BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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          |SENATE RULES COMMITTEE            |                  SB 1729|
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                              UNFINISHED BUSINESS


          Bill No:  SB 1729
          Author:   Migden (D)
          Amended:  8/13/08
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  7-3, 4/16/08
          AYES:  Kuehl, Alquist, Cedillo, Negrete McLeod,  
            Ridley-Thomas, Steinberg, Yee
          NOES:  Aanestad, Cox, Wyland
          NO VOTE RECORDED:  Maldonado

           SENATE APPROPRIATIONS COMMITTEE  :  8-4, 5/22/08
          AYES:  Torlakson, Cedillo, Corbett, Florez, Kuehl, Oropeza,  
            Simitian, Yee
          NOES:  Cox, Aanestad, Ashburn, Dutton
          NO VOTE RECORDED:  Ridley-Thomas, Runner, Wyland

           SENATE FLOOR  :  24-15, 5/27/08
          AYES:  Alquist, Calderon, Cedillo, Corbett, Correa,  
            Ducheny, Florez, Kehoe, Kuehl, Lowenthal, Migden, Negrete  
            McLeod, Oropeza, Padilla, Perata, Ridley-Thomas, Romero,  
            Scott, Simitian, Steinberg, Torlakson, Vincent, Wiggins,  
            Yee
          NOES:  Aanestad, Ackerman, Ashburn, Battin, Cogdill, Cox,  
            Denham, Dutton, Harman, Hollingsworth, Maldonado,  
            Margett, McClintock, Runner, Wyland
          NO VOTE RECORDED:  Machado
           
          ASSEMBLY FLOOR  :  43-28, 8/15/08 - See last page for vote


           SUBJECT  :    Health care facilities:  training
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           SOURCE  :     Equality California


           DIGEST  :    This bill requires all registered nurses,  
          certified nurse assistants, licensed vocational nurses, and  
          physicians working in skilled nursing facilities or  
          congregate living health facilities to participate in a  
          training program focused on preventing and eliminating  
          discrimination based on sexual orientation and gender  
          identity. 

           Assembly Amendments  were clarifying.

           ANALYSIS  :    

          Existing law:

          1. Requires the Department of Public Health (DPH) to  
             license and regulate skilled nursing facilities (SNFs)  
             and congregate living health facilities, as defined. 

          2. Requires each of the Area Agencies on Aging to include  
             the needs of lesbian, gay, bisexual, and transgender  
             (LGBT) seniors in their needs assessment and area plans.  


          3. Requires the Department of Aging to provide technical  
             assistance to the Area Agencies on Aging regarding the  
             unique needs of LGBT seniors. 

          4. Places a number of training and continuing education  
             requirements on nurses and physicians related to  
             cultural competence, but none are specifically related  
             to LGBT issues.

          This bill:

          1. Makes several declarations and findings regarding the  
             marginalization of LGBT seniors and the opportunity  
             California has to continue to serve as a model for other  
             states in the protections it affords to LGBT persons. 

          2. Requires all registered nurses, certified nurse  

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             assistants, licensed vocational nurses, and physicians  
             working in SNF or congregate living health facilities to  
             participate in a training program, prescribed by the  
             DPH, that focuses on preventing and eliminating  
             discrimination based on sexual orientation and gender  
             identity. 

          3. Permits DPH to incorporate the training prescribed in #2  
             above, into any existing training program that is  
             designed to prevent or eliminate discrimination in  
             senior care facilities. 

          4. Permits DPH to charge each licensed SNF and congregate  
             living health facility a fee associated with determining  
             compliance and requires the fee to not exceed DPH's  
             costs for the enforcement of the provisions of this  
             bill. 

          5. Clarifies existing law which defines sexual orientation  
             and gender identity as follows: 

             A.    "Sexual orientation" means heterosexuality,  
                homosexuality, or bisexuality.
              
             B.    "Gender identity" means sex, including a person's  
                gender-related appearance and behavior whether or not  
                stereotypically associated with the person's assigned  
                sex at birth. 

           Background  

          According to a 2000 Policy Institute of the National Gay  
          and Lesbian Task Force Foundation report of public policy  
          issues affecting LGBT seniors, three to eight percent of  
          Americans over the age of 65 are LGBT.  According to the  
          report, some of the reasons why LGBT seniors may be at  
          higher risk for institutionalization are: 

          1. Social Security pays survivor benefits to widows and  
             widowers but not to the surviving same-sex life partner  
             of someone who dies. 

          2. Married spouses are eligible for Social Security spousal  
             benefits, which can allow them to earn half their  

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             spouse's Social Security benefit if it is larger than  
             their own Social Security benefit.  Unmarried partners  
             in lifelong relationships are not eligible for spousal  
             benefits.

          3. Medicaid regulations protect the assets and homes of  
             married spouses when the other spouse enters a nursing  
             home or long-term care facility, but no such protections  
             are offered to same-sex partners.

          4. Tax laws and other regulations of 401(k)s and pensions  
             discriminate against same-sex partners.

          5. Rights, such as hospital visitation or the right to die  
             in the same nursing home, are regularly denied same-sex  
             partners.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

          According to the Senate Appropriations Committee:

                          Fiscal Impact (in thousands)

             Major Provisions                2008-09     2009-10     
             2010-11               Fund  

            Administration      $18       $60       $60        
            General

           SUPPORT  :   (Verified  5/23/08) (Unable to reverify)

          Equality California (source)
          California Alliance for Retired Americans
          Lambda Letters Project
          Stonewall Democratic Club of Greater Sacramento

           OPPOSITION  :    (Verified  5/23/08) (Unable to reverify)

          California Association of Health Facilities
          Capitol Resource Family Impact

           ARGUMENTS IN SUPPORT  :    According to Equality California  
          (EQCA), social marginalization of LGBT seniors is often  

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          exacerbated once these individuals enter institutionalized  
          care.  EQCA states that lack of recognition of LGBT  
          seniors' partners or family structures may deprive  
          individuals of needed support and lead to increased  
          isolation, and LGBT seniors may face outright homophobia  
          and transphobia while institutionalized, limiting their  
          access to essential services, programs and activities.   
          EQCA writes that this bill would ensure that licensed  
          health professionals who have constant interaction with  
          seniors in institutional settings will better understand  
          how to foster an environment that is free from  
          discrimination based on sexual orientation and gender  
          identity.  EQCA contends that such trainings will educate  
          providers about nondiscrimination laws and policies, how to  
          avoid assumptions based on heterosexual experience, and how  
          to create a culture of respect for gender and sexual  
          orientation diversity.  These trainings have already proven  
          effective in transforming institutions to be more inclusive  
          of, and welcoming to, LGBT seniors. 

           ARGUMENTS IN OPPOSITION  :    The California Association of  
          Health Facilities states:  "This bill will have a large  
          cost to both SNF employers and to the state Medi-Cal  
          system, and is unnecessary.  Why is it unnecessary?  The  
          California Fair Employment and Housing Act (FEHA) was  
          amended in 1984 to prohibit harassment in the workplace  
          (See Government Code  12940).  The anti-harassment  
          provisions of FEHA make an employer liable for harassment  
          in the workplace and requires the employer to 'take all  
          reasonable steps to prevent harassment from occurring.'  In  
          2004, the Legislature passed AB 1825 [Chapter 933], which  
          requires employers with 50 or more employees to provide two  
          hours of training and education regarding sexual harassment  
          to all supervisory employees, once every two years.   
          Because discrimination based on sexual orientation and  
          gender identity is included under the protections of FEHA,  
          supervisors are trained in this area."


           ASSEMBLY FLOOR  : 
          AYES:  Arambula, Beall, Berg, Brownley, Caballero, Carter,  
            Coto, Davis, De La Torre, De Leon, DeSaulnier, Eng,  
            Evans, Feuer, Fuentes, Furutani, Galgiani, Hancock,  
            Hayashi, Hernandez, Huffman, Jones, Karnette, Krekorian,  

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            Laird, Leno, Levine, Lieber, Lieu, Ma, Mendoza, Mullin,  
            Nava, Nunez, Parra, Portantino, Ruskin, Salas, Saldana,  
            Solorio, Swanson, Wolk, Bass
          NOES:  Adams, Aghazarian, Anderson, Benoit, Blakeslee,  
            Cook, DeVore, Duvall, Emmerson, Fuller, Gaines, Garrick,  
            Horton, Houston, Huff, Jeffries, Keene, La Malfa, Maze,  
            Nakanishi, Niello, Silva, Smyth, Spitzer, Strickland,  
            Tran, Villines, Walters
          NO VOTE RECORDED:  Berryhill, Charles Calderon, Dymally,  
            Garcia, Plescia, Price, Sharon Runner, Soto, Torrico


          CTW:mw  8/19/08   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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