Existing law requires the Director of Health Care Services to, among other things, maintain or enter into contracts directly with nonprofit caregiver resource centers (CRCs) to provide direct services to caregivers of cognitively impaired adults, as defined, throughout the state. These services include, but are not limited to, specialized information, family consultation, respite care, short-term counseling, and support groups.

This bill would, each fiscal year, commencing with the 201718 fiscal year, appropriate $3,300,000 from the General Fund to the State Department of Health Care Services for allocation to CRCs for the purpose of providing those respite care services. services, and would require this funding to be used by the department to supplement, and not supplant, the level of funding that was allocated in the 201617 fiscal year for CRCs. The bill would also authorize those services to be provided in person and, except for respite care services, through the use of remote technologies.

Existing law requires the Director of Health Care Services to, among other things, maintain or enter into contracts directly with nonprofit caregiver resource centers (CRCs) to provide direct services to caregivers of cognitively impaired adults, as defined, throughout the state. These services include, but are not limited to, specialized information, family consultation, respite care, short-term counseling, and support groups.

This bill would, each fiscal year, commencing with the 201718 fiscal year, appropriate $3,300,000 from the General Fund to the State Department of Health Care Services for allocation to CRCs for the purpose of providing those respite care services. The bill would also authorize those services to be provided in person and, except for respite care services, through the use of remote technologies.

SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2017 - 2018 Regular Session

SB 177 (Nguyen) - Cognitively impaired adults: caregiver resource centers

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

SB 177 would appropriate $3.3 million from the General Fund each year to provide support for Caregiver Resource Centers. The bill would also clarify that services provided by Caregiver Resource Centers may be provided through remote technologies.

Fiscal Impact:

• Ongoing appropriation of $3.3 million per year for support of Caregiver Resource Centers (General Fund).
• No significant costs are anticipated due to the change in law specifically allowing most services to be provides through remote technologies. Under current practice, Caregiver Resource Centers are allowed to provide services through remote technologies such as telephone, the internet, or other services. To the extent that Caregiver Resources Centers do make use of such technologies, they may be able to provide services to the public at lower cost.

Background:

Under current law, Caregiver Resource Centers are authorized to provide services to the caregivers of cognitively impaired adults – such as individuals with Alzheimer’s disease, stroke, traumatic brain injury, or other degenerative diseases. Caregiver Resource Centers generally provide support services to caregivers, such as education and training or emotional support services. In addition, Caregiver Resource Centers provide respite care to cognitively impaired adults. Respite services are used to provide care to a cognitively impaired adult for a limited amount of time so that caregivers have some relief from the constant demands of caring for a loved one. Respite services can be provided in the home or in other settings such as adult day care centers. There are eleven Caregiver Resource Centers in the state.

Funding for Caregiver Resource Centers has gone from a high of $12.2 million in 2000-01 to a low of $2.9 million from 2009-10 to 2014-15. In 2015-16, funding was increased to $4.9 million (which is the amount provided in the current 2016-17 budget and proposed in the Governor’s January budget proposal for 2017-18). All funding for Caregiver Resource Centers comes from the General Fund.

Proposed Law:

SB 177 would appropriate $3.3 million from the General Fund each year to provide support for Caregiver Resource Centers. The bill requires that such funding be used to supplement, not supplant, the level of funding provided in the 2016-17 budget year.

The bill would also clarify that services provided by Caregiver Resource Centers may be provided through remote technologies (except for respite services).

Related Legislation:

SB 1377 (Nguyen) was substantially similar to this bill. That bill was held on this committee’s Suspense File.

Staff Comments:

The bill includes language that seems to create a maintenance of effort requirement on the state, in that it would require the $3.3 million appropriated in the bill each year to be in addition to the $4.9 million level of funding provided in the 2016-17 Budget Act. As a general principal, a legislature cannot bind a future legislature using statute, so it does not appear as if this provision of the bill would actually impose a binding requirement on future legislatures.

Similarly, if the Legislature were not to include any funding for Caregiver Resource Centers in a future Budget Act, it is not clear whether the Administration would actually be obligated to provide the funding appropriated in this bill, since the courts have tended to defer to the enacted Budget Act as main source of General Funds for funding state programs.

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SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: SB 177

SUBJECT: Cognitively impaired adults: caregiver resource centers

SUMMARY:

Appropriates $3.3 million from the General Fund each fiscal year beginning with the 2017-18 fiscal year to the Department of Health Care Services for Caregiver Resource Centers (CRCs) for purpose of providing respite care. Permits CRC services to be provided both in-person and through the use of remote technologies (except for respite care services), including but not limited to, web-based services, mobile applications, and telephone messaging services.

Existing law:

1. Requires the director of Department of Health Care Services (DHCS) to maintain or enter into contracts directly with nonprofit CRCs to provide direct services to caregivers throughout the state in the existing geographic service areas.
2. Requires CRCs to deliver services to and advocate for caregivers of cognitively impaired adults, as established in the CRC Operations Manual. Requires CRC services to include, but not be limited to, all of the following:
   1. Specialized information on chronic and disabling conditions and diseases, aging, caregiving issues, and community resources;
   2. Family consultation to provide support, alleviate stress, examine options, and enable them to make decisions related to the care of cognitively impaired adults, including an assessment of caregiver needs, short- and long-term care planning, and ongoing consultation;
   3. Family consultation to provide support, alleviate stress, examine options, and enable them to make decisions related to the care of cognitively impaired adults, including an assessment of caregiver needs, short- and long-term care planning, and ongoing consultation;
   4. Respite care;
   5. Short-term counseling;
   6. Support groups;
   7. Legal and financial consultation, including professional legal assistance or referrals to professional legal assistance, that can help caregivers with a variety of issues, including estate planning, trusts, wills, conservatorships, and durable powers of attorney; and,
   8. Education and training of caregivers and community professionals on a variety of topics related to caregiving.
3. Defines “respite care” as substitute care or supervision in support of the caregiver for the purposes of providing relief from the stresses of providing constant care and so as to enable the caregiver to pursue a normal routine and responsibilities. Allows respite care to be provided in the home or in an out-of-home setting, such as day care centers or short-term placements in inpatient facilities.

This bill:

1. Appropriates $3.3 million from the General Fund (GF) each fiscal year beginning with the 2017-18 fiscal year, to DHCS for allocation to CRCs for allocation to the CRCs for purpose of providing respite care.
   
2. Permits CRC services to be provided both in-person and through the use of remote technologies (except for respite care services), including but not limited to, web-based services, mobile applications, and telephone messaging services in order to advance consumer choice in service delivery and expand service in rural areas.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, an estimated 58% of Californians juggle work in the labor force with unpaid work as a family caregiver. When it becomes difficult to juggle caregiving with work and other family responsibilities, many employed caregivers make changes such as arriving to work late or leaving early. Sometimes they also have to quit work in order to provide care to a family member at home. According to data from AARP, approximately 4.5 million family caregivers in California provide care to an adult with limitations in daily activities. The economic value of the 3.85 million hours of unpaid labor provided by these California caregivers is approximately $47 billion. This is equivalent to 1.25 times total Medi-Cal spending. One-third of all California households contain at least one caregiver who provides 20+ unpaid hours a week.

Respite care provides caregivers a temporary rest from caregiving, while the person who is being cared for continues to receive assistance in a safe environment. Respite supports and strengthens a caregiver’s ability to stay healthy. Respite care can be provided as in-home care, adult day care, residential, and transportation services to relieve the caregiver from the stresses of constant care provision. Currently there are over 5,000 caregivers on wait lists for respite.

1. CRCs. CRCs provide a single point-of-entry network for caregivers focusing on providing services to families whose loved ones are suffering from Alzheimer’s disease, stroke, Huntington’s disease, Parkinson’s disease, traumatic brain injury, and other chronic or degenerative cognitive disorders that affect adults. There are 11 CRCs statewide that provide information, education, respite care, and emotional support services to California families that are caregivers in an effort to help those families provide long-term care at home to those suffering from chronic or degenerative cognitive disorders.

CRCs were overseen by the Department of Mental Health (DMH) from FY 2000-01 through 2011-12, when oversight transitioned to DHCS. In 2000-01, funding for CRCs was $12.2 million. This amount was reduced to $11.7 million in 2001-02, to $11.4 million in 2007-08, and to $10.5 million in 2008-09. In 2009-10, funding was reduced to $2.9 million. That funding level remained the same until it was increased by $2 million (to $4.9 million) in the 2015-16 Budget. The funding reductions from CRCs have resulted in reduction of CRC services, staffing and service locations. CRC funding for the 2016-17 fiscal year is $4.9 million, and the Governor’s budget proposes the same level of funding for CRCs of $4.9 million for 2017-18.

Amounts appropriated to CRCs are not for a specific CRC service (such as respite care) as DHCS indicates CRCs are allocated a fixed total budget amount and have the ability to establish their budget across available services as needed, with approval from DHCS.
DHCS indicates CRC services are not only delivered in person and, depending on the service, there are a variety of service delivery methods. For example, services may be delivered in-person, on-line, telephonic, educational events, interactive webinars, and Skype or Facetime. DHCS indicates CRCs are not prevented from using technology to provide services, and that the operations manual does not specify that services have to be delivered in person. DHCS indicates that, given the geography of the state and the many rural areas that the CRCs serve, the use of technology to deliver services is often the preferred mode of service delivery.

1. Prior legislation. SB 1377 (Nguyen, 2016) would have appropriated $3.3 million to CRCs, beginning with the 2016-17 fiscal year, for respite care services. SB 1377 was held on the Senate Appropriations suspense file.
   
   AB 1467 (Budget Committee, Chapter 23, Statutes of 2012) transferred the CRC program from the DMH to DHCS, due to the elimination of DMH in the 2012 Budget.
2. Support. Supporters of this bill include senior and caregiver representatives, who argue that CRCs are the lead agency in California that exclusively serve and support unpaid family caregivers through respite and counseling services. Supporters state that CRC funding was cut 74% in 2009 and respite services were nearly eliminated. Supporters argue CRCs are a vital safety net for family caregivers carving for a loved one with Alzheimer’s disease, Parkinson’s, traumatic brain injury, stroke or related dementia, and not providing respite care services will force people into more expensive services.
3. Potential fiscal issue. While this bill appropriates on an on-going basis $3.3 million in GF, the language in this bill does not indicate this amount is in addition to the current amount proposed in the annual budget act.
   

SUPPORT AND OPPOSITION:

Support: AARP

A Senior Blessing

Acacia Adult Day Services

Age Well Senior Services, Inc.

ALS Association Golden West Chapter

ALS Association Greater Sacramento Chapter

ALS Association Greater San Diego Chapter

Alzheimer’s Association

Alzheimer’s Orange County

Association of California Caregiver Resource Centers

At Your Home Family Care

Brookdale Fresno

California Association of Public Authorities for IHSS

California Commission on Aging

California Health Advocates

California Long-Term Care Ombudsman Association

Care to Caregiver

Carepatrol of Fresno

Changing Lives in The Central Valley

Comfort Keepers

Del Oro Caregiver Resource Center

Disability Rights California

Elderhelp of San Diego

Family Caregiver Source Center Orange County

Home Instead Senior Care

Lamerson Landy Care, Inc.

Life Skills Training and Educational Programs, Inc.

Neighborhood House Association

Parkinson Association of Northern California

Right at Home

SeniorServ

Silverado Memory Care - Escondido

St. Joseph Hoag Health

St. Jude Medical Center
United Domestic Workers of America/AFSCME Local 3930

Triple-R Adult Day Program

University of California Alzheimer’s Disease Research Center

Valley Caregiver Resource Center

Over 120 individuals

Oppose: None received

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