BILL ANALYSIS Ó AB 918 Page 1 ASSEMBLY THIRD READING AB 918 (Mark Stone) As Amended May 28, 2015 Majority vote ------------------------------------------------------------------- |Committee |Votes |Ayes |Noes | | | | | | | | | | | |----------------+------+--------------------+----------------------| |Health |18-0 |Bonta, Maienschein, | | | | |Bonilla, Burke, | | | | |Chávez, Chiu, | | | | |Gomez, Gonzalez, | | | | |Lackey, Nazarian, | | | | |Patterson, | | | | | | | | | | | | | | |Ridley-Thomas, | | | | |Rodriguez, | | | | |Santiago, | | | | |Steinorth, | | | | |Thurmond, Waldron, | | | | |Wood | | | | | | | |----------------+------+--------------------+----------------------| |Appropriations |17-0 |Gomez, Bigelow, | | | | |Bonta, Calderon, | | | | |Chang, Daly, | | | | |Eggman, Gallagher, | | | | | | | AB 918 Page 2 | | | | | | | |Eduardo Garcia, | | | | |Gordon, Holden, | | | | |Jones, Quirk, | | | | |Rendon, Wagner, | | | | |Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------- SUMMARY: Requires the Secretary of California Health and Human Services to establish a system of mandatory, consistent, timely, and publicly accessible data collection related to data on seclusion and restraint in community facilities serving aged and developmentally disabled persons, as specified. Requires the Department of Developmental Services (DDS) to publish on its Web page the number of incidents of physical and chemical restraint in community facilities, as specified. Requires community facilities to report every death or serious injury of a person in seclusion or in physical or chemical restraint no later than the close of business day following the death or serious injury. FISCAL EFFECT: According to the Assembly Appropriations Committee, this bill would have minor and absorbable costs to DDS, assuming facilities comply with reporting requirements. If facilities don't comply, there could be cost pressure to enforce the reporting requirements or to provide additional education and training. Any cost pressure for enforcement or provider education would depend on the robustness of the activities. COMMENTS: According to the author, while existing 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 AB 918 Page 3 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. 1)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. More than 99% of DDS consumers receive services in this way under the Community Services Program. 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. AB 918 Page 4 2)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 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. DRC, the sponsors of the bill, write in support of the bill that 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 about deaths or serious AB 918 Page 5 injury available to the protection and advocacy agency designated by the Governor. There is no known opposition to this bill. Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0000850