Existing law requires the State Department of Public Health to license and regulate skilled nursing facilities (SNFs) and intermediate care facilities (ICFs). Existing law requires the State Department of Social Services to license and regulate residential care facilities for the elderly (RCFEs). A violation of those licensing provisions is generally a crime. Existing law prohibits those facilities from prohibiting the formation of a family council, which is a meeting of family members, friends, or representatives of 2 or more residents to confer in private without facility staff. Existing law prohibits those facilities from willfully interfering with the formation, maintenance, or promotion of a family council, as specified.

This bill would make changes to the definition and scope of prohibited interference.

Existing law sets forth various requirements on facilities relating to a family council with regard to providing a designated staff person, providing adequate posting and meeting space for the family council, and responding to written requests, concerns, or recommendations within specified timeframes.

For SNFs and ICFs, this bill would require that the designated staff person be approved by the family council, as specified. The bill would require that the family council be allowed to meet virtually or at an offsite location at its discretion. If a family council submits written requests, concerns, or recommendations, the bill would require the facility to respond in writing regarding any action or inaction within 14 calendar days, as specified.

Existing law authorizes staff or visitors to attend family council meetings, at the groups invitation.

This bill would instead authorize facility staff to attend meetings only at the invitation of the family council.

Existing law requires a facility to inform family members or representatives of the existence of the family council, if applicable.

This bill would also require the facility to inform friends identified in certain materials and to provide the name and contact information of the family council representative prior to or within 5 business days after the residents admission. The bill would make certain other related changes.

The bill would, for SNFs and ICFs, to the extent not in conflict with state and federal law, require a facility to inform the identified family members, friends, and representatives of their right to have their contact information shared with the family council.

The bill would, for RCFEs, require a facility to inform the identified family members, friends, and representatives of their right to have their contact information shared with the family council and of their right to consent or withhold consent to their contact information being shared.

If an RCFE does not have a family council, existing law requires the facility to provide written information to a newly admitted residents family or representative of their right to form a family council.

This bill would also add a residents friends as recipients of that information, and would apply those provisions to SNFs and ICFs, as specified.

Under existing law, a violation of the family council-related provisions is subject to specified civil penalties. In the case of RCFEs, existing law exempts a violation of those provisions from the above-described criminal penalty.

This bill would also specify that, in the case of SNFs and ICFs, a violation of those provisions is exempt from the above-described criminal penalty.

Existing law requires the State Department of Public Health to license and regulate skilled nursing facilities (SNFs) and intermediate care facilities (ICFs). Existing law requires the State Department of Social Services to license and regulate residential care facilities for the elderly (RCFEs). A violation of those licensing provisions is generally a crime. Existing law prohibits those facilities from prohibiting the formation of a family council, which is a meeting of family members, friends, or representatives of 2 or more residents to confer in private without facility staff. Existing law prohibits those facilities from willfully interfering with the formation, maintenance, or promotion of a family council, as specified.

This bill would make changes to the definition and scope of prohibited interference.

Existing law sets forth various requirements on facilities relating to a family council with regard to providing a designated staff person, providing adequate posting and meeting space for the family council, and responding to written requests, concerns, or recommendations within specified timeframes.

For SNFs and ICFs, this bill would require that the designated staff person be approved by the family council, as specified. The bill would require that the family council be allowed to meet virtually or at an offsite location at its discretion. If a family council submits written requests, concerns, or recommendations, the bill would require the facility to respond in writing regarding any action or inaction within 14 calendar days, as specified.

Existing law authorizes staff or visitors to attend family council meetings, at the groups invitation.

This bill would instead authorize facility staff to attend meetings only at the invitation of the family council.

Existing law requires a facility to inform family members or representatives of the existence of the family council, if applicable.

This bill would also require the facility to inform friends identified in certain materials and to provide the name and contact information of the family council representative prior to or within 5 business days after the residents admission. The bill would make certain other related changes.

The bill would, for SNFs and ICFs, to the extent not in conflict with state and federal law, require a facility to inform the identified family members, friends, and representatives of their right to have their contact information shared with the family council.

The bill would, for RCFEs, require a facility to inform the identified family members, friends, and representatives of their right to have their contact information shared with the family council and of their right to consent or withhold consent to their contact information being shared.

If an RCFE does not have a family council, existing law requires the facility to provide written information to a newly admitted residents family or representative of their right to form a family council.

This bill would also add a residents friends as recipients of that information, and would apply those provisions to SNFs and ICFs, as specified.

Under existing law, a violation of the family council-related provisions is subject to specified civil penalties. In the case of RCFEs, existing law exempts a violation of those provisions from the above-described criminal penalty.

This bill would also specify that, in the case of SNFs and ICFs, a violation of those provisions is exempt from the above-described criminal penalty.

Existing law requires the State Department of Public Health to license and regulate skilled nursing facilities (SNFs) and intermediate care facilities (ICFs). Existing law requires the State Department of Social Services to license and regulate residential care facilities for the elderly (RCFEs). A violation of those licensing provisions is generally a crime. Existing law prohibits those facilities from prohibiting the formation of a family council, which is a meeting of family members, friends, or representatives of 2 or more residents to confer in private without facility staff. Existing law prohibits those facilities from willfully interfering with the formation, maintenance, or promotion of a family council, as specified.

This bill would make changes to the definition and scope of prohibited interference.

Existing law sets forth various requirements on facilities relating to a family council with regard to providing a designated staff person, providing adequate posting and meeting space for the family council, and responding to written requests, concerns, or recommendations within specified timeframes.

For SNFs and ICFs, this bill would require that the designated staff person be approved by the family council, as specified. The bill would require that the family council be allowed to meet virtually or at an offsite location at its discretion. If a family council submits written requests, concerns, or recommendations, the bill would require the facility to respond in writing regarding any action or inaction within 14 calendar days, as specified.

Existing law authorizes staff or visitors to attend family council meetings, at the groups invitation.

This bill would instead authorize facility staff to attend meetings only at the invitation of the family council.

Existing law requires a facility to inform family members or representatives of the existence of the family council, if applicable.

This bill would also require the facility to inform friends identified in certain materials and to provide the name and contact information of the family council representative prior to or within 5 business days after the residents admission. The bill would make certain other related changes.

The bill would, for SNFs and ICFs, to the extent not in conflict with state and federal law, require a facility to inform the identified family members, friends, and representatives of their right to have their contact information shared with the family council.

If an RCFE does not have a family council, existing law requires the facility to provide written information to a newly admitted residents family or representative of their right to form a family council.

This bill would also add a residents friends as recipients of that information, and would apply those provisions to SNFs and ICFs, as specified.

Under existing law, a violation of the family council-related provisions is subject to specified civil penalties. In the case of RCFEs, existing law exempts a violation of those provisions from the above-described criminal penalty.

This bill would also specify that, in the case of SNFs and ICFs, a violation of those provisions is exempt from the above-described criminal penalty.

Existing law requires the State Department of Public Health to license and regulate skilled nursing facilities (SNFs) and intermediate care facilities (ICFs). Existing law requires the State Department of Social Services to license and regulate residential care facilities for the elderly (RCFEs). A violation of those licensing provisions is generally a crime. Existing law prohibits those facilities from prohibiting the formation of a family council, which is a meeting of family members, friends, or representatives of 2 or more residents to confer in private without facility staff. Existing law prohibits those facilities from willfully interfering with the formation, maintenance, or promotion of a family council, as specified.

This bill would remove willfulness as a condition of that prohibition and would make changes to the definition and scope of prohibited interference.

Existing law sets forth various requirements on facilities relating to a family council with regard to providing a designated staff person, providing adequate posting and meeting space for the family council, and responding to written requests, concerns, or recommendations within specified timeframes.

For SNFs and ICFs, this bill would require that the designated staff person be approved by the family council, as specified. The bill would require that the family council be allowed to meet virtually or at an offsite location at its discretion. If a family council submits written requests, concerns, or recommendations, the bill would require the facility to respond in writing regarding any action or inaction within 5 business 14 calendar days, as specified.

Existing law authorizes staff or visitors to attend family council meetings, at the groups invitation.

This bill would instead authorize a person other than a family member, friend, or resident representative to attend meetings, but only at the family councils invitation. facility staff to attend meetings only at the invitation of the family council.

Existing law requires a facility to inform family members or representatives of the existence of the family council, if applicable.

This bill would also require the facility to inform friends identified in certain materials and to provide the name and contact information of the family council representative prior to or within 5 business days after the residents admission. The bill would make certain other related changes.

The bill would, to the extent not in conflict with state and federal law, require a facility to provide the family council with certain contact information that the facility has for any family members, friends, and representatives of current residents, unless the individual has opted out of having their contact information shared with the family council based on a notification that the facility would be required to provide before sharing any contact information. inform the identified family members, friends, and representatives of their right to have their contact information shared with the family council.

If an RCFE does not have a family council, existing law requires the facility to provide written information to a newly admitted residents family or representative of their right to form a family council.

This bill would also add a residents friends as recipients of that information, and would apply those provisions to SNFs and ICFs, as specified.

Under existing law, a violation of the family council-related provisions is subject to specified civil penalties. In the case of RCFEs, existing law exempts a violation of those provisions from the above-described criminal penalty.

This bill would also specify that, in the case of SNFs and ICFs, a violation of those provisions is exempt from the above-described criminal penalty.

Existing law requires the State Department of Public Health to license and regulate skilled nursing facilities (SNFs) and intermediate care facilities (ICFs). Existing law requires the State Department of Social Services to license and regulate residential care facilities for the elderly (RCFEs). A violation of those licensing provisions is generally a crime. Existing law prohibits those facilities from prohibiting the formation of a family council, which is a meeting of family members, friends, or representatives of 2 or more residents to confer in private without facility staff. Existing law prohibits those facilities from willfully interfering with the formation, maintenance, or promotion of a family council, as specified.

This bill would remove willfulness as a condition of that prohibition and would make changes to the definition and scope of prohibited interference.

Existing law sets forth various requirements on facilities relating to a family council with regard to providing a designated staff person, providing adequate posting and meeting space for the family council, and responding to written requests, concerns, or recommendations within specified timeframes.

This bill would require that the designated staff person be approved by the family council, as specified. The bill would require that the family council be allowed to meet virtually or at an offsite location at its discretion. If a family council submits written requests, concerns, or recommendations, the bill would require the facility to respond in writing regarding any action or inaction within 5 business days, as specified.

Existing law authorizes staff or visitors to attend family council meetings, at the groups invitation.

This bill would instead authorize a person other than a family member, friend, or resident representative to attend meetings, but only at the family councils invitation.

Existing law requires a facility to inform family members or representatives of the existence of the family council, if applicable.

This bill would also require the facility to inform friends identified in certain materials and to provide the name and contact information of the family council representative prior to or within 5 business days after the residents admission. The bill would make certain other related changes.

The bill would, to the extent not in conflict with federal law, require a facility to provide the family council with certain contact information that the facility has for any family members, friends, and representatives of current residents, unless the individual has opted out of having their contact information shared with the family council based on a notification that the facility would be required to provide before sharing any contact information.

If an RCFE does not have a family council, existing law requires the facility to provide written information to a newly admitted residents family or representative of their right to form a family council.

This bill would also add a residents friends as recipients of that information, and would apply those provisions to SNFs and ICFs, as specified.

Under existing law, a violation of the family council-related provisions is subject to specified civil penalties. In the case of RCFEs, existing law exempts a violation of those provisions from the above-described criminal penalty.

This bill would also specify that, in the case of SNFs and ICFs, a violation of those provisions is exempt from the above-described criminal penalty.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 979

Author:(Alvarez)

As Amended Ver:August 14, 2023

Majority vote

SUMMARY

Expands upon and strengthens provisions of law governing the rights and operations of family councils at nursing homes, as well as those governing family councils at residential care facilities for the elderly, by, among other provisions, conforming the two sets of laws so they are more closely aligned with each other and with federal law, permitting family councils to be allowed to meet virtually or at an offsite location, and requiring written responses to requests or concerns raised by the family councils to have detailed rationales for any action or inaction taken in response to those requests or concerns.

Senate Amendments

Clarifies how identified family members, friends and representatives have their information shared with the family council.

COMMENTS

California's aging population is growing faster than any other age group. By 2030, over 25% of the population in California will be 60 and older.^[1] The population in the state is becoming more racially and ethnically diverse, and yet the COVID-19 pandemic impacted Californians disparately.

Family councils during the pandemic: While state law protects the rights of family members and representatives of residents in SNFs, ICFs and RCFEs to join and form family councils, the pandemic created an unforeseen barrier in keeping loved ones out of facilities. Family councils play a vital role in improving and maintaining quality within facilities. They also provide a conduit for communication between facilities, residents and their loved ones. While state law requires family councils have adequate space on a prominent bulletin board or other posting area to notice meetings and display other information, this information could not be seen during the first year plus of the pandemic. Family councils struggled to meet and communicate. Family councils must have the ability to meet in all ways that fit their needs, including virtual communication.

The COVID-19 pandemic forced statewide prohibitions of visitation for hundreds of thousands of residents in long-term care. Outside of the emotional toll of being isolated, residents were also unable to address issues within the facility. Resident representatives and family members of residents were physically barred from visiting the residents in their facility homes and may see similar prohibitions in the future. Allowing family councils to operate virtually will allow for continued communication between residents, residents families and representatives and facilities.

According to the Author

"As an independent, representative group of friends and family members of long-term care facility residents, family councils are critical to ensuring that facilities address residents' needs and concerns. Unfortunately, existing regulations are inadequate to ensure family councils can effectively do their job. AB 979 resolves some of these inadequacies by modernizing meeting options, expanding access to family councils, and requiring facilities to respond promptly to concerns raised by family councils. Adding these regulations ensures that our often under supported aging population receive the best care possible."

Arguments in Support

The California Advocates for Nursing Home Reform (CANHR), the sponsor of AB 979 writes, "AB 979 modernizes existing family council laws, so that members can meet and communicate electronically and continue to operate during a public health emergency. The bill also ensures that facilities will be more responsive to concerns raised by family councils, discourages operators from undermining family council activities, and clarifies that control of the family council membership and participation in meetings lies with the family council itself."

AARP also writes in support "Forming and participating in a family council are the rights of every nursing home resident, codified in both federal and state statute. AB 979 will allow family council meetings to be virtual, updating the statute for the 21^st century."

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, estimated General Fund costs, limited term and ongoing, to the California Department of Social Services, which regulates RCFEs, of an unknown amount, are likely in the low-hundreds of thousands of dollars annually. Costs would update regulations and the CARE tool, and manage additional workload associated with facility inspections.

The Department of Public Health, which regulates SNFs and ICFs, anticipates minor and absorbable costs.

VOTES:

ASM AGING AND LONG-TERM CARE: 7-0-1

YES: Bains, Ta, Alvarez, Haney, Stephanie Nguyen, Reyes, Blanca Rubio

ABS, ABST OR NV: Joe Patterson

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

ASSEMBLY FLOOR: 80-0-0

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones- Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

SENATE FLOOR: 40-0-0

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

UPDATED

VERSION: August 14, 2023

CONSULTANT: Elizabeth Fuller / AGING & L.T.C. / (916) 319-3990 FN: 0001334

1. Projections | Department of Finance (ca.gov) ↑

 CONSENT  

Bill No: AB 979

Author: Alvarez (D)

Amended: 8/14/23 in Senate

Vote: 21

SENATE HEALTH COMMITTEE: 12-0, 6/21/23

AYES: Eggman, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Roth, Rubio, Wahab, Wiener

SENATE HUMAN SERVICES COMMITTEE: 5-0, 7/3/23

AYES: Alvarado-Gil, Ochoa Bogh, Hurtado, Menjivar, Wahab

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 80-0, 5/30/23 - See last page for vote

SUBJECT: Long-term care: family councils

SOURCE: Author

DIGEST:

This bill recasts and strengthens provisions of law governing the rights and operations of family councils at nursing homes, as well as those governing family councils at residential care facilities for the elderly, by, among other provisions, conforming the two sets of laws so they are more closely aligned with each other and with federal law, permitting family councils to be allowed to meet virtually or at an offsite location, and requiring written responses to requests or concerns raised by the family councils to have detailed rationales for any action or inaction taken in response to those requests or concerns.

ANALYSIS:

Existing law:

1. Licenses and regulates long-term health care facilities, including skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) by the California Department of Public Health (CDPH). [ Health and Safety Code (HSC) §1250(c) and (d)]
2. Licenses and regulates residential care facilities for the elderly (RCFEs) by the California Department of Social Services (DSS), defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided. [HSC §1569 et seq.]
3. Defines “family council,” for purposes of SNFs, ICFs, and RCFEs, as a meeting of family members, friends, or representatives of two or more residents to confer in private without facility staff. [HSC §1418.4(c), §1569.158(c)]
4. Prohibits SNFs, ICFs, and RCFEs from prohibiting the formation of a family council, and, when requested by a member of the resident’s family or the resident’s representative, requires a SNF or ICF to allow a family council to be allowed to meet in a common meeting room of the facility at least once a month during mutually agreed upon hours. [HSC §1418.4(a), §1569.158(a)]
5. Prohibits SNFs, ICFs, and RCFEs policies on family councils that limit the right of residents, family members, and family council members to meet independently with outside persons, including members of nonprofit or government organizations or with facility personnel during nonworking hours. [HSC §1418.4(b), §1569.158(b)]
6. Requires SNFs and ICFs, and RCFEs with a capacity of 16 or more, to provide a designated staff person who is responsible for providing assistance and responding to written requests that result from family council meetings. For SNFs and ICFs, requires the facility to consider the views and act upon the grievances and recommendations of a family council concerning proposed policy and operational decisions affecting resident care and life in the facility. Requires SNFs and ICFs to respond in writing to written requests or concerns of the family council within ten working days. [HSC §1418.4(f),(g),(h), §1569.158(h)]
7. Requires a SNF or ICF, when a family council exists, to include notice of the family council meetings in at least a quarterly mailing, and to inform family members or representatives of new residents of the existence of the family council, and the person to contact regarding involvement in the family council. [HSC §1418.4(i)]
8. Prohibits a facility from interfering with a family council, including discrimination or retaliation in any way against an individual as a result of his or her participation in a family council, or the willful scheduling of facility events in conflict with a previously scheduled family council meeting. Makes a violation of this family council requirements a “B” violation, as defined. [HSC §1418.4(j) and (k)]

This bill recasts and strengthens provisions of law governing the rights and operations of family councils at SNFs and ICFs, as well as those governing family councils at RCFEs, by conforming the two sets of laws so they are more closely aligned with each other and with federal law, and by doing the following:

1. Permitting a family council to be allowed to meet virtually or at an offsite location, in addition to existing law permitting a family council to meet in a common meeting room of the facility.
2. Requiring, in the case of SNFs and ICFs, that the designated staff person assigned the facility to be responsible for providing assistance and responding to requests of family councils be approved by the family council. For SNFs, ICFs, and RCFEs, permits the family council to request an alternate staff person as needed.
3. Expanding on the requirement that a SNF or ICF respond in writing to written requests or concerns of the family council within ten working days, to instead require a written response within 14 calendar days regarding any action or inaction taken in response to the requests, concerns, or recommendations, and requires SNFs, ICFs, and RCFEs to detail its rationale for their responses.
4. Requiring the notification of the existence of a family council to family members or representatives of new residents to be made prior to or within five business days after the resident’s admission.
5. Requiring a SNF or ICF, when a facility does not have a family council, to provide upon admission of a new resident, written information to the resident’s family members or representatives of their right to form a family council.
6. Requiring facilities to provide family councils with the names, email addresses, and other contact information for each resident’s representatives, family members, or other individuals designated by the resident if the person has provided written consent that their contact information may be shared with the family council, and requires facilities to inform family members and representatives of their right to have their contact information shared with the family council.
7. Making other minor modifications and revisions to family council law to update and conform with federal requirements.

Comments

1. Author’s statement. According to the author, as an independent, representative group of friends and family members of long-term care (LTC) facility residents, family councils are critical to ensuring that facilities address residents' needs and concerns. Unfortunately, existing regulations are inadequate to ensure family councils can effectively do their job. This bill resolves some of these inadequacies by modernizing meeting options, expanding access to family councils, and requiring facilities to respond promptly to concerns raised by family councils. Adding these regulations ensures that our often under supported aging population receive the best care possible.
2. Background on family councils. The provisions of state law governing family councils is based on federal requirements. Under federal law passed as part of the 1987 Nursing Home Reform Act [42 CFR §483.10(f)(5) and (6)], residents of LTC facilities have a right to participate in both resident groups and family groups, and facilities are required to provide groups with private space and designate a staff person to respond to written requests that result from group meetings. According to the National Consumer Voice for Quality Long-Term Care, family councils can play a crucial role in voicing concerns, requesting improvements, supporting new family members and residents, and supporting facility efforts to work for high quality of care and life in the facility. When a family council exists, the facility is required to listen to the views and act upon the grievances and recommendations concerning proposed policy and operational decisions.

According to the author, California’s family council laws are increasingly anachronistic, representing a time before email communication and COVID-19 lockdowns. These laws guarantee the use of facility space for in-person meetings and physical bulletin boards for displaying meeting notices and other important communication but do not account for virtual meetings or communication through email. The author states this problem was emphasized during COVID-19 lockdowns when non-facility personnel were severely restricted in entering LTCs and family councils struggled to meet and communicate.

1. State and local LTC Ombudsman Programs. The LTC Ombudsman Program is a federally authorized program, partially funded by the federal government, to advocate for the rights of residents in LTC facilities. Ombudsman programs are required under federal law to support the development of resident and family councils. In California, there is the Office of the State LTC Ombudsman, which is housed with the Department of Aging, and develops policy and provides oversight to the 35 local Ombudsman Program Coordinators. The LTC ombudsman’s advocacy role take two forms:
   1. To receive and resolve individual complaints and issues by, or on behalf of, LTC facility residents; and,
   2. To pursue resident advocacy in the LTC system, its laws, policies, regulations, and administration through public education and consensus building.

Residents or their family members can file a complaint directly with the local LTC Ombudsman, and all LTC facilities are required to post, in a conspicuous location, the phone number for the local LTC Ombudsman office and the statewide CRISIS line, which is available 24 hours a day, seven days a week to take calls and refer complaints. State law gives LTC Ombudsmen the right to enter and move with LTC facilities and RCFs to identify, hear, investigate, and resolve complaints; to observe and monitor conditions of residents and facilities; to speak confidentially with residents; and to provide services to assist residents in protecting their health, safety, welfare, and rights. There are 35 local LTC Ombudsman programs, with 205 paid staff, and 508 certified volunteers who advocate on behalf of the residents of LTC facilities.

1. Limitation on visitation and LTC Ombudsmen access during pandemic. At the beginning of the COVID-19 pandemic, after an outbreak at a nursing home in Washington followed by nursing homes elsewhere, the Centers for Medicare and Medicaid Services (CMS) issued guidance in March 2020 that restricted all visitors to nursing homes, without an exception for LTC Ombudsmen. Over the course of this pandemic, the guidance from CMS, as well as guidance from CDPH and DSS, evolved in response to changing conditions. By June 2020, CDPH sent out an All Facilities Letter (AFL) permitting facilities not experiencing an outbreak to permit LTC Ombudsman in the facility. On August 25, 2020, CDPH sent out an AFL updating the guidance to require facilities to permit LTC ombudsmen to enter regardless of whether or not there is a COVID-19 outbreak, after being screening for fever and COVID-19 symptoms and wearing appropriate personal protective equipment. Vaccination clinics began for LTC residents in December 2020, followed by a sharp decline in COVID-19 cases and deaths. CMS lifted restrictions on visitors to nursing homes on March 10, 2021, allowing for responsible indoor visitation at all times and for all residents, with certain exceptions for facilities in counties with high positivity rates and low vaccination rates.
2. Concerns over restrictions on visitations. In September 2020, CMS convened the Coronavirus Commission on Safety and Quality in Nursing Homes (Commission), which released a report addressing safety and quality in nursing homes in relation to the public health emergency. The Commission found that while restrictions on visitation protected the physical health of residents, these restrictions created substantial harm, including loneliness, anxiety, and depression among residents, and distress for families who were unable to assess the well-being and safety of loved ones. The Commission concluded that visitation is a vital resident right and recommended updated in-person guidance to enable safe visitation, including visitation by LTC Ombudsman representatives.
   
   Human Rights Watch raised concerns over neglect, isolation, and deteriorating quality of care affecting nursing home residents in the U.S. during the pandemic. Their reporting in May 2021 documented problems such as extreme weight loss, dehydration, untreated bedsores, inadequate hygiene, mental and physical decline, and inappropriate use of psychotropic mediations. The report also cites an analysis by the Associated Press that approximately 40,000 excess deaths (not from COVID-19) occurred in U.S. nursing homes between March and November 2020. Understaffing in facilities, combined with restrictions on visitations from family members who usually assisted with resident care, contributed to heightened concerns about neglect and inadequate care. Human Rights Watch also noted that CMS prohibiting LTC ombudsmen from entering facilities contributed to reduced transparency into nursing home operations.

Related/Prior Legislation

AB 1309 (Reyes, 2023) requires long-term health care facilities to provide residents and their representatives with additional documentation as part of the required written notice of an involuntary transfer or discharge, including a copy of the resident’s discharge needs and discharge plan, and if the transfer or discharge is based on the facility being unable to meet the resident’s needs, a description of the specific needs that cannot be met and the services available at the receiving facility that meet the resident’s needs. AB 1309 is pending on the Assembly Floor.

AB 895 (Holden, Chapter 577, Statutes of 2022) required SNFs and RCFEs to provide a written notice to a prospective resident, or their representative, that includes the contact information for the local LTC ombudsman, and links to specified websites governing licensing and quality of care.

AB 1855 (Nazarian, Chapter 583, Statutes of 2022) prohibited a SNF or residential care facility from denying entry to a representative of the State LTC Ombudsman acting in their official capacity, except under specified circumstances.

AB 940 (Weber, Chapter 274, Statues of 2017) required a LTC facility to notify the local LTC ombudsman when a resident is notified in writing of a facility-initiated transfer or discharge from the facility.

AB 1572 (Eggman, Chapter 177, Statutes of 2014) required an RCFE to assist residents in establishing and maintaining a resident council at the request of two or more residents, instead of at the request of a majority of residents. AB 1572 requires facilities to respond to resident council concerns in writing and to promote the resident council, as specified, and requires facilities to respond to concerns raised by family councils and to include notice of the family council.

SB 609 (Wolk, Chapter 251, Statutes of 2013) increased fines for willfully interfering with the LTC ombudsman’s lawful actions, and required fines to fund LTC ombudsman program costs, as specified.

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

SUPPORT: (Verified 8/22/23)

American Association of Retired Persons California

Calegislation
California Advocates for Nursing Home Reform
California Commission on Aging

California Continuing Care Residents Association

California Geriatric Circle
California Long-Term Care Ombudsman Association
California Senior Legislature
Choice in Aging
Consumer Attorneys of California
Disability Rights California
Essential Caregivers Coalition
Gray Panthers of San Francisco
Justice in Aging

Long Term Care Services of Ventura Company Ombudsman Program

Retired Public Employees Association

Three individuals

OPPOSITION: (Verified 8/22/23)

None received

ARGUMENTS IN SUPPORT: California Advocates for Nursing Home Reform (CANHR) states in support that they have worked to foster and support family councils, and have shared their “Organizing Family Councils” guide with family members and friends of long-term care residents interested in starting or maintaining family councils. CANHR states that their work to promote family councils is grounded in their deep commitment to the idea that they can be one of the most effective agents for identifying issues of concerns to residents, preventing problems from reoccurring, and improving the care in these facilities. The California Long-Term Care Ombudsman Association states in support that this bill harmonizes family council protections in nursing homes and assisted living facilities, which is long overdue, and will ensure that facilities will be more responsive to concerns raised by family councils and discourage operators from undermining family council activities. Numerous other groups make similar arguments in support.

ASSEMBLY FLOOR: 80-0, 5/30/23

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

Prepared by: Vincent D. Marchand / HEALTH / (916) 651-4111

8/23/23 14:19:00

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SENATE COMMITTEE ON HUMAN SERVICES

Senator Alvarado-Gil, Chair

2023 - 2024 Regular

Subject: Long-term care: family councils

SUMMARY

This bill creates additional requirements for a licensed skilled nursing facility, intermediary care facility, or residential care facility for the elderly (RCFE) related to providing support of a family council.

ABSTRACT

Existing law:

1. Prohibits a licensed skilled nursing facility or intermediate care facility from prohibiting the formation of a family council, and specifies that a family council shall be allowed to meet at least once per month, as specified. Defines “family council” as a meeting of family members, friends, or representatives of two or more residents to confer in private without facility staff. Further specifies the rights of family councils and requirements of facilities to support a family council. (HSC 1418.4)
   
2. Prohibits an RCFE from prohibiting the formation of a family council, and specifies that a family council shall be allowed to meet at least once per month, as specified. Defines “family council” as a meeting of family members, friends, or representatives of two or more residents to confer in private without facility staff. Further specifies the rights of family councils and requirements of facilities to support a family council. (HSC 1569.158)

This bill:

1. Makes findings and declarations about the critical role of family councils in improving and maintaining the quality of care in skilled nursing facilities, intermediate care facilities, and residential care facilities for the elderly; the prohibitions of visitation of residents in long-term care and the inability to address grievances and problems within facilities due to the COVID-19 pandemic; and the need to give equal footing to electronic forms of meeting and communicating as what is provided for in-person meeting and communicating.
   
2. Strikes and replaces language related to family councils at a licensed skilled nursing facility or an intermediary care facility and makes the following changes:
   
   1. Requires a family council to be allowed to meet virtually or at an offsite location at its discretion.
      
   2. Specifies that a person other than a family member, friend, or resident representative, including facility staff, may include a family council meeting, but only by invitation of the family council.
      
   3. Requires a facility’s designated staff person to provide assistance to the family council to be approved by the family council, and authorizes a family council to request an alternate staff person as needed.
      
   4. Requires a facility to respond in writing within 14 calendar days, rather than 10, if a family council submits written requests, concerns, or recommendations, and requires the facility to detail its rational for its response.
      
   5. Specifies requirements for how a facility shall inform a resident, resident’s representatives, family members, or other designated individuals of the existence of a family council, including providing contact information prior to or within five days of the resident’s admission. Requires a facility to provide, upon admission of a new resident, written information to the resident’s family members, friends, or designated representatives their right to form a family council if a facility does not have a family council.
      
   6. Requires a facility to provide the family council with the names, email addresses, and other contact information for each resident’s representatives, family members, or other designated individuals if the person has provided written consent to share such information. Requires the facility to inform these individuals of their right to have their contact information shared with the family council.
      
   7. Prohibits a facility from willfully interfere with a family council’s participation in governmental surveys or inspection activities performed by any applicable departments or other governmental agencies. Adds to the definition of “willful interference” the refusal to publicize family council meetings or provide appropriate space for meetings or postings, and failure to respond to written requests, concerns, or recommendations by a family council.
      
   8. Specifies that a violation of family council protections shall not be subject to a misdemeanor offense or a fine.
      
3. Strikes and replaces language related to family councils at an RCFE and makes the following changes:
   
   1. Specifies if, not when, an RCFE is requested by a member of the resident’s family or the resident representative, the family council shall be allowed to meet in a common meeting room, as specified, and authorizes a family council to meet virtually or at an offsite location at its discretion.
      
   2. Specifies that a person other than a family member, friend, or resident representative, including facility staff, may include a family council meeting, but only by invitation of the family council.
      
   3. Requires a facility to detail its rational for its response when responding to written requests, concerns, or recommendations submitted by a family council.
      
   4. Requires a facility to inform a resident and the resident’s representatives, family members, or other designated individuals of the existence of a family council and provide the name and contact information of the designated family council representative in writing prior to or within five business days after the resident’s admission. Requires a facility to include notice of family council meetings in routine mailings to those designated individuals when such family council meeting information is provided. Requires the notice to include the time, place, and date of meetings, and the name and contact information of the designated family council representative. Requires a facility to provide, upon admission of a new resident, written information to the resident’s family members, friends, or designated representatives their right to form a family council if a facility does not have a family council.
      
   5. Requires a facility to provide the family council with the names, email addresses, and other contact information for each resident’s representatives, family members, or other designated individuals if the person has provided written consent to share such information. Requires the facility to inform these individuals of their right to have their contact information shared with the family council.
      
   6. Authorizes a family council to request an alternate staff person as needed.
      
   7. Prohibits a facility from willfully interfere with a family council’s participation in governmental surveys or inspection activities performed by any applicable departments or other governmental agencies.

FISCAL IMPACT

The Assembly Appropriations Committee estimates General Fund costs, limited term and ongoing, to the California Department of Social Services, which regulates RCFEs, of an unknown amount, but likely in the low-hundreds of thousands of dollars annually, to update regulations and the CARE tool, and manage additional workload associated with facility inspections. The Department of Public Health, which regulates SNFs and ICFs, anticipates minor and absorbable costs.

BACKGROUND AND DISCUSSION

Purpose of the bill:

According to the author, “As an independent, representative group of friends and family members of long-term care facility residents, family councils are critical to ensuring that facilities address residents' needs and concerns. Unfortunately, existing regulations are inadequate to ensure family councils can effectively do their job. AB 979 resolves some of these inadequacies by modernizing meeting options, expanding access to family councils, and requiring facilities to respond promptly to concerns raised by family councils. Adding these regulations ensures that our often under supported aging population receive the best care possible.”

Family Councils

The provisions of state law governing family councils are based on federal requirements. Under federal law passed as part of the 1987 Nursing Home Reform Act (42 CFR §483.10(f)(5-6)), residents of long-term care facilities have a right to participate in both resident groups and family groups, and facilities are required to provide groups with private space and designate a staff person to respond to written requests that result from group meetings. According to the National Consumer Voice for Quality Long-Term Care, family councils can play a crucial role in voicing concerns, requesting improvements, supporting new family members and residents, and supporting facility efforts to work for high quality of care and life in the facility. When a family council exists, the facility is required to listen to the views and act upon the grievances and recommendations concerning proposed policy and operational decisions.

Visitation Limitations During the Pandemic

At the beginning of the COVID-19 pandemic, after an outbreak at a nursing home in Washington followed by nursing homes elsewhere, the Centers for Medicare and Medicaid Services (CMS) issued guidance in March of 2020 that restricted all visitors to nursing homes, without an exception for long-term care (LTC) ombudsmen. Over the course of this pandemic, the guidance from CMS, as well as guidance from CDPH and CDSS, evolved in response to changing conditions. Vaccination clinics began for LTC residents in December 2020, followed by a sharp decline in COVID-19 cases and deaths. CMS lifted restrictions on visitors to nursing homes on March 10, 2021, allowing for responsible indoor visitation at all times and for all residents, with certain exceptions for facilities in counties with high positivity rates and low vaccination rates.

In September 2020, CMS convened the Coronavirus Commission on Safety and Quality in Nursing Homes (Commission), which released a report addressing safety and quality in nursing homes in relation to the public health emergency. The Commission found that while restrictions on visitation protected the physical health of residents, these restrictions created substantial harm, including loneliness, anxiety, and depression among residents, and distress for families who were unable to assess the well-being and safety of loved ones. The Commission concluded that visitation is a vital resident right and recommended updated in-person guidance to enable safe visitation, including visitation by LTC ombudsman representatives.

Human Rights Watch raised concerns over neglect, isolation, and deteriorating quality of care affecting nursing home residents in the U.S. during the pandemic. Their report^[1] in May 2021 documented problems such as extreme weight loss, dehydration, untreated bedsores, inadequate hygiene, mental and physical decline, and inappropriate use of psychotropic mediations. The report also cites an analysis by the Associated Press that approximately 40,000 excess deaths (not from COVID-19) occurred in U.S. nursing homes between March and November 2020. Understaffing in facilities, combined with restrictions on visitations from family members who usually assisted with resident care, contributed to heightened concerns about neglect and inadequate care. Human Rights Watch also noted that CMS prohibiting LTC ombudsmen from entering facilities contributed to reduced transparency into nursing home operations.

Related legislation:

AB 1572 (Eggman, Chapter 177, Statutes of 2014) required an RCFE to assist residents in establishing and maintaining a resident council at the request of two or more residents, and required facilities to respond to resident council and family council concerns in writing, among other things.

SB 1551 (Dunn, Chapter 448, Statutes of 2000) strengthened the rights of a family council in a skilled nursing facility or intermediate care facility and imposed penalties for violation of those rights.

COMMENTS

This bill seeks to strengthen family councils at licensed skilled nursing facilities, intermediary care facilities, and residential care facilities for the elderly.

Families play an integral role in aging and long-term care. The COVID-19 pandemic limited families’ ability to visit residents in care facilities. In a survey by Human Rights Watch, 71 percent of relatives of nursing home residents said they had concerns about their relative’s treatment in the facility. Strengthening supports for family councils and allowing the continuation of virtual meetings could help residents and families feel more connected and empowered to raise concerns about resident treatment and facility conditions. According to a 2007 study^[2], family councils provide mutual support, empower its members, advocate change to improve the residents’ quality of life, and contribute to a culture of mutual respect within a facility. A report^[3] published by the National Long-Term Care Ombudsman Resource Center states that many family councils across the U.S. have been able to increase the quality of life and well-being of their loved ones through their work.

PRIOR VOTES

POSITIONS

Support:

AARP
California Advocates for Nursing Home Reform
California Commission on Aging
California Continuing Care Residents Association
California Long-term Care Ombudsman Association
California Office of The State Long-term Care Ombudsman
Consumer Attorneys of California
Essential Caregivers Coalition
Gray Panthers of San Francisco
Long Term Care Services of Ventura Co, Ombudsman
The Geriatric Circle

Oppose:

None received

-- END --

1. https://www.hrw.org/sites/default/files/media_2022/02/drd_nursinghome0521_brochure_PRINT_0.pdf ↑

2. https://www.sciencedirect.com/science/article/abs/pii/S0197457207000316 ↑

3. https://theconsumervoice.org/uploads/files/family-member/Guide-toEffective-Family-Councils.pdf ↑

SENATE COMMITTEE ON HEALTH

Senator Dr. Susan Talamantes Eggman, Chair

BILL NO: AB 979

SUBJECT: Long-term care: family councils

SUMMARY:

Recasts and strengthens provisions of law governing the rights and operations of family councils at nursing homes, as well as those governing family councils at residential care facilities for the elderly, by, among other provisions, conforming the two sets of laws so they are more closely aligned with each other and with federal law, permitting family councils to be allowed to meet virtually or at an offsite location, and requiring written responses to requests or concerns raised by the family councils to have detailed rationales for any action or inaction taken in response to those requests or concerns.

Existing law:

1. Licenses and regulates long-term health care facilities, including skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) by the California Department of Public Health (CDPH). [HSC §1250(c) and (d)]
2. Licenses and regulates residential care facilities for the elderly (RCFEs) by the California Department of Social Services (DSS), defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided. [HSC §1569 et seq.]
3. Defines “family council,” for purposes of SNFs, ICFs, and RCFEs, as a meeting of family members, friends, or representatives of two or more residents to confer in private without facility staff. [HSC §1418.4(c), §1569.158(c)]
4. Prohibits SNFs, ICFs, and RCFEs from prohibiting the formation of a family council, and, when requested by a member of the resident’s family or the resident’s representative, requires a SNF or ICF to allow a family council to be allowed to meet in a common meeting room of the facility at least once a month during mutually agreed upon hours. [HSC §1418.4(a), §1569.158(a)]
5. Prohibits SNFs, ICFs, and RCFEs policies on family councils that limit the right of residents, family members, and family council members to meet independently with outside persons, including members of nonprofit or government organizations or with facility personnel during nonworking hours. [HSC §1418.4(b), §1569.158(b)]
6. Requires SNFs and ICFs, and RCFEs with a capacity of 16 or more, to provide a designated staff person who is responsible for providing assistance and responding to written requests that result from family council meetings. For SNFs and ICFs, requires the facility to consider the views and act upon the grievances and recommendations of a family council concerning proposed policy and operational decisions affecting resident care and life in the facility. Requires SNFs and ICFs to respond in writing to written requests or concerns of the family council within ten working days. [HSC §1418.4(f),(g),(h), §1569.158(h)]
7. Requires a SNF or ICF, when a family council exists, to include notice of the family council meetings in at least a quarterly mailing, and to inform family members or representatives of new residents of the existence of the family council, and the person to contact regarding involvement in the family council. [HSC §1418.4(i)]
8. Prohibits a facility from interfering with a family council, including discrimination or retaliation in any way against an individual as a result of his or her participation in a family council, or the willful scheduling of facility events in conflict with a previously scheduled family council meeting. Makes a violation of this family council requirements a “B” violation, as defined. [HSC §1418.4(j) and (k)]

This bill: Recasts and strengthens provisions of law governing the rights and operations of family councils at SNFs and ICFs, as well as those governing family councils at RCFEs, by conforming the two sets of laws so they are more closely aligned with each other and with federal law, and by doing the following:

1. Permitting a family council to be allowed to meet virtually or at an offsite location, in addition to existing law permitting a family council to meet in a common meeting room of the facility.
2. Requiring, in the case of SNFs and ICFs, that the designated staff person assigned the facility to be responsible for providing assistance and responding to requests of family councils be approved by the family council. For SNFs, ICFs, and RCFEs, permits the family council to request an alternate staff person as needed.
3. Expands on the requirement that a SNF or ICF respond in writing to written requests or concerns of the family council within ten working days, to instead require a written response within 14 calendar days regarding any action or inaction taken in response to the requests, concerns, or recommendations, and requires SNFs, ICFs, and RCFEs to detail its rationale for their responses.
4. Requires the notification of the existence of a family council to family members or representatives of new residents to be made prior to or within five business days after the resident’s admission.
5. Requires a SNF or ICF, when a facility does not have a family council, to provide upon admission of a new resident, written information to the resident’s family members or representatives of their right to form a family council.
6. Requires facilities to provide family councils with the names, email addresses, and other contact information for each resident’s representatives, family members, or other individuals designated by the resident if the person has provided written consent that their contact information may be shared with the family council, and requires facilities to inform family members and representatives of their right to have their contact information shared with the family council.
7. Makes other minor modifications and revisions to family council law to update and conform with federal requirements.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

Estimated General Fund costs, limited term and ongoing, to DSS, which regulates RCFEs, of an unknown amount, but likely in the low-hundreds of thousands of dollars annually, to update regulations and the CARE tool, and manage additional workload associated with facility inspections.

CDPH, which regulates SNFs and ICFs, anticipates minor and absorbable costs.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, as an independent, representative group of friends and family members of long-term care (LTC) facility residents, family councils are critical to ensuring that facilities address residents' needs and concerns. Unfortunately, existing regulations are inadequate to ensure family councils can effectively do their job. This bill resolves some of these inadequacies by modernizing meeting options, expanding access to family councils, and requiring facilities to respond promptly to concerns raised by family councils. Adding these regulations ensures that our often under supported aging population receive the best care possible.
   
2. Background on family councils. The provisions of state law governing family councils is based on federal requirements. Under federal law passed as part of the 1987 Nursing Home Reform Act [42 CFR §483.10(f)(5) and (6)], residents of LTC facilities have a right to participate in both resident groups and family groups, and facilities are required to provide groups with private space and designate a staff person to respond to written requests that result from group meetings. According to the National Consumer Voice for Quality Long-Term Care, family councils can play a crucial role in voicing concerns, requesting improvements, supporting new family members and residents, and supporting facility efforts to work for high quality of care and life in the facility. When a family council exists, the facility is required to listen to the views and act upon the grievances and recommendations concerning proposed policy and operational decisions.
   
   According to the author, California’s family council laws are increasingly anachronistic, representing a time before email communication and COVID lockdowns. These laws guarantee the use of facility space for in-person meetings and physical bulletin boards for displaying meeting notices and other important communication but do not account for virtual meetings or communication through email. The author states this problem was emphasized during COVID-19 lockdowns when non-facility personnel were severely restricted in entering long-term care facilities and family councils struggled to meet and communicate.
3. State and local LTC Ombudsman Programs. The LTC Ombudsman Program is a federally authorized program, partially funded by the federal government, to advocate for the rights of residents in LTC facilities. Ombudsman programs are required under federal law to support the development of resident and family councils. In California, there is the Office of the State LTC Ombudsman, which is housed with the Department of Aging, and develops policy and provides oversight to the 35 local Ombudsman Program Coordinators. The LTC ombudsman’s advocacy role take two forms: a) to receive and resolve individual complaints and issues by, or on behalf of, LTC facility residents; and, b) to pursue resident advocacy in the LTC system, its laws, policies, regulations, and administration through public education and consensus building. Residents or their family members can file a complaint directly with the local LTC Ombudsman, and all LTC facilities are required to post, in a conspicuous location, the phone number for the local LTC ombudsman office and the statewide CRISIS line, which is available 24 hours a day, seven days a week to take calls and refer complaints. State law gives LTC ombudsmen the right to enter and move with LTC facilities and RCFs to identify, hear, investigate, and resolve complaints; to observe and monitor conditions of residents and facilities; to speak confidentially with residents; and to provide services to assist residents in protecting their health, safety, welfare, and rights. There are 35 local LTC ombudsman programs, with 205 paid staff, and 508 certified volunteers who advocate on behalf of the residents of LTC facilities.
4. Limitation on visitation and LTC ombudsmen access during pandemic. At the beginning of the COVID-19 pandemic, after an outbreak at a nursing home in Washington followed by nursing homes elsewhere, the Centers for Medicare and Medicaid Services (CMS) issued guidance in March of 2020 that restricted all visitors to nursing homes, without an exception for LTC ombudsmen. Over the course of this pandemic, the guidance from CMS, as well as guidance from CDPH and DSS, evolved in response to changing conditions. By June of 2020, CDPH sent out an All Facilities Letter (AFL) permitting facilities not experiencing an outbreak to permit LTC ombudsman in the facility. On August 25 of 2020, CDPH sent out an AFL updating the guidance to require facilities to permit LTC ombudsmen to enter regardless of whether or not there is a COVID-19 outbreak, after being screening for fever and COVID-19 symptoms and wearing appropriate personal protective equipment. Vaccination clinics began for LTC residents in December 2020, followed by a sharp decline in COVID-19 cases and deaths. CMS lifted restrictions on visitors to nursing homes on March 10, 2021, allowing for responsible indoor visitation at all times and for all residents, with certain exceptions for facilities in counties with high positivity rates and low vaccination rates
5. Concerns over restrictions on visitations. In September 2020, CMS convened the Coronavirus Commission on Safety and Quality in Nursing Homes (Commission), which released a report addressing safety and quality in nursing homes in relation to the public health emergency. The Commission found that while restrictions on visitation protected the physical health of residents, these restrictions created substantial harm, including loneliness, anxiety, and depression among residents, and distress for families who were unable to assess the well-being and safety of loved ones. The Commission concluded that visitation is a vital resident right and recommended updated in-person guidance to enable safe visitation, including visitation by LTC ombudsman representatives.
   
   Human Rights Watch raised concerns over neglect, isolation, and deteriorating quality of care affecting nursing home residents in the U.S. during the pandemic. Their reporting in May 2021 documented problems such as extreme weight loss, dehydration, untreated bedsores, inadequate hygiene, mental and physical decline, and inappropriate use of psychotropic mediations. The report also cites an analysis by the Associated Press that approximately 40,000 excess deaths (not from COVID-19) occurred in U.S. nursing homes between March and November 2020. Understaffing in facilities, combined with restrictions on visitations from family members who usually assisted with resident care, contributed to heightened concerns about neglect and inadequate care. Human Rights Watch also noted that CMS prohibiting LTC ombudsmen from entering facilities contributed to reduced transparency into nursing home operations.
6. Double referral. This bill is double-referred. Should it pass out of this committee, it will be referred to the Senate Committee on Human Services.
7. Related legislation. AB 1309 (Reyes) requires long-term health care facilities to provide residents and their representatives with additional documentation as part of the required written notice of an involuntary transfer or discharge, including a copy of the resident’s discharge needs and discharge plan, and if the transfer or discharge is based on the facility being unable to meet the resident’s needs, a description of the specific needs that cannot be met and the services available at the receiving facility that meet the resident’s needs. AB 1309 is set for hearing on June 21, 2023 in this Committee.
8. Prior legislation. AB 1855 (Nazarian, Chapter 583, Statutes of 2022) prohibits a SNF or residential care facility from denying entry to a representative of the State LTC Ombudsman acting in their official capacity, except under specified circumstances.
   
   AB 895 (Holden, Chapter 577, Statutes of 2022) requires SNFs and RCFEs to provide a written notice to a prospective resident, or their representative, that includes the contact information for the local LTC ombudsman, and links to specified websites governing licensing and quality of care.
   
   AB 940 (Weber, Chapter 274, Statues of 2017) requires a LTC facility to notify the local LTC ombudsman when a resident is notified in writing of a facility-initiated transfer or discharge from the facility.
   
   AB 1572 (Eggman, Chapter 177, Statutes of 2014) requires an RCFE to assist residents in establishing and maintaining a resident council at the request of two or more residents, instead of at the request of a majority of residents. AB 1572 requires facilities to respond to resident council concerns in writing and to promote the resident council, as specified, and requires facilities to respond to concerns raised by family councils and to include notice of the family council.
   
   SB 609 (Wolk, Chapter 251, Statues of 2013) increases fines for willfully interfering with the LTC ombudsman’s lawful actions, and required fines to fund LTC ombudsman program costs, as specified.
9. Support. California Advocates for Nursing Home Reform (CANHR) states in support that they have worked to foster and support family councils, and have shared their “Organizing Family Councils” guide with family members and friends of long-term care residents interested in starting or maintaining family councils. CANHR states that their work to promote family councils is grounded in their deep commitment to the idea that they can be one of the most effective agents for identifying issues of concerns to residents, preventing problems from reoccurring, and improving the care in these facilities. The California Long-Term Care Ombudsman Association states in support that this bill harmonizes family council protections in nursing homes and assisted living facilities, which is long overdue, and will ensure that facilities will be more responsive to concerns raised by family councils and discourage operators from undermining family council activities. Numerous other groups make similar arguments in support.

SUPPORT AND OPPOSITION:

Support: American Association of Retired Persons California
California Advocates for Nursing Home Reform
California Commission on Aging
California Long-term Care Ombudsman Association
California Senior Legislature
Choice in Aging
Consumer Attorneys of California
Disability Rights California
Essential Caregivers Coalition
Gray Panthers of San Francisco
Justice in Aging

Long Term Care Services of Ventura Company Ombudsman Program

Retired Public Employees Association

Three individuals

Oppose: None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 979

Author:(Alvarez)

As Amended Ver:April 20, 2023

Majority vote

SUMMARY

Expands upon the rights of family councils in skilled nursing facilities (SNF), intermediate care facilities (ICFs) and residential care facilities for the elderly (RCFEs) and repeals all of HSC § 1418.4 and 1569.158 and inserts language referenced below:

Major Provisions

Health and Safety Code, Section 1418.4 which:

1. Allows the formation of family councils in a licensed SNF or intermediate care facility. Allows the family council to meet in a common meeting room of the facility at least once per month during mutually agreed-upon hours, if requested, or can meet virtually or at an offsite location at its discretion.
2. Allows residents, family members, and family council members to meet independently with outside persons, including members of nonprofit or governmental organizations or with facility personnel during nonworking hours without limitation of facility policies on family councils.
3. Defines "family council" as a meeting of family members, friends, or representatives of two or more residents to confer in private without facility staff.
4. Requires adequate space be provided on a prominent bulletin board or other posting area for the display of meeting notices, minutes, newsletters, or other information pertaining to the operation or interest of the family council.
5. Allows a person other than a family member, friend, or resident representative, including facility staff, may attend a family council meeting, but only at the invitation of the family council.
6. Provides a designated staff person from the facility, approved by the family council, who shall be responsible for providing assistance and responding to written requests that result from family council meetings. The family council may request an alternate staff person as needed.
7. Requires the facility to consider the views and act upon the grievances and recommendations of a family council concerning proposed policy and operational decisions affecting resident care and life in the facility.
8. Necessitates the facility respond in writing regarding any action or inaction taken in response to the requests, concerns, or recommendations within 14 calendar days and shall detail its rationale for that response if a family council submits written requests, concerns, or recommendations.
9. Requires the facility to inform the resident and the resident's representatives, family members, or other individuals designated by the resident and identified on the contract of admission, during the admission process, or in the resident's records of the existence of the family council, if one does exist, and provide the name and contact information of the family council representative, as designated by the family council, in writing, prior to or within five business days after the resident's admission. Requires the facility to include notice of the family council meetings in quarterly mailings to those family members, friends, and resident representatives when family council meeting information is provided to the facility by the family council. The notice shall include the time, place, and date of meetings, and the name and contact information of the family council representative, as designated by the family council. Requires a facility without a family council, to provide, upon admission of a new resident, written information to the resident's family members, friends, or resident representatives identified on the contract of admission, during the admission process, or in the resident's records, of their right to form a family council.
10. Requires a facility to provide the family council with the names, email addresses, and other contact for each resident's representatives, family members, or other individuals designated by the resident if the person has provided written consent specifying the contact information that may be shared with the family council.
11. Informs the identified family members, friends, and representatives of their right to have their contact information shared with the family council by the facility.
12. Disallows a facility from willfully interfering with the formation, maintenance, or promotion of a family council, or with a family council's participation in governmental surveys or inspection activities performed by any applicable departments or other governmental entities.
    1. Defines for purposes of this subdivision, willful interference includes, but is not be limited to, discrimination or retaliation in any way against an individual as a result of their participation in a family council, refusal to publicize family council meetings or provide appropriate space for meetings or postings as required under this section, failure to respond to written requests, concerns, or recommendations by a family council, or the willful scheduling of facility events in conflict with a previously scheduled family council meeting.
    2. Constitutes any violation of this section as a violation of resident rights.
    3. Constitutes any violation of this section as a class "B" violation, as defined in Section 1424.

Health and Safety Code, Section 1569.158 which:

1. Allows the formation of family councils in a RCFE. Allows the family council to meet in a common meeting room of the facility at least once per month during mutually agreed-upon hours if requested or can meet virtually or at an offsite location at its discretion.
2. Allows residents, family members, and family council members to meet independently with outside persons, including members of nonprofit or governmental organizations or with facility personnel during nonworking hours without limitation of facility policies on family councils.
3. Defines "family council" as a meeting of family members, friends, or representatives, or agents, as defined in Welfare and Instiutions Code, Section 14110.8, of two or more residents to confer in private without facility staff.
4. Provides a family council with adequate space on a prominent bulletin board or other posting area for the display of meeting notices, minutes, information, and newsletters.
5. Allows a person other than a family member, friend, or resident representative, including facility staff, to attend a family council meeting, but only at the invitation of the family council.
6. Requires a facility to respond to a family council written requests, concerns, or recommendations, within 14 calendar days in writing regarding any action or inaction taken in response and shall detail its rationale for that response.
7. Requires the facility to inform the resident and the resident's representatives, family members, or other individuals designated by the resident and identified on the contract of admission, during the admission process, or in the resident's records of the existence of the family council, if one does exist, and provide the name and contact information of the family council representative, as designated by the family council, in writing, prior to or within five business days after the resident's admission. Requires the facility to include notice of the family council meetings in routine mailings to those family members, friends, and resident representatives when family council meeting information is provided to the facility by the family council. Notices include the time, place, and date of meetings, and the name and contact information of the family council representative, as designated by the family council. Requires a facility without a family council, to provide, upon admission of a new resident, written information to the resident's family members, friends, or resident representatives identified on the contract of admission, during the admission process, or in the resident's records, of their right to form a family council.
8. Allows the facility to share the name and contact information of the designated representative of the family council with the long-term care ombudsman program upon request and with the permission of the family council.
9. Requires a facility to provide the family council with the names, email addresses, and other contact for each resident's representatives, family members, or other individuals designated by the resident if the person has provided written consent specifying the contact information may be shared with the family council.
10. Informs the identified family members, friends, and representatives of their right to have their contact information shared with the family council by the facility.
11. Appoints a designated staff liaison responsible for providing assistance to the family council and responds to written requests that result from family council meetings. Provides an alternate staff liaison as needed.
12. Disallows a facility from willfully interfering with the formation, maintenance, or promotion of a family council, or with a family council's participation in governmental surveys or inspection activities performed by any applicable departments or other governmental entities.
    1. Defines for purposes of this subdivision, willful interference includes, but is not be limited to, discrimination or retaliation in any way against an individual as a result of their participation in a family council, refusal to publicize family council meetings or provide appropriate space for meetings or postings as required under this section, failure to respond to written requests, concerns, or recommendations by a family council, or the willful scheduling of facility events in conflict with a previously scheduled family council meeting.
    2. Constitutes a violation of this section not be subject to Section 1569.40.
    3. Constitutes a violation of resident rights.
    4. Subjects a facility to a daily civil penalty of two hundred fifty dollars ($250) if violated until the violation is corrected. Deems the violation corrected on the date the facility submits documentation of the correction and if the correction is verified.

COMMENTS

California's aging population is growing faster than any other age group. By 2030, over 25 percent of the population in California will be 60 and older.^[1] The population in the state is becoming more racially and ethnically diverse, and yet the COVID-19 pandemic impacted Californians disparately.

Family councils during the pandemic: While state law protects the rights of family members and representatives of residents in SNFs, ICFs and RCFEs to join and form family councils, the pandemic created an unforeseen barrier in keeping loved ones out of facilities. Family councils play a vital role in improving and maintaining quality within facilities. They also provide a conduit for communication between facilities, residents and their loved ones. While state law requires family councils have adequate space on a prominent bulletin board or other posting area to notice meetings and display other information, this information could not be seen during the first year plus of the pandemic. Family councils struggled to meet and communicate. Family councils must have the ability to meet in all ways that fit their needs, including virtual communication.

The COVID-19 pandemic forced statewide prohibitions of visitation for hundreds of thousands of residents in long-term care. Outside of the emotional toll of being isolated, residents were also unable to address issues within the facility. Resident representatives and family members of residents were physically barred from visiting the residents in their facility homes and may see similar prohibitions in the future. Allowing family councils to operate virtually will allow for continued communication between residents, residents families and representatives and facilities.

Master Plan for Aging: In January of 2021, the Governor released his Master Plan for Aging (MPA). The MPA prioritizes the health and well-being of older Californians and the need for policies that promote healthy aging. The MPA serves as a blueprint for state government, local government, the private sector, and philanthropy to prepare the state for the coming demographic changes and continue California's leadership in aging, disability, and equity.

The MPA outlines five bold goals, 23 strategies and currently seeks to advance 95 initiatives to build a California for All Ages by 2030. It also includes a Data Dashboard on Aging to measure progress. AB 979 can be linked to goals one, two, three and four:

1. Goal One: Housing for All Ages and Stages
2. Goal Two: Health Reimagined
3. Goal Three: Inclusion and Equity, Not Isolation
4. Goal Four: Caregiving That Works
5. Goal Five: Affording Aging

According to the Author

"As an independent, representative group of friends and family members of long-term care facility residents, family councils are critical to ensuring that facilities address residents' needs and concerns. Unfortunately, existing regulations are inadequate to ensure family councils can effectively do their job. AB 979 resolves some of these inadequacies by modernizing meeting options, expanding access to family councils, and requiring facilities to respond promptly to concerns raised by family councils. Adding these regulations ensures that our often under supported aging population receive the best care possible."

Arguments in Support

The California Advocates for Nursing Home Reform (CANHR), the sponsor of AB 979 writes, "AB 979 modernizes existing family council laws, so that members can meet and communicate electronically and continue to operate during a public health emergency. The bill also ensures that facilities will be more responsive to concerns raised by family councils, discourages operators from undermining family council activities, and clarifies that control of the family council membership and participation in meetings lies with the family council itself. AB 979 also harmonizes the federal and state rules for nursing home family councils and aligns the rules for nursing homes and RCFEs."

Arguments in Opposition

None on file.

FISCAL COMMENTS

1. Estimated General Fund costs, limited term and ongoing, to the California Department of Social Services, which regulates RCFEs, of an unknown amount, but likely in the low-hundreds of thousands of dollars annually, to update regulations and the CARE tool, and manage additional workload associated with facility inspections.
2. The Department of Public Health, which regulates SNFs and ICFs, anticipates minor and absorbable costs.

VOTES

ASM AGING AND LONG-TERM CARE: 7-0-1

YES: Bains, Ta, Alvarez, Haney, Stephanie Nguyen, Reyes, Blanca Rubio

ABS, ABST OR NV: Joe Patterson

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

UPDATED

VERSION: April 20, 2023

CONSULTANT: Elizabeth Fuller / AGING & L.T.C. / (916) 319-3990 FN: 0000433

1. https://dof.ca.gov/forecasting/demographics/projections/ ↑

Date of Hearing: May 17, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 979

Author:(Alvarez) – As Amended Ver:April 20, 2023

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

SUMMARY:

This bill makes various changes to the laws governing family councils at skilled nursing facilities (SNFs), intermediate facilities (ICFs), and residential care facilities for the elderly (RCFEs).

Among its provisions, this bill:

1. Requires a designated facility staff person be approved by the family council.
2. Requires the family council be allowed to meet virtually or at an offsite location at its discretion.
3. Requires, if a family council submits written requests, concerns, or recommendations, the facility to respond in writing regarding any action or inaction within 14 calendar days.
4. Authorizes facility staff to attend meetings only at the invitation of the family council, instead of at the group’s invitation.
5. Requires the facility to inform friends identified in certain materials of the family council and to provide the name and contact information of the family council representative to the friends prior to or within 5 business days after the resident’s admission.
6. To the extent not in conflict with state and federal law, requires a facility to inform the identified family members, friends, and representatives of their right to have their contact information shared with the family council.
7. If a facility does not have a family council, add a resident’s friends as recipients of written information provided to a newly admitted resident’s family or representative of their right to form a family council.

FISCAL EFFECT:

1. Estimated General Fund costs, limited term and ongoing, to the California Department of Social Services, which regulates RCFEs, of an unknown amount, but likely in the low-hundreds of thousands of dollars annually, to update regulations and the CARE tool, and manage additional workload associated with facility inspections.
2. The Department of Public Health, which regulates SNFs and ICFs, anticipates minor and absorbable costs.

COMMENTS:

1. Purpose. According to the author:

As an independent, representative group of friends and family members of long-term care facility residents, family councils are critical to ensuring that facilities address residents' needs and concerns. Unfortunately, existing regulations are inadequate to ensure family councils can effectively do their job. [This bill] resolves some of these inadequacies by modernizing meeting options, expanding access to family councils, and requiring facilities to respond promptly to concerns raised by family councils. Adding these regulations ensures that our often under supported aging population receive the best care possible.

1. Background. Existing law prohibits long-term care facilities from prohibiting the formation of a family council, which is a meeting of family members, friends, or representatives of two or more residents to confer in private without facility staff. Existing law also sets forth various requirements on facilities relating to a family council with regard to providing a designated staff person, providing adequate posting and meeting space for the family council, and responding to written requests, concerns, or recommendations within specified timeframes.

While state law protects the rights of family members and representatives of residents in SNFs, ICFs, and RCFEs to join and form family councils, the pandemic created an unforeseen barrier in keeping loved ones out of facilities. While state law requires family councils have adequate space on a prominent bulletin board or other posting area to notice meetings and display other information, this information could not be seen during the first years of the pandemic. Family councils struggled to meet and communicate.

The COVID-19 pandemic forced statewide prohibitions of visitation for hundreds of thousands of residents in long-term care. Outside of the emotional toll of being isolated, residents were also unable to address issues within the facility. The State Long-Term Care Ombudsman (LTCO), which is tasked with identifying, investigating, and resolving complaints made by or on behalf of long-term care residents, received over 29,000 complaints in 2020, and over 40,000 complaints in 2021, an increase of 37%. Representatives from the Office of the State LTCO were also kept out of facilities at the beginning of the pandemic.

The California Advocates for Nursing Home Reform (CANHR), the sponsor of this bill, writes in support:

[This bill] modernizes existing family council laws, so that members can meet and communicate electronically and continue to operate during a public health emergency. The bill also ensures that facilities will be more responsive to concerns raised by family councils, discourages operators from undermining family council activities, and clarifies that control of the family council membership and participation in meetings lies with the family council itself. [The bill] also harmonizes the federal and state rules for nursing home family councils and aligns the rules for nursing homes and RCFEs.

1. Master Plan for Aging (MPA). California’s senior population is growing faster than any other age group. By 2030, over 25% of the population in California will be 60 and older. In January of 2021, the Governor released his MPA, which prioritizes the health and well-being of older Californians and the need for policies that promote healthy aging. AB 979 advances the goals of the MPA regarding care needs of older Californians.

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

Date of Hearing: April 25, 2023

ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE

Jasmeet Bains, Chair

ABPCA Bill Id:AB 979 (

Author:Alvarez) – As Amended Ver:April 20, 2023

SUBJECT: Long-term care: family councils

SUMMARY: Expands upon the rights of family councils in skilled nursing facilities (SNF), intermediate care facilities (ICFs) and residential care facilities for the elderly (RCFEs) Specifically, this bill repeals all of HSC § 1418.4 and 1569.158 and inserts:

HSC § 1418.4 which:

1. Allows the formation of family councils in a licensed SNF or intermediate care facility. Allows the family council to meet in a common meeting room of the facility at least once per month during mutually agreed-upon hours, if requested, or can meet virtually or at an offsite location at its discretion.
2. Allows residents, family members, and family council members to meet independently with outside persons, including members of nonprofit or governmental organizations or with facility personnel during nonworking hours without limitation of facility policies on family councils.
3. Defines “family council” as a meeting of family members, friends, or representatives of two or more residents to confer in private without facility staff.
4. Requires adequate space be provided on a prominent bulletin board or other posting area for the display of meeting notices, minutes, newsletters, or other information pertaining to the operation or interest of the family council.
5. Allows a person other than a family member, friend, or resident representative, including facility staff, may attend a family council meeting, but only at the invitation of the family council.
6. Provides a designated staff person from the facility, approved by the family council, who shall be responsible for providing assistance and responding to written requests that result from family council meetings. The family council may request an alternate staff person as needed.
7. Requires the facility to consider the views and act upon the grievances and recommendations of a family council concerning proposed policy and operational decisions affecting resident care and life in the facility.
8. Necessitates the facility respond in writing regarding any action or inaction taken in response to the requests, concerns, or recommendations within 14 calendar days and shall detail its rationale for that response if a family council submits written requests, concerns, or recommendations.
9. Requires the facility to inform the resident and the resident’s representatives, family members, or other individuals designated by the resident and identified on the contract of admission, during the admission process, or in the resident’s records of the existence of the family council, if one does exist, and provide the name and contact information of the family council representative, as designated by the family council, in writing, prior to or within five business days after the resident’s admission. Requires the facility to include notice of the family council meetings in quarterly mailings to those family members, friends, and resident representatives when family council meeting information is provided to the facility by the family council. The notice shall include the time, place, and date of meetings, and the name and contact information of the family council representative, as designated by the family council. Requires a facility without a family council, to provide, upon admission of a new resident, written information to the resident’s family members, friends, or resident representatives identified on the contract of admission, during the admission process, or in the resident’s records, of their right to form a family council.
10. Requires a facility to provide the family council with the names, email addresses, and other contact for each resident’s representatives, family members, or other individuals designated by the resident if the person has provided written consent specifying the contact information that may be shared with the family council.
11. Informs the identified family members, friends, and representatives of their right to have their contact information shared with the family council by the facility.
12. Disallows a facility from willfully interfering with the formation, maintenance, or promotion of a family council, or with a family council’s participation in governmental surveys or inspection activities performed by any applicable departments or other governmental entities.
    1. Defines for purposes of this subdivision, willful interference includes, but is not be limited to, discrimination or retaliation in any way against an individual as a result of their participation in a family council, refusal to publicize family council meetings or provide appropriate space for meetings or postings as required under this section, failure to respond to written requests, concerns, or recommendations by a family council, or the willful scheduling of facility events in conflict with a previously scheduled family council meeting.
    2. Constitutes any violation of this section as a violation of resident rights.
    3. Constitutes any violation of this section as a class “B” violation, as defined in Section 1424.

HSC § 1569.158 which:

1. Allows the formation of family councils in a RCFE. Allows the family council to meet in a common meeting room of the facility at least once per month during mutually agreed-upon hours if requested or can meet virtually or at an offsite location at its discretion.
2. Allows residents, family members, and family council members to meet independently with outside persons, including members of nonprofit or governmental organizations or with facility personnel during nonworking hours without limitation of facility policies on family councils.
3. Defines “family council” as a meeting of family members, friends, or representatives, or agents, as defined in WIC § 14110.8, of two or more residents to confer in private without facility staff.
4. Provides a family council with adequate space on a prominent bulletin board or other posting area for the display of meeting notices, minutes, information, and newsletters.
5. Allows a person other than a family member, friend, or resident representative, including facility staff, to attend a family council meeting, but only at the invitation of the family council.
6. Requires a facility to respond to a family council written requests, concerns, or recommendations, within 14 calendar days in writing regarding any action or inaction taken in response and shall detail its rationale for that response.
7. Requires the facility to inform the resident and the resident’s representatives, family members, or other individuals designated by the resident and identified on the contract of admission, during the admission process, or in the resident’s records of the existence of the family council, if one does exist, and provide the name and contact information of the family council representative, as designated by the family council, in writing, prior to or within five business days after the resident’s admission. Requires the facility to include notice of the family council meetings in routine mailings to those family members, friends, and resident representatives when family council meeting information is provided to the facility by the family council. Notices include the time, place, and date of meetings, and the name and contact information of the family council representative, as designated by the family council. Requires a facility without a family council, to provide, upon admission of a new resident, written information to the resident’s family members, friends, or resident representatives identified on the contract of admission, during the admission process, or in the resident’s records, of their right to form a family council.
8. Allows the facility to share the name and contact information of the designated representative of the family council with the long-term care ombudsman program upon request and with the permission of the family council.
9. Requires a facility to provide the family council with the names, email addresses, and other contact for each resident’s representatives, family members, or other individuals designated by the resident if the person has provided written consent specifying the contact information may be shared with the family council.
10. Informs the identified family members, friends, and representatives of their right to have their contact information shared with the family council by the facility.
11. Appoints a designated staff liaison responsible for providing assistance to the family council and responds to written requests that result from family council meetings. Provides an alternate staff liaison as needed.
12. Disallows a facility from willfully interfering with the formation, maintenance, or promotion of a family council, or with a family council’s participation in governmental surveys or inspection activities performed by any applicable departments or other governmental entities.
    1. Defines for purposes of this subdivision, willful interference includes, but is not be limited to, discrimination or retaliation in any way against an individual as a result of their participation in a family council, refusal to publicize family council meetings or provide appropriate space for meetings or postings as required under this section, failure to respond to written requests, concerns, or recommendations by a family council, or the willful scheduling of facility events in conflict with a previously scheduled family council meeting.
    2. Constitutes a violation of this section not be subject to Section 1569.40.
    3. Constitutes a violation of resident rights.
    4. Subjects a facility to a daily civil penalty of two hundred fifty dollars ($250) if violated until the violation is corrected. Deems the violation corrected on the date the facility submits documentation of the correction and if the correction is verified.

EXISTING LAW:

1. Establishes, in federal law, the Older Americans Act (OAA), which promotes the well-being of Americans 60 years old and above through services and programs designed to meet their needs. (42 United States Code (USC.) § 3001, et seq.)
2. Establishes, within the OAA, the Office of the Long-Term Care Ombudsman (LTCO) Program and requires states to establish and operate a LTCO for the purpose of identifying, investigating, and resolving complaints that may adversely affect the health, safety, welfare, or rights of residents of long-term care facilities. (42 USC § 3058(g))
3. Establishes the Office of the State LTCO under the California Department of Aging (CDA), for the purpose of protecting and advocating for the rights and health and safety of long-term care facility residents, and in providing leadership, direction, and support to local LTCO programs. (WIC § 9700 et seq.)
4. Defines “long-term health care facility” to mean a SNF; ICF, including an ICF for individuals with developmental disabilities, as specified, a congregate living health facility; a nursing facility, and a pediatric day health and respite care facility. Specifies that a “long-term health care facility” does not include a general acute care hospital or acute psychiatric hospital, as specified. (HSC § 1418)
5. Defines “long-term care facility,” for purposes of establishing the role of the State LTCO, to mean a nursing facility or SNF, including distinct parts of facilities that are required to comply with licensure requirements for SNFs, or a RCFE. (WIC § 9701).
6. Defines a RCFE to mean a housing arrangement chosen voluntarily by individuals ages 60 and older, or their authorized representative, where varying levels and intensities of care and supervision, protective supervision, personal care, or health-related services are provided, based upon their varying needs, as determined in order to be admitted and to remain in the facility. (HSC § 1569.2(p)(1))
7. Establishes the RCFE Resident’s Bill of Rights, as provided, which includes the right to consent to have relatives and other individuals of the resident’s choosing visit during reasonable hours, privately and without prior notice, among other rights. (HSC § 1569.269)
8. Protects the formation of a family council inside of a SNF or ICF, when requested by a member of the resident’s family or the resident’s representative, and shall be allowed to meet. (HSC § 1418.4 et seq.)
9. Protects the formation of a family council within a RCFE. When requested by a member of the resident’s family or the resident representative, a family council shall be allowed to meet. (HSC § 1569.158 et seq.)

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

Author’s Statement: “As an independent, representative group of friends and family members of long-term care facility residents, family councils are critical to ensuring that facilities address residents' needs and concerns. Unfortunately, existing regulations are inadequate to ensure family councils can effectively do their job. AB 979 resolves some of these inadequacies by modernizing meeting options, expanding access to family councils, and requiring facilities to respond promptly to concerns raised by family councils. Adding these regulations ensures that our often under supported aging population receive the best care possible.”

BACKGROUND

California’s aging population is growing faster than any other age group. By 2030, over 25 percent of the population in California will be 60 and older.^[1] The population in the state is becoming more racially and ethnically diverse, and yet the COVID-19 pandemic impacted Californians disparately.

Family councils during the pandemic: While state law protects the rights of family members and representatives of residents in SNFs, ICFs and RCFEs to join and form family councils, the pandemic created an unforeseen barrier in keeping loved ones out of facilities. Family councils play a vital role in improving and maintaining quality within facilities. They also provide a conduit for communication between facilities, residents and their loved ones. While state law requires family councils have adequate space on a prominent bulletin board or other posting area to notice meetings and display other information, this information could not be seen during the first year plus of the pandemic. Family councils struggled to meet and communicate. Family councils must have the ability to meet in all ways that fit their needs, including virtual communication.

The COVID-19 pandemic forced statewide prohibitions of visitation for hundreds of thousands of residents in long-term care. Outside of the emotional toll of being isolated, residents were also unable to address issues within the facility. Resident representatives and family members of residents were physically barred from visiting the residents in their facility homes and may see similar prohibitions in the future. Allowing family councils to operate virtually will allow for continued communication between residents, residents families and representatives and facilities.

Long-Term Care Facilities: Sometimes referred to as assisted living facilities, RCFEs are responsible for providing housing, housekeeping, supervision, and personal care assistance with activities of daily living, like hygiene, dressing, eating, and walking, to individuals ages 60 and older. California’s network of RCFEs consists of small homes serving a handful of residents to larger RCFEs that can house over 100 residents in communities across the state. Facilities provide a special combination of housing, personalized supportive services, and 24-hour staff designed to respond to the individual needs of those who require help with activities of daily living. This level of care and supervision is for people who are unable to live by themselves but who do not need 24 hour nursing care. They are considered non-medical facilities and are not required to have nurses, certified nursing assistants or doctors on staff. RCFEs are licensed and overseen by CDSS.

SNFs are health facilities that provide skilled nursing care and supportive care to patients whose primary need is for skilled nursing care on an extended basis. ICFs are health facilities that provide inpatient care to ambulatory or nonambulatory patients who have recurring needs for skilled nursing supervision and need supportive care, but who do not require availability of continuous skilled nursing care. As health care facilities, SNFs and ICFs are licensed and overseen by the California Department of Public Health (CDPH). ICFs for Individuals with Intellectual Disabilities (ICF/IID) are also health facilities licensed by CDPH to provide 24-hour residential habilitative or nursing services. ICF/IIDs are approved by the Department of Developmental Services (DDS) prior to CDPH licensure. SNFs and ICFs are under the purview of the Senate Committee on Health.

Office of the State Long-Term Care Ombudsman (LTCO): Under the federal OAA, each state is required to operate an Office of the State LTCO, which is charged with identifying, investigating, and resolving complaints that are made by, or on behalf of, residents of long-term care facilities. In California, the Office of the LTCO is housed under CDA. The State LTCO and their local representatives assist residents in long-term care facilities with issues related to day-to-day care, health, safety, and personal preferences, including investigating abuse and violations of residents’ rights or dignity, and other issues regarding quality of care.

The LTCO has oversight responsibility for 35 local Ombudsman programs throughout California. Approximately 216 paid staff and 717 certified volunteers advocate on behalf of residents of LTC facilities. These facilities include 1230 skilled nursing and intermediate care facilities, and 7307 residential care facilities for the elderly, with a combined count of 308,011 LTC beds.^[2]

Effect of COVID-19 Pandemic on Long-Term Care Residents: On February 29, 2020, the first documented outbreak of COVID-19 occurred at a SNF in Washington. The Centers for Medicare & Medicaid Services (CMS) restricted all visitors, including LTCOs, to nursing homes on March 13, 2020, shortly before Governor Newsom issued a statewide stay-at-home order to slow the spread of COVID-19.

Human Rights Watch raised concerns over neglect, isolation, and deteriorating quality of care affecting nursing home residents in the United States during the pandemic.^[3] Their reporting in May 2021 documented problems such as extreme weight loss, dehydration, untreated bedsores, inadequate hygiene, mental and physical decline, and inappropriate use of psychotropic mediations. The report also cites an analysis by the Associated Press that approximately 40,000 excess deaths (not from COVID-19) occurred in U.S. nursing homes between March and November 2020. Understaffing in facilities, combined with restrictions on visitations from family members who usually assisted with resident care, contributed to heightened concerns about neglect and inadequate care.

The State LTCO, which is tasked with identifying, investigating, and resolving complaints made by or on behalf of long-term care residents, received over 29,000 complaints in 2020, and over 40,000 complaints in 2021, an increase of 37 percent. The most common complaints in 2020 related to violations of residents’ rights, including abuse, gross neglect, and exploitation.

The isolation of residents in facilities during the pandemic was felt not just by those who lived within the facilities, but for their families as well. A disconnect between families, friends, residents and the facilities only led to greater frustration. Representatives from the Office of the State LTCO were also kept out of facilities at the beginning of the pandemic.

Master Plan for Aging: In January of 2021, the Governor released his Master Plan for Aging (MPA). The MPA prioritizes the health and well-being of older Californians and the need for policies that promote healthy aging. The MPA serves as a blueprint for state government, local government, the private sector, and philanthropy to prepare the state for the coming demographic changes and continue California’s leadership in aging, disability, and equity.

After work began on the MPA, the COVID-19 pandemic reached California. The virus disproportionately harmed older and other at-risk adults, and it strained aging and disability services that were perpetually underfunded. Worldwide, older adults have experienced unprecedented death rates. California’s diverse population saw disproportionate numbers, particularly among Latino, Black and Asian Pacific Islander communities and those living in nursing homes. The pandemic intensified social isolation.

The work plan laid out in the MPA two years after its release continues to highlight the urgent needs facing California’s older adults, people with disabilities, their families, advocates and the workforce supporting these populations.

The MPA outlines five bold goals, 23 strategies and currently seeks to advance 95 initiatives to build a California for All Ages by 2030. It also includes a Data Dashboard on Aging to measure progress. AB 979 can be linked to goals one, two, three and four:

• Goal One: Housing for All Ages and Stages
• Goal Two: Health Reimagined
• Goal Three: Inclusion and Equity, Not Isolation
• Goal Four: Caregiving That Works
• Goal Five: Affording Aging

Argument in Support: The California Advocates for Nursing Home Reform (CANHR), the sponsor of AB 979 writes, “AB 979 modernizes existing family council laws, so that members can meet and communicate electronically and continue to operate during a public health emergency. The bill also ensures that facilities will be more responsive to concerns raised by family councils, discourages operators from undermining family council activities, and clarifies that control of the family council membership and participation in meetings lies with the family council itself. AB 979 also harmonizes the federal and state rules for nursing home family councils and aligns the rules for nursing homes and RCFEs.”

AARP also writes in support “Forming and participating in a family council are the rights of every nursing home resident, codified in both federal and state statute. AB 979 will allow family council meetings to be virtual, updating the statute for the 21^st century. Moreover, it forbids Skilled Nursing Facility (SNF) staff from preventing the formation of a family council.”

Argument in Opposition: None.

REGISTERED SUPPORT / OPPOSITION:

Support

California Advocates for Nursing Home Reform (sponsor)

AARP
Calegislation
California Commission on Aging
California Long-Term Care Ombudsman Association
California Senior Legislature
Choice in Aging
Consumer Attorneys of California
Disability Rights California
Essential Caregivers Coalition
Gray Panthers of San Francisco
Justice in Aging
Senior Advocacy Services
California Geriatric Circle

Several individual letters

Opposition

None on file.

Analysis Prepared by: Elizabeth Fuller / AGING & L.T.C. / (916) 319-3990

1. Projections | Department of Finance (ca.gov) ↑

2. https://aging.ca.gov/Providers_and_Partners/Long-Term_Care_Ombudsman/Program_Narrative_and_Fact_Sheets/ ↑

3. Human Rights Watch: US: Concerns of Neglect in Nursing Homes, May 2021. This report focuses on concerns affecting nursing homes nationally, and does not create a distinction between nursing homes and other types of long-term care facilities, such as RCFEs, which are specific to California’s licensing structure. ↑