BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:  April 7, 2015


                            ASSEMBLY COMMITTEE ON HEALTH


                             Mark Stone Rob Bonta, Chair


          AB 918  
          Mark Stone - As Amended April 6, 2015


          SUBJECT:  Health and care facilities:  seclusion and behavioral  
          restraints.


          SUMMARY:  Requires specified community facilities to report to  
          the appropriate and designated agency each death or serious  
          injury of a person occurring during, or related to, the use of  
          seclusion or behavioral restraints.  Specifically, this bill:  


          1)Requires the following types of facilities to report each  
            death or serious injury of a person occurring during, or  
            related to, the use of seclusion or behavioral restraints:


             a)   Intermediate care facilities (ICF);


             b)   Intermediate care facilities/developmentally  
               disabled-nursing (ICF-DDN);


             c)   Intermediate care facilities for the developmentally  
               disabled (ICF-DD);










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             d)   Intermediate care facilities/developmentally  
               disabled-habilitative (ICF-DDH);


             e)   Group homes;


             f)   Adult residential facilities; and,


             g)   Mental health rehabilitation centers.


          2)Requires the Secretary of the California Health and Human  
            Services Agency (CHHSA), or his or her designee, to establish  
            on or before January 1, 2017, a system of mandatory,  
            consistent, timely and publically accessible data collection  
            regarding the use of seclusion and behavioral restraints.


          3)Requires data collected to include the following information:


             a)   The number of deaths that occur while persons are in  
               seclusion or behavioral restraints or where it is  
               reasonable to assume that a death was proximately related  
               to the use of seclusions or behavioral restraints;


             b)   The number of serious injuries sustained by persons  
               while in seclusion or subject to behavioral restraints;


             c)   The number of serious injuries sustained by staff, that  
               occur during the use of seclusion or behavioral restraints;


             d)   The number of incidents of seclusion;









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             e)   The number of incidents of use of behavioral restraints;


             f)   The duration of time spent per incident in seclusion;


             g)   The duration of time spent per incident subject to  
               behavioral restraints; and,


             h)   The number of times an involuntary emergency medication  
               is used to control behavior, as defined by the Department  
               of State Hospitals.


          EXISTING LAW:  


          1)Requires the following types of facilities to report each  
            death or serious injury of a person occurring during, or  
            related to, the use of seclusion or behavioral restraints:


             a)   Psychiatric units of general acute care hospitals;


             b)   Acute psychiatric hospitals;


             c)   Psychiatric health facilities;


             d)   Crisis stabilization units;


             e)   Community treatment facilities;










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             f)   Group homes;


             g)   Skilled nursing facilities (SNFs);


             h)   ICFs;


             i)   Community care facilities; and,


             j)   Mental health rehabilitation centers.


          2)Does not require the above entities to fulfill the above  
            reporting requirements if adequate resources are not  
            available.


          3)Defines "ICF" as a health facility that provides inpatient  
            care to ambulatory or nonambulatory patients who have  
            recurring need for skilled nursing supervision and need  
            supportive care, but who do not require availability of  
            continuous skilled nursing care.


          4)Defines "ICF-DDN" as a facility with a capacity of four to 15  
            beds that provides 24-hour personal care, developmental  
            services, and nursing supervision for persons with  
            developmental disabilities who have intermittent recurring  
            needs for skilled nursing care but have been certified by a  
            physician and surgeon as not requiring continuous skilled  
            nursing care.  The facility shall serve medically fragile  
            persons with developmental disabilities or who demonstrate  
            significant developmental delay that may lead to a  
            developmental disability if not treated.










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          5)Defines "ICF-DD" as a facility that provides 24-hour personal  
            care, habilitation, developmental, and supportive health  
            services to persons with developmental disabilities whose  
            primary need is for developmental services and who have a  
            recurring but intermittent need for skilled nursing services.


          6)Defines "ICF-DDH" as a facility with a capacity of four to 15  
            beds that provides 24-hour personal care, habilitation,  
            developmental, and supportive health services to 15 or fewer  
            persons with developmental disabilities who have intermittent  
            recurring needs for nursing services, but have been certified  
            by a physician and surgeon as not requiring availability of  
            continuous skilled nursing care.


          7)Defines "group home" as a residential facility that provides  
            24-hour care and supervision to children, delivered at least  
            in part by staff employed by the licensee in a structured  
            environment.  Limits the care and supervision provided by a  
            group home to be nonmedical, except as otherwise permitted by  
            law.


          8)Defines "residential facility" as any family home, group care  
            facility, or similar facility determined by the director, for  
            24-hour nonmedical care of persons in need of personal  
            services, supervision, or assistance essential for sustaining  
            the activities of daily living or for the protection of the  
            individual.


          FISCAL EFFECT:  None.


          COMMENTS:  


          1)PURPOSE OF THIS BILL.  According to the author, while existing  








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            law protects individuals with developmental disorders in  
            developmental centers (DCs) from unreported use of seclusions  
            and restraint, the populations in these facilities are  
            changing.  State facilities are beginning to close and more  
            people are living in community facilities. The author states  
            that this move can be heralded as an important and beneficial  
            move for those with developmental disabilities, but it also  
            leaves them vulnerable to the use of seclusion and behavioral  
            restraint as tactics to control behavior. 

            The author also states that the Legislature has made findings  
            and declarations indicating that the use of seclusions and  
            restraints is not a treatment nor does it positively change  
            behavior. When the state first implemented reporting and  
            publishing requirements, most individuals were living in DCs.   
            However, now California is moving individuals to community  
            facilities, where no such requirement exists.  According to  
            the author, California must protect these vulnerable  
            individuals, give consumers more information when choosing a  
            facility, and allow the government and the designated  
            protection and advocacy agency, Disability Rights California  
            (DRC), the ability to compare the use of seclusion and  
            restraint across facilities. 

          2)BACKGROUND.  

             a)   Lanterman Act.  The Department of Developmental Services  
               (DDS) is responsible under the Lanterman Developmental  
               Disabilities Services Act of 1969 (Lanterman Act) for  
               ensuring that approximately 280,000 individuals with  
               developmental disabilities receive the services and support  
               they require to lead more independent and productive lives  
               and to make choices and decisions about their lives. 

          The Lanterman Act defines a developmental disability as a  
          "substantial disability" that starts before age 18 and is  
          expected to continue indefinitely.  The developmental  
          disabilities for which an individual may be eligible to receive  
          services under the Lanterman Act include:  cerebral palsy;,  








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          epilepsy; autism, intellectual disabilities; and, other  
          conditions closely related to intellectual disabilities that  
          require similar treatment (such as a traumatic brain injury).

             b)   DCs.  California provides services and support to  
               individuals with developmental disabilities in two ways.   
               The vast majorities of people live in their families' homes  
               or other community settings and receive state-funded  
               services that are coordinated by one of 21 non-profit  
               corporations known as regional centers (RCs).  More than  
               99% of DDS consumers receive services in this way under the  
               Community Services Program.  These consumers live with  
               their parents or other relatives, in their own houses or  
               apartments, or in residential facilities or group homes  
               designed to meet their needs.  A smaller number of  
               individuals, or less than 1% of the DDS caseload, live in  
               three state-operated DCs and one state-operated community  
               facility.  DDS operates three DCs:  Fairview (Orange  
               County); Porterville (Tulare County); and, Sonoma (Sonoma  
               County).  Among other services, Porterville also provides  
               secure treatment services.  A fourth DC, Lanterman,  
               transitioned its last resident into community living on  
               December 23, 2014.  Services at all facilities involve the  
               provision of active treatment through residential and day  
               programs on a 24-hour basis, including appropriate medical  
               and dental care, health maintenance activities, and  
               assistance with activities of daily living, training,  
               education, and employment.

             c)   Population Transitions.  During a period of recent  
               budget deficits, the Legislature enacted numerous DDS  
               budget reductions and cost savings measures to yield  
               General Fund savings.  The 2012-13 budget imposed a  
               moratorium on admissions to DCs except for individuals  
               involved in the criminal justice system, and consumers in  
               an acute crisis needing short-term stabilization.  The high  
               costs to maintain and staff these facilities, coupled with  
               an emphasis on transitioning individuals back into their  
               community, have led to the closure and/or restructuring of  








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               many DCs.  The moratorium on DC admission as well as the  
               need for the availability of services in the community have  
               led to a shift in spending from the DCs to the community  
               services programs.  The 2015-16 budget reflects this  
               change, as the budget for DCs has decreased and the  
               Community Services budget has increased.

          3)SUPPORT.  DRC, the sponsors of the bill, write that current  
            law requires state and non-public facilities to collect and  
            publicly report the use of seclusion and behavioral  
            restraints. When the law was enacted, the Department of State  
            Hospitals and DDS immediately implemented their data  
            collection and public data reporting. This requirement was not  
            implemented for non-public facilities.  Therefore, there is no  
            publicly accessible data regarding the use of these  
            interventions in most of the facilities where they are used.  
            The sponsor goes on to state that the populations served in  
            state facilities has changed.  Residents in DCs are moving  
            from large state facilities and into smaller community  
            facilities.  Family members and advocates are concerned about  
            the unknown and unreported use of behavioral restraint and  
            seclusion; dangerous practices that often result in serious  
            injuries, even death.  The concern continues to grow as  
            individuals with behavioral challenges migrate from DCs where  
            there is public reporting and accountability to isolated  
            community settings where there is no public accountability  
            regarding as to the use of seclusion and behavioral restraint.  
            People with disabilities should live in the community with  
            appropriate services and supports; and there should be  
            appropriate oversight of community facilities that use  
            dangerous restraint and seclusion practices. 
            
            The National Association of Social Workers (NASW) writes that  
            through previous legislation, the state has attempted to  
            reduce or eliminate the use of seclusion or behavior  
            restraints at state facilities. Efforts have also been made to  
            make the data on the use of seclusion and restraints available  
            to the public. Currently, these laws do not apply to community  
            facilities. NASW argues this bill will require information  








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            about deaths or serious injury available to the protection and  
            advocacy agency designated by the Governor. Deaths or serious  
            injury cannot go unnoticed. Those with the most expertise in  
            protecting this vulnerable population should have access to  
            information that could prevent additional tragedies.

          4)PREVIOUS LEGISLATION.  SB 130 (Chesbro), Chapter 750, Statutes  
            of 2003, made a number of changes to state law regarding the  
            use of seclusion and restraints in a variety of residential  
            facilities, including psychiatric hospitals, DCs, skilled  
            nursing facilities and foster care group homes.
          REGISTERED SUPPORT / OPPOSITION:




          Support


          Disability Rights California (sponsor)


          California Long-Term Care Ombudsman Association


          National Association of Social Workers, California Chapter


          The Alliance Supporting People with Intellectual and  
          Developmental Disabilities




          Opposition


          None on file.









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          Analysis Prepared by:Paula Villescaz / HEALTH / (916) 319-2097