates have been working to
resolve the conflict, a solution has not yet been reached.
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ASSEMBLY FLOOR :
AYES: Adams, Aghazarian, Arambula, Bass, Beall, Benoit,
Berg, Berryhill, Blakeslee, Brownley, Caballero, Charles
Calderon, Carter, Cook, Coto, Davis, De La Torre, De
Leon, DeSaulnier, DeVore, Duvall, Emmerson, Eng, Evans,
Feuer, Fuller, Gaines, Galgiani, Garcia, Hancock,
Hayashi, Hernandez, Horton, Houston, Huff, Huffman,
Jeffries, Jones, Karnette, Keene, Krekorian, La Malfa,
Laird, Leno, Levine, Lieber, Ma, Maze, Mendoza, Mullin,
Nakanishi, Nava, Niello, Parra, Plescia, Portantino,
Price, Richardson, Salas, Saldana, Silva, Smyth, Solorio,
Spitzer, Strickland, Swanson, Torrico, Tran, Villines,
Walters, Wolk, Nunez
NO VOTE RECORDED: Anderson, Dymally, Garrick, Lieu, Sharon
Runner, Ruskin, Soto, Vacancy
CTW:mw 6/26/07 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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