SB 280: Building standards: fall prevention.
- Session Year: 2019-2020
- House: Senate
- Latest Version Date: 2019-10-08
Existing law, the California Building Standards Law, provides for the adoption of building standards by state agencies by requiring all state agencies that adopt or propose adoption of any building standard to submit the building standard to the California Building Standards Commission for approval and adoption. Existing law requires the commission to publish, or cause to be published, editions of the code in its entirety once every 3 years. Existing law, the State Housing Law, requires the Department of Housing and Community Development to propose the adoption, amendment, or repeal of building standards to the California Building Standards Commission.
This bill would, at the next triennial building standards rulemaking cycle that commences on or after January 1, 2020, require the Department of Housing and Community Development to investigate possible changes to the building standards in the California Residential Code for adoption by the California Building Standards Commission to promote aging-in-place design, as specified.
The Legislature finds and declares all of the following:
(a)According to the Public Policy Institute of California, by 2030, the California population of persons 65 years of age and older will increase by more than four million.
(b)Most older adults prefer to remain in their own homes as long as possible, but many are forced into skilled nursing, assisted living, or other congregate living options because their homes are no longer physically safe for them to live in.
(c)Falls are the leading cause of both fatal and nonfatal injuries for Californians 65 years of age and older.
(d)In 2014, there were 208,564 Californians 65 years of age and older treated in emergency departments for fall-related injuries and 74,954 were hospitalized as a result of an unintentional fall injury.
(e)In 2013, 1,733 Californians died as a result of a fall injury.
(f)Many of those fall patients will use Medicare, Medicaid, or both, to pay their medical expenses, including the charges for skilled nursing or rehabilitation facilities, costing the federal and state governments large amounts of money.
(g)The federal Centers for Disease Control and Prevention states that there are proven interventions that can reduce falls and help older adults live better and longer.
(h)The federal Centers for Medicare and Medicaid Services evidence-based review of multifactorial fall prevention programs concluded that the incidence of falls was reduced by a minimum of 11 percent with a potential of a 23-percent reduction when falls prevention strategies are implemented.
(i)In many cases, the retrofit of homes to add fall prevention features to an existing house can be quite expensive and beyond the means of senior residents.
SEC. 2.Section 17922.15 is added to the Health and Safety Code, to read:17922.15.(a)At the next triennial building standards rulemaking cycle that commences on or after January 1, 2020, the Department of Housing and Community Development shall investigate possible changes to the building standards in the California Residential Code (Part 2.5 of Title 24 of the California Code of Regulations) that promote aging-in-place design and are limited to all of the following:
(1)The location of doorbells, light switches, and heating, ventilation, and air-conditioning (HVAC) controls that are reachable by those with mobility impairments.
(2)The installation of support backing for the later installation of grab bars in one or more bathrooms.
(3)The provision of a 32-inch clearance in the width opening for one bathroom door and one bedroom door on the ground floor, or, in the case of a two- or three-story single-family dwelling, on the second or third floor of the dwelling if a bathroom or bedroom is not located on the ground floor.
(b)If the department determines that one or more of the changes described in subdivision (a) can be incorporated into the California Residential Code without significantly increasing the cost of construction, the department may propose building standards to that effect for consideration by the California Building Standards Commission. The department shall include in any proposed building standard, regarding the 32-inch clearance width for a bathroom and bedroom door described in paragraph (3) of subdivision (a), a finding whether a delay of 18 months in the effective date of that proposed building standard is warranted to provide adequate time for industry to incorporate this change into standard designs.
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Date
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Status
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|---|---|
| Oct 8, 2019 | Chaptered by Secretary of State. Chapter 640, Statutes of 2019. |
| Oct 8, 2019 | Approved by the Governor. |
| Sep 18, 2019 | Enrolled and presented to the Governor at 4 p.m. |
| Sep 11, 2019 | Assembly amendments concurred in. (Ayes 39. Noes 0.) Ordered to engrossing and enrolling. |
| Sep 11, 2019 | Ordered to special consent calendar. |
| Sep 10, 2019 | In Senate. Concurrence in Assembly amendments pending. |
| Sep 10, 2019 | Read third time. Passed. Ordered to the Senate. |
| Sep 6, 2019 | Read third time and amended. |
| Sep 3, 2019 | Read second time. Ordered to third reading. |
| Aug 30, 2019 | From committee: Do pass. (Ayes 18. Noes 0.) (August 30). |
| Aug 21, 2019 | August 21 set for first hearing. Placed on APPR. suspense file. |
| Jul 3, 2019 | From committee: Do pass and re-refer to Com. on APPR. with recommendation: To consent calendar. (Ayes 8. Noes 0.) (July 3). Re-referred to Com. on APPR. |
| Jun 26, 2019 | Coauthors revised. |
| Jun 13, 2019 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on AGING & L.T.C. |
| Jun 6, 2019 | Referred to Coms. on AGING & L.T.C. and H. & C.D. |
| May 24, 2019 | In Assembly. Read first time. Held at Desk. |
| May 23, 2019 | Read third time. Passed. (Ayes 38. Noes 0.) Ordered to the Assembly. |
| May 21, 2019 | Ordered to special consent calendar. |
| May 16, 2019 | From committee: Do pass. (Ayes 6. Noes 0.) (May 16). |
| May 10, 2019 | Set for hearing May 16. |
| May 6, 2019 | May 6 hearing: Placed on APPR. suspense file. |
| Apr 26, 2019 | Set for hearing May 6. |
| Apr 23, 2019 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (April 22). Re-referred to Com. on APPR. |
| Apr 10, 2019 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on HOUSING. |
| Apr 5, 2019 | Set for hearing April 22. |
| Mar 27, 2019 | Read second time and amended. Re-referred to Com. on HOUSING. |
| Mar 26, 2019 | From committee: Do pass as amended and re-refer to Com. on HOUSING. (Ayes 5. Noes 1.) (March 25). |
| Mar 5, 2019 | Set for hearing March 25. |
| Feb 21, 2019 | Referred to Coms. on HUMAN S. and HOUSING. |
| Feb 14, 2019 | From printer. May be acted upon on or after March 16. |
| Feb 13, 2019 | Introduced. Read first time. To Com. on RLS. for assignment. To print. |
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Date
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Description
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Location
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Votes
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|---|---|---|---|---|
| Sep 11, 2019 | Unfinished Business SB280 Jackson et al. Concurrence | Senate Floor |
Passed |
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| Sep 10, 2019 | SB 280 Jackson Senate Third Reading By Friedman | Assembly Floor |
Passed |
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| Aug 30, 2019 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
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| Jul 3, 2019 | Do pass and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly Standing Committee on Housing and Community Development |
Passed |
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| Jun 25, 2019 | Do pass and be re-referred to the Committee on [Housing and Community Development] | Assembly Standing Committee on Aging and Long-Term Care |
Passed |
|
| May 23, 2019 | Special Consent SB280 | Senate Floor |
Passed |
|
| May 16, 2019 | Do pass | Senate Standing Committee on Appropriations |
Passed |
|
| May 6, 2019 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 22, 2019 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Housing |
Passed |
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| Mar 25, 2019 | Do pass as amended, but first amend, and re-refer to the Committee on [Housing] | Senate Standing Committee on Human Services |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 280 |
UNFINISHED BUSINESS
Bill No: SB 280
Amended: 9/6/19
SENATE HUMAN SERVICES COMMITTEE: 5-1, 3/25/19
AYES: Hurtado, Beall, Jackson, Pan, Wiener
NOES: Stone
SENATE HOUSING COMMITTEE: 11-0, 4/22/19
AYES: Wiener, Morrell, Bates, Caballero, Durazo, McGuire, Moorlach, Roth, Skinner, Umberg, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/16/19
AYES: Portantino, Bates, Bradford, Hill, Jones, Wieckowski
SENATE FLOOR: 38-0, 5/23/19
AYES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dodd, Durazo, Galgiani, Glazer, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk
ASSEMBLY FLOOR: 78-0, 9/10/19 - See last page for vote
SUBJECT: Building standards: fall prevention
SOURCE: California Senior Legislature
DIGEST:
This bill requires the Department of Housing and Community Development (HCD) to investigate possible changes to building standards that promote aging in place.
Assembly Amendments remove the following provisions: (1) repeal obsolete statutes that establish unfunded programs within the California Department of Aging (CDA) and in their place establishes the Dignity at Home and Fall Prevention Program; and (2) requirements for CDA to provide grants to area agencies on aging for injury prevention services, as specified.
Existing law:
- Establishes the California Building Standards Commission (CBSC) within the Department of General Services, and requires any building standards adopted or proposed by state agencies to be submitted to, and approved by, the CBSC prior to codification into the California Building Standards Code.
- Requires HCD to propose the adoption, amendment, or repeal of building standards to the CBSC and to adopt, amend, and repeal other rules and regulations to protect the health, safety, and welfare of occupants and to the public.
This bill:
- Requires HCD to investigate possible changes to building standards that promote aging in place, including:
- The location of doorbells, light switches and heating, ventilation and air-conditioning controls.
- The installation of support backing for the later installation of grab bars in one or more bathrooms.
- A 32-inch clearance for one bathroom door and one bedroom door on the ground floor.
- Permits HCD to propose the above building standards for consideration by CBSC if the changes will not significantly increase the cost of construction.
- Requires HCD to include in any proposed building standard, regarding 32-inch clearance width for bathroom and bedroom doors, a finding whether a delay of 18 months in the effective date of that proposed building standard is warranted to provide adequate time for industry to incorporate the change into standard designs.
Background
According to the author, many seniors and others at risk of falling are on reduced or fixed incomes and “simple home improvements to make their homes safer could mean the difference between being in their own homes and having to seek institutional care.” SB 280 would create a Dignity at Home and Fall Prevention Program, through which local area agencies on aging (AAAs) will be able to obtain grant funds in order to provide injury prevention information, education and services for the purpose of enabling older adults and persons with disabilities to live independently in the home environment for as long as possible.
Older Adults and Falls
More than 7.8 million Californians are age 60 and older today. By 2030, that number is estimated to increase by 40 percent and the number of Californians age 85 and older is expected to grow by over 37 percent.
Falls are the leading cause of fatal and non-fatal injuries for older Americans. Falls threaten seniors’ safety and independence and generate enormous economic and personal costs.
The Centers for Disease Control and Prevention (CDCP) reports that more than one out of four older people falls each year and that falling once doubles the chances of falling again. In the home, factors like poor lighting, loose carpets and lack of safety equipment (i.e., grab bars, stair rails and high toilets) increase risks of falling.
Falls can cause injuries as simple as bumps and bruises and as complex as broken hips. Falls are the most common cause of traumatic brain injuries in older adults, and they may also cause other severe injuries, such as fractures of the hip, that can have extremely negative impacts on quality of life. Even falls without injury can cause fear of falling, leading to physical decline, depression, and social isolation. The more severe the injury, the more likely a fall could result in hospitalization and institutionalization.
According to CDCP, in 2015, the medical costs for falls totaled more than $50 billion. Medicare and Medicaid paid 75 percent of these costs. CDCP also reports that one out of five falls causes a serious injury such as broken bones or head injury; three million older people are treated in emergency rooms a year for fall injuries; over 800,000 patients a years are hospitalized because of a fall injury, most often because of head injury or hip fracture; and falls are the most common cause of traumatic brain injury.
State Building Standards
The California Building Standards Law established the CBSC and the process for adopting state building codes. Under this process, relevant state agencies propose amendments to model building codes, which the CBSC must then adopt, modify, or reject. HCD is the relevant state agency for residential building codes. Every three years, the CBSC adopts a new version of the California Building Code, known as the triennial update. The building codes apply to all building occupancies and related features and equipment throughout the state.
This bill will require HCD to investigate building standards that facilitate aging in place before proposing any new standards for the CBSC to consider. Requiring HCD to investigate any new standards, is intended to allow HCD to develop standards that will work for all of California.
Related/Prior Legislation
SB 1026 (Jackson, 2018) was similar to this bill in that it would have repealed obsolete statutes that establish programs within the CDA and instead established the Dignity at Home and Fall Prevention Program, which required CDA to provide grants to AAAs for injury prevention services, as specified. The bill did not pass out of the Assembly Appropriations Committee.
SBX1-24 (Committee on Budget, Chapter 24, Statutes of 2003) provided that the Senior Housing Information and Support Center would be implemented only to the extent that funds for these purposes are appropriated by the Legislature in the annual Budget Act or other statute.
SB 370 (Ortiz, Chapter 689, Statutes of 2001) established the Program for Injury Prevention in the Home Environment to award grants to eligible local level entities for injury prevention information and educational programs and services.
SB 1846 (Lowenthal, Chapter 797, Statutes of 2000) established the Senior Housing Information and Support Center within CDA for the purpose of providing information and training relating to specified subjects, including housing options and home modification alternatives designed to support independent living, and available innovative resources and senior services.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Assembly Appropriations Committee:
- One-time costs to HCD of $336,000 (General Fund (GF)) over two years for a limited term position to conduct research, solicit feedback from earlier and new participants, update and introduce previously developed building standards, and participate in the 18-month CBSC code adoption process.
- Ongoing costs of approximately $411,000 (GF) per year to CDA for additional personnel to administer the grant program and meet reporting requirements.
- Ongoing costs, contingent upon funding in the budget act, likely in the range of $1 million to $5 million (GF) annually, to provide grants to regional AAAs for fall prevention programs. Each AAA can be awarded up to $150,000. There are currently 33 AAAs for a potential total of $4.95 million, if all 33 AAAs were awarded the maximum grant amount.
- The Budget Act of 2019 (AB 74, Ting, Chapter 23, Statutes of 2019) contains $4.6 million and one-time provisional budget bill language for CDA to provide fall prevention grants to AAAs.
California Senior Legislature (source)
Arc Of California
California Association for Health Services at Home
California Association of Public Authorities for IHSS
California Alliance for Retired Americans
Congress of California Seniors
Contra Costa County
County of San Diego
County of Santa Clara
County of Ventura
County Welfare Directors Association of California
National Multiple Sclerosis Society, MS-Can
United Cerebral Palsy California Collaboration
OPPOSITION: (Verified 9/10/19)
None received
ASSEMBLY FLOOR: 78-0, 9/10/19
AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo 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, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon
NO VOTE RECORDED: Ramos
Prepared by: Alison Hughes / HOUSING / (916) 651-4124
9/10/19 22:03:29
SENATE THIRD READING
STR Bill Id:SB 280
Author:(Jackson)
As Amended Ver:September 6, 2019
Majority vote
SUMMARY:
This bill requires the Department of Housing and Community Development (HCD) to investigate possible changes to building standards that promote aging in place.
Major Provisions
- States legislative findings that most older adults prefer to remain in their own homes as long as possible, recognizes many are forced into skilled nursing, assisted living, or other congregate living options because their homes are no longer physically safe for them to live in, and recognizes that falls are the leading cause of both fatal and nonfatal injuries for Californians 65 years of age and older.
- Requires the HCD to, at the next triennial building standards rulemaking cycle that commences after January 1, 2020, to explore revisions to residential building standards code that promote aging in place design.
COMMENTS:
This bill seeks to help individuals who are aging to remain safely in their home and age with dignity and independence. Polling overwhelmingly shows that older adults want to remain at home and not be forced to go to an institution and in any event too often cannot afford the cost.
According to the Author:
"Under SB 280, the Building Standards Commission is asked to develop building standards that take mobility into account – for example, ground-level entries, wide interior doors and space for maneuverability. With these simple modifications and changes to how homes are constructed, seniors and others with mobility challenges will be better able to age in place and remain independent."
Arguments in Support:
Contra Costa County writes in a letter, "Contra Costa County has one of the highest concentrations of older adults in the country. We support funding opportunities and policies which promote the development of aging-friendly support systems and housing in our community. SB 280 seeks to address this by providing services and supports such as home assessments and modifications."
Arguments in Opposition:
None.
FISCAL COMMENTS:
According to the Assembly Committee on Appropriations:
One-time costs to HCD of $336,000 (General Fund) over two years for a limited term position to conduct research, solicit feedback from earlier and new participants, update and introduce previously developed building standards, and participate in the 18-month Building Standards Commission code adoption process.
VOTES:
SENATE FLOOR: 38-0-0
YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dodd, Durazo, Galgiani, Glazer, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk
ASM AGING AND LONG-TERM CARE: 7-0-0
YES: Nazarian, Voepel, Boerner Horvath, Kalra, Lackey, Reyes, Blanca Rubio
ASM HOUSING AND COMMUNITY DEVELOPMENT: 8-0-0
YES: Chiu, Diep, Gabriel, Gloria, Kiley, Limón, Maienschein, Quirk-Silva
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: September 6, 2019
CONSULTANT: Gail Gronert / AGING & L.T.C. / (916) 319-3990 FN: 0002088
SENATE THIRD READING
STR Bill Id:SB 280
Author:(Jackson)
As Amended Ver:June 13, 2019
Majority vote
SUMMARY:
This bill requires the Department of Housing and Community Development (HCD) to investigate possible changes to building standards that promote aging in place. This bill also repeals obsolete statutes within the Department of Aging (CDA) and instead establishes the Dignity at Home and Fall Prevention Act within CDA to provide grants to area agencies on aging (AAAs) for injury prevention services.
Major Provisions
- States legislative findings that most older adults prefer to remain in their own homes as long as possible, recognizes many are forced into skilled nursing, assisted living, or other congregate living options because their homes are no longer physically safe for them to live in, and recognizes that falls are the leading cause of both fatal and nonfatal injuries for Californians 65 years of age and older.
- Requires the HCD to, at the next triennial building standards rulemaking cycle that commences after January 1, 2020, to explore revisions to residential building standards code that promote aging in place design.
- Directs agencies that receive funds regarding fall prevention to provide information on injury prevention, home environmental assessments, and requires grantees to partner with local agencies that have expertise in injury prevention services.
COMMENTS:
This bill seeks to help individuals who are aging to remain safely in their home and age with dignity and independence. Polling overwhelmingly shows that older adults want to remain at home and not be forced to go to an institution and in any event too often cannot afford the cost.
According to the Author:
"Under SB 280 the Department of Aging would contract with Area Agencies on Aging to provide injury prevention information, education and services for the purpose of enabling older adults and persons with disabilities to live independently in the home environment for as long as possible. In addition under SB 280, the Building Standards Commission is asked to develop building standards that take mobility into account – for example, ground-level entries, wide interior doors and space for maneuverability. With these simple modifications and changes to how homes are constructed, seniors and others with mobility challenges will be better able to age in place and remain independent."
Arguments in Support:
Contra Costa County writes in a letter, "Contra Costa County has one of the highest concentrations of older adults in the country. We support funding opportunities and policies which promote the development of aging-friendly support systems and housing in our community. SB 280 seeks to address this by providing education about the risk of falling and how to better prevent falls, and support those who may be at risk of falling by providing services and supports such as home assessments and modifications."
Arguments in Opposition:
None on file.
FISCAL COMMENTS:
According to the Assembly Committee on Appropriations:
- One-time costs to HCD of $336,000 (General Fund (GF)) over two years for a limited term position to conduct research, solicit feedback from earlier and new participants, update and introduce previously developed building standards, and participate in the 18-month Building Standards Commission code adoption process.
- Ongoing costs of approximately $411,000 (GF) per year to CDA for additional personnel to administer the grant program and meet reporting requirements.
- Ongoing costs, contingent upon funding in the budget act, likely in the range of $1 million to $5 million (GF) annually, to provide grants to regional AAAs for fall prevention programs. Each AAA can be awarded up to $150,000. There are currently 33 AAAs for a potential total of $4.95 million, if all 33 AAAs were awarded the maximum grant amount.
- The Budget Act of 2019 (AB 74 (Ting), Chapter 23, Statutes of 2019), contains $4.6 million and one-time provisional budget bill language for CDA to provide fall prevention grants to AAAs.
VOTES:
SENATE FLOOR: 38-0-0
YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dodd, Durazo, Galgiani, Glazer, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk
ASM AGING AND LONG-TERM CARE: 7-0-0
YES: Nazarian, Voepel, Boerner Horvath, Kalra, Lackey, Reyes, Blanca Rubio
ASM HOUSING AND COMMUNITY DEVELOPMENT: 8-0-0
YES: Chiu, Diep, Gabriel, Gloria, Kiley, Limón, Maienschein, Quirk-Silva
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: June 13, 2019
CONSULTANT: Gail Gronert / AGING & L.T.C. / (916) 319-3990 FN: 0001628
Date of Hearing: August 21, 2019
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SBPCA Bill Id:SB 280
Author:(Jackson) – As Amended Ver:June 13, 2019
Policy Committee: | Aging and Long Term Care | Vote: | 7 - 0 |
Housing and Community Development | 8 - 0 | ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill requires the Department of Housing and Community Development (HCD) to investigate possible changes to building standards that promote aging in place. This bill also repeals obsolete statutes that establish unfunded programs within the Department of Aging (CDA) and instead establishes the Dignity at Home and Fall Prevention Act within CDA to provide grants to area agencies on aging (AAAs) for injury prevention services. Specifically, this bill:
- Requires the HCD to, at the next triennial building standards rulemaking cycle commencing after January 1, 2020, to explore revisions to residential building standards code that promote aging-in-place design.
- Establishes the Dignity at Home and Fall Prevention Program at CDA to provide grants of up to $150,000 to AAAs for injury prevention information, education and services to enable older adults and persons with disabilities to live independently in the home environment for as long as possible.
- Requires the grant program provide funding for injury prevention services, equipment, materials and labor costs.
- Requires each grantee to submit a report to CDA, and to the appropriate fiscal and policy committees of each house of the Legislature, that includes specific performance measures, barriers encountered and level of administrative funding used.
- Specifies grant funding is contingent on funding in the budget.
FISCAL EFFECT:
- One-time costs to HCD of $336,000 (GF) over two years for a limited term position to conduct research, solicit feedback from earlier and new participants, update and introduce previously developed building standards, and participate in the 18-month Building Standards Commission code adoption process.
- Ongoing costs of approximately $411,000 (GF) per year to CDA for additional personnel to administer the grant program and meet reporting requirements.
- Ongoing costs, contingent upon funding in the budget act, likely in the range of $1 million to $5 million (GF) annually, to provide grants to regional AAAs for fall prevention programs. Each AAA can be awarded up to $150,000. There are currently 33 AAAs for a potential total of $4.95 million, if all 33 AAAs were awarded the maximum grant amount.
- The Budget Act of 2019 (AB 74 (Ting), Chapter 23, Statutes of 2019), contains $4.6 million and one-time provisional budget bill language for CDA to provide fall prevention grants to AAAs.
COMMENTS:
- Purpose. This bill seeks to enable older adults and persons with disabilities to live independently in their homes through home modifications that reduce the risk of falling and through home construction standards that account for mobility challenges.
- Background. CDA administers programs that serve older adults, adults with disabilities, family caregivers and residents in long-term care facilities throughout the state. It administers funds allocated under the federal Older Americans Act (OAA), the state Older Californians Act and through the Medicaid (Medi-Cal in California) program.
CDA contracts with and provides leadership and direction to the 33 AAAs operating in California. The AAAs play a key role in planning, developing, coordinating and delivering a wide range of services and supports to consumers in their local planning service areas. They directly manage federal- and state-funded services that help older adults find employment; support older and disabled individuals to live as independently as possible in the community; promote healthy aging and community involvement; and assist family members as care givers. They function as a community link at the local level for development of home and community-based services provided under the department’s programs.
More than 7.8 million Californians are age 60 and older today. By 2030, that number is estimated to increase by 40% and the number of Californians age 85 and older is expected to grow by over 37%.
Falls are the leading cause of fatal and non-fatal injuries for older Americans. The Centers for Disease Control and Prevention (CDCP) reports that more than one out of four older people falls each year and that falling once doubles the chances of falling again. Studies indicate providing adequate lighting in the home, grab bars and railings on both sides of stairs significantly reduce the chances of falling.
This bill investigates possible changes to building standards and replaces obsolete CDA programs with a more-focused Dignity at Home and Fall Prevention Program to provide grants to AAAs for injury prevention information, education and services to enable qualified low-income older adults and persons with disabilities to remain in their homes.
- Prior Legislation. SB 1026 (Jackson), of the 2017-2018 Legislative Session, would have established the Dignity at Home and Fall Prevention Program, similar to this bill. That bill was held on this committee’s Suspense File.
Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081
Date of Hearing: July 3, 2019
ASSEMBLY COMMITTEE ON HOUSING AND COMMUNITY DEVELOPMENT
David Chiu, Chair
SBPCA Bill Id:SB 280
Author:(Jackson) – As Amended Ver:June 13, 2019
SENATE VOTE: 38-0
SUBJECT: Older adults and persons with disabilities: fall prevention
SUMMARY: Requires the Department of Housing and Community Development (HCD) to investigate possible changes to building standards that promote aging in place and establishes the Dignity at Home and Fall Prevention Act under the Department of Aging (CDA) to facilitate “aging in place.” Specifically, this bill:
- Requires the HCD to, at the next triennial building standards rulemaking cycle that commences after January 1, 2020, to explore revisions to residential building standards code that promote aging in place design.
- Repeals obsolete code section references.
- Establishes the Dignity at Home and Fall Prevention Program at the Department of Aging to provide grants to area agencies on aging for injury prevention information, education, and services to enable older adults and persons with disabilities to live independently in the home environment for as long as possible.
- Directs agencies receiving funds to provide information on injury prevention, home environmental assessments, and requires grantees to partner with local agencies that have expertise in injury prevention services.
- Requires the grant program to provide funding for injury prevention services, equipment, materials, and costs of labor.
- Defines eligibility for equipment and services to be limited to older adults and persons with disabilities who meet both of the following requirements:
a) The older adult or person with a disability has an adjusted household income that does not exceed 80 percent of the area median income.
b) The older adult or person with a disability has fallen, is at risk for falling, or is at risk for institutionalization, and is otherwise unable to afford the equipment or services to be provided by the program.
- Requires the CDA to consult with experts including the Fall Prevention Center of Excellence at the University of Southern California, local fall prevention coalitions, and local public health agencies.
- Requires the CDA to establish a grant application form and selection methodology.
- Requires each applicant to submit a plan and details for how the area agency on aging will provide injury prevention education, assessment services, equipment, and activities in an effective and cost-appropriate manner. The plan shall include information about the number of clients and type of service.
- Requires each grantee to submit a report to the CDA and to the appropriate fiscal and policy committees of each house of the Legislature that includes the specific performance measures as provided. The report must include information of barriers encountered and level of administrative funding used.
- Specifies that funding for grants is contingent on funding in the budget, and caps the grant funding per agency at $150,000.
EXISTING LAW:
- Establishes the California Building Standards Commission (CBSC) within the Department of General Services, and requires any building standards adopted or proposed by state agencies to be submitted to, and approved by, the CBSC prior to codification into the California Building Standards Code.
- Requires HCD to propose the adoption, amendment, or repeal of building standards to the CBSC and to adopt, amend, and repeal other rules and regulations to protect the health, safety, and welfare of occupants and to the public.
- Establishes the Senior Housing Information and Support Center within CDA, which provides and distributes information for seniors and their families with respect to available innovative resources and senior services.
- Supports the concept of “aging in place” by providing funding for education and home improvements while making recommendations for changes in home modification policies and providing information on the benefits on home modification for this concept.
- Establishes the Program for Injury Prevention in the Home Environment under CDA, which provides grants to local entities for injury prevention information and education programs and services to increase the awareness and prevention of injuries.
FISCAL EFFECT: Unknown
COMMENTS:
Purpose of the Bill: According to the author, “For many of our seniors and others at risk of falling who are on reduced or fixed incomes, simple home improvements to make their homes safer could mean the difference between being in their own homes and having to seek institutional care. Under SB 280 the Department of Aging would contract with Area Agencies on Aging to provide injury prevention information, education and services for the purpose of enabling older adults and persons with disabilities to live independently in the home environment for as long as possible. In addition under SB 280 the Building Standards Commission is asked to develop building standards that take mobility into account – for example, ground-level entries, wide interior doors and space for maneuverability. With these simple modifications and changes to how homes are constructed, seniors and others with mobility challenges will be better able to age in place and remain independent.”
Background: California’s population of people over the age of 65 is expected to increase about 50 percent from 2020 to 2030, growing from nearly 6 million people to 9 million people. This group’s share of the state’s population is growing as well, from approximately 15 percent of Californians to nearly 20 percent. The number of seniors who are divorced or never married is expected to increase commensurately, as is the percent without children. These projections indicate that older adults will be more likely to live alone.
Fall Prevention Building Standards: According to the Center for Disease Control (CDC), three million older people are treated for injuries related to falls in emergency departments across the country every year. Many elders who fall without being injured become afraid of falling again, this fear causes them to become less active, which leads to them become weaker and therefore increase their chances of falling once again. According to multiple research studies, some major risk factors for falling include lower body weakness, difficulties with walking and balance, medications that affect balance, vision, and hazards such as broken or uneven steps and rugs or clutter that the individual can trip over. Adequate lighting in the home, adding grab bars inside and outside the tub or shower and next to the toilet, as well as having railings on both sides of stairs have been proven to significantly reduce the chances of falling.
This bill proposes to investigate possible changes to building standards that will allow elders to remain in their homes and will further California’s efforts to promote aging in place. This bill would require HCD to investigate building standards that facilitate aging in place before proposing these standards for CBSC to consider. By investigating these standards, HCD can more efficiently develop standards that will work for all of California.
Fall Prevention Programs: The Senior Housing Information and Support Center and the Program for Injury Prevention were funded from Fiscal Year 2000-01 to Fiscal Year 2001-02. However, the funding was eliminated in December 2002 during the state’s energy crisis. Both programs continue to exist in statute under the Older California’s Act as unfunded programs. This bill would repeal those statutes, as neither of these programs has been operational since 2003, due to lack of funding.
This bill would replace those programs with a new more-focused Dignity at Home and Fall Prevention Program through which CDA would provide grants to area agencies on aging for injury prevention information, education, and services for the purpose of enabling qualified low-income older adults and persons with disabilities to live independently in the home environment for as long as possible. The grant funds would be used for injury prevention needs, including injury prevention equipment, services, materials, and labor costs for homeowners and renters meeting income requirements.
Additionally, to provide oversight of the new grant program, area agencies on aging that receive grants would be required to submit a report to CDA and to the appropriate fiscal and policy committees of each house of the Legislature that includes the specific performance measures. The report is also required to include information on the administrative costs incurred by the agency in carrying out the program and any barriers to service that the agency encountered, as specified.
Related Legislation:
SB 1026 (Jackson) (2018): Similarly to this bill, would have repealed obsolete statutes that establish programs CDA and instead establishes the Dignity at Home and Fall Prevention Program, which requires CDA to provide grants to AAAs for injury prevention services, as specified. The bill did not pass out of the Assembly Committee on Appropriations.
SB 24X (Committee on Budget), Chapter 24, Statutes of 2003: Provided that the Senior Housing Information and Support Center would be implemented only to the extent that funds for these purposes are appropriated by the Legislature in the annual Budget Act or other statute.
SB 370 (Ortiz), Chapter 689, Statutes of 2001: Established the Program for Injury Prevention in the Home Environment to award grants to eligible local level entities for injury prevention information and educational programs and services.
SB 1846 (Lowenthal), Chapter 797, Statutes of 2000: Established the Senior Housing Information and Support Center within CDA for the purpose of providing information and training relating to specified subjects, including housing options and home modification alternatives designed to support independent living, and available innovative resources and senior services.
Double referred: This bill is double referred. It was heard in the Assembly Committee on Aging and Long-Term Care on June 25, 2019 and passed on a vote of 7-0.
REGISTERED SUPPORT / OPPOSITION:
Support
California Senior Legislature (Sponsor)
Alameda County Board of Supervisors
California Association for Health Services At Home
California Association of Area Agencies on Aging
California Association of Public Authorities for IHSS
County of Santa Clara
County Welfare Directors Association of California
National Multiple Sclerosis Society
Professional Fiduciary Association of California
San Diego County
Opposition
None on file
Analysis Prepared by: Steve Wertheim / H. & C.D. / (916) 319-2085
Date of Hearing: June 25, 2019
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Adrin Nazarian, Chair
SBPCA Bill Id:SB 280
Author:(Jackson) – As Amended Ver:June 13, 2019
SENATE VOTE: 38-0
SUBJECT: Older adults and persons with disabilities: fall prevention.
SUMMARY: This bill creates the Dignity at Home and Fall Prevention Program at the California Department of Aging (CDA), which requires CDA to provide grants to area agencies on aging (AAAs) for injury prevention services, as specified, and repeals obsolete statutes that establish unfunded programs within CDA. It also requires the Department of Housing and Community Development (HCD) to develop and propose for adoption building standards requiring fall prevention structural features in single and multifamily dwellings, as specified. Specifically, this bill:
- States legislative findings that most older adults prefer to remain in their own homes as long as possible, but many are forced into skilled nursing, assisted living, or other congregate living options because their homes are no longer physically safe for them to live in, and recognizes that falls are the leading cause of both fatal and nonfatal injuries for Californians 65 years of age and older.
- Requires the HCD to, at the next triennial building standards rulemaking cycle that commences after January 1, 2020, to explore revisions to residential building standards code that promote aging in place design.
- Repeals obsolete code section references.
- Establishes the Dignity at Home and Fall Prevention Program at the Department of Aging to provide grants to area agencies on aging for injury prevention information, education, and services to enable older adults and persons with disabilities to live independently in the home environment for as long as possible.
- Directs agencies receiving funds to provide information on injury prevention, home environmental assessments, and requires grantees to partner with local agencies that have expertise in injury prevention services.
- Requires the grant program provide funding for injury prevention services, equipment, materials, and costs of labor.
- Defines eligibility for equipment and services to be limited to older adults and persons with disabilities who meet both of the following requirements:
a) The older adult or person with a disability has an adjusted household income that does not exceed 80 percent of the area median income.
b) The older adult or person with a disability has fallen, is at risk for falling, or is at risk for institutionalization, and is otherwise unable to afford the equipment or services to be provided by the program.
- Requires the CDA to consult with experts including the Fall Prevention Center of Excellence at the University of Southern California, local fall prevention coalitions, and local public health agencies.
- Requires the CDA to establish a grant application form and selection methodology.
- Requires each applicant to submit a plan and details for how the area agency on aging will provide injury prevention education, assessment services, equipment, and activities in an effective and cost-appropriate manner.
- The plan shall include information about the number of clients and type of service.
- Each grantee shall submit a report to the CDA and to the appropriate fiscal and policy committees of each house of the Legislature that includes the specific performance measures as provided; the report shall include information of barriers encountered and level of administrative funding used.
- Funding for grants is contingent on funding in the budget.
- Caps the grant funding per agency at $150,000.
EXISTING LAW:
- Establishes, in federal law, the Older Americans Act, which promotes the well-being of Americans 60 years old and above through services and programs designed to meet the specific needs of older citizens. Services provided under the Older Americans Act include home-delivered and communal meals; family caregiver support; health services home assistance for the elderly; job training and volunteer opportunities; and protections from elder abuse (42 U.S. Code 3001, et seq.)
- Requires the state, in order to be eligible for grants for certain programs within the Older Americans Act, to designate AAAs to serve older adults within a planning and service area and sets other requirements for AAAs, as specified. (42 U.S. Code 3025, et seq.)
- Establishes the Mello-Granlund Older Californians Act, finds and declares that one in three Americans over 65 years of age suffers a fall each year, often in the home, which can cause serious injury and depression. The Act establishes the CDA, and sets forth its duties and powers, including, among other things, entering into a contract for the development of information and materials to educate Californians on the concept of “aging in place” and the benefits of home modification. (WIC 9100 et seq.)
- Establishes the Senior Housing Information and Support Center within CDA for the purpose of providing information, or contracting with another entity, to provide information concerning housing options and home modification alternatives, to enable seniors to live independently or with their families as often as possible, as specified. (WIC 9115 et seq.)
- Declares and recognizes AAAs to be the local units on aging in California that are supported from an array of sources, including federal funding largely through the federal Older Americans Act, state and local governmental assistance, the private sector, and individual contributions for services. Requires AAAs to operate in compliance with the Older Americans Act and applicable regulations and sets other mandates on the operation of AAAs. (WIC 9400, et. seq.)
- States Legislative intent regarding aging in place and requires CDA, subject to budget appropriation, to develop information and materials which shall be used to educate Californians on the concept of aging in place and the benefits of home modification, as specified. (WIC 9450 et seq.)
- States Legislative intent regarding aging in place and requires CDA, subject to budget appropriation, to develop information and materials which shall be used to educate Californians on the concept of aging in place and the benefits of home modification, as specified. (WIC 9450 et seq.)
FISCAL EFFECT: According to the Senate Appropriations Committee’s analysis of SB 280 as amended April 10, 2019:
- Ongoing costs of approximately $411,000 per year to CDA for additional personnel to develop training materials, program standards, and regulations for program implementation; develop specific performance measures for grant recipients; procure and contract with AAAs to provide services; monitor operations to ensure compliance of program and fiscal performance requirements; and receive and compile required annual reports. (GF)
- Significant costs for awarding grants to AAAs. Each AAA can be awarded up to $150,000. There are currently 33 AAAs for a potential total of up to $4.95 million if all 33 AAAs were awarded the maximum grant amount. (GF)
- Significant costs to HCD of $336,000 over two years for a limited term position to conduct research, solicit feedback from earlier and new participants, update and introduce previously developed building standards, and participate in the 18-month Building Standards Commission code adoption process.
COMMENTS:
According to the author and sponsor, the CA Senior Legislature, SB 280 seeks to allow more aging Californians and disabled individuals to age in place and stay in their own homes through both the use of simple, inexpensive home modifications that reduce the risk of falling as well as through home construction standards that account for mobility challenges.
In support, the County Welfare Directors Association writes that “the clientele we serve through both In-Home Supportive Services and Adult Protective Services can be vulnerable to falls, and often are low-income, meaning their ability to pay for necessary home modifications is extremely limited…..(SB 280) is timely and will only be more needed as our population continues to age.”
Budget Act of 2019-20: AB 74 conference report contains $5 million and one-time provisional budget bill language to fund fall prevention grants at the Department of Aging.
Double referral: This bill will be referred to the Assembly Committee on Housing and Community Development should it pass out of this committee.
Related/Prior Legislation:
SB 1026 (Jackson, 2018) was similar to this bill in that it would have repealed obsolete statutes that establish programs CDA and instead establishes the Dignity at Home and Fall Prevention Program, which requires CDA to provide grants to AAAs for injury prevention services, as specified. The bill did not pass out of the Assembly Committee on Appropriations.
SB 24X (Committee on Budget, Chapter 24, Statutes of 2003) provided that the Senior Housing Information and Support Center would be implemented only to the extent that funds for these purposes are appropriated by the Legislature in the annual Budget Act or other statute.
SB 370 (Ortiz, Chapter 689, Statutes of 2001) established the Program for Injury Prevention in the Home Environment to award grants to eligible local level entities for injury prevention information and educational programs and services.
SB 1846 (Lowenthal, Chapter 797, Statutes of 2000) established the Senior Housing Information and Support Center within CDA for the purpose of providing information and training relating to specified subjects, including housing options and home modification alternatives designed to support independent living, and available innovative resources and senior services.
REGISTERED SUPPORT / OPPOSITION:
Support
California Senior Legislature – Sponsor
Alzheimer’s Association
The Arc and United Cerebral Palsy California Collaboration
California Alliance for Retired Americans (CARA)
California Association of Area Agencies on Aging (C4A)
California Association for Health Services at Home (CAHSAH)
California Association of Public Authorities for IHSS
Congress of California Seniors
Contra Costa County
County of San Diego
County of Santa Clara
County Welfare Director Association of California (CWDA)
National Multiple Sclerosis Society
Ventura County Board of Supervisors
Opposition
None on file.
Analysis Prepared by: Gail Gronert / AGING & L.T.C. / (916) 319-3990
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 280 |
THIRD READING
Bill No: SB 280
Amended: 4/10/19
SENATE HUMAN SERVICES COMMITTEE: 5-1, 3/25/19
AYES: Hurtado, Beall, Jackson, Pan, Wiener
NOES: Stone
SENATE HOUSING COMMITTEE: 11-0, 4/22/19
AYES: Wiener, Morrell, Bates, Caballero, Durazo, McGuire, Moorlach, Roth, Skinner, Umberg, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/16/19
AYES: Portantino, Bates, Bradford, Hill, Jones, Wieckowski
SUBJECT: Older adults and persons with disabilities: fall prevention
DIGEST:
This bill (1) repeals obsolete statutes that establish unfunded programs within the California Department of Aging (CDA) and in their place establishes the Dignity at Home and Fall Prevention Program; (2) requires CDA to provide grants to area agencies on aging (AAAs) for injury prevention services, as specified; and (3) requires the Department of Housing and Community Development (HCD) to investigate possible changes to building standards that promote aging in place.
Existing law:
- Establishes in federal law the Older Americans Act, which promotes the well-being of Americans 60 years old and above through services and programs designed to meet the specific needs of older citizens. Services provided under the Older Americans Act include home-delivered and communal meals; family caregiver support; health services home assistance for the elderly; job training and volunteer opportunities; and protections from elder abuse (42 U.S. Code 3001, et seq.)
- Establishes the Mello-Granlund Older Californians Act, finds and declares that one in three Americans over 65 years of age suffers a fall each year, often in the home, which can cause serious injury and depression. The Act establishes the CDA, and sets forth its duties and powers, including, among other things, entering into a contract for the development of information and materials to educate Californians on the concept of “aging in place” and the benefits of home modification. (WIC 9100 et seq.)
- Establishes the Senior Housing Information and Support Center within CDA for the purpose of providing information, or contracting with another entity, to provide information concerning housing options and home modification alternatives, to enable seniors to live independently or with their families as often as possible, as specified. (WIC 9115 et seq.)
- Declares and recognizes AAA to be the local units on aging in California that are supported from an array of sources, including federal funding largely through the federal Older Americans Act, state and local governmental assistance, the private sector, and individual contributions for services. Requires AAAs to operate in compliance with the Older Americans Act and applicable regulations and sets other mandates on the operation of AAAs. (WIC 9400, et. seq.)
States legislative intent regarding aging in place and requires CDA, subject to budget appropriation, to develop information and materials which shall be used to educate Californians on the concept of aging in place and the benefits of home modification, as specified. (WIC 9450 et seq.)
- Establishes the Program for Injury Prevention in the Home Environment, under which CDA, through the Senior Housing and Information Support Center, is required to provide grants to eligible local entities for injury prevention educational programs and services for the purpose of increasing the awareness and prevention of injuries, and for provision of certain defined home modifications. (WIC 9675 et seq.)
This bill:
- Makes a series of legislative findings and declarations regarding older adults, their risk of falling, the impact of falls, and the benefits of home modifications to reduce those risks.
- Requires HCD to investigate possible changes to building standards that promote aging in place, including:
- The location of doorbells, light switches and heating, ventilation and air-conditioning controls.
- The installation of support backing for the later installation of grab bars in one or more bathrooms.
- A 32-inch clearance for one bathroom door and one bedroom door on the ground floor.
- Permits HCD to propose the above building standards for consideration by California Building Standards Commission (CBSC) if the changes will not significantly increase the cost of construction.
- Requires HCD to include in any proposed building standard, regarding 32-inch clearance width for bathroom and bedroom doors, a finding whether a delay of 18 months in the effective date of that proposed building standard is warranted to provide adequate time for industry to incorporate the change into standard designs.
- Repeals the statute that created the Senior Housing Information and Support Center within CDA and created the center’s functions.
- Repeals legislative findings, declarations and intent with regard to “aging in place” concept.
- Repeals statute that created the Program for Injury Prevention in the Home Environment.
- Provides that it shall be known and may be cited as the Dignity at Home and Fall Prevention Act.
- Establishes the Dignity at Home and Fall Prevention Program, under which CDA shall provide grants to AAAs for injury prevention information, education, and services for the purpose of enabling older adults and persons with disabilities to live independently in the home environment for as long as possible.
- Requires a participating AAA that receives grant funds to provide specified information and services to older adults and persons with disabilities living in the community.
- Requires a participating AAA that receives grant funds to partner with local public and private nonprofit agencies that are experienced in injury prevention services, including, but not limited to, medical providers and hospital systems, fire departments, independent living centers, and home modification providers.
- Requires the Dignity at Home and Fall Prevention Program to include funding for injury prevention needs, including injury prevention equipment, services, materials, and labor costs for homeowners and renters meeting income requirements, as specified. Requires a participating AAA to comply with all specified requirements.
- Requires specified equipment and services to be covered under the program.
- Requires that eligibility for specified equipment and services shall be limited to older adults and persons with disabilities who meet specified income and fall requirements.
- Requires that all other potential funding sources for the equipment and services covered under the program shall be exhausted before funds appropriated for the program may be used.
- Requires CDA, in consultation with experts knowledgeable in injury prevention for older adults and persons with disabilities, including, but not limited to, the Fall Prevention Center of Excellence at the University of Southern California, local fall prevention coalitions, and local public health agencies, to develop and compile training materials and program standards for implementation of this article.
- Requires the director of CDA, in consultation with specified entities, to establish an application process and a selection methodology for program grants
- Requires CDA, as part of the grant application process, to require an applicant to submit a plan that details how the AAA will provide injury prevention education, assessment services, equipment, and activities in an effective and cost-appropriate manner, as specified.
- Provides that the grant funding awarded to participating AAAs shall, to the extent that funds are appropriated, be sufficient to provide injury prevention education, assessment services, equipment, and activities necessary for injury prevention in the home.
- Requires the director of CDA, in consultation with specified entities, to identify specific performance measures for grant recipients to include in a report to the Legislature, as specified.
- Requires AAAs that receive grants to submit a report to CDA and to the appropriate fiscal and policy committees of each house of the Legislature that includes the specific performance measures identified by CDA, as specified
- Requires that funding of grants shall be subject to the appropriation of funds by the Legislature in the Budget Act or another statute.
- Requires that appropriations made shall be expended to fund grants to eligible area AAAs in an amount not to exceed one hundred fifty thousand dollars ($150,000) each.
Background
According to the author, many seniors and others at risk of falling are on reduced or fixed incomes and “simple home improvements to make their homes safer could mean the difference between being in their own homes and having to seek institutional care.” SB 280 would create a Dignity at Home and Fall Prevention Program, through which local AAAs will be able to obtain grant funds in order to provide injury prevention information, education and services for the purpose of enabling older adults and persons with disabilities to live independently in the home environment for as long as possible.
Older Adults and Falls
More than 7.8 million Californians are age 60 and older today. By 2030, that number is estimated to increase by 40 percent and the number of Californians age 85 and older is expected to grow by over 37 percent.
Falls are the leading cause of fatal and non-fatal injuries for older Americans. Falls threaten seniors’ safety and independence and generate enormous economic and personal costs.
The Centers for Disease Control and Prevention (CDCP) reports that more than one out of four older people falls each year and that falling once doubles the chances of falling again. In the home, factors like poor lighting, loose carpets and lack of safety equipment (i.e., grab bars, stair rails and high toilets) increase risks of falling.
Falls can cause injuries as simple as bumps and bruises and as complex as broken hips. Falls are the most common cause of traumatic brain injuries in older adults, and they may also cause other severe injuries, such as fractures of the hip, that can have extremely negative impacts on quality of life. Even falls without injury can cause fear of falling, leading to physical decline, depression, and social isolation. The more severe the injury, the more likely a fall could result in hospitalization and institutionalization.
According to CDCP, in 2015, the medical costs for falls totaled more than $50 billion. Medicare and Medicaid paid 75 percent of these costs. CDCP also reports that one out of five falls causes a serious injury such as broken bones or head injury; three million older people are treated in emergency rooms a year for fall injuries; over 800,000 patients a years are hospitalized because of a fall injury, most often because of head injury or hip fracture; and falls are the most common cause of traumatic brain injury.
Fall Prevention Programs
Fall prevention programs can include home modifications, assistive devices, and exercise programs. Fall prevention home modifications can range from improved lighting and installation of grab bars to widening of doorways. Assistive devices are items like bathtub transfer benches and emergency alert devices. There are a number of fall prevention programs that provide older adults with safe exercises designed to increase balance and mobility and strengthen muscles. Two of which were established in code but have been unfunded for over 15 years.
The Senior Housing Information and Support Center and the Program for Injury Prevention were funded from Fiscal Year 2000-01 to Fiscal Year 2001-02. However, the funding was eliminated in December 2002 during the state’s energy crisis. Both programs continue to exist in statute under the Older California’s Act as unfunded programs. This bill repeals those statutes, as neither of these programs has been operational since 2003, due to lack of funding.
This bill replaces those programs with a new more-focused Dignity at Home and Fall Prevention Program through which CDA would provide grants to AAAs for injury prevention information, education, and services for the purpose of enabling qualified low-income older adults and persons with disabilities to live independently in the home environment for as long as possible. The grant funds would be used for injury prevention needs, including injury prevention equipment, services, materials, and labor costs for homeowners and renters meeting income requirements.
State Building Standards
The California Building Standards Law established the CBSC and the process for adopting state building codes. Under this process, relevant state agencies propose amendments to model building codes, which the CBSC must then adopt, modify, or reject. HCD is the relevant state agency for residential building codes. Every three years, the CBSC adopts a new version of the California Building Code, known as the triennial update. The building codes apply to all building occupancies and related features and equipment throughout the state.
This bill will require HCD to investigate building standards that facilitate aging in place before proposing any new standards for the CBSC to consider. Requiring HCD to investigate any new standards, is intended to allow HCD to develop standards that will work for all of California.
Related/Prior Legislation
SB 1026 (Jackson, 2018) was similar to this bill in that it would have repealed obsolete statutes that establish programs CDA and instead establishes the Dignity at Home and Fall Prevention Program, which requires CDA to provide grants to AAAs for injury prevention services, as specified. The bill did not pass out of Assembly Committee on Appropriations.
SB 24X (Committee on Budget, Chapter 24, Statutes of 2003) provided that the Senior Housing Information and Support Center would be implemented only to the extent that funds for these purposes are appropriated by the Legislature in the annual Budget Act or other statute.
SB 370 (Ortiz, Chapter 689, Statutes of 2001) established the Program for Injury Prevention in the Home Environment to award grants to eligible local level entities for injury prevention information and educational programs and services.
SB 1846 (Lowenthal, Chapter 797, Statutes of 2000) established the Senior Housing Information and Support Center within CDA for the purpose of providing information and training relating to specified subjects, including housing options and home modification alternatives designed to support independent living, and available innovative resources and senior services.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
According to the Senate Appropriations Committee, this bill will likely have the following fiscal impact:
- Ongoing costs of approximately $411,000 per year to CDA for additional personnel to develop training materials, program standards, and regulations for program implementation; develop specific performance measures for grant recipients; procure and contract with AAAs to provide services; monitor operations to ensure compliance of program and fiscal performance requirements; and receive and compile required annual reports. (GF)
- Significant costs for awarding grants to AAAs. Each AAA can be awarded up to $150,000. There are currently 33 AAAs for a potential total of up to $4.95 million if all 33 AAAs were awarded the maximum grant amount. (GF)
- Significant costs to HCD of $336,000 over two years for a limited term position to conduct research, solicit feedback from earlier and new participants, update and introduce previously developed building standards, and participate in the 18-month Building Standards Commission code adoption process.
California Association for Health Services at Home
California Association of Public Authorities for IHSS
Congress of California Seniors
County of San Diego
County of Ventura
County Welfare Directors Association of California
National Multiple Sclerosis Society, MS-Can
OPPOSITION: (Verified 5/15/19)
California Apartment Association
California Association of Realtors
California Building Notary Association
California Business Properties Association
California Chamber of Commerce
Prepared by: Taryn Smith / HUMAN S. /
5/18/19 12:53:15
**** END ****
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anthony Portantino, Chair
2019 - 2020 Regular Session
SB 280 (Jackson) - Older adults and persons with disabilities: fall prevention
Version: April 10, 2019 | Policy Vote: HUMAN S. 5 - 1, HOUSING 11 - 0 |
Urgency: No | Mandate: No |
Hearing Date: May 6, 2019 | Consultant: Debra Cooper |
Bill Summary:
SB 280 would repeal obsolete statutes that establish unfunded programs within the California Department of Aging (CDA) and in their place establish the Dignity at Home and Fall Prevention Program, which would require CDA to provide grants to area agencies on aging (AAAs) for injury prevention services, as specified. This bill would also require the Department of Housing and Community Development (HCD) to develop and propose the adoption of building standards requiring fall prevention structural features in single and multifamily dwellings, as specified.
Fiscal Impact:
- Ongoing costs of approximately $411,000 per year to CDA for additional personnel to develop training materials, program standards, and regulations for program implementation; develop specific performance measures for grant recipients; procure and contract with AAAs to provide services; monitor operations to ensure compliance of program and fiscal performance requirements; and receive and compile required annual reports. (GF)
- Significant costs for awarding grants to AAAs. Each AAA can be awarded up to $150,000. There are currently 33 AAAs for a potential total of up to $4.95 million if all 33 AAAs were awarded the maximum grant amount. (GF)
- Significant costs to HCD of $336,000 over two years for a limited term position to conduct research, solicit feedback from earlier and new participants, update and introduce previously developed building standards, and participate in the 18-month Building Standards Commission code adoption process.
Background:
CDA administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the state. It administers funds allocated under the federal Older Americans Act, the state Older Californians Act, and through the Medicaid (Medi-Cal in California) program.
CDA contracts with and provides leadership and direction to the 33 AAAs operating in California. The AAAs play a key role in planning, developing, coordinating and delivering a wide range of services and supports to consumers in their local planning service areas. They directly manage federal and state-funded services that help older adults find employment; support older and disabled individuals to live as independently as possible in the community; promote healthy aging and community involvement; and assist family members as care givers. They function as a community link at the local level for development of home- and community-based services provided under the department’s programs. CDA and AAAs offer a wide array of programs, at least two of which currently offer services in fall prevention.
More than 7.8 million Californians are age 60 and older today. By 2030, that number is estimated to increase by 40%. By 2030, the number of Californians age 85 and older is expected to grow by over 37%. One in three people over age 65 suffers a fall each year, often in the home. Falls can cause injuries as simple as bumps and bruises, or as complex as broken hips. The more severe the injury, the more likely a fall could result in hospitalization and institutionalization. In 2015, the medical costs for falls totaled more than $50 billion. Medicare and Medicaid paid 70% of these costs.
The budget for FY 2000-01 provided $516 million in funding to implement the Aging with Dignity Initiative, which was intended to expand in-home and community-based care options for elderly Californians and disabled adults. Under this initiative, CDA received funding for the Senior Housing Information Support Center. The Senior Housing Information and Support Center and the Program for Injury Prevention were funded from FY 2000-01 to FY 2001-02. However, the funding was eliminated in December 2002 during the state’s energy crisis. Both programs continue to be in statute under the Older California’s Act as unfunded programs.
The California Building Standards Law established the California Building Standards Commission (CBSC) and the process for adopting state building codes. Under this process, relevant state agencies propose amendments to model building codes, which the CBSC must then adopt, modify, or reject. Among other things, HCD proposes amendments to California's residential building standards for new construction to the CSBC and helps train local government inspectors to better understand the new requirements.
Proposed Law:
This bill would:
- Require HCD, at the next triennial building standards rulemaking cycle that commences on or after January 1, 2020, to investigate possible changes to building standards that promote aging in place, as specified;
- State that HCD may propose the above building standards for consideration by CSBC if the changes will not significantly increase the cost of construction;
- Replace the Senior Housing Information and Support Center, the Home Modifications for Seniors and the Program for Injury Prevention in the Home Environment with a new Dignity at Home and Fall Prevention Act, which will provide grants to “area agencies on aging” to provide services, information, and education on injury prevention;
- Require CDA to develop and compile training materials and program standards for the Dignity at Home and Fall Prevention Act, as specified;
- Require grant applicants to submit a plan that details how the AAA will provide the injury prevention education, assessment services, equipment, and activities in an effective and cost-appropriate manner as specified;
- Require CDA to identify specific performance measures for grant recipients, as specified;
- Require an AAA that receives a grant to submit a report to CDA and the Legislature that includes the specific performance measures identified by CDA as well as administrative costs and any barriers to service that the agency encountered;
- Provide that funding for this program shall be subject to legislative or budget appropriation and caps individual grants at $150,000.
Related Legislation:
SB 1026 (Jackson, 2018), similar to this bill, would have repealed obsolete statutes that establish programs within CDA and instead establish the Dignity at Home and Fall Prevention Program, which would have required CDA to provide grants to AAAs for injury prevention services, as specified. The measure was held in the Assembly Committee on Appropriations.
Staff Comments:
This bill would repeal the Senior Housing Information and Support Center and the Program for Injury Prevention in the Home Environment. Both of these programs were funded via the General Fund from 2000-2002; however, neither have been funded since December 2002. Therefore, repealing these programs will have no fiscal effect on CDA.
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SENATE COMMITTEE ON HOUSING
Senator Scott Wiener, Chair
2019 - 2020 Regular
Bill No: SB 280 Hearing Date: 4/22/2019
Author: | Jackson | ||
Version: | 4/10/2019 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Lizeth Perez | ||
SUBJECT: Older adults and persons with disabilities: fall prevention
DIGEST: This bill requires the Department of Housing and Community Development (HCD) to investigate possible changes to building standards that promote aging in place and establishes the Dignity at Home and Fall Prevention Act under the Department of Aging (CDA) to facilitate “aging in place”.
ANALYSIS:
Existing law:
- Establishes the California Building Standards Commission (CBSC) within the Department of General Services, and requires any building standards adopted or proposed by state agencies to be submitted to, and approved by, the CBSC prior to codification into the California Building Standards Code.
- Requires the Department of Housing and Community Development (HCD) to propose the adoption, amendment, or repeal of building standards to the CBSC and to adopt, amend, and repeal other rules and regulations to protect the health, safety, and welfare of occupants and to the public.
- Establishes the Senior Housing Information and Support Center within CDA, which provides and distributes information for seniors and their families with respect to available innovative resources and senior services.
- Supports the concept of “aging in place” by providing funding for education and home improvements while making recommendations for changes in home modification policies and providing information on the benefits on home modification for this concept.
- Establishes the Program for Injury Prevention in the Home Environment under CDA, which provides grants to local entities for injury prevention information and education programs and services to increase the awareness and prevention of injuries.
This bill:
- Requires HCD to investigate possible changes to building standards that promote aging in place, including:
- The location of doorbells, light switches and heating, ventilation and air-conditioning (HVAC) controls.
- The installation of support backing for the later installation of grab bars in one or more bathrooms.
- A 32-inch clearance for one bathroom door and one bedroom door on the ground floor.
- States that HCD may propose the above building standards for consideration by CBSC if the changes will not significantly increase the cost of construction.
- Replaces the Senior Housing Information and Support Center, the Home Modifications for Seniors and the Program for Injury Prevention in the Home Environment with a new Dignity at Home and Fall Prevention Act, which will provide grants to “area agencies on aging” to provide services, information, and education on injury prevention.
- Requires CDA to develop and compile training materials and program standards for the Dignity at Home and Fall Prevention Act, as specified.
- Requires grant applicants to submit a plan that details how the area agency on aging will provide the injury prevention education, assessment services, equipment, and activities in an effective and cost-appropriate manner as specified.
- Requires CDA to identify specific performance measures for grant recipients, as specified.
- Requires an area agency on aging that receives a grant to submit a report to CDA and the Legislature that includes the specific performance measures identified by CDA as well as administrative costs and any barriers to service that the agency encountered.
- Provides that funding for this program shall be subject to legislative or budget appropriation and caps individual grants at $150,000.
COMMENTS
- Purpose of the bill. The author states that “for elder and disabled Californians, the risk of fall at home is very real and can have long-lasting repercussions. For too many, the difference between aging in place and institutionalization may be simple home modifications to prevent falls and ease access. SB 280 creates the Dignity at Home and Fall Prevention Program, which does two things. First, it would, at the next triennial building standards rulemaking cycle that commences on or after January 1, 2020, require the Department of Housing and Community Development to [investigate possible changes to building standards that promote aging in place]. Second, it tasks the state’s Department of Aging with making grants to area Agencies on Aging for injury prevention information, education and services to enable older adults and those with disabilities to live independently in their own homes, with modifications. Studies show that basic home modifications can improve safety and make it easier to maneuver about the home – all while forestalling hospitalizations and nursing home placements.”
- California’s aging population. According to the Public Policy Institute of California (PPIC), by 2030 there will be over four million people over the age of 65. Between 2012 and 2030, the number of seniors who are divorced or never married will increase by 115% and 210% respectively, and the number without children will increase from 15% to 20%. These projections indicate that older adults will be more likely to live alone, and since adult children often care for their senior parents, an alternative non-family source of care will be more common in the future. According to the Center for Disease Control (CDC), three million older people are treated for injuries related to falls in emergency departments across the country every year. Many elders who fall without being injured become afraid of falling again, this fear causes them to become less active, which leads to them become weaker and therefore increase their chances of falling once again. According to multiple research studies, some major risk factors for falling include lower body weakness, difficulties with walking and balance, medications that affect balance, vision, and hazards such as broken or uneven steps and rugs or clutter that the individual can trip over. Adequate lighting in the home, adding grab bars inside and outside the tub or shower and next to the toilet, as well as having railings on both sides of stairs have been proven to significantly reduce the chances of falling. This bill proposes to investigate possible changes to building standards that will allow elders to remain in their homes and will further California’s efforts to promote aging in place.
- Building standards background. The California Building Standards Law established the CBSC and the process for adopting state building codes. Under this process, relevant state agencies propose amendments to model building codes, which the CBSC must then adopt, modify, or reject. For example, HCD is the relevant state agency for residential building codes. Every three years, the CBSC adopts a new version of the California Building Code (CBC), known as the triennial update. The building codes apply to all building occupancies and related features and equipment throughout the state. This bill will require HCD to investigate building standards that facilitate aging in place before proposing these standards for CBSC to consider. By investigating these standards, HCD can more efficiently develop standards that will work for all of California.
- Double referral. This bill was passed by the Human Services Committee, who considered the provisions relating to the Dignity at Home and Fall Prevention Program, on a 5-1 vote on March 27th. This committee will consider the building standards provision of this bill.
Related Legislation:
SB 1026 (Jackson, 2018) — would have established the Dignity at Home and Fall Prevention Program, requiring CDA to provide grants to area agencies on aging for injury prevention information, education, and services for the purpose of enabling older adults and persons with disabilities to live independently in the home. This bill died in the Assembly Appropriations Committee.
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No
POSITIONS: (Communicated to the committee before noon on Wednesday,
April 17, 2019.)
SUPPORT:
California Senior Legislature (Sponsor)
Arc Of California
California Association For Health Services At Home
Congress Of California Seniors
Contra Costa County
County Welfare Directors Association Of California
National Multiple Sclerosis Society
San Diego; County Of
Santa Clara; County Of
United Cerebral Palsy California Collaboration
Ventura; County Of
OPPOSITION:
None received.
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SENATE COMMITTEE ON HUMAN SERVICES
Senator Hurtado, Chair
2019 - 2020 Regular
Bill No: SB 280
Author: | Jackson | ||
Version: | February 13, 2019 | Hearing Date: | March 25, 2019 |
Urgency: | No | Fiscal: | Yes |
Consultant: | Taryn Smith | ||
Subject: Older adults and persons with disabilities: fall prevention
SUMMARY
This bill repeals obsolete statutes that establish unfunded programs within the California Department of Aging (CDA) and in their place establishes the Dignity at Home and Fall Prevention Program, which requires CDA to provide grants to area agencies on aging (AAAs) for injury prevention services, as specified. It also requires the Department of Housing and Community Development (HCD) to develop and propose for adoption building standards requiring fall prevention structural features in single and multifamily dwellings, as specified.
ABSTRACT
Existing Law:
- Establishes, in federal law, the Older Americans Act, which promotes the well-being of Americans 60 years old and above through services and programs designed to meet the specific needs of older citizens. Services provided under the Older Americans Act include home-delivered and communal meals; family caregiver support; health services home assistance for the elderly; job training and volunteer opportunities; and protections from elder abuse (42 U.S. Code 3001, et seq.)
- Requires the state, in order to be eligible for grants for certain programs within the Older Americans Act, to designate AAAs to serve older adults within a planning and service area and sets other requirements for AAAs, as specified. (42 U.S. Code 3025, et seq.)
- Establishes the Mello-Granlund Older Californians Act, finds and declares that one in three Americans over 65 years of age suffers a fall each year, often in the home, which can cause serious injury and depression. The Act establishes the CDA, and sets forth its duties and powers, including, among other things, entering into a contract for the development of information and materials to educate Californians on the concept of “aging in place” and the benefits of home modification. (WIC 9100 et seq.)
- Establishes the Senior Housing Information and Support Center within CDA for the purpose of providing information, or contracting with another entity, to provide information concerning housing options and home modification alternatives, to enable seniors to live independently or with their families as often as possible, as specified. (WIC 9115 et seq.)
- Declares and recognizes AAA to be the local units on aging in California that are supported from an array of sources, including federal funding largely through the federal Older Americans Act, state and local governmental assistance, the private sector, and individual contributions for services. Requires AAAs to operate in compliance with the Older Americans Act and applicable regulations and sets other mandates on the operation of AAAs. (WIC 9400, et. seq.)
States Legislative intent regarding aging in place and requires CDA, subject to budget appropriation, to develop information and materials which shall be used to educate Californians on the concept of aging in place and the benefits of home modification, as specified. (WIC 9450 et seq.)
- Establishes the Program for Injury Prevention in the Home Environment, under which CDA, through the Senior Housing and Information Support Center, is required to provide grants to eligible local entities for injury prevention educational programs and services for the purpose of increasing the awareness and prevention of injuries, and for provision of certain defined home modifications. (WIC 9675 et seq.)
This Bill:
- Makes a series of Legislative finding and declarations regarding older adults, their risk of falling, the impact of falls, and the benefits of home modifications to reduce those risks as follows:
- According to the Public Policy Institute of California, by 2030, the California population of persons 65 years of age and older will increase by more than four million.
- Most elders prefer to remain in their own homes as long as possible, but many are forced into skilled nursing, assisted living, or other congregate living options because their homes are no longer physically safe for them to live in.
- Falls are the leading cause of both fatal and nonfatal injuries for Californians 65 years of age and older.
- In 2014, there were 208,564 Californians 65 years of age and older treated in emergency departments for fall-related injuries and 74,954 were hospitalized as a result of an unintentional fall injury.
- In 2013, 1,733 Californians died as a result of a fall injury.
- The behavioral risk factor surveillance system survey states that 30.7 percent of older Californians reported falling in the previous 12 months.
- Of those adults 65 years of age and older who are hospitalized for a hip fracture, 40 percent never return home or live independently again, and 25 percent will die within one year.
- In 2015, according to a 2016 analysis published in the journal of safety research, fatal falls cost an average of $26,340, while nonfatal falls cost an average of $9,780.
- By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 million.
- Many of those fall patients will use Medicare, Medicaid, or both, to pay their medical expenses, including the charges for skilled nursing or rehabilitation facilities, costing the federal and state governments large amounts of money.
- The United States Centers for Disease Control and Prevention states that there are proven interventions that can reduce falls and help older adults live better and longer.
- The Centers for Medicare and Medicaid Services’ evidence-based review of multifactorial fall preventions programs concluded that the incidence of falls was reduced by a minimum of 11 percent with a potential of a 23-percent reduction when falls prevention strategies are implemented.
- A University of California, Los Angeles health policy research brief from May 2010 reports that guidelines published by the American Geriatrics Society includes home modification as one of the strategies to reduce falls.
- In many cases, the retrofit of homes to add fall prevention features to an existing house can be quite expensive and beyond the means of senior residents.
- Requires HCD to develop and propose for adoption by the Building Standards Commission building standards requiring fall prevention structural features in single and multifamily dwellings to prevent falls and to facilitate aging in place, including, but not limited to, one ground-level entry, wide interior doors, adequate space in bathrooms and kitchens for maneuverability, blocking in bathrooms to allow future grab bar installation, reachable electrical controls, and a step-free path through the entire ground floor, as specified.
- Repeals the statute that created the Senior Housing Information and Support Center within CDA and created the center’s functions.
- Repeals Legislative findings, declarations and intent with regard to “aging in place” concept being recognized and supported by the state; that funding for education and home improvements be facilitated through public and private sources; and that recommendations for changes in home modification policies and information for home modification projects and products be developed.
- Repeals statute that created the Program for Injury Prevention in the Home Environment.
- Provides that it shall be known and may be cited as the Dignity at Home and Fall Prevention Act.
- Establishes the Dignity at Home and Fall Prevention Program, under which CDA shall provide grants to AAAs for injury prevention information, education, and services for the purpose of enabling older adults and persons with disabilities to live independently in the home environment for as long as possible.
- Requires a participating AAA that receives grant funds to provide all of the following:
- Information and education on injury prevention to older adults and persons with disabilities living in the community.
- Referral-related resources and services in the community.
- Home environmental assessments and assessments of individual injury prevention needs, including instruction on behavioral, physical, and environmental aspects of injury prevention.
- Requires a participating AAA that receives grant funds to partner with local public and private nonprofit agencies that are experienced in injury prevention services, including, but not limited to, medical providers and hospital systems, fire departments, independent living centers, and home modification providers.
- Requires the Dignity at Home and Fall Prevention Program to include funding for injury prevention needs, including injury prevention equipment, services, materials, and labor costs for homeowners and renters meeting income requirements, as specified. Requires a participating area agency on aging to comply with all specified requirements.
- Requires that equipment and services covered under the program include, but not be limited to, all of the following:
- Grab bars, nonskid surfaces, toilet seat risers, shower seats, and transfer benches.
- Indoor and outdoor handrails and threshold modifications.
- Reconfiguration of furniture and other elements of the physical home environment to reduce hazards.
- Wearable medical alert devices.
- Requires that eligibility for specified equipment and services shall be limited to older adults and persons with disabilities who meet both of the following requirements:
- The older adult or person with a disability has an adjusted household income that does not exceed 80 percent of the area median income.
- The older adult or person with a disability has fallen, is at risk for falling, or is at risk for institutionalization, and is otherwise unable to afford the equipment or services to be provided by the program.
- Requires that all other potential funding sources for the equipment and services covered under the program shall be exhausted before funds appropriated for the program may be used.
- Requires CDA, in consultation with experts knowledgeable in injury prevention for older adults and persons with disabilities, including, but not limited to, the Fall Prevention Center of Excellence at the University of Southern California, local fall prevention coalitions, and local public health agencies, to develop and compile training materials and program standards for implementation of this article.
- Requires the director of CDA, in consultation with specified entities, to establish an application process and a selection methodology for program grants
- Requires CDA, as part of the grant application process, to require an applicant to submit a plan that details how the AAA will provide injury prevention education, assessment services, equipment, and activities in an effective and cost-appropriate manner. The plan shall include, but not be limited to, all of the following information:
- The projected number of clients to be served.
- A description of the local population to be served.
- The geographic locations at which services will be provided.
- The array of services that will be offered.
- The ability of the AAA to administer an effective service program.
- The ability of the AAA to collaborate with local entities, including, but not limited to, public and private nonprofit agencies that are experienced in injury prevention services, home modification services, home safety services, and services for seniors and persons with disabilities, for purposes of program coordination.
- The ability of the AAA to gather and utilize other resources to supplant funding provided by CDA and whether any local funding match is available.
- Provides that the grant funding awarded to participating AAAs shall, to the extent that funds are appropriated, be sufficient to provide injury prevention education, assessment services, equipment, and activities necessary for injury prevention in the home.
- Requires the director of CDA, in consultation with specified entities, to identify specific performance measures for grant recipients to include in a report to the Legislature. These performance measures shall include, but not be limited to the number of people served and the types of services received by program participants.
- Requires AAAs that receive grants to submit a report to CDA and to the appropriate fiscal and policy committees of each house of the Legislature that includes the specific performance measures identified by CDA. The report shall also provide information on the administrative costs incurred by the agency in carrying out the program and any barriers to service that the agency encountered, as specified.
- Requires that funding of grants shall be subject to the appropriation of funds by the Legislature in the Budget Act or another statute.
- Requires that appropriations made shall be expended to fund grants to eligible area AAAs in an amount not to exceed one hundred fifty thousand dollars ($150,000) each.
FISCAL IMPACT
This bill has not yet been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the Bill:
According to the author, many seniors and others at risk of falling are on reduced or fixed incomes and “simple home improvements to make their homes safer could mean the difference between being in their own homes and having to seek institutional care.” SB 280 would create a Dignity at Home and Fall Prevention Program, through which local AAAs will be able to obtain grant funds in order to provide injury prevention information, education and services for the purpose of enabling older adults and persons with disabilities to live independently in the home environment for as long as possible.
In addition, under SB 280, the Building Standards Commission is required to develop building standards that take mobility into account – for example, ground-level entries, wide interior doors and space for maneuverability. “With these simple modifications and changes to how homes are constructed, seniors and others with mobility challenges will be better able to age in place and remain independent,” the author states.
Older Adults and Falls
More than 7.8 million Californians are age 60 and older today. By 2030, that number is estimated to increase by 40 percent and the number of Californians age 85 and older is expected to grow by over 37 percent.
Falls are the leading cause of fatal and non-fatal injuries for older Americans. Falls threaten seniors’ safety and independence and generate enormous economic and personal costs.
The Centers for Disease Control and Prevention (CDCP) reports that more than one out of four older people falls each year and that falling once doubles the chances of falling again. In the home, factors like poor lighting, loose carpets and lack of safety equipment (i.e., grab bars, stair rails and high toilets) increase risks of falling.
Falls can cause injuries as simple as bumps and bruises and as complex as broken hips. Falls are the most common cause of traumatic brain injuries in older adults, and they may also cause other severe injuries, such as fractures of the hip, that can have extremely negative impacts on quality of life—and on our economy in general. Even falls without injury can cause fear of falling, leading to physical decline, depression, and social isolation. The more severe the injury, the more likely a fall could result in hospitalization and institutionalization.
According to CDCP, in 2015, the medical costs for falls totaled more than $50 billion. Medicare and Medicaid paid 75 percent of these costs. CDCP also reports that one out of five falls causes a serious injury such as broken bones or head injury; 3 million older people are treated in emergency rooms a year for fall injuries; over 800,000 patients a years are hospitalized because of a fall injury, most often because of head injury or hip fracture; and falls are the most common cause of traumatic brain injury.
CDCP recommends the following home modifications to help prevent falls:
- Add grab bars inside and outside the tub or shower and next to the toilet.
- Install railings on both sides of stairs.
- Improve lighting in the home by adding more or brighter light bulbs.
- Remove items that can cause falls, including small throw rugs.
Experts also recommend that older adults stay active, as building muscle strength and balance are key to avoiding falls.
CDA and AAAs
CDA administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the state. It administers funds allocated under the federal Older Americans Act (OAA), the state Older Californians Act, and through the Medicaid (Medi-Cal in California) program.
CDA contracts with and provides leadership and direction to the 33 AAAs operating in California. The AAAs play a key role in planning, developing, coordinating and delivering a wide range of services and supports to consumers in their local planning service areas. They directly manage federal- and state-funded services that help older adults find employment; support older and disabled individuals to live as independently as possible in the community; promote healthy aging and community involvement; and assist family members as care givers. They function as a community link at the local level for development of home and community based services provided under the department’s programs.
Services provided by AAAs, or through their contracts with community providers, include: home adaptation funding; provision of assistive devices; support groups; nutrition programs, including congregate nutrition programs and home delivered meal programs; disease prevention and health promotion programs; family caregiver support programs, including training and education; and supportive services programs.
Fall Prevention Programs
Fall prevention programs can include home modifications, assistive devices, and exercise programs. Fall prevention home modifications can range from improved lighting and installation of grab bars to widening of doorways. Assistive devices are items like bathtub transfer benches and emergency alert devices. There are a number of fall prevention programs that provide older adults with safe exercises designed to increase balance and mobility and strengthen muscles. Some of the government-funded fall prevention services offered at the local level are summarized below.
Local Multipurpose Senior Service Program (MSSP) is a Medi-Cal Home and Community Based Waiver program designed to provide social and health care management for frail elderly clients who are eligible for Medi-Cal and certifiable for placement in a nursing facility but who wish to remain in the community. MSSP is both federally and state-funded and has a fall prevention component but the program is not solely dedicated to fall prevention. MSSP funds may be used to provide an array of services including adult day care, chore and personal care assistance, protective supervision, care management, respite, transportation, meals, social services and communication services. MSSP funds can also be used for housing assistance, which may include provision of physical adaptations and assistive devices, emergency assistance in situations that demand relocation, temporary lodging expenses in particular situations, and assistance to restore utility services.
There are several optional fall prevention services offered by AAAs through the OAA and funded with federal dollars. While there are core programs each AAA must provide, availability of these services may vary based on each AAA’s assessment and prioritization of local needs. Therefore, not all AAAs offer these programs and services.
- The Supportive Services Program provides a variety of services to address functional limitations, maintain health and independence, and promote access to services. Among other things, this program provides home repairs or modification to address minor repairs or modifications needed so an older adult can remain safely at home. According to CDA, seven of the 33 AAAs offer this service.
- The Evidence-Based Disease Prevention and Health Promotion Services Program includes providing evidence-based services to help delay and/or manage chronic health conditions, prevent falls, and promote physical fitness. Under this program local AAAs support healthy lifestyles and healthy behaviors at multipurpose senior centers, at congregate meal sites, through home delivered meal programs, and at other appropriate sites. Program activities promote improved nutrition, emotional and social well-being, physical fitness, and fall prevention. However, funds are not typically used to make improvements in the home that would reduce risk of falls. While all 33 AAAs participate in this program, the frequency of this service being used in California has decreased from 40,166 in FY 2014/15 to 29,546 in FY 2016/17. According to CDA this is due to challenges that AAAs had with providing evidence-based programs, more stringent regulations, and decreased contracted service providers.
- The Family Caregiver Support Program can assist families caring for an older adult (or an older caregiver caring for a younger family member) by providing an array of supplemental services including assistive devices (e.g., bathtub transfer bench, emergency alert fall prevention device, etc.) and home adaptations (e.g., installation of grab bars, replacement of door handles, installation of wheelchair ramp, etc.). According to CDA, 19 of the 33 AAAs offer this service.
The budget for Fiscal Year 2000-01 provided $516 million in funding to implement the Aging with Dignity Initiative, which was intended to expand in-home and community-based care options for elderly Californians and disabled adults. Under this initiative, CDA received funding for the Senior Housing Information Support Center for the purpose of providing information concerning housing options and home modification alternatives, in order to enable seniors to live independently or with their families. The budget also funded the Program for Injury Prevention in the Home Environment, under which the Senior Housing Information Support Centers provided grants to eligible local entities for injury prevention education and for certain defined home modifications.
The Senior Housing Information and Support Center and the Program for Injury Prevention were funded from Fiscal Year 2000-01 to Fiscal Year 2001-02. However, the funding was eliminated in December 2002 during the state’s energy crisis. Both programs continue to exist in statute under the Older California’s Act as unfunded programs. This bill would repeal those statutes, as neither of these programs has been operational since 2003, due to lack of funding.
This bill would replace those programs with a new more-focused Dignity at Home and Fall Prevention Program through which CDA would provide grants to AAAs for injury prevention information, education, and services for the purpose of enabling qualified low-income older adults and persons with disabilities to live independently in the home environment for as long as possible. The grant funds would be used for injury prevention needs, including injury prevention equipment, services, materials, and labor costs for homeowners and renters meeting income requirements.
Additionally, to provide oversight of the new grant program, AAAs that receive grants would be required to submit a report to CDA and to the appropriate fiscal and policy committees of each house of the Legislature that includes the specific performance measures. The report is also required to include information on the administrative costs incurred by the agency in carrying out the program and any barriers to service that the agency encountered, as specified.
State Building Standards
Among other things, HCD proposes amendments to California's residential building standards for new construction to the California Building Standards Commission and helps train local government inspectors to better understand the new requirements.
This bill requires HCD to develop and propose for adoption by the Building Standards Commission a new set of building standards that would require structural features in single and multifamily dwellings to prevent falls and to facilitate aging in place, including, but not limited to, one ground-level entry, wide interior doors, adequate space in bathrooms and kitchens for maneuverability, blocking in bathrooms to allow future grab bar installation, reachable electrical controls, and a step-free path through the entire ground floor.
The policy issues around developing new building standards are outside the jurisdiction of this committee, therefore, this bill has also been referred to Senate Housing Committee. Should this bill move out of this committee, provisions of the bill dealing with building standards will be addressed in the Senate Housing Committee.
Related/Prior Legislation:
SB 1026 (Jackson, 2018) was similar to this bill in that it would have repealed obsolete statutes that establish programs CDA and instead establishes the Dignity at Home and Fall Prevention Program, which requires CDA to provide grants to AAAs for injury prevention services, as specified. The bill did not pass out of Assembly Committee on Appropriations.
SB 24X (Committee on Budget, Chapter 24, Statutes of 2003) provided that the Senior Housing Information and Support Center would be implemented only to the extent that funds for these purposes are appropriated by the Legislature in the annual Budget Act or other statute.
SB 370 (Ortiz, Chapter 689, Statutes of 2001) established the Program for Injury Prevention in the Home Environment to award grants to eligible local level entities for injury prevention information and educational programs and services.
SB 1846 (Lowenthal, Chapter 797, Statutes of 2000) established the Senior Housing Information and Support Center within CDA for the purpose of providing information and training relating to specified subjects, including housing options and home modification alternatives designed to support independent living, and available innovative resources and senior services.
COMMENTS
In order to refine the legislative findings and declarations within this bill, the committee suggests the following amendments:
On page 3, line 3:
(a) According to the Public Policy Institute of California, by 2030, the California population of persons 65 years of age and older will increase by more than four million.
(b) Most elders older adults prefer to remain in their own homes as long as possible, but many are forced into skilled nursing, assisted living, or other congregate living options because their homes are no longer physically safe for them to live in.
(c) Falls are the leading cause of both fatal and nonfatal injuries for Californians 65 years of age and older.
(d) In 2014, there were 208,564 Californians 65 years of age and older treated in emergency departments for fall-related injuries and 74,954 were hospitalized as a result of an unintentional fall injury.
(e) In 2013, 1,733 Californians died as a result of a fall injury.
(f) The behavioral risk factor surveillance system survey states that 30.7 percent of older californians reported falling in the previous 12 months.
(g) Of those adults 65 years of age and older who are hospitalized for a hip fracture, 40 percent never return home or live independently again, and 25 percent will die within one year.
(h) In 2015, according to a 2016 analysis published in the journal of safety research, fatal falls cost an average of $26,340, while nonfatal falls cost an average of $9,780.
(i) By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 million.
(j) Many of those fall patients will use Medicare, Medicaid, or both, to pay their medical expenses, including the charges for skilled nursing or rehabilitation facilities, costing the federal and state governments large amounts of money.
(k) The United States Centers for Disease Control and Prevention states that there are proven interventions that can reduce falls and help older adults live better and longer.
(l) The Centers for Medicare and Medicaid Services’ evidence-based review of multifactorial fall preventions programs concluded that the incidence of falls was reduced by a minimum of 11 percent with a potential of a 23-percent reduction when falls prevention strategies are implemented.
(m) A University of California, Los Angeles health policy research brief from May 2010 reports that guidelines published by the American Geriatrics Society includes home modification as one of the strategies to reduce falls.
(n) In many cases, the retrofit of homes to add fall prevention features to an existing house can be quite expensive and beyond the means of senior residents.
This bill has also been referred to the Senate Housing Committee. Should it move out of this committee, the bill will be referred to Senate Housing Committee for consideration of policy issues within that committee’s jurisdiction, such as the proposed update the state building standards.
SUPPORT/OPPOSITION
Arguments in Support:
The Ventura County Board of Supervisors writes the following in support of SB 280: “Falls remain the leading cause of injury (or) death for older Americans. Falls threaten seniors’ safety and independence and generate enormous economic and person costs…The cause of falls is composed of multiple contributing factors including lack of strength in the lower extremities, the use of multiple medications, reduced vision, chronic health problems, and unsafe environments…For these reasons, the Ventura County Board of Supervisors supports SB 280.”
Arguments in Opposition:
A coalition consisting of the California Building Industry Association, California Apartment Association, California Business Properties Association, California Chamber of Commerce and California Association of Realtors opposes the provisions of the bill requiring an update of the building standards to include fall prevention standards for the following reasons: 1) it would create more costly mandates for single-family homes; 2) state mandated design runs contrary to buyer preference; 3) it would only affect new home construction, which amounts to about 5 percent of total housing stock over the next decade; 4) and retrofitting of existing dwellings is more practical, efficient and precise.
POSITIONS
Support:
California Association for Health Services at Home
Congress of California Seniors
County Of Ventura
County Welfare Directors Association of California (CWDA)
National Multiple Sclerosis Society, Ms-Can
Oppose:
California Building Industry Association; California Apartment Association; California Business Properties Association; California Chamber of Commerce; California Association of Realtors
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Bill Author
Bill Co-Author(s):
