RCFE Reform Act Update
The San Diego assisted living facility resident fell onto the floor and spent two days there before a security guard found him. The resident had various sores, abrasions, and dried feces on his body. The resident was rushed to the hospital and eventually died the next day.
Another San Diego assisted living facility resident required hospitalization and eventually died after developing six open sores on his hip, heel, coccyx, and testicles. The facility staff overlooked the ulcers, even though they were showering and changing him.
These cases are just two of many instances of elder abuse and neglect occurring in California assisted living facilities, also known as Residential Care Facilities for the Elderly (RCFEs). According to a U-T San Diego Newspaper watchdog special report, since 2008, at least 27 San Diego County seniors have died from injuries and/or neglect in assisted living facilities.
The RCFE Reform Act is a set of 12 bills which address potentially life-threatening health and safety concerns faced by RCFE residents and their families in California.
RCFEs are also known as assisted living facilities, retirement homes, and board and care homes. RCFEs provide housing and services to people 60 years of age and over. RCFE employees supervise and assist residents with activities of daily living, such as bathing and grooming. Some RCFEs may provide incidental medical services under special care plans. RCFEs range in size from six beds or less to over 100 beds. Over 174,000 California residents live in over 7,500 RCFEs. RCFEs are overseen by the Department of Social Services (DSS).
Governor Brown signs 10 RCFE bills into law
The following ten RCFE Reform Act bills have been signed into law by Governor Jerry Brown:
- SB 895 (Corbett): DSS must conduct unannounced visits to certain percentage of facilities; DSS must post inspection reports; DSS must report on annual inspections; RCFEs must post reporting information in case of a complaint or emergency in the main entryway of its facility; RCFE must remedy deficiencies within 10 days of notification.
- SB 911 (Block): RCFE administrator training requirements are increased from 40 to 80 hours; RCFEs must employ trained medical personnel if residents with certain health conditions are accepted and retained; RCFE staff employees must complete an increased number of hours of initial training, either 24 hours or 10 hours, depending on the number of residents; RCFEs are prohibited from retaliating against an employee or resident who calls 911 when a resident is injured and in need of medical care.
- SB 1382 (Block): Increases RCFE initial application and annual fees.
- SB 1153 (Leno): DSS may order the suspension of admitting new residents where a RCFE has violated a statute or regulation and either 1) the violation indicates a direct and immediate risk to the health and safety of a resident and the violation is not corrected or 2) the RCFE has failed to pay the assessed fine.
- AB 1523 (Atkins): RCFEs are required to carry liability insurance of at least one million dollars per occurrence and three million dollars in the total annual aggregate.
- AB 1572 (Eggman): Increases the rights of resident councils and family councils in RCFEs.
- AB 1899 (Brown): Licensees who abandon their RCFEs and their residents cannot seek reinstatement of their license.
- AB 2044 (Rodriguez): At least one administrator must be on-site 24 hours a day, 7 days a week; one staff member who has CPR training and first aid training must be on duty at all times; staff members must receive 40 hours of training.
- AB 2171 (Wieckowski): Creates a statutory Resident Bill of Rights, which includes confidential treatment of records and personal information, to be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse, etc.
- AB 2236 (Stone & Mainschein): Increases penalties from current maximum of $150; imposes a $10,000 fine against RCFEs for physical abuse or serious bodily harm; imposes a $15,000 fine for deaths due to violations; and creates four levels of appeal for RCFE providers to appeal the fines.
New challenges and recommendations
Although great legislative strides have been made on behalf of RCFE residents and their families, DSS faces the daunting execution of these changes. Consumer Advocates for RCFE Reform (CARR), a 501(c)(3) advocacy organization providing access to regulatory compliance documents, states that DSS is already over-burdened. CARR suggests that DSS has “limited ability to enforce compliance and to influence improved quality of care.” California Advocates for Nursing Home Reform (CANHR), a statewide nonprofit 501(c)(3) advocacy organization, also points to the importance of implementation and enforcement of these new laws.
Ultimately, DSS needs additional funding to offset recent budget cuts and to carry out the new RCFE reform laws. Additional funding is also necessary to pass other, much-needed RCFE reform bills which failed solely due to fiscal concerns.
The two RCFE Reform Act bills which failed in the Senate Appropriations Committee were AB 1571 (Eggman) andAB 1554 (Skinner). AB 1554 (Skinner) would require the Department of Social Services to begin and complete complaint investigations in a timely manner. It would also give complainants written notice of findings and an opportunity to appeal. AB 1571 (Eggman) would require the Department of Social Services to establish an online RCFE consumer information system regarding every licensed RCFE in California. In addition, this bill would require complete disclosure of ownership and prior ownership of any type of facility, including nursing facilities, and would have established a rating system by 2019.
Both bills failed due to fiscal concerns. According to CANHR, the budget analysis for AB 1554 (Skinner) stated that a reliable complaint investigation system would incur ongoing costs of $250,000 to $500,000. Similarly, the budget analysis for AB 1571 (Skinner) stated that creating and implementing a RCFE ratings system could result in a “significant” cost in excess of $750,000, with ongoing maintenance costs exceeding $500,000. However, both budget analyses failed to consider the substantial ongoing costs of failing to respond to complaints and protecting RCFE residents; namely, the costs related to serious bodily injury and hospital visits.
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