Existing law requires the State Department of Social Services to regulate activities relating to continuing care contracts that govern care provided to a resident in a continuing care retirement community for the duration of the residents life or a term in excess of one year. Existing law provides that all residents in residential living units, as defined to mean a living unit in a continuing care retirement community, shall have certain specified rights, such as the right to live in an environment that enhances personal dignity, maintains independence, and encourages self-determination, and the right to participate in activities that meet individual physical, intellectual, social, and spiritual needs. Under existing law, in addition to any statutory or regulatory bill of rights required to be provided to residents of residential care facilities for the elderly or skilled nursing facilities, a provider of continuing care retirement services is required to provide a copy of the rights specified for residents in residential living units to each resident at the time or before the resident signs a continuing care contract, and at any time when the resident is proposed to be moved to a different level of care. A violation of these provisions is subject to a civil penalty.

This bill would revise those provisions to expressly require a continuing care retirement community provider, at the time or before a resident signs a continuing care contract, and when the resident is proposed to be moved to a different level of care, to provide the resident with a copy of the above-described rights, a copy of the residential care facility for the elderly bill of rights, or, if the if the resident is moving into the continuing care retirement communitys skilled nursing unit, a copy of the rights applicable to residents of skilled nursing facilities.

Existing law requires the State Department of Social Services to regulate activities relating to continuing care contracts that govern care provided to a resident in a continuing care retirement community for the duration of the residents life or a term in excess of one year. Existing law provides that all residents in residential living units, as defined to mean a living unit in a continuing care retirement community, shall have certain specified rights, such as the right to live in an environment that enhances personal dignity, maintains independence, and encourages self-determination, and the right to participate in activities that meet individual physical, intellectual, social, and spiritual needs. Under existing law, in addition to any statutory or regulatory bill of rights required to be provided to residents of residential care facilities for the elderly or skilled nursing facilities, a provider of continuing care retirement services is required to provide a copy of the rights specified for residents in residential living units to each resident at the time or before the resident signs a continuing care contract, and at any time when the resident is proposed to be moved to a different level of care. A violation of these provisions is subject to a civil penalty.

This bill would revise those provisions to expressly require a continuing care retirement community provider, at the time or before a resident signs a continuing care contract, and when the resident is proposed to be moved to a different level of care, to provide the resident with a copy of the above-described rights, a copy of the residential care facility for the elderly bill of rights, or, if the if the resident is moving into the continuing care retirement communitys skilled nursing unit, a copy of the rights applicable to residents of skilled nursing facilities.

Existing law requires the State Department of Social Services to regulate activities relating to continuing care contracts that govern care provided to a resident in a continuing care retirement community for the duration of the residents life or a term in excess of one year. Existing law provides that all residents in residential living units, as defined to mean a living unit in a continuing care retirement community, shall have certain specified rights, such as the right to live in an environment that enhances personal dignity, maintains independence, and encourages self-determination, and the right to participate in activities that meet individual physical, intellectual, social, and spiritual needs. Under existing law, in addition to any statutory or regulatory bill of rights required to be provided to residents of residential care facilities for the elderly or skilled nursing facilities, a provider of continuing care retirement services is required to provide a copy of the rights specified for residents in residential living units to each resident at the time or before the resident signs a continuing care contract, and at any time when the resident is proposed to be moved to a different level of care. A violation of these provisions is subject to a civil penalty.

This bill would revise those provisions to expressly require a continuing care retirement community provider, at the time or before a resident signs a continuing care contract, and when the resident is proposed to be moved to a different level of care, to provide the resident with a copy of the above-described rights, a copy of the residential care facility for the elderly bill of rights, and, or, if the if the resident is moving into the continuing care retirement communitys skilled nursing unit, a copy of the rights applicable to residents of skilled nursing facilities.

Existing law requires the State Department of Social Services to regulate activities relating to continuing care contracts that govern care provided to a resident in a continuing care retirement community for the duration of the residents life or a term in excess of one year. Existing law provides that all residents in residential living units, as defined to mean a living unit in a continuing care retirement community, shall have certain specified rights, such as the right to live in an environment that enhances personal dignity, maintains independence, and encourages self-determination, and the right to participate in activities that meet individual physical, intellectual, social, and spiritual needs. Under existing law, in addition to any statutory or regulatory bill of rights required to be provided to residents of residential care facilities for the elderly or skilled nursing facilities, a provider of continuing care retirement services is required to provide a copy of the rights specified for residents in residential living units to each resident at the time or before the resident signs a continuing care contract, and at any time when the resident is proposed to be moved to a different level of care. A violation of these provisions is subject to a civil penalty.

This bill would revise those provisions to expressly require a continuing care retirement community provider, at the time or before a resident signs a continuing care contract, and when the resident is proposed to be moved to a different level of care, to provide the resident with a copy of the above-described rights, a copy of the residential care facility for the elderly bill of rights, and, if the continuing care contract provides skilled nursing services, if the resident is moving into the continuing care retirement communitys skilled nursing unit, a copy of the rights applicable to residents of skilled nursing facilities.

Existing law requires the State Department of Social Services to regulate activities relating to continuing care contracts that govern care provided to a resident in a continuing care retirement community for the duration of the residents life or a term in excess of one year. Existing law provides that all residents in residential living units, as defined to mean a living unit in a continuing care retirement community, shall have certain specified rights, such as the right to live in an environment that enhances personal dignity, maintains independence, and encourages self-determination, and the right to participate in activities that meet individual physical, intellectual, social, and spiritual needs. Under existing law, in addition to any statutory or regulatory bill of rights required to be provided to residents of residential care facilities for the elderly or skilled nursing facilities, a provider of continuing care retirement services is required to provide a copy of the rights specified for residents in residential living units to each resident at the time or before the resident signs a continuing care contract, and at any time when the resident is proposed to be moved to a different level of care. A violation of these provisions is subject to a civil penalty.

This bill would add to these rights the right to be free from discrimination based on sex, race, color, religion, ancestry, national origin, disability, medical condition, except as permitted by licensure requirements, marital status or domestic partner status, sexual characteristics, sexual orientation, or gender identity and expression. revise those provisions to expressly require a continuing care retirement community provider, at the time or before a resident signs a continuing care contract, and when the resident is proposed to be moved to a different level of care, to provide the resident with a copy of the above-described rights, a copy of the residential care facility for the elderly bill of rights, and, if the continuing care contract provides skilled nursing services, a copy of the rights applicable to residents of skilled nursing facilities.

Existing law requires the State Department of Social Services to regulate activities relating to continuing care contracts that govern care provided to a resident in a continuing care retirement community for the duration of the residents life or a term in excess of one year. Existing law provides that all residents in residential living units, as defined to mean a living unit in a continuing care retirement community, shall have certain specified rights, such as the right to live in an environment that enhances personal dignity, maintains independence, and encourages self-determination, and the right to participate in activities that meet individual physical, intellectual, social, and spiritual needs. A violation of these provisions is subject to a civil penalty.

This bill would add to these rights the right to be free from discrimination based on sex, race, color, religion, ancestry, national origin, disability, medical condition, except as permitted by licensure requirements, marital status or domestic partner status, sexual characteristics, sexual orientation, or gender identity and expression.

 UNFINISHED BUSINESS  

Bill No: SB 1352

Author: Wahab (D), et al.

Amended: 6/19/24

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/15/24

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

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SENATE FLOOR: 36-0, 5/13/24

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

NO VOTE RECORDED: Atkins, Gonzalez, Menjivar, Padilla

ASSEMBLY FLOOR: 72-0, 8/8/24 (Consent) - See last page for vote

SUBJECT: Continuing care retirement communities

SOURCE: Author

DIGEST:

This bill requires a resident who is signing a continuing care contract, or anytime they are proposed to be moved to a different level of care, be provided copies of their rights and a copy of the rights for residential care facilities for the elderly. This bill provides that if they are moving into the continuing care retirement community’s skilled nursing unit, requires they be provided the rights for skilled nursing facility patients.

Assembly Amendments

make technical and clarifying changes.

ANALYSIS:

Existing law:

1. Provides that residents of Continuing Care Retirement Communities (CCRCs) shall not be deprived of any civil or legal right, benefit, or privilege guaranteed by law, by the California Constitution, or the United States Constitution, solely by reason of status as a resident of a community. (Health and Safety Code (HSC) §1771.7(a))
2. Provides that all residents in residential living units in CCRCs shall have all of the following rights:
   1. To live in an attractive, safe, and well maintained physical environment.
   2. To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination.
   3. To participate in activities that meet individual physical, intellectual, social, and spiritual needs.
   4. To expect effective channels of communication between residents and staff, and between residents and the administration or provider’s governing body.
   5. To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the continuing care retirement community.
   6. To manage his or her financial affairs.
   7. To be assured that all donations, contributions, gifts, or purchases of provider-sponsored financial products shall be voluntary, and may not be a condition of acceptance or of ongoing eligibility for services.
   8. To maintain and establish ties to the local community.
   9. To organize and participate freely in the operation of independent resident organizations and associations. (HSC §1771.7(c))
3. Provides that CCRCs shall maintain an environment that enhances the residents’ self-determination and independence. (HSC §1771.7(d))

This bill:

1. Requires a CCRC provider at the time or before a resident signs a continuing care contract, and when a resident is proposed to be moved to a different level of care, to provide the resident with a copy of their rights.
2. Provides that if the resident is moving into the continuing care retirement community’s skilled nursing facility, a copy of the rights to residents of skilled nursing facilities shall be provided to the resident.

Background

1. Continuing Care Retirement Communities. CCRCs offer people age 60 and older a full range of long-term care options that includes independent living, assisted living, and skilled nursing care. This model allows senior residents to move from independence to high levels of care without leaving the community in which they reside. Typically, this is provided in a campus-like community setting, usually for a resident’s lifetime, and always for at least one year. CCRCs require residents to sign a contract that sets forth the range of services, sometimes at an additional cost, depending on the type of contract, to be provided by the CCRC to the resident. CCRCs offer a broad range of contract options so that they have the flexibility to offer a range of services that meet their consumers’ varying needs. Each CCRC offers different options on costs of service, payment methods, services provided, and other elements, including lifestyle choices. All CCRCs must obtain a Residential Care Facility for the Elderly (RCFE) license and if they offered skilled nursing services, must hold a Skilled Nursing Facility License issued by the California Department of Public Health.
2. Residential Care Facilities for the Elderly. The California Residential Care Facilities for the Elderly Act requires RCFEs to be licensed as a separate category within the existing structure of CDSS. RCFEs are defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, 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. Within RCFEs, “health-related services” are services that shall be directly provided by an appropriate skilled professional, including a registered nurse, licensed vocational nurse, physical therapist, or occupational therapist. (HSC §1569 et seq.)

California law provides for a RCFE Resident’s Bill of Rights. (HSC §1569.261 et seq.) The rights enumerated in that bill of rights includes, among other things that “A licensed RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.” (HSC §1569.269(b)) Since CCRCs must obtain a RCFE license, the Residents Bill of Rights for RCFEs would appear to equally apply to CCRC residents.

1. Master Plan for Aging. California is projected to be home to 10.8 million people age 60 and older in 2030. This is nearly twice as many people age 60 and older as there were in 2010. Additionally, by 2030 one out of every four Californians will be older adults. The state is making efforts to meet the needs of this growing population. In January 2021, the Newsom Administration published its Master Plan for Aging, which is intended to be a ten year 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 Master Plan for Aging outlines five goals, twenty-three strategies, and over 100 initiatives. The five goals of the Master Plan are: housing for all ages and stages; health reimagined; inclusion and equity, not isolation; caregiving that works; and affording aging. Goal Three is further outlined as “we will have lifelong opportunities for work, volunteering, engagement, and leadership and will be protected from isolation, discrimination, abuse, neglect, and exploitation.”

Related/Prior Legislation

AB 2171 (Wieckowski, Chapter 2171, Statutes of 2014) established a bill of rights for residents of RCFEs and provided that a RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.

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

According to the Assembly Appropriations Committee, The California Department of Social Services anticipates no costs.

SUPPORT: (Verified 8/8/24)

California Advocates for Nursing Home Reform
California Assisted Living Association
California Continuing Care Residents Association
California Retired Teachers Association

OPPOSITION: (Verified 8/8/24)

None received

ASSEMBLY FLOOR: 72-0, 8/8/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bennett, Berman, Boerner, Bryan, Calderon, Juan Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Friedman, Gabriel, Gallagher, 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, Quirk-Silva, Ramos, Rendon, Reyes, Luz Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Villapudua, Waldron, Wallis, Ward, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Bauer-Kahan, Bonta, Wendy Carrillo, Garcia, Petrie-Norris, Valencia, Weber

Prepared by: Heather Hopkins / HUMAN S. / (916) 651-1524

8/9/24 16:38:06

**** END ****

Date of Hearing: July 2, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

SBPCA Bill Id:SB 1352

Author:(Wahab) – As Amended Ver:June 19, 2024

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

SUMMARY:

This bill clarifies a continuing care retirement community (CCRC) provider, at the time or before a resident signs a continuing care contract, and when a resident is proposed to be moved to a different level of care, must provide the resident a copy of the residential care facility for the elderly (RCFE) bill of rights or a copy of the rights applicable to residents of skilled nursing facilities, as applicable. This requirement is in addition to the existing requirement that a CCRC provider provide to the resident a copy of the CCRC residents’ rights.

FISCAL EFFECT:

The California Department of Social Services anticipates no costs.

COMMENTS:

1. Purpose. According to the author:

While there is flexibility in the law to ensure age-based CCRCs are allowed to exist in the first place, we must be crystal clear that these flexibilities do not permit any form of discrimination based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity. Informing prospective residents about the RCFE Bill of Rights will go far in ensuring equal treatment for all residents, and increase resident self-advocacy.

1. Background. CCRCs. A CCRC is designed to allow aging adults 60 years of age or older a full range of long-term care options that includes independent living, assisted living, and skilled nursing care. This model allows seniors to “age in place” by residing in one facility or campus as their care needs increase overtime. CCRCs can be apartment-type dwellings, high-rise buildings, a subdivision setting, or any other housing design. Most CCRCs have designated assisted living units, formally known as residential care facilities for the elderly (RCFEs), and a skilled nursing facility either on or near the facility. CCRCs require residents to sign a contract that sets forth the range of services to be provided by the CCRC to the resident, usually for the duration of the resident’s life. All CCRCs must obtain an RCFE license and, if a CCRC offers skilled nursing services, it must hold a Skilled Nursing Facility License issued by the California Department of Public Health. The California Department of Social Services (CDSS) regulates continuing care contracts that govern care provided to residents in CCRCs.

Resident rights. Existing law provides each resident in a residential living unit in a CCRC with certain specified rights, such as the right to live in a safe and well maintained physical environment and to live in an environment that enhances personal dignity, maintains independence, and encourages self-determination, among numerous other rights. These rights are separate, and in addition to, rights established for residents of RCFEs and, separately, skilled nursing facilities.

Under existing law, the rights enumerated in the RCFE resident’s bill of rights include, among other things, that a licensed RCFE “shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.”

Existing law requires a CCRC service provider to give a copy of the rights specified for all CCRC residents to each resident at the time or before the resident signs a continuing care contract, and at any time when the resident is proposed to be moved to a different level of care. This requirement is in addition to a statutory or regulatory bill of rights required to be provided to residents of RCFEs or skilled nursing facilities.

This bill revises this requirement to, instead, require a CCCR provider to provide a resident of a CCRC a copy of both the CCRC resident rights and either the RCFE or skilled nursing bills of rights, as applicable.

Master Plan for Aging. California’s aging population is growing faster than any other age group. The U.S. Census Bureau estimates about 22% of California's population will be over the age of 60 by the year 2030, up from the current 15.8%. The California Department of Finance projects about one in four Californians will be over the age of 65 by 2040.

In January of 2021, the Governor released his Master Plan for Aging (MPA), which prioritizes the health and well-being of older Californians and the need for policies that promote healthy aging. The MPA outlines five bold goals and seeks to advance 95 initiatives to build a California for All Ages by 2030. This bill supports these efforts.

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

Date of Hearing: June 25, 2024

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Alex Lee, Chair

SBPCA Bill Id:SB 1352

Author:(Wahab) – As Amended Ver:June 19, 2024

SENATE VOTE: 36-0

SUBJECT: Continuing care retirement communities

SUMMARY: Expressly requires a Continuing Care Retirement Community (CCRC) provider, at the time or before a resident signs a continuing care contract, and when a resident is proposed to be moved to a different level of care, to provide the resident with a copy of their rights; and if the resident is moving into the CCRC’s skilled nursing facility, a copy of the rights to residents of skilled nursing facilities.

EXISTING LAW:

1. Provides that residents of CCRCs shall not be deprived of any civil or legal right, benefit, or privilege guaranteed by law, by the California Constitution, or the United States Constitution, solely by reason of status as a resident of a community. (Health and Safety Code [HSC] § 1771.7(a))
2. Provides that all residents in residential living units in CCRCs shall have all of the following rights:
3. To live in an attractive, safe, and well maintained physical environment;
4. To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination;
5. To participate in activities that meet individual physical, intellectual, social, and spiritual needs;
6. To expect effective channels of communication between residents and staff, and between residents and the administration or provider’s governing body;
7. To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the CCRC;
8. To manage his or her financial affairs;
9. To be assured that all donations, contributions, gifts, or purchases of provider-sponsored financial products shall be voluntary, and may not be a condition of acceptance or of ongoing eligibility for services;
10. To maintain and establish ties to the local community; and,
11. To organize and participate freely in the operation of independent resident organizations and associations. (HSC § 1771.7(c)).
12. Provides that CCRCs shall maintain an environment that enhances the residents’ self-determination and independence including the formation of a resident association and establishing policies and procedures that promote the sharing of information between residents and management. (HSC § 1771.7(d))
13. Establishes the California Residential Care Facilities for the Elderly (RCFE) Act to provide for the licensure and regulation of RCFEs as a separate category within the existing licensing structure of the California Department of Social Services (CDSS). (HSC § 1569 et seq.)
14. Requires the CCRC provide a copy of the bill of rights at any time when the resident is proposed to be moved to a different level of care. (HSC § 1771.7(e))
15. Requires CDSS to consolidate and develop one comprehensive Patients’ Bill of Rights for skilled nursing facilities and shall be a mandatory attachment to all skilled nursing facility, intermediate care facility, and nursing facility contracts, as specified. (HSC § 1599.61 et seq.)
16. Allows CDSS to impose and collect a civil penalty upon a CCRC for a violation. (HSC § 1569.49)
17. Provides requirements for all CCRC contracts with residents. (HSC § 1788)

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, the April 17, 2024, version of this bill would result in negligible state costs.

COMMENTS:

Background: Continuing Care Retirement Communities. CCRCs are designed to allow aging adults 60 years of age or older to reside in one facility or campus as their care needs increase overtime. This model allows adults to “age in place.” A CCRC is a facility where services promised in a continuing care contract are provided. CCRCs can be apartment-type dwellings, high-rise buildings, a subdivision setting, or any other housing design. Most CCRCs have designated assisted living units and a skilled nursing facility either on or near the facility.

CCRCs require residents to sign a contract that sets forth the range of services, sometimes at an additional cost, depending on the type of contract, to be provided by the CCRC to the resident. Contracts must include a promise to provide a range of services at a CCRC for a period longer than one year, in exchange for payment. Usually, but not always, the promise is effective for the life of the resident. CDSS reviews each provider's continuing care contract form to assure they contain all provisions required by HSC § 1788.

CCRCs offer a broad range of contract options so that they have the flexibility to offer a range of services that meet their consumers’ varying needs. Each CCRC offers different options on costs of service, payment methods, services provided, and other elements, including lifestyle choices. All CCRCs must obtain an RCFE license and if they offer skilled nursing services, must hold a Skilled Nursing Facility License issued by the California Department of Public Health.

Author’s Statement: According to the Author, “Aging adults are deserving of dignity, and that includes not being subjected to discriminatory practices associated with their housing, medical care, who they choose to associate with, or the cultural practices they keep. Our communities have become more diverse over the decades, and that means our aging population is becoming more diverse. We have seniors who don't simply require accommodations based on their aging, but culturally competent care, as well. This may include the type of food options available to them, living/visitation arrangements with family members, the ability to worship freely in their community, and the freedom to live with their partners regardless of marital status or sex.

“While there is flexibility in the law to ensure age-based continuing care retirement communities are allowed to exist in the first place, we must be crystal clear that these flexibilities do not permit any form of discrimination based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity. Informing prospective residents about the RCFE Bill of Rights will go far in ensuring equal treatment for all residents, and increase resident self-advocacy.”

Equity Implications: The current law lacks explicit protection against discrimination for residents based on civil rights protections as it pertains to their interaction with owners, providers and associations within continuing care communities. This exposes residents to potential mistreatment and undermines the principles of fairness and equal treatment.

While existing law already prevents discrimination in certain continuing care facilities, the lack of proactive disclosure of rights leaves residents in the independent living population feeling uncertain about the rights they have.

Double referral: This bill was previously heard in the Assembly Aging and Long Term Care Committee on June 18, 2024, and was approved on a 6-0 vote.

RELATED AND PRIOR LEGISLATION:

AB 2171 (Wieckowski), Chapter 702, Statutes of 2014 established a bill of rights for residents of RCFEs and provided that a RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.

REGISTERED SUPPORT / OPPOSITION:

Support

California Advocates for Nursing Home Reform

California Assisted Living Association

California Continuing Care Residents Association (CALCRA)

Opposition

None on file.

Analysis Prepared by: Alexandria Smith / HUM. S. / (916) 319-2089

Date of Hearing: June 18, 2024

ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE

Jasmeet Bains, Chair

SBPCA Bill Id:SB 1352

Author:(Wahab) – As Amended Ver:June 11, 2024

SENATE VOTE: 36-0

SUBJECT: Continuing care retirement communities (CCRC)

SUMMARY: Expressly requires a CCRC provider at the time or before a resident signs a continuing care contract, and when a resident is proposed to be moved to a different level of care, to provide the resident with a copy of their rights; and if the resident is moving into the continuing care retirement community’s skilled nursing facility, a copy of the rights to residents of skilled nursing facilities.

EXISTING LAW:

1. Provides that residents of CCRCs shall not be deprived of any civil or legal right, benefit, or privilege guaranteed by law, by the California Constitution, or the United States Constitution, solely by reason of status as a resident of a community. ( Health and Safety Code (HSC) § 1771.7(a))
2. Provides that all residents in residential living units in CCRCs shall have all of the following rights:
   1. To live in an attractive, safe, and well maintained physical environment;
   2. To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination;
   3. To participate in activities that meet individual physical, intellectual, social, and spiritual needs;
   4. To expect effective channels of communication between residents and staff, and between residents and the administration or provider’s governing body;
   5. To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the CCRC;
   6. To manage his or her financial affairs;
   7. To be assured that all donations, contributions, gifts, or purchases of provider-sponsored financial products shall be voluntary, and may not be a condition of acceptance or of ongoing eligibility for services;
   8. To maintain and establish ties to the local community; and,
   9. To organize and participate freely in the operation of independent resident organizations and associations. (HSC § 1771.7(c)).
3. Provides that CCRCs shall maintain an environment that enhances the residents’ self-determination and independence including the formation of a resident association and establishing policies and procedures that promote the sharing of information between residents and management. (HSC § 1771.7(d))
4. Establishes the “California Residential Care Facilities for the Elderly (RCFE) Act” to provide for the licensure and regulation of RCFEs as a separate category within the existing licensing structure of California Department of Social Services (DSS). (HSC § 1569 et seq.)
5. Requires the CCRC provide a copy of the bill of rights at any time when the resident is proposed to be moved to a different level of care. (HSC § 1771.7(e))
6. Requires DSS to consolidate and develop one comprehensive Patients’ Bill of Rights for skilled nursing facilities and shall be a mandatory attachment to all skilled nursing facility, intermediate care facility, and nursing facility contracts as specified. (HSC § 1599.61et seq.))
7. Allows DSS to impose and collect a civil penalty upon a CCRC for a violation ((HSC § 1569.49)

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

COMMENTS:

Author’s Statement: “Aging adults are deserving of dignity, and that includes not being subjected to discriminatory practices associated with their housing, medical care, who they choose to associate with, or the cultural practices they keep. Our communities have become more diverse over the decades, and that means our aging population is becoming more diverse. We have seniors and residents who don't simply require accommodations based on their aging, but culturally competent care, as well. This may include the type of food options available to them, living/visitation arrangements with family members, the ability to worship freely in their community, and the freedom to live with their partners regardless of marital status or sex.

While there is flexibility in the law to ensure age-based continuing care retirement communities are allowed to exist in the first place, we must be crystal clear that these flexibilities do not permit any form of discrimination based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity. Informing prospective residents about the RCFE Bill of Rights will go far in ensuring equal treatment for all residents, and increase resident self-advocacy.”

BACKGROUND

Continuing Care Retirement Communities. CCRCs offer people age 60 and older a full range of long-term care options that includes independent living, assisted living, and skilled nursing care. This model allows senior residents to move from independence to high levels of care without leaving the community in which they reside. Typically, this is provided in a campus-like community setting, usually for a resident’s lifetime, and always for at least one year. CCRCs require residents to sign a contract that sets forth the range of services, sometimes at an additional cost, depending on the type of contract, to be provided by the CCRC to the resident. CCRCs offer a broad range of contract options so that they have the flexibility to offer a range of services that meet their consumers’ varying needs. Each CCRC offers different options on costs of service, payment methods, services provided, and other elements, including lifestyle choices. All CCRCs must obtain a RCFE license and if they offered skilled nursing services, must hold a Skilled Nursing Facility License issued by the California Department of Public Health.

Residential Care Facilities for the Elderly. The California Residential Care Facilities for the Elderly Act requires RCFEs to be licensed as a separate category within the existing structure of CDSS. RCFEs are defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, 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. Within RCFEs, “health-related services” are services that shall be directly provided by an appropriate skilled professional, including a registered nurse, licensed vocational nurse, physical therapist, or occupational therapist.

California law provides for a RCFE Resident’s Bill of Rights. The rights enumerated in that bill of rights includes, among other things that “A licensed RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.” Since CCRCs must obtain a RCFE license, the Residents Bill of Rights for RCFEs would appear to equally apply to CCRC residents.

Aging in California: California is projected to be one of the fastest growing states in the nation in total population. In 2016, California comprised 12 percent of the nation's population^[1] and is expected to grow 30 percent by the year 2060 (an increase of 11.7 million people.^[2] In California, the population aged 60 years and over is expected to grow more than three times as fast as the total population and this growth will vary by region.

The population over age 60 will have an overall increase of 166 percent during the period from 2010 to 2060. More than half the counties will have over a 100 percent increase in this age group. Nearly half of these counties will have growth rates of over 150 percent. These counties are located throughout the central and southern areas of the State. The influence of the 60 and over age group on California is expected to emerge most strongly between 2010 to 2030.

The population over age 85 will increase at an even a faster rate than those over 60 years of age, having an overall increase of 489 percent during the period from 2010 to 2060. Counties can expect to experience even higher growth rates after 2020. In particular, the influence of the 85 and over age group on California will emerge most strongly between 2030 to 2040 as the first of the baby boomers reach 85 years of age.^[3]

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

In 2024-25, the MPA outlines five bold goals and currently seeks to advance 95 initiatives to build a California for All Ages by 2030. Each initiative features a designated area of focus; to deliver, to analyze and to communicate. It also includes a Data Dashboard on Aging to measure progress.

• 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

Committee Amendments: Clarifying amendments are needed to specify which rights are required for distribution to the resident.

Argument in Support: California Advocates for Nursing Home Reform writes in support of the bill, “SB 1352 will resolve the problem of uninformed CCRC residents by ensuring they are provided a list of the important rights they have under Health and Safety Code Section 1569.269 as well as the rights they have as nursing home residents if the CCRC includes a nursing home. This is a simple but valuable measure to help CCRC residents.”

California Assisted Living Association, also writes in support, “CALA supports the anti-discrimination objectives of the bill and appreciates CCRC residents receive copies of the rights that are applicable to the unit to which they are moving.”

Argument in Opposition: None.

Related/Prior Legislation:

AB 2171 (Wieckowski, Chapter 2171, Statutes of 2014) established a bill of rights for residents of RCFEs and provided that a RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.

REGISTERED SUPPORT / OPPOSITION:

Support

California Advocates for Nursing Home Reform

California Assisted Living Association

California Continuing Care Residents Association

Opposition

None on file.

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

1. https://factfinder.census.gov ↑

2. http://www.dof.ca.gov/Forecasting/Demographics/Projections ↑

3. https://aging.ca.gov/Data_and_Reports/Facts_About_California%27s_Elderly/ ↑

 THIRD READING  

Bill No: SB 1352

Author: Wahab (D)

Amended: 4/17/24

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 5-0, 4/15/24

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

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SUBJECT: Continuing care retirement communities

SOURCE: Author

DIGEST:

This bill requires that when residents of continuing care retirement communities (CCRC) sign a contract or are moved to a different level of care they receive a copy of their rights.

ANALYSIS:

Existing law:

1. Provides that residents of CCRCs shall not be deprived of any civil or legal right, benefit, or privilege guaranteed by law, by the California Constitution, or the United States Constitution, solely by reason of status as a resident of a community. ( Health and Safety Code (HSC) 1771.7(a))
2. Provides that all residents in residential living units in CCRCs shall have all of the following rights:
   1. To live in an attractive, safe, and well maintained physical environment.
   2. To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination.
   3. To participate in activities that meet individual physical, intellectual, social, and spiritual needs.
   4. To expect effective channels of communication between residents and staff, and between residents and the administration or provider’s governing body.
   5. To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the continuing care retirement community.
   6. To manage his or her financial affairs.
   7. To be assured that all donations, contributions, gifts, or purchases of provider-sponsored financial products shall be voluntary, and may not be a condition of acceptance or of ongoing eligibility for services.
   8. To maintain and establish ties to the local community.
   9. To organize and participate freely in the operation of independent resident organizations and associations. (HSC 1771.7(c))
3. Provides that CCRCs shall maintain an environment that enhances the residents’ self-determination and independence. (HSC 1771.7(d))

This bill requires that when a resident of a CCRC signs a contract, and any time they are proposed to be moved to a different level of care, the provider shall provide them with a copy of the CCRC bill of rights, residential care facilities for the elderly (RCFE) bill of rights and skilled nursing facility (SNF) bill of rights.

Comments

Author’s statement. According to the author, “SB 1352 will expand protections against discrimination in continuing care retirement communities. Specifically, this bill enhances resident rights and seeks to eliminate discrimination based on specified characteristics found in civil rights law. Aging adults are deserving of dignity, and that includes not being subjected to discriminatory practices associated with their housing, medical care, or any services typically found in Continuing Care Communities, otherwise known as CCRCs. Our communities have become more diverse over the decades, and that means our aging population is becoming more diverse. Seniors not only require accommodations based on their aging, but also need to be assured that the full range of services typically found in a CCRC are provided with cultural inclusion in mind. This may include the type of food options available to them, the ability to worship freely in their community, the freedom to live with their partners regardless of marital status, sex, or sexual orientation. It also includes the right of prospective residents to be informed of all of their rights upon signing with a CCRC to live there. While there is flexibility in the law to ensure age-based continuing care retirement communities are allowed to exist in the first place, we must be crystal clear that these flexibilities do not permit any form of discrimination based on specified characteristics found in civil rights law.”

Continuing Care Retirement Communities. CCRCs offer people age 60 and older a full range of long-term care options that includes independent living, assisted living, and skilled nursing care. This model allows senior residents to move from independence to high levels of care without leaving the community in which they reside. Typically, this is provided in a campus-like community setting, usually for a resident’s lifetime, and always for at least one year. CCRCs require residents to sign a contract that sets forth the range of services, sometimes at an additional cost, depending on the type of contract, to be provided by the CCRC to the resident. CCRCs offer a broad range of contract options so that they have the flexibility to offer a range of services that meet their consumers’ varying needs. Each CCRC offers different options on costs of service, payment methods, services provided, and other elements, including lifestyle choices. All CCRCs must obtain a RCFE license and if they offered skilled nursing services, must hold a Skilled Nursing Facility License issued by the California Department of Public Health.

Residential Care Facilities for the Elderly. The California Residential Care Facilities for the Elderly Act requires RCFEs to be licensed as a separate category within the existing structure of CDSS. RCFEs are defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, 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. Within RCFEs, “health-related services” are services that shall be directly provided by an appropriate skilled professional, including a registered nurse, licensed vocational nurse, physical therapist, or occupational therapist. (HSC 1569 et seq.)

California law provides for a RCFE Resident’s Bill of Rights. (HSC 1569.261 et seq.) The rights enumerated in that bill of rights includes, among other things that “A licensed RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.” (HSC 1569.269(b)) Since CCRCs must obtain a RCFE license, the Residents Bill of Rights for RCFEs would appear to equally apply to CCRC residents.

Master Plan for Aging. California is projected to be home to 10.8 million people age 60 and older in 2030. This is nearly twice as many people age 60 and older as there were in 2010. Additionally, by 2030 one out of every four Californians will be older adults. The state is making efforts to meet the needs of this growing population. In January 2021, the Newsom Administration published its Master Plan for Aging, which is intended to be a ten year 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 Master Plan for Aging outlines five goals, twenty-three strategies, and over 100 initiatives. The five goals of the Master Plan are: housing for all ages and stages; health reimagined; inclusion and equity, not isolation; caregiving that works; and affording aging. Goal Three is further outlined as “we will have lifelong opportunities for work, volunteering, engagement, and leadership and will be protected from isolation, discrimination, abuse, neglect, and exploitation.”

Related/Prior Legislation:

AB 2171 (Wieckowski, Chapter 2171, Statutes of 2014) established a bill of rights for residents of RCFEs and provided that a RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.

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

SUPPORT: (Verified 5/1/24)

California Advocates for Nursing Home Reform

California Continuing Care Residents Association

California Retired Teachers Association

OPPOSITION: (Verified 5/1/24)

None received

Prepared by: Heather Hopkins / HUMAN S. / (916) 651-1524

5/1/24 14:12:40

**** END ****

SENATE COMMITTEE ON HUMAN SERVICES

Senator Alvarado-Gil, Chair

2023 - 2024 Regular

Subject: Continuing care retirement communities

SUMMARY

This bill adds to the rights of residents of continuing care retirement communities (CCRCs), the right to be free from discrimination based on sex, race, color, religion, ancestry, national origin, disability, medical condition (except as permitted by licensure requirements), marital status or domestic partner status, sexual characteristics, sexual orientation, or gender identity and expression.

ABSTRACT

Existing Law:

1. Provides that residents of CCRCs shall not be deprived of any civil or legal right, benefit, or privilege guaranteed by law, by the California Constitution, or the United States Constitution, solely by reason of status as a resident of a community. (HSC 1771.7(a))
   
2. Provides that all residents in residential living units in CCRCs shall have all of the following rights:
   
   1. To live in an attractive, safe, and well maintained physical environment.
      
   2. To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination.
      
   3. To participate in activities that meet individual physical, intellectual, social, and spiritual needs.
      
   4. To expect effective channels of communication between residents and staff, and between residents and the administration or provider’s governing body.
      
   5. To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the continuing care retirement community.
      
   6. To manage his or her financial affairs.
      
   7. To be assured that all donations, contributions, gifts, or purchases of provider-sponsored financial products shall be voluntary, and may not be a condition of acceptance or of ongoing eligibility for services.
      
   8. To maintain and establish ties to the local community.
      
   9. To organize and participate freely in the operation of independent resident organizations and associations. (HSC 1771.7(c))
      
3. Provides that CCRCs shall maintain an environment that enhances the residents’ self-determination and independence. (HSC 1771.7(d))

This Bill:

1. Provides that residents of CCRCs have the right to be free from discrimination based on sex, race, color, religion, ancestry, national origin, disability, medical condition (except as permitted by licensure requirements), marital status or domestic partner status, sexual characteristics, sexual orientation, or gender identity and expression.

FISCAL IMPACT

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

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “This bill will prevent discrimination in CCRCs, specifically it will establish and reinforce protections against discrimination based on various factors, such as sex, race, color, religion, and disability. Aging adults are deserving of dignity, and that includes not being subjected to discriminatory practices associated with their housing, medical care, or the intersection of the two. Our communities have become more diverse over the decades, and that means our aging population is becoming more diverse. We have seniors who do not simply require accommodations based on their aging, but culturally competent accommodations. This may include the type of food options available to them, the ability to worship freely in their community, the freedom to live with their partners regardless of marital status or sex. While there is flexibility in the law to ensure age-based CCRCs are allowed to exist in the first place, we must be crystal clear that these flexibilities do not permit any form of discrimination based on sex, race, color, religion, and disability.”

Continuing Care Retirement Communities

CCRCs offer people age 60 and older a full range of long-term care options that includes independent living, assisted living, and skilled nursing care. This model allows senior residents to move from independence to high levels of care without leaving the community in which they reside. Typically, this is provided in a campus-like community setting, usually for a resident’s lifetime, and always for at least one year. CCRCs require residents to sign a contract that sets forth the range of services, sometimes at an additional cost, depending on the type of contract, to be provided by the CCRC to the resident. CCRCs offer a broad range of contract options so that they have the flexibility to offer a range of services that meet their consumers’ varying needs. Each CCRC offers different options on costs of service, payment methods, services provided, and other elements, including lifestyle choices. All CCRCs must obtain a Residential Care Facility for the Elderly (RCFE) license and if they offered skilled nursing services, must hold a Skilled Nursing Facility License issued by the California Department of Public Health.

Residential Care Facilities for the Elderly

The California Residential Care Facilities for the Elderly Act requires RCFEs to be licensed as a separate category within the existing structure of CDSS. RCFEs are defined as a housing arrangement chosen voluntarily by persons 60 years of age or over, 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. Within RCFEs, “health-related services” are services that shall be directly provided by an appropriate skilled professional, including a registered nurse, licensed vocational nurse, physical therapist, or occupational therapist. (HSC 1569 et seq.)

California law provides for a RCFE Resident’s Bill of Rights. (HSC 1569.261 et seq.) The rights enumerated in that bill of rights includes, among other things that “A licensed RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.” (HSC 1569.269(b)) Since CCRCs must obtain a RCFE license, the Residents Bill of Rights for RCFEs would appear to equally apply to CCRC residents.

Master Plan for Aging

California is projected to be home to 10.8 million people age 60 and older in 2030. This is nearly twice as many people age 60 and older as there were in 2010. Additionally, by 2030 one out of every four Californians will be older adults. The state is making efforts to meet the needs of this growing population. In January 2021, the Newsom Administration published its Master Plan for Aging, which is intended to be a ten year 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 Master Plan for Aging outlines five goals, twenty-three strategies, and over 100 initiatives. The five goals of the Master Plan are: housing for all ages and stages; health reimagined; inclusion and equity, not isolation; caregiving that works; and affording aging. Goal Three is further outlined as “we will have lifelong opportunities for work, volunteering, engagement, and leadership and will be protected from isolation, discrimination, abuse, neglect, and exploitation.” This goal is further outlined in the plan’s six strategies, the first of which states:

“Inclusion and Equity in Aging: As the most racially, ethnically, and linguistically diverse state in the nation, California can lead in combatting ageism, ableism, racism, xenophobia, sexism, homophobia, and all prejudices and in expanding opportunities for all older adults and people with disabilities to be economically, civically, and socially engaged, without experiencing discrimination or bias. California’s aging and disability leaders, providers, and partners are committed to becoming increasingly culturally responsive through strategies including trainings, data collection, public campaigns (including with partners in California’s entertainment industry), and targeted equity and inclusion goals in workforce, service planning, and service delivery.”

This bill is related to Goal Three and the first of six strategies set forth within Goal Three by explicitly outlining the types of discrimination seniors in CCRC’s are protected from.

Related/Prior Legislation:

AB 2171 (Wieckowski, Chapter 2171, Statutes of 2014) establishes a bill of rights for residents of RCFEs and provided that a RCFE shall not discriminate against a person seeking admission or a resident based on sex, race, color, religion, national origin, marital status, registered domestic partner status, ancestry, actual or perceived sexual orientation, or actual or perceived gender identity.

COMMENTS

Concerns have been raised by advocates that when entering into a contract with CCRCs, residents are only required to receive a copy of the CCRC bill of rights. RCFEs have their own bill of rights, which is broader than the CCRC bill of rights. In order to ensure that residents of CCRCs are being made aware of all of their rights under the law, the committee suggests amending this bill to strike the current changes made by the bill and instead require the RCFE bill of rights, in addition to the CCRC bill of rights, be included in the documentation CCRC residents are given at the time they sign their contract.

Suggested Amendment

771.7.

(a) No A resident of a continuing care retirement community shall not be deprived of any civil or legal right, benefit, or privilege guaranteed by law, by the California Constitution, or by the United States Constitution, solely by reason of status as a resident of a community. In addition, because of the discretely different character of residential living unit programs that are a part of continuing care retirement communities, this section shall augment Chapter 3.9 (commencing with Section 1599), Sections 72527 and 87572 87468 of Title 22 of the California Code of Regulations, and other applicable state and federal law and regulations.

(b) A prospective resident shall have the right to visit each of the different care levels and to inspect assisted living and skilled nursing home licensing reports including, but not limited to, the most recent inspection reports and findings of complaint investigations covering a period of no less than two years, prior to before signing a continuing care contract.

(c) All residents in residential living units shall have all of the following rights:

(1) To live in an attractive, safe, and well maintained physical environment.

(2) To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination.

(3) To participate in activities that meet individual physical, intellectual, social, and spiritual needs.

(4) To expect effective channels of communication between residents and staff, and between residents and the administration or provider’s governing body.

(5) To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the continuing care retirement community.

(6) To manage his or her their financial affairs.

(7) To be assured that all donations, contributions, gifts, or purchases of provider-sponsored financial products shall be voluntary, and may not be a condition of acceptance or of ongoing eligibility for services.

(8) To maintain and establish ties to the local community.

(9) To organize and participate freely in the operation of independent resident organizations and associations.

(10) To be free from discrimination based on sex, race, color, religion, ancestry, national origin, disability, medical condition, except as permitted by licensure requirements, marital status or domestic partner status, sexual characteristics, sexual orientation, or gender identity and expression.

(d) A continuing care retirement community shall maintain an environment that enhances the residents’ self-determination and independence. The provider shall do both of the following:

(1)  Encourage the formation of a resident association by interested residents who may elect a governing body. The provider shall provide space and post notices for meetings, and provide assistance in attending meetings for those residents who request it. In order to promote a free exchange of ideas, at least part of each meeting shall be conducted without the presence of any continuing care retirement community personnel. The association may, among other things, make recommendations to management regarding resident issues that impact the residents’ quality of life, quality of care, exercise of rights, safety and quality of the physical environment, concerns about the contract, fiscal matters, or other issues of concern to residents. The management shall respond, in writing, to a written request or concern of the resident association within 20 working days of receiving the written request or concern. Meetings shall be open to all residents to attend as well as to present issues. Executive sessions of the governing body shall be attended only by the governing body.

(2) Establish policies and procedures that promote the sharing of information, dialogue between residents and management, and access to the provider’s governing body. The provider shall biennially conduct a resident satisfaction survey that shall be made available to the resident association or its governing body, or, if neither exists, to a committee of residents at least 14 days prior to before the next semiannual meeting of residents and the governing board of the provider required by subdivision (c) of Section 1771.8. A copy of the survey shall be posted in a conspicuous location at each facility.

(e) In addition to any statutory or regulatory bill of rights required to be provided to residents of residential care facilities for the elderly or skilled nursing facilities, the provider shall provide a copy of the bill of rights prescribed by this section as well as in section 1569.269 to each resident at the time or before the resident signs a continuing care contract, and at any time when the resident is proposed to be moved to a different level of care.

(f) Each continuing care retirement community shall prominently post in areas accessible to the residents and visitors a notice that a copy of rights applicable to residents pursuant to this section and any governing regulation issued by the Continuing Care Contracts Branch of the State Department of Social Services is available upon request from the provider. The notice shall also state that the residents have a right to file a complaint with the Continuing Care Contracts Branch for any violation of those rights and shall contain information explaining how a complaint may be filed, including the telephone number and address of the Continuing Care Contracts Branch.

(g) The resident has the right to freely exercise all rights pursuant to this section, in addition to political rights, without retaliation by the provider.

(h) The department may, upon receiving a complaint of a violation of this section, request a copy of the policies and procedures along with documentation on the conduct and findings of any self-evaluations.

(i) Failure to comply with this section shall be grounds for the imposition of conditions on, suspension of, or revocation of the provisional certificate of authority or certificate of authority pursuant to Section 1793.21.

(j) Failure to comply with this section constitutes a violation of residents’ rights. Pursuant to Section 1569.49 of the Health and Safety Code, the department shall impose and collect a civil penalty of not more than one hundred fifty dollars ($150) per violation upon a continuing care retirement community that violates a right guaranteed by this section.

POSITIONS

Support:

California Retired Teachers Association

Oppose:

California Assisted Living Association

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