CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1766

Author:(Bloom)

As Amended Ver:August 20, 2020

Majority vote

SUMMARY:

Requires the California Department of Social Services (CDSS) to send a list of specified information, at specified intervals, about adult residential facilities (ARFs) and residential care facilities for the elderly (RCFEs) to each county's department of mental health or behavioral health.

The Senate Amendments:

1. Delete language requiring CDSS to collect specified data from licensed ARFs and RCFEs relating to residents with mental illness, as specified.
2. Add language requiring CDSS, beginning May 1, 2021, and annually thereafter, to collect information and send a report to each county's department of mental health or behavioral health of all licensed ARFs and RCFEs in the county that accept the federal supplemental security rate and accept residents with a serious mental disorder as well as the number of licensed beds at each facility.
3. Add language requiring CDSS, beginning May 1, 2021, and quarterly thereafter, to send to each county's department of mental health or behavioral health the report of licensed ARFs and RCFEs that closed permanently in the prior quarter, as specified.
4. Add language requiring CDSS, upon receiving notice that a licensed ARF or RCFE intends to close permanently, to notify the county mental or behavioral health department within three business days.
5. Add language requiring an applicant or licensee of an adult community care facility to maintain an email address of record with CDSS and provide written notification of any change to the email address, as specified.

COMMENTS:

Need for this bill: According to the author's office, adult residential facilities (ARFs) play an important role in serving individuals with severe mental illness and, in some cases, preventing these individuals from experiencing homelessness by providing them a safe residence when they face limited housing options. At the same time, the author's office also reports that the inventory of beds in these facilities has been decreasing over time. This bill, by requiring data collection regarding individuals living in certain residential facilities who have a diagnosis of severe mental illness, will help CDSS and the state to gain a better understanding of existing need and facilities' current capacity to meet that need.

According to the Author:

"The lack of safe and affordable housing is one of the most significant barriers to recovery for people living with serious mental illness. Adult Residential Facilities (ARFs) and Residential Care Facilities for the Elderly (RCFEs), also known as Board-and-Cares are an important option for older adults and people with disabilities that require long-term supervision. People with severe mental illness are more likely than others to be incarcerated or enter long-term health care institutions or cycle between institutionalization and homelessness. Board and Cares are a critical component of California's housing continuum.

"[This bill] addresses a key gap in our understanding of who licensed ARFs are currently serving and how many beds we are losing due to the closure of a home, sale of property for another use or conversion to another demographic offering more profitable subsidy by authorizing the collection of data. Currently there is no reliable statewide data on the number of homes the state is losing. This data will show us whether the number of bed spaces we have available for those living with severe mental illness is enough to support this population."

Arguments in Support:

According to the Steinberg Institute, "[this bill] addresses [the significant data gap between the needs of clients living with severe mental illness and the available housing and care options] by requiring DSS to share existing information about ARFs and RCFEs with county behavioral health departments beginning next year. This information includes which facilities serve people living with severe mental illness or development disabilities and how many closed in the previous quarter. With this data in hand, local and state policymakers can evaluate whether the number of available board and care homes for Californians living with severe mental illness is adequate and the extent to which various solutions to facility closures will have a meaningful impact."

Arguments in Opposition:

None on file

FISCAL COMMENTS:

According to the Senate Appropriations Committee on August 20, 2020, the cost of this bill would be minor and absorbable.

VOTES:

ASM HUMAN SERVICES: 8-0-0

YES: Reyes, Mathis, Luz Rivas, Choi, Friedman, Gipson, Maienschein, Mark Stone

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

ASSEMBLY FLOOR: 77-0-3

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, O'Donnell, Obernolte, Patterson, Petrie‑Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

ABS, ABST OR NV: Brough, Cooley, Eduardo Garcia

SENATE FLOOR: 39-0-1

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dahle, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Leyva, McGuire, Melendez, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Umberg, Wieckowski, Wiener, Wilk

ABS, ABST OR NV: Jones

UPDATED:

VERSION: August 20, 2020

CONSULTANT: Debra Cooper / HUM. S. / (916) 319-2089 FN: 0003340

 THIRD READING  

Bill No: AB 1766

Author: Bloom (D)

Amended: 8/20/20 in Senate

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 7-0, 8/10/20

AYES: Hurtado, Jones, Beall, Jackson, Melendez, Pan, Wiener

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/20/20

AYES: Portantino, Bates, Bradford, Hill, Jones, Leyva, Wieckowski

ASSEMBLY FLOOR: 77-0, 5/29/19 - See last page for vote

SUBJECT: Licensed adult residential facilities and residential care facilities for the elderly: data collection: residents with a serious mental disorder

SOURCE: Steinberg Institute

DIGEST:

This bill requires the California Department of Social Services (CDSS) to collect and report specified information to county’s department of mental health or behavioral health regarding adult residential facilities (ARFs) and residential care facilities for the elderly (RCFEs). It also requires an applicant or licensee of an adult community care facility to maintain an email address of record with CDSS, as specified.

ANALYSIS:

Existing law:

1. Establishes the California Community Care Facilities Act, which provides regulatory structure for coordinated and comprehensive statewide system of care for mentally ill, developmentally and physically disabled, and children and adults who require care or services provided by licensed community care facilities. (HSC 1500 et seq.)
2. Defines “residential facility” to mean any family home, group care facility, or similar facility determined by the department, 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. (HSC 1501(a)(1))
3. Requires a licensee of an ARF to inform the city and county in which the facility is located of a proposed closure, including whether the licensee intends to sell the property or business, no later than 180 days before its proposed closure, or as soon as practicably possible. (HSC 1562.2)
4. Establishes the “California Residential Care Facilities for the Elderly Act” to provide for the licensure and regulation of RCFEs as a separate category within the existing licensing structure of the CDSS. (HSC 1569 et seq.)
5. Defines “residential care facility for the elderly” to mean a housing arrangement chosen voluntarily by individuals ages 60 and older, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. (HSC 1569.2(p)(1))
6. Defines “adult residential facility” in regulations to mean any facility of any capacity that provides 24-hour-a-day nonmedical care and supervision to persons 18 years of age through 59 years of age. (22 CCR 80001(a)(5))
7. Establishes in federal law the Supplemental Security Income for the Aged, Blind, and Disabled (SSI) Program to provide cash assistance to meet the basic needs of aged and blind individuals and individuals with disabilities. (42 USC 1381-1383(f)
8. Defines “serious mental disorder” as it applies to adults and older adults to mean a mental disorder that is severe in degree and persistent in duration, which may cause behavioral functioning which interferes substantially with the primary activities of daily living, and which may result in an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation for a long or indefinite period of time. Serious mental disorders include, but are not limited to, schizophrenia, bipolar disorder, post-traumatic stress disorder, as well as major affective disorders or other severely disabling mental disorders. (WIC 5600.3(b)(1) 
9. Establishes the State Supplementary Payment (SSP) for people who are aged, blind or disabled, which is intended to supplement federal SSI and provide persons whose need results from age, blindness or disability with assistance and services that help them meet basic needs and maintain or increase independence. Further provides that eligibility requirements for SSP match federal SSI criteria, and requires a minimum level of SSP benefits to be provided in order to maintain federal Medicaid funding, as specified. (WIC 12000 et seq.)

This bill:

1. Requires that, beginning May 1, 2021, and annually thereafter, CDSS shall collect information and send a report to each county’s department of mental health or behavioral health of all licensed ARFs and RCFEs in the county that accept the federal supplemental security rate and accept residents with a serious mental disorder, as defined, and the number of licensed beds at each facility.
2. Requires that, beginning May 1, 2021, and quarterly thereafter, CDSS send to each county’s department of mental health or behavioral health the report of licensed ARFs and RCFEs that closed permanently in the prior quarter, by county, and shall include the number of licensed beds of each facility and the reason for closing. Further requires that the report include cumulative data and closure trends for each county and be based on facilities identified in the annual report also required by this bill.
3. Requires that an applicant or licensee of an adult community care facility shall maintain an email address of record with CDSS. Further requires the applicant or licensee to provide written notification to CDSS of the email address and of any change to the email address within 10 business days of the change.

Background

According to the author, “The lack of safe and affordable housing is one of the most significant barriers to recovery for people living with serious mental illness. Adult Residential Facilities (ARFs), also known as board-and-cares, are an important option for older adults and people with disabilities that require long-term supervision. People with severe mental illness are more likely than others to be incarcerated or enter long-term health care institutions or cycle between institutionalization and homelessness. Board and Cares are a critical component of California’s housing continuum.”

The author further states that “AB 1766 addresses a key gap in our understanding of who licensed ARFs are currently serving and how many beds we are losing due to the closure of a home, sale of property for another use or conversion to another demographic offering more profitable subsidy by authorizing the collection of data. Currently there is no reliable statewide date on the number of homes the state is losing. This date will show us whether the number of bed spaces we have available for those living with severe mental illness is enough to support this population.”

Homelessness in California. Homelessness continues to be a pervasive and growing problem throughout California. The U.S. Department of Housing and Urban Development’s (HUD) 2019 Annual Homeless Assessment Report to Congress found that over 150,000 individuals were experiencing homelessness in California on the day of HUD’s point-in-time count. The same HUD report found that almost 35,000 people living in California and experiencing homelessness self-reported having a severe mental illness. By some estimates, about third of those experiencing homelessness are suffering from some form of mental illness. This means tens of thousands of Californians are living with the combined challenges of mental illness and homelessness.

Prior to the COVID-19 outbreak and the Governor’s ensuing executive orders designed to contain the virus, addressing homelessness was a top priority for policy makers and the people of California. The COVID-19 pandemic has enhanced concerns about homelessness and highlighted the intersection between public health and homelessness. This is because people experiencing homelessness often suffer from chronic health conditions, have little or no access to medical care, and lack the ability to practice the social distancing and frequent handwashing necessary to avoid the transmission of COVID-19.

Residential Care Facilities for the Elderly (RCFEs) and Adult Residential Facilities (ARFs). Licensed residential facilities that provide care and housing to adults typically fall into one of two categories:

• RCFEs (also known as assisted living facilities) are residential facilities that provide 24-hour nonmedical care and supervision for persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual who is 60 years of age or older;
• ARFs (also known as board and care homes) are residential facilities that provide 24-hour nonmedical care and supervision for persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of individuals ages 18 – 59.

Both RCFEs and ARFs provide housing, housekeeping, supervision, and personal care assistance with activities of daily living to individuals who need that level of care. These are nonmedical facilities that are designed for individuals who are unable to live by themselves, but who do not need 24-hour nursing care, and as such the facilities are not required to have nurses, certified nursing assistants or doctors on staff. These facilities usually centrally store and distribute medications for residents to self-administer. Residents in both RCFEs and ARFs may have mental, behavioral, or physical health needs or a developmental disability that results in their inability to live independently. These facilities range in size from small facilities operating out of a single family homes serving a handful of residents to larger buildings that can house over a 100 residents.

Impact of Closures of Licensed Residential Facilities on Homelessness. While there are many reasons a person may become homeless, contributing factors can include the need for assistance with medicines, food preparation and other types of care provided in ARFs and RCFEs. Prior to the COVID-19 outbreak, policy-makers and advocates were exploring the effects that closure of licensed residential facilities was having on homelessness. Counties throughout the state reported that housing options for low-income individuals within licensed residential facilities had been shrinking.

Low reimbursement rates for facilities that accept Supplemental Security Income/State Supplementary Payment (SSI/SSP) recipients and facilities’ generally high operating costs are two commonly cited reasons for closure of such facilities. It has been observed that this problem is particularly exacerbated in areas with high costs of living and high property values, because the owners of residential facilities may choose to sell the property rather than continue operations.

Many counties use ARFs in their efforts to find residential placements for people experiencing homelessness. For example, the County of Los Angeles has placed over 1,000 people who were experiencing homelessness into board and care homes, many of whom struggle with severe mental illness. This demonstrates a connection between maintaining the operation of board and care facilities and preventing homelessness.

According to the San Francisco Department of Public Health, ARFs are closing at an alarming rate, with San Francisco alone having lost 43 facilities with 243 beds between 2012 and 2019, a nine percent decline. In 2019, Los Angeles lost more than 200 beds for low-income people with serious mental illness. CDSS reports that there were about 7,360 licensed ARFs with a capacity to serve about 37,240 residents in Fiscal Year 2018-19. While the number of licensed ARFs increased by 132 from 2014-15 to 2018-19, overall capacity decreased by 1,572. This suggests newly opened ARFs have less capacity than those that closed.

Special Populations Served by ARFs and RCFEs. This bill proposes to gather information regarding the availability of housing within ARFs and RCFEs for low-income individuals who receive SSI/SSP or have a serious mental disorder, which are described below.

• Supplemental Security Income/State Supplementary Payment (SSI/SSP).

SSI/SSP provides a monthly cash benefit to qualified low-income individuals and couples in order to help them pay for basic living expenses, such as food, clothing and shelter. In order to be eligible for SSI/SSP, a person must be at least 65 years old, blind or disabled (including disabled children) and meet certain income and resource requirements. A qualified SSI recipient is automatically eligible for SSP. SSI is a federally funded benefit. The SSP benefit is funded with the state’s General Fund and California sets its own SSP rates.

SSI/SSP grant amounts vary based on a number of factors, including: whether a recipient is aged, blind, or living with disabilities; the individual's or couple's living arrangements; a recipient's marital status; and whether or not a recipient is a minor. CDSS data shows the SSI/SSP caseload at about 1.25 million.

• Serious Mental Disorders. California statute defines a serious mental disorder to mean a mental disorder that is severe and persistent, interferes substantially with the primary activities of daily living, and which may result in an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation. Serious mental disorders include schizophrenia, bipolar disorder, post-traumatic stress disorder, as well as other major disorders. Serious mental disorder does not include individuals who have a diagnosis of substance abuse, developmental disability or other physical or mental disorder. Mental health services can include inpatient treatment/counseling or outpatient treatment/counseling or prescription medication for problems with emotions, nerves, or mental health.

While some ARFs and RCFEs provide housing for these vulnerable populations, the exact number and location of these facilities is not known to the state or to the counties in which they operate.

Related/Prior Legislation

SB 1259 (Hurtado, 2020) requires the CDSS to establish a task force for the purpose of issuing a report that includes recommendations on how to meet the housing and care needs of low-income individuals who are blind, disabled or over 65 years of age and receiving SSI/SSP.  This bill was held in the Assembly Appropriations Committee.

AB 2377 (Chiu, 2020) establishes procedures and requirements for transferring a resident a licensed ARF to another facility or to an independent living arrangement as a result of the forfeiture of a license or a closure of the facility for another reason. The bill also gives the city or county in which an ARF is located the right of first refusal to purchase the property on which an ARF is operating and authorizes the city or county to either take over operation of the facility or enter into a long-term lease for its continued operation, as specified. This bill is awaiting a vote on the Senate floor.

AB 79 (Committee on Budget, Chapter 11, Statutes of 2020), among other things, required a licensee of an ARF to inform the city and county in which the facility is located of a proposed closure, including whether the licensee intends to sell the property or business, no later than 180 days before its proposed closure, or as soon as practicably possible.

forfeiture.

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

SUPPORT: (Verified 8/20/20)

Steinberg Institute (source)

California Association of Local Behavioral Health Boards and Commissions

California Behavioral Health Planning Council
California Commission on Aging
County Behavioral Health Directors Association
County of Los Angeles Board of Supervisors
Los Angeles County Chief Executive Office

OPPOSITION: (Verified 8/20/20)

None received

ASSEMBLY FLOOR: 77-0, 5/29/19

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Brough, Cooley, Eduardo Garcia

Prepared by: Taryn Smith / HUMAN S. /

8/25/20 9:26:07

**** END ****

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

AB 1766 (Bloom) - Licensed adult residential facilities and residential care facilities for the elderly: data collection: residents with a serious mental disorder

Bill Summary:

Assembly Bill 1766 would require the Department of Social Services (CDSS) to report specified information, starting January 1, 2021 and May 1, 2021, respectively, about adult residential facilities (ARFs) and residential care facilities for the elderly (RCFEs) to each county’s department of mental health or behavioral health.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on August 20, 2020

Fiscal Impact:

Department of Social Services. Minor and absorbable.

Author Amendments:

The author’s amendments would include the following:

• Requires the CDSS, beginning May 1, 2021, and annually thereafter, to collect information and send a report to each county department of mental health or behavioral health of all ARFs and RCFEs that accept the federal supplemental security rate and accept residents with a serious mental disorder.
• Requires the CDSS, beginning May 1, 2021, and quarterly thereafter, to send each county department of mental health or behavioral health information about ARFs that closed permanently in the prior quarter, by county, the number of each licensed beds for each facility, reason for closure, and cumulative closure trends.
• Deletes from the list of information that CDSS was required to report, including whether the residents were clients of the State regional center system, were homeless at any time in the 12 months prior to admission, the destination for all residents with a serious mental disorder, as specified, and the average length of stay for residents with a serious mental disorder.
• Deletes the requirement that data be aggregated and deidentified.
• Deletes the provision that authorizes CDSS to contract with a third party to create a searchable database.
• Deletes the authority for CDSS to consolidate any of the specified reports.

-- END --

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

AB 1766 (Bloom) - Licensed adult residential facilities and residential care facilities for the elderly: data collection: residents with a serious mental disorder.

Bill Summary:

Assembly Bill 1766 would require the Department of Social Services (CDSS) to report specified information, at specified intervals, about adult residential facilities (ARFs) and residential care facilities for the elderly (RCFEs) to each county’s department of mental health or behavioral health.

Fiscal Impact:

Staff estimates $696,026 (General Fund) in FY 2020-21, $676,390 (General Fund) in FY 2021-22, and $376,390 (General Fund) in FY 2022-23 and the same amount annually, ongoing, for 2.0 permanent full-time Information Technology Specialist I, and two 2-year contracts to develop Guardian, the information technology system and to develop the searchable data.

Background:

The DSS’ Community Care Licensing Division conducts oversight of over licensed residential facilities that provide care and housing to adults, including:

• RCFEs (also known as assisted living facilities) provide 24-hour nonmedical care and supervision for persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual who is 60 years of age or older;
• ARFs (also known as board and care homes) are residential facilities that provide 24-hour nonmedical care and supervision for persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of individuals ages 18 – 59.

Both RCFEs and ARFs provide housing, housekeeping, supervision, and personal care assistance with activities of daily living to individuals. Residents in both RCFEs and ARFs may have mental, behavioral, or physical health needs or a developmental disability that results in their inability to live independently. These facilities range in size from small facilities operating out of a single family homes serving a handful of residents to larger buildings that can house over a 100 residents.

According to the Senate Health Committee analysis:

In 2019, Los Angeles lost more than 200 beds for low-income people with serious mental illness.^[1] CDSS reports that there were about 7,360 licensed ARFs with a capacity to serve about 37,240 residents in Fiscal Year 2018-19. While the number of licensed ARFs increased by 132 from 2014-15 to 2018-19, overall capacity decreased by 1,572. This suggests newly opened ARFs have less capacity than those that closed.

As facilities reduce capacity or close, residents may not have many options for their level of care, and may end up homeless. This bill proposes to gather information regarding the availability of housing within ARFs and RCFEs for low-income individuals who receive SSI/SSP, who are over 65, have a developmental disability or a serious mental disorder.

Proposed Law:

AB 1766 would include the following provisions:

• Requires, beginning January 1, 2021, and quarterly thereafter, the CDSS to send a list of the following to each county’s department of mental health or behavioral health:
  • All licensed ARFs, and all RCFEs, in the county that are a regional center vendor within the regional center system, and the number of licensed beds at each facility.
  • All licensed ARFs, and all RCFEs, in the county that accept the federal supplemental security rate and serve residents with a serious mental disorder, as defined in state law, and the number of licensed beds at each facility.
• Requires, beginning May 1, 2021, and quarterly thereafter, the CDSS to publicly report the list of licensed ARFs, and RCFEs, that closed permanently in the prior quarter, by facility type and by county, the number of licensed beds of each facility, the reason for closing, and whether the facility served regional center clients, people with a serious mental disorder, or accepted federal supplemental security income rate. The report must include cumulative data and closure trends for each county.
• Upon receiving notice that a licensed ARF or RCFE intends to close permanently, the CDSS must notify the county mental or behavioral health department within three business days.
• Require, beginning no later than January 1, 2022, the CDSS to report annually specified data, by facility, including the number of residents in total, during the previous 12 months, who met had a serious mental disorder, were regional center clients, were homeless at any time in the 12 months prior to admission, and paid the federal supplemental security income rate at the time of admission; the destination for all residents with a serious mental disorder who exited during the previous 12 months, if known; and the average length of stay for residents with a serious mental disorder.
• Require the data to be aggregated and deidentified and not include any health information that is protected by the federal Health Insurance Portability and Accountability Act and the California Consumer Privacy Act of 2018.
• Require data to be posted on the CDSS website in a searchable format no later than January 1, 2023.
• Authorize the CDSS to contract with a third party that specializes in creating a searchable database.
• Authorizes the CDSS to consolidate any of the reports.

Related Legislation:

• SB 1259 (Hurtado, 2020) requires the CDSS establish a task force to includes recommendations on how to meet the housing and care needs of low-income individuals who are blind, disabled or over 65 years of age and receiving SSI/SSP.  This bill is currently in Assembly Appropriations Committee.
• AB 2377 (Chiu) This bill establishes procedures and requirements for transferring a resident a licensed ARF to another facility or to an independent living arrangement as a result of the forfeiture of a license or a closure of the facility for another reason. The bill also gives the city or county in which an ARF is located the right of first refusal to purchase the property on which an ARF is operating and authorizes the city or county to either take over operation of the facility or enter into a long-term lease for its continued operation, as specified. This bill is set to be heard by this committee on August 10, 2020.
• AB 79 (Committee on Budget, Chapter 11, Statutes of 2020), among other things, required a licensee of an ARF to inform the city and county in which the facility is located of a proposed closure, including whether the licensee intends to sell the property or business, no later than 180 days before its proposed closure, or as soon as practicably possible.

-- END --

1. Overlooked Mental Health Catastrophe: Vanishing Board and Care Homes Leave Residents With Few Options,” CAL Matters, April 2019 ↑

SENATE COMMITTEE ON HUMAN SERVICES

Senator Hurtado, Chair

2019 - 2020 Regular

Subject: Licensed adult residential facilities and residential care facilities for the elderly: data collection: residents with a serious mental disorder

SUMMARY

This bill establishes certain reporting requirements for the California Department of Social Services (CDSS) regarding adult residential facilities (ARFs) and residential care facilities for the elderly (RCFEs).

ABSTRACT

Existing Law:

1. Establishes the California Community Care Facilities Act, which provides regulatory structure for coordinated and comprehensive statewide system of care for mentally ill, developmentally and physically disabled, and children and adults who require care or services provided by licensed community care facilities. (HSC 1500 et seq.)
2. Defines “community care facility” to mean any facility, place, or building that is maintained and operated to provide non-medical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children. (HSC 1502(a))
3. Defines “residential facility” to mean any family home, group care facility, or similar facility determined by the department, 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. (HSC 1501(a)(1))
4. Requires a licensee of an ARF to inform the city and county in which the facility is located of a proposed closure, including whether the licensee intends to sell the property or business, no later than 180 days before its proposed closure, or as soon as practicably possible. (HSC 1562.2)
5. Establishes the “California Residential Care Facilities for the Elderly Act” to provide for the licensure and regulation of RCFEs as a separate category within the existing licensing structure of the CDSS. (HSC 1569 et seq.)
6. Defines “residential care facility for the elderly” to mean a housing arrangement chosen voluntarily by individuals ages 60 and older, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. (HSC 1569.2(p)(1))
7. Defines “adult residential facility” in regulations to mean any facility of any capacity that provides 24-hour-a-day nonmedical care and supervision to persons 18 years of age through 59 years of age. (22 CCR 80001(a)(5))
8. Establishes in federal law the Supplemental Security Income for the Aged, Blind, and Disabled (SSI) Program to provide cash assistance to meet the basic needs of aged and blind individuals and individuals with disabilities. (42 USC 1381-1383(f))
9. Establishes the Lanterman Developmental Disabilities Services Act, which states that California is responsible for providing an array of services and supports sufficiently complete to meet the needs and choices of each person with developmental disabilities, regardless of age or degree of disability, and at each stage of life, and to support their integration into the mainstream life of the community. (WIC 4500 et seq.)
10. Defines a “developmental disability” to mean a disability that originates before an individual attains 18 years of age which continues, or can be expected to continue, indefinitely and constitutes a substantial disability for that individual, including intellectual disability, cerebral palsy, epilepsy, and autism and related conditions, but excluding other handicapping conditions that are solely physical in nature. (WIC 4512(a))
11. Establishes a system of nonprofit regional centers and prescribes the activities that regional centers shall conduct on behalf of persons with developmental disabilities and their families, including but not limited to, information and referral; assessment and diagnosis; counseling; lifelong individual planning and service coordination; purchase of necessary services and supports; case management services, resource development; outreach; assistance in finding and using community and other resources; early intervention services; family support; planning, placement, and monitoring of purchased services and supports. (WIC 4620 et seq.)
12. Defines “serious mental disorder” as it applies to adults and older adults to mean a mental disorder that is severe in degree and persistent in duration, which may cause behavioral functioning which interferes substantially with the primary activities of daily living, and which may result in an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation for a long or indefinite period of time. Serious mental disorders include, but are not limited to, schizophrenia, bipolar disorder, post-traumatic stress disorder, as well as major affective disorders or other severely disabling mental disorders. (WIC 5600.3(b)(1) 
13. Establishes the State Supplementary Payment (SSP) for people who are aged, blind or disabled, which is intended to supplement federal SSI and provide persons whose need results from age, blindness or disability with assistance and services that help them meet basic needs and maintain or increase independence. Further provides that eligibility requirements for SSP match federal SSI criteria, and requires a minimum level of SSP benefits to be provided in order to maintain federal Medicaid funding, as specified. (WIC 12000 et seq.)

This Bill:

1. Requires the following for ARFs and RCFEs:
2. Beginning January 1, 2021, and quarterly thereafter, CDSS shall send a list of the following to each county’s department of mental health or behavioral health:
3. All licensed ARFs and RCFEs in the county that are a regional center vendor within the regional center system administered by CDSS and the number of licensed beds at each facility.
4. All licensed ARFs and RCFEs in the county that accept the federal supplemental security rate and serve residents with a serious mental disorder, as defined, and the number of licensed beds at each facility.
5. Requires CDSS to, beginning May 1, 2021, and quarterly thereafter, publicly report the list of licensed ARFs and RCFEs that closed permanently in the prior quarter, by facility type and by county, and shall include the number of licensed beds of each facility, the reason for closing, and whether the facility served regional center clients, people with a serious mental disorder, or accepted federal supplemental security income rate. Requires the report to include cumulative data and closure trends for each county.
6. Requires CDSS to, upon receiving notice that a licensed ARF or RCFE intends to close permanently, notify the county mental or behavioral health department within three business days.
7. Requires CDSS to, beginning no later than January 1, 2022, report annually the following data by facility:
   1. The number of ARF and RCFE residents in total, during the previous 12 months, who met each of the following descriptions:
8. Had a serious mental disorder;
9. Were clients of the DSS regional center system;
10. Were homeless at any time in the 12 months prior to admission; and
11. Paid the federal supplemental security income rate at the time of admission.
    1. The destination for all ARF and RCFE residents with a serious mental disorder who exited during the previous 12 months, if known.
    2. The average length of stay for ARF and RCFE residents with a serious mental disorder.
12. Requires the data provided in the annual report to be aggregated and de-identified and not include any health information that is protected by the federal Health Insurance Portability and Accountability Act (HIPAA) and the California Consumer Privacy Act of 2018.
13. Requires that, if CDSS determines that reporting any of the data on a facility-by-facility basis would violate state or federal law, the department shall instead report it in a manner that complies with those laws.
14. Requires the data in the annual report shall be posted on CDSS’s internet website in a searchable format no later than January 1, 2023.
15. Permits CDSS to contract with a third party that specializes in creating a searchable database, as specified.
16. Permits CDSS to consolidate any of the reports required in the bill.
17. Requires that, if CDSS determines that reporting any of the ARF data on a facility-by-facility basis would violate state or federal law, the department shall instead report it in a manner that complies with those laws.

FISCAL IMPACT

According to an analysis prepared by Assembly Appropriations Committee, the April 11, 2019 version of this bill would like generate estimated costs to CDSS of $1.4 million (GF) in Fiscal Year 2019-20 and $1.1 million (GF) ongoing for collecting, verifying, aggregating and analyzing data and placement trends for approximately 10,000 RCFEs and ARFs.

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “The lack of safe and affordable housing is one of the most significant barriers to recovery for people living with serious mental illness. Adult Residential Facilities (ARFs), also known as board-and-cares, are an important option for older adults and people with disabilities that require long-term supervision.

People with severe mental illness are more likely than others to be incarcerated or enter long-term health care institutions or cycle between institutionalization and homelessness. Board and Cares are a critical component of California’s housing continuum.”

The author further states that “AB 1766 addresses a key gap in our understanding of who licensed ARFs are currently serving and how many beds we are losing due to the closure of a home, sale of property for another use or conversion to another demographic offering more profitable subsidy by authorizing the collection of data. Currently there is no reliable statewide date on the number of homes the state is losing. This date will show us whether the number of bed spaces we have available for those living with severe mental illness is enough to support this population.”

Homelessness in California

Homelessness continues to be a pervasive and growing problem throughout California. The U.S. Department of Housing and Urban Development’s (HUD) 2019 Annual Homeless Assessment Report to Congress found that over 150,000 individuals were experiencing homelessness in California on the day of HUD’s point-in-time count. The same HUD report found that almost 35,000 people living in California and experiencing homelessness self-reported having a severe mental illness.^[1] By some estimates, about third of those experiencing homelessness are suffering from some form of mental illness. This means tens of thousands of Californians are living with the combined challenges of mental illness and homelessness.

Prior to the COVID-19 outbreak and the Governor’s ensuing executive orders designed to contain the virus, addressing homelessness was a top priority for policy makers and the people of California. The COVID-19 pandemic has enhanced concerns about homelessness and highlighted the intersection between public health and homelessness. This is because people experiencing homelessness often suffer from chronic health conditions, have little or no access to medical care, and lack the ability to practice the social distancing and frequent handwashing necessary to avoid the transmission of COVID-19.

Residential Care Facilities for the Elderly (RCFEs) and Adult Residential Facilities (ARFs)

Licensed residential facilities that provide care and housing to adults typically fall into one of two categories:

• RCFEs (also known as assisted living facilities) are residential facilities that provide 24-hour nonmedical care and supervision for persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual who is 60 years of age or older;
• ARFs (also known as board and care homes) are residential facilities that provide 24-hour nonmedical care and supervision for persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of individuals ages 18 – 59.

Both RCFEs and ARFs provide housing, housekeeping, supervision, and personal care assistance with activities of daily living to individuals who need that level of care. These are nonmedical facilities that are designed for individuals who are unable to live by themselves, but who do not need 24-hour nursing care, and as such the facilities are not required to have nurses, certified nursing assistants or doctors on staff. These facilities usually centrally store and distribute medications for residents to self-administer. Residents in both RCFEs and ARFs may have mental, behavioral, or physical health needs or a developmental disability that results in their inability to live independently. These facilities range in size from small facilities operating out of a single family homes serving a handful of residents to larger buildings that can house over a 100 residents.

Impact of Closures of Licensed Residential Facilities on Homelessness

While there are many reasons a person may become homeless, contributing factors can include the need for assistance with medicines, food preparation and other types of care provided in ARFs and RCFEs. Prior to the COVID-19 outbreak, policy-makers and advocates were exploring the effects that closure of licensed residential facilities was having on homelessness. Counties throughout the state reported that housing options for low-income individuals within licensed residential facilities had been shrinking.

Low reimbursement rates for facilities that accept Supplemental Security Income/State Supplementary Payment (SSI/SSP) recipients and facilities’ generally high operating costs are two commonly cited reasons for closure of such facilities. It is feared that this problem is particularly exacerbated in areas with high costs of living and high property values, because the owners of residential facilities may choose to sell the property rather than continue operations.

Many counties use ARFs in their efforts to find residential placements for people experiencing homelessness. For example, the County of Los Angeles has placed over 1,000 people who were experiencing homelessness into board and care homes, many of whom struggle with severe mental illness. This demonstrates a connection between maintaining the operation of board and care facilities and preventing homelessness.

According to the San Francisco Department of Public Health, ARFs are closing at an alarming rate, with San Francisco alone having lost 43 facilities with 243 beds between 2012 and 2019, a nine percent decline.^[2] In 2019, Los Angeles lost more than 200 beds for low-income people with serious mental illness.^[3] CDSS reports that there were about 7,360 licensed ARFs with a capacity to serve about 37,240 residents in Fiscal Year 2018-19. While the number of licensed ARFs increased by 132 from 2014-15 to 2018-19, overall capacity decreased by 1,572. This suggests newly opened ARFs have less capacity than those that closed.

Special Populations Served by ARFs and RCFEs

This bill proposes to gather information regarding the availability of housing within ARFs and RCFEs for low-income individuals who receive SSI/SSP, who are over 65, have a developmental disability or a serious mental disorder, which are described below.

• Supplemental Security Income/State Supplementary Payment (SSI/SSP)

SSI/SSP provides a monthly cash benefit to qualified low-income individuals and couples in order to help them pay for basic living expenses, such as food, clothing and shelter. In order to be eligible for SSI/SSP, a person must be at least 65 years old, blind or disabled (including disabled children) and meet certain income and resource requirements. A qualified SSI recipient is automatically eligible for SSP. SSI is a federally funded benefit. The SSP benefit is funded with the state’s General Fund and California sets its own SSP rates.

SSI/SSP grant amounts vary based on a number of factors, including: whether a recipient is aged, blind, or living with disabilities; the individual's or couple's living arrangements; a recipient's marital status; and whether or not a recipient is a minor. CDSS data shows the SSI/SSP caseload at about 1.25 million.

• People with Developmental Disabilities

In California, a developmental disability is defined as one that originates before an individual attains 18 years of age which continues, or can be expected to continue, indefinitely and constitutes a substantial disability for that individual, including intellectual disability, cerebral palsy, epilepsy, and autism and related conditions, but excluding other handicapping conditions that are solely physical in nature. If an individual is determined to have a qualifying condition, then developmental services in California are considered an entitlement to care, regardless of income or public benefit eligibility. Developmental services are coordinated for eligible individuals through California’s 21 nonprofit Regional Centers. These Regional Centers provide services and supports to individuals in their communities through contracts with and the provision of funding to vendors, or service providers, in the Regional Center’s surrounding area.

• Serious Mental Disorders

California statute defines a serious mental disorder to mean a mental disorder that is severe and persistent, interferes substantially with the primary activities of daily living, and which may result in an inability to maintain stable adjustment and independent functioning without treatment, support, and rehabilitation. Serious mental disorders include schizophrenia, bipolar disorder, post-traumatic stress disorder, as well as other major disorders. Serious mental disorder does not include individuals who have a diagnosis of substance abuse, developmental disability or other physical or mental disorder. Mental health services can include inpatient treatment/counseling or outpatient treatment/counseling or prescription medication for problems with emotions, nerves, or mental health.

While some ARFs and RCFEs provide housing for these vulnerable populations, the exact number and location of these facilities is not known to the state or to the counties in which they operate.

Related/Prior Legislation:

SB 1259 (Hurtado, 2020) requires the CDSS to establish a task force for the purpose of issuing a report that includes recommendations on how to meet the housing and care needs of low-income individuals who are blind, disabled or over 65 years of age and receiving SSI/SSP.  This bill is currently in Assembly Appropriations Committee.

AB 2377 (Chiu) This bill establishes procedures and requirements for transferring a resident a licensed ARF to another facility or to an independent living arrangement as a result of the forfeiture of a license or a closure of the facility for another reason. The bill also gives the city or county in which an ARF is located the right of first refusal to purchase the property on which an ARF is operating and authorizes the city or county to either take over operation of the facility or enter into a long-term lease for its continued operation, as specified. This bill is set to be heard by this committee on August 10, 2020.

AB 79 (Committee on Budget, Chapter 11, Statutes of 2020), among other things, required a licensee of an ARF to inform the city and county in which the facility is located of a proposed closure, including whether the licensee intends to sell the property or business, no later than 180 days before its proposed closure, or as soon as practicably possible.

AB 1034 (Friedman, 2019) would have required community care facilities that serve children or nonminor dependents, resource families, certified or licensed foster family homes, small family homes, community care facilities that serve adults, residential care facilities for persons with a chronic, life-threatening illness, and child care centers to have emergency and disaster plans. AB 1034 was held in the Assembly Appropriations Committee.

AB 275 (Wood, Chapter 185, Statutes of 2017) revised procedures for long-term health care facilities as the result of license change or closure.

SB 1329 (Leno, 2010) would have required RCFEs to notify residents and CDSS of specified events related to missed or delayed facility upkeep payments and would have required the department to initiate a compliance plan or other appropriate actions upon notice of such event. SB 1329 was vetoed.

AB 949 (Krekorian, Chapter 686, Statutes of 2007) established procedures for RCFEs to transfer residents as the result of a change in facility use or license forfeiture.

COMMENTS

As California continues to struggle with homelessness, especially among populations that are extremely vulnerable due to age, disability or mental illness, identifying housing placements for these populations becomes increasingly important. This bill seeks to facilitate such placements within ARFs and RCFEs by creating reports on ARF and RCFE capacity to serve these populations.

This bill requires CDSS to annually publicly report facility specific information on how many residents of each ARF and RCFE in the past 12 months had a serious mental disorder, were clients of the DSS regional center system, were homeless at any time in the 12 months prior to admission, and/or were SSI/SSP recipients, by facility. However, in response to concerns over privacy, the bill was recently amended to permit the department to, upon determining if reporting such data would violate state or federal law, instead report it in a manner that complies with those laws.

There are various laws protecting the personal information of Californians, including HIPAA, the California Medical Information Act, the California Information Practices Act, and the California Consumer Privacy Act. Given the nature of the information to be provided and the size of some of these facilities, it is arguably unclear which information, if any, would be considered “protected” and not disclosable and what should be included in the information provided. Therefore, it might be difficult for operators of residential facilities to understand what could or must be disclosed to CDSS. Contributing to the clarity issues, it is also uncertain how information should be deidentified and aggregated to ensure the privacy of the residents, given that some facilities house a small group of residents and that there is no definition for deidentification.

While the targeted populations are particularly vulnerable to homelessness, the reporting of this sensitive, and potentially confidential, information could potentially violate privacy laws and create concerns within the communities in which they reside. Such reporting of residents’ personal information to the state and to the public could also be problematic, as the facilities may not have first-hand knowledge of their residents mental and physical health diagnosis or history of homelessness and the department will not have ability to confirm the information provided by the facilities. For these reasons, the author might consider amending the bill to no longer require annual reports on the residents of the past 12 months and instead report on facilities’ capacity to serve the targeted populations.

While the bill requires reporting of certain information by CDSS, it does not provide CDSS with authority or mandate to collect the information. The author might consider amending that authority into the bill.

PRIOR VOTES

POSITIONS

Support:

Steinberg Institute (Sponsor)

CA Behavioral Health Planning Council
County Behavioral Health Directors Association
County of Los Angeles Board of Supervisors
Los Angeles County Chief Executive Office
Steinberg Institute
The California Association of Local Behavioral Health Boards and Commissions

Oppose:

None received -- END –

1. While the above data is helpful in providing an understanding of the scope of the homelessness problem in California, it is important to note that HUD’s point-in-time count is commonly understood as reflecting an undercount. The numbers above are thus a useful estimate, and not an exact reflection of California’s current homeless population. ↑

2. Adult Residential Care Facilities Background Proposal” San Francisco Department of Public Health, Grant Colfax, MD, Director of Health ↑

3. Overlooked Mental Health Catastrophe: Vanishing Board and Care Homes Leave Residents With Few Options,” CAL Matters, April 2019 ↑

ASSEMBLY THIRD READING

ATR Bill Id:AB 1766

Author:(Bloom)

As Amended Ver:April 11, 2019

Majority vote

SUMMARY:

Requires the California Department of Social Services (CDSS) to collect data related to the population of individuals with severe mental illness living in certain types of community care facilities, as follows: the number of individuals with a diagnosis of severe mental illness residing in each facility; the length of stay for individuals with a diagnosis of mental illness; the reason for discharge of individuals with mental illness; the locations to which people with mental illness are discharged; and, the referral source for individuals with mental illness in order to determine if the types of licensed adult residential facilities are appropriate to meet the needs of individuals with severe mental illness.

Major Provisions

COMMENTS:

Homelessness in California: The United States Department of Housing and Urban Development (HUD) conducts an annual point-in-time count of individuals across the country who are experiencing homelessness. The "HUD 2018 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations" report for California indicates that, on a single night in January 2018, just under 130,000 people in the state were experiencing homelessness. Of these individuals, almost 90,000 were unsheltered. An individual experiencing chronic homelessness is defined by HUD to mean "either 1) an unaccompanied homeless individual with a disabling condition who has been continuously homeless for a year or more, or 2) an unaccompanied individual with a disabling condition who has had at least four episodes of homelessness in the past three years." The 2018 HUD report indicates that over one-fourth (34,332) of individuals experiencing homelessness in California during the point-in-time count were experiencing chronic homelessness. Additionally, one-fourth of those experiencing homelessness (32,168) were also found to have severe mental illness, defined by HUD as, "persons with mental health problems that are expected to be of long-continued and indefinite duration and substantially impairs the person's ability to live independently."

In January of this year, this Committee and the Assembly Committee on Housing and Community Development held a joint hearing examining homelessness in California, and local, state, and federal responses to homelessness. It is clear that the state is facing a crisis resulting in no small part from the lack of affordable housing in the state. Additionally, it is clear that individuals experiencing homelessness often face significant barriers and issues, including mental illness and substance use disorders that may both contribute to and also be compounded by experiences of homelessness. A 2017 article in The Journal of Law, Medicine and Ethics stated that: "Poor health is simultaneously a cause and consequence of homelessness. The experience of homelessness leads to new health conditions, exacerbates existing ones, and complicates treatment options. Consequently, homeless people have high rates of chronic disease and acute illnesses, often associated with, or exacerbated by, their living situations. A considerable amount of published research on the health status and conditions of homeless persons also shows that they have a broad range of mental health and substance use needs. Greater exposure to violence, malnutrition, extreme weather, and criminal charges are additional risk factors for homeless persons, contributing to poor health outcomes and premature deaths."

Need for this bill: According to the author's office, adult residential facilities (ARFs) play an important role in serving individuals with severe mental illness and, in some cases, preventing these individuals from experiencing homelessness by providing them a safe residence when they face limited housing options. At the same time, the author's office also reports that the inventory of beds in these facilities has been decreasing over time. This bill, by requiring data collection regarding individuals living in certain residential facilities who have a diagnosis of severe mental illness, will help CDSS and the state to gain a better understanding of existing need and facilities' current capacity to meet that need.

According to the Author:

"The lack of safe and affordable housing is one of the most significant barriers to recovery for people living with serious mental illness. Adult Residential Facilities (ARFs), also known as board-and-cares are an important option for older adults and people with disabilities that require long-term supervision. People with severe mental illness are more likely than others to be incarcerated or enter long-term health care institutions or cycle between institutionalization and homelessness. Board and Cares are a critical component of California's housing continuum. [This bill] addresses a key gap in our understanding of who licensed ARFs are currently serving and how many beds we are losing due to the closure of a home, sale of property for another use or conversion to another demographic offering more profitable subsidy by authorizing the collection of data. Currently there is no reliable statewide data on the number of homes the state is losing. This data will show us whether the number of bed spaces we have available for those living with severe mental illness is enough to support this population."

Arguments in Support:

Writing in support, the Los Angeles County Board of Supervisors states that, "[This bill] would provide previously unavailable data, which would allow [the County's Department of Mental Health] and its partners to better understand the existing system of facilities and to match individuals with serious mental illness to community-based settings to receive the critical care necessary for recovery."

Arguments in Opposition:

None on file

FISCAL COMMENTS:

According to the Assembly Appropriations Committee on May 1, 2019, this bill may result in estimated costs to CDSS of $1.4 million (General Fund [GF]) in fiscal year 2019-20 and $1.1 million (GF) ongoing for collecting, verifying, aggregating and analyzing data and placement trends for approximately 10,000 residential care facilities for the elderly and ARFs.

VOTES:

ASM HUMAN SERVICES: 8-0-0

YES: Reyes, Mathis, Luz Rivas, Choi, Friedman, Gipson, Maienschein, Mark Stone

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

UPDATED:

VERSION: April 11, 2019

CONSULTANT: Daphne Hunt / HUM. S. / (916) 319-2089 FN: 0000627

Date of Hearing: May 1, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 1766

Author:(Bloom) – As Amended Ver:April 11, 2019

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the Department of Social Services (DSS) to collect data related to individuals with severe mental illness living in licensed adult residential facilities (ARFs) and residential care facilities for the elderly (RCFEs) to determine if these types of facilities are appropriately meeting the needs of these individuals. The bill specifies the data include the number of individuals with a diagnosis of severe mental illness at each facility, the length of stay, reason for discharge, location to which a patient is discharged and the referral source.

FISCAL EFFECT:

Estimated costs to DSS of $1.4 million (GF) in fiscal year (FY) 2019-20 and $1.1 million (GF) ongoing for collecting, verifying, aggregating and analyzing data and placement trends for approximately 10,000 RCFEs and ARFs.

COMMENTS:

1. Purpose. This bill seeks to help DSS and the state better understand the existing need for housing individuals with severe mental illnesses and the state’s current capacity to meet that need. According to the author:

[This bill] addresses a key gap in our understanding of who licensed ARFs are currently serving and how many beds we are losing due to the closure of a home, sale of property for another use or conversion to another demographic offering more profitable subsidy by authorizing the collection of data. Currently there is no reliable statewide date on the number of homes the state is losing. This data will show us whether the number of bed spaces we have available for those living with severe mental illness is enough to support this population.

1. Background. The Community Care Licensing Division (CCLD) within DSS licenses and regulates a variety of community care facilities. There were approximately 72,000 CCLD-licensed facilities with the total capacity of nearly 1.4 million as of June 29, 2018. These include 5,092 ARFs with a total capacity of 37,561 individuals, and 7,252 RCFEs with a total capacity of 153,195 individuals.

In January of this year, the Assembly Committee on Human Services and the Assembly Committee on Housing and Community Development held a joint hearing examining homelessness in California and local, state and federal responses. Among the findings was that individuals experiencing homelessness often face significant barriers and issues, including mental illness and substance use disorders that may both contribute to and also be compounded by homelessness. According to the author, ARF’s play an important role in serving individuals with severe mental illness and, in some cases, preventing these individuals from experiencing homelessness by providing a safe residence when they face limited housing options. The author’s office is concerned that the inventory of beds in these facilities has been decreasing over time.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 23, 2019

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Eloise Gómez Reyes, Chair

ABPCA Bill Id:AB 1766 (

Author:Bloom) – As Amended Ver:April 11, 2019

SUBJECT: Licensed adult residential facilities and residential care facilities for the elderly: data collection: severe mental illness

SUMMARY: Requires the California Department of Social Services (CDSS) to collect data related to the population of individuals with severe mental illness living in certain types of community care facilities, as follows:

1. The number of individuals with a diagnosis of severe mental illness residing in each facility;
2. The length of stay for individuals with a diagnosis of mental illness;
3. The reason for discharge of individuals with mental illness;
4. The locations to which people with mental illness are discharged; and,
5. The referral source for individuals with mental illness in order to determine if the types of licensed adult residential facilities are appropriate to meet the needs of individuals with severe mental illness.

EXISTING LAW:

1. Establishes the “California Community Care Facilities Act” to provide for the licensure and regulation of community care facilities. (Health and Safety Code [HSC] Section 1500 et seq.)
2. Defines “community care facility” to mean any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, individuals with physical disabilities or mental impairments and abused or neglected children. Includes within this definition, among a number of other facilities: adult day programs, foster family homes, small family homes, full-service adoption agencies, short-term residential therapeutic programs, and crisis nurseries. (HSC 1502(a))
3. Defines “residential facility” to mean any family home, group care facility, or similar facility determined by CDSS, for 24-hour nonmedical care of persons in need of personal services, supervision, or assistance essential for sustaining the activities of daily living for the protection of the individual. (HSC 1502(a)(1))
4. Establishes the “California Residential Care Facilities for the Elderly Act” to provide for the licensure and regulation of residential care facilities for the elderly (RCFEs) as a separate category within the existing licensing structure of the California Department of Social Services (DSS). (Health and Safety Code [HSC] 1569 et seq.)
5. Defines “residential care facility for the elderly” to mean a housing arrangement chosen voluntarily by individuals ages 60 and older, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. (HSC 1569.2(p)(1))

FISCAL EFFECT: Unknown

COMMENTS:

Community care licensing: The Community Care Licensing Division (CCLD) within CDSS is charged with licensing and regulating a variety of community care facilities, defined in the California Health and Safety Code as “any facility, place, or building that is maintained and operated to provide nonmedical residential care, day treatment, adult day care, or foster family agency services for children, adults, or children and adults, including, but not limited to, the physically handicapped, mentally impaired, incompetent persons, and abused or neglected children” (HSC 1502). Community care facilities include an array of programs and settings, such as foster family agencies, foster family homes, adult day programs, social rehabilitation facilities, transitional shelters, group homes, runaway and homeless youth shelters, and others. CCLD also licenses and regulates facilities such as child care centers and residential care facilities for the elderly. There were approximately 72,000 CCLD-licensed facilities with the total capacity to serve almost 1.4 million Californians as of June 29, 2018. These include 5,092 adult residential facilities with capacity to serve a total of 37,561 individuals, and 7,252 RCFEs with capacity to serve a total of 153,195 individuals.

Homelessness in California: The United States Department of Housing and Urban Development (HUD) conducts an annual point-in-time count of individuals across the country who are experiencing homelessness. The “HUD 2018 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations” report for California indicates that, on a single night in January 2018, just under 130,000 people in the state were experiencing homelessness. Of these individuals, almost 90,000 were unsheltered. An individual experiencing chronic homelessness is defined by HUD to mean “either (1) an unaccompanied homeless individual with a disabling condition who has been continuously homeless for a year or more, or (2) an unaccompanied individual with a disabling condition who has had at least four episodes of homelessness in the past three years.” The 2018 HUD report indicates that over one-fourth (34,332) of individuals experiencing homelessness in California during the point-in-time county were experiencing chronic homelessness. Additionally, one-fourth of those experiencing homelessness (32,168) were also found to have severe mental illness, defined by HUD as, “persons with mental health problems that are expected to be of long-continued and indefinite duration and substantially impairs the person’s ability to live independently.”

In January of this year, this Committee and the Assembly Committee on Housing and Community Development held a joint hearing examining homelessness in California, and local, state, and federal responses to homelessness. It is clear that the state is facing a crisis resulting in no small part from the lack of affordable housing in the state. Additionally, it is clear that individuals experiencing homelessness often face significant barriers and issues, including mental illness and substance use disorders that may both contribute to and also be compounded by experiences of homelessness. A 2017 article in The Journal of Law, Medicine and Ethics stated that: “Poor health is simultaneously a cause and consequence of homelessness. The experience of homelessness leads to new health conditions, exacerbates existing ones, and complicates treatment options. Consequently, homeless people have high rates of chronic disease and acute illnesses, often associated with, or exacerbated by, their living situations. A considerable amount of published research on the health status and conditions of homeless persons also shows that they have a broad range of mental health and substance use needs. Greater exposure to violence, malnutrition, extreme weather, and criminal charges are additional risk factors for homeless persons, contributing to poor health outcomes and premature deaths.”

Need for this bill: According to the author’s office, adult residential facilities play an important role in serving individuals with severe mental illness and, in some cases, preventing these individuals from experiencing homelessness by providing them a safe residence when they face limited housing options. At the same time, the author’s office also reports that the inventory of beds in these facilities has been decreasing over time. This bill, by requiring data collection regarding individuals living in certain residential facilities who have a diagnosis of severe mental illness, will help CDSS and the state to gain a better understanding of existing need and facilities’ current capacity to meet that need.

According to the author, “The lack of safe and affordable housing is one of the most significant barriers to recovery for people living with serious mental illness. Adult Residential Facilities (ARFs), also known as board-and-cares are an important option for older adults and people with disabilities that require long-term supervision. People with severe mental illness are more likely than others to be incarcerated or enter long-term health care institutions or cycle between institutionalization and homelessness. Board and Cares are a critical component of California’s housing continuum.

“[This bill] addresses a key gap in our understanding of who licensed ARFs are currently serving and how many beds we are losing due to the closure of a home, sale of property for another use or conversion to another demographic offering more profitable subsidy by authorizing the collection of data. Currently there is no reliable statewide date on the number of homes the state is losing. This data will show us whether the number of bed spaces we have available for those living with severe mental illness is enough to support this population.”

REGISTERED SUPPORT / OPPOSITION:

Support

Steinberg Institute (Sponsor)
The California Association of Local Behavioral Health Boards and Commissions

Opposition

None on file

Analysis Prepared by: Daphne Hunt / HUM. S. / (916) 319-2089