Nursing Home Reform -SB 1312 (Alquist) California NeuroAlliance Position: SUPPORT
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- Andrea Webb
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1 Issue Paper Nursing Home Reform -SB 1312 (Alquist) California NeuroAlliance Position: SUPPORT Background Two decades ago, the Patient s Rights Protection Act of 1985 strengthened rights and protections for California s nursing home residents. Nonetheless, 20 years later, many nursing home residents still do not enjoy the benefits of dozens of state laws passed by the Legislature to improve their care. For instance, hundreds of nursing homes routinely violate minimum staffing requirements of 3.2 hours of direct patient care per day per patient, creating a severe threat to residents health and safety. The reason that some nursing homes are not abiding by state laws is that the Department of Health Services (DHS) has relied on a state law (Health and Safety Code Section 1279) that exempts DHS from performing an annual inspection, or survey, of nursing homes. Currently, the state conducts a mandatory annual inspection of California s skilled nursing homes. During the inspections, health facility evaluators monitor a number of federally required standards for quality and safety. However, the evaluators do not evaluate or enforce the state laws, many which have been on the books for 20 years. The Department of Health Services says it does not have to inspect nursing homes for compliance with the state laws since, in 1992, the Legislature relaxed the inspection requirement due to the state s budget shortfall and lack of money to pay for inspectors. The law remains in effect today and is relied upon by DHS to justify their non-enforcement of a variety of state laws. What SB 1312 Does SB 1312 ensures that the Department of Health Services (DHS) enforces the numerous nursing home reform laws that the Legislature has passed in the last 20 years. In order to assure that DHS enforce all nursing home laws, SB 1312 removes the language that DHS says exempts it from annual surveys of
2 nursing homes and inserts language to reaffirm that DHS must enforce all state nursing home laws. Impact of SB 1312 on People with Neurological Conditions Many people disabled by a neurological disease eventually rely on nursing homes for their care. Patients and their families rely on the State to ensure that laws are enforced that assure quality and maintain safety in nursing homes. Lack of enforcement of these laws could ultimately result in tragedy an injury or even death, which these laws were intended to prevent.
3 State Nursing Home Laws Nursing Home Reform AB 2257 (Agnos) establishes notice and appeal rights for those who file complaints against nursing homes; protections for residents and employees against retaliation; and expands the role of the long term care ombudsman. Effective 1/1/85. Nursing Home Reform SB 53 (Mello) and AB 180 (Isenberg) includes most of the provisions of the Nursing Home Patients Protection Act of 1994, including increasing penalties and protection of residents from eviction for conversion to Medi-Cal status. Effective 1/1/85. Division of Community Property AB 987 (Margolin) establishes protections for division of community property when one spouse enters a nursing home to prevent spousal impoverishment. Effective 9/1/86. CNA Wage Pass-Through AB 4172 (Agnos) requires facilities to pass through a certain percentage of rate increases to direct care staff for wage and benefit increases. Effective 9/1/86 Responsible Parties AB 3943 (Agnos) prohibits nursing homes from requiring a responsible party to sign the admission agreement as a condition of admission. Effective 1/1/87 Admission Agreements SB 1330 (McCorquodale) provides consumer protections in nursing home admission agreements. Effective January , facilities are required to explicitly state, in large print, a number of patients' rights regarding admission and to list all patients' rights. Effective 1/1/88 Nursing Home Administrators SB 183 (Mello) requires reporting to DHS of any changes in administrator; requires Board of Nursing Home Administrators to track record of administrators. Effective 1/1/88 Elder Abuse SB 1162 (Mello) defines the inappropriate use of chemical and physical restraints as "physical abuse," and makes such abuse subject to California's Elder Abuse Law. Effective 1/1/88 Receivership Reform SB 1220 (Mello) expands the powers and duties of a receiver when a nursing home is in receivership; disallows certain debts. Effective 1/1/87 Theft & Loss AB 2047 (Katz) requires nursing homes to develop and implement specific theft and loss reduction programs to protect patient's property. Effective 1/1/88 Medi-Cal Eviction AB 688 (Isenberg) prevents the eviction or transfer of current or potential Medi-Cal patients when a facility withdraws from the Medi-Cal program. Effective 12/1/87
4 Transfer Trauma AB 2196 (Friedman) establishes policies to reduce transfer trauma when nursing home residents are being transferred to another facility. These policies must include a medical assessment of the patient's condition, counseling services, evaluation of relocation needs, 30 day advance notice, and appropriate arrangements for future medical care. Effective 1/1/88 Medi-Cal Notice SB 69 (Mello) requires nursing homes to provide every resident or applicant and their representative a notice of spousal impoverishment and Medi-Cal rights. Effective 1/1/88. Long Term Care Insurance SB 170 (Mello), a consumer protection bill for the sale and issuance of long term care insurance, prohibits certain practices and specifies certain consumer protections for he sale and issuance of long term care insurance in California. Effective 1/1/89. Family Councils AB 4319 (Connelly) defines family councils, permits the formation in nursing homes and requires facilities to provide space for meetings. Effective 1/1/89. Disclosure of Ownership SB 1525 (Mello) requires applicants and current licensees of nursing homes to submit complete disclosure of ownership information and provides for suitability of ownership requirements. Effective 1/1/90. Family Councils in RCFEs SB 1102 (Roberti) allows for the organization of family councils in Residential Care Facilities for the Elderly. Effective 1/1/90. Spousal Impoverishment SB 1413 (Maddy) implements the spousal impoverishment provisions of the new federal laws. Allows at-home spouse to keep a minimum resource and income level. Effective 1/1/90. Elder Abuse SB 679 (Mello) allows pain and suffering damages to survive the death of the victim in elder abuse cases. This Elder Abuse and Dependent Adult Civil Protection Act was effective 1/1/92. Citation Reform SB 1570 (Mello) shifts the burden of going forward on judicial appeal for adverse Citation Review Conference decisions to the licensee. Effective January 1, Liens on Homes of Nursing Home Residents and Surviving Spouses SB 412 (Marks) eliminates the ability to impose liens on the homes of nursing home residents or the surviving spouses of deceased residents who received Medi-Cal. Effective January 1, Nursing Home Ownership Disclosure SB 1649 (Mello) amends the law to require nursing home ownership disclosure changes to be disclosed at the annual renewal and makes this information available to the public. Effective January 1, 1997.
5 Nursing Home Admission Agreements SB 1061 (Vasconcellos) mandates a standardized admission agreement to be promulgated by DHS to be used by all nursing homes in California. Effective 1/1/98; to be implemented 1/1/2000. Citation Reform AB 1133 (Gallegos) eliminates the automatic waiver of Class B penalties; reduces from 50% to 35% the reduction of fines in lieu of not appealing citation; allows consumer attorney representative at the Citation Review Conference. Effective January 1, RCFE Care Plan AB 2155 (Keeley) requires RCFEs to have a written service plan for each resident and that residents and residents representatives be informed of the plan. Effective January 1, RCFE Consumer Information SB 1630 (Rosenthal) requires RCFEs to post the last survey results and requires Department of Social Services to make facility information available to the public. Effective January 1, Medi-Cal Notices AB 1161 (Soto) requires that Medi-Cal offices and nursing homes provide specific notice of Medi-Cal rights, including circumstances under which the beneficiary may transfer property. Effective January 1, Family Councils SB 1551 (Dunn) Conforms state law with federal law on family councils; provides certain rights and protections for family councils in nursing homes; provides for penalties for violations by facilities. Effective January 1, Medi-Cal Rights SB 2194 (Soto) Conforms state statutes with federal laws regarding the transfer of property by Medi-Cal applicants or beneficiaries. Effective January 1, Senior Fraud Protection Act of 2000 AB 2107 (Scott) : Establishes duty of honesty, good faith and fair dealing for insurance transaction involving elders; establishes protections from the sale and marketing of annuities for the purposes of long term care planning; and amends the fiduciary abuse laws to protect elders and dependent adults. Effective January 1, Family Councils SB 1551 (Dunn) Increases the rights and protections for family councils in California nursing homes; provides for penalties for violations by facilities. Effective 1/1/01. Medi-Cal Rights SB 2194 (Soto) conforms state statutes with federal laws regarding the transfer of property by Medi-Cal applicants or beneficiaries. Effective 1/101. Discharge Planning/Relocation Guidelines SB 587 (Soto) provides that acute care hospitals must establish specific discharge planning protocols prior to the discharge of a
6 patient. Effective 1/1/02. Nursing Home Staffing Ratios AB 1075 (Shelley) requires DHS to develop regulations that establish staff-to-patient ratios in skilled nursing facilities. Also requires facilities to post information about staffing levels. Effective 1/1/02. Nursing Home Patient Transfers SB 339 (Ortiz) increased relocation protections prior to the transfer of nursing home residents, in order to reduce incidents of transfer trauma. Also allows residents to remain in a facility past the 30 day notice if adequate placement has not been made, and requires DHS to request that the Attorney General seek injunctive relief when facilities fail or refuse to provide appropriate relocation services. Effective 1/1/03. Medi-Cal Notice Regarding Principal Residence SB 1633 (Soto) requires the Department of Health Services to provide any aged, blind or disabled Medi-Cal applicant a notice explaining in clear and simple language the circumstances under which an interest in a home may be transferred without affecting Medi-Cal eligibility. Effective 1/1/03.
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