Assembly Standing Committee on Aging and Long-Term Care

If any Member of the public in the room would like to testify today, I will ask you to approach the microphone after each Assembly Member presents their Bill. We also accept written testimony through the position letter portal with instructions on the Committee's website, and you can find the email for the Committee there as well. We will be using a moderated telephone service through which any witness can add their position to a Bill.

Our call a number for add on support and opposition is 877-692-8957 the PIN is 131-5444 again, that number is 877-692-8957 and the PIN number is 131544. All right, and then the operator on the line will give you instructions on how to be placed in the queue based on whether you support or oppose the Bill. If you are calling in, please eliminate all background noise. This includes muting your live stream broadcast and your smart devices to reduce sound issues.

If you're having any problems with the moderated phone service, you can call my capital office at 916-319-2035 and staff will be there to try to help. Thank you for understanding as we implement methods to continue to serve the people of California and allow greater access to the legislative process for all in our state. I would like to apologize for being in my scrubs today. I actually just came straight from a mass casualty training with the Emergency Medical Services Authority because I'm still working as a physician.

It was a great morning. We got to learn how the state can do better in preparing for disaster events. So great morning. Apologize for being in my scrubs today. With that, let's call the role to establish a quorum secretary. Please call the roll.

[Roll Call]

All right, so it looks like we have a quorum. All right, so we'll start off with the hearing of AB 979. Assemblymember Alvarez, please present your Bill.

Thank you, Madam Chair. It's always great to present a Bill to this Committee. Thank you for the opportunity. I also wanted to start off by thanking staff for the diligent work going above and beyond to be able to be here today with this Bill for you as many of you know, family councils are organized groups of family members and friends of long term care facility residents who meet regularly to share information and discuss concerns about the quality of care at each of the facilities.

Family councils are essential to ensuring that family and friends play a critical role in guaranteeing that our vulnerable populations in long term care facilities are receiving the best care possible. Unfortunately, the lockdowns in the pandemic has shown us very painfully the need to modernize our family council regulations so that they are empowered to fulfill their representative role. This Bill modernizes existing family council law so that Members can meet and communicate in more efficient ways and that they can operate during a public health emergency.

AB 979 also strengthens the family council's ability to represent residents by requiring facilities to be more responsive to concerns raised by family councils and discourages operators from undermining family council activities. AB 979 enjoys no opposition, and in fact, we worked extensively with facilities to ensure that their concerns were addressed before coming before you today. With that, I'd like to introduce a witness from the Senior Staff Attorney from the California advocates for Nursing Home Reform, Tony Chicotel. You got it.

Welcome.

Hi. Thanks. Good afternoon. First of all, I want to thank the Committee Staff for their really great work on this Bill. It was awesome, lots of work, and I think we have a really great product here. So, as the Member said, family councils are awesome. The problem is they're sort of delicate. It really requires family members who have, in addition to taking care of their loved ones and maybe their families at home, have the time and energy to advocate for better conditions in the facility.

And that's unfortunately a little too rare for them to have the ability to organize like this. So we want to do everything we can to facilitate the formation of family councils, the maintenance of family councils, going back a little ways. In 2014, we updated the assisted living Family Council laws, but didn't align that with the nursing home laws. So there was some dissonance there.

And then in 2016, the Federal Government updated some nursing home regulations, and again, we have some misalignment with what's required in the federal law and the state law. So we're kind of overdue to revisit this. And then Covid happened.

And what we learned was so much of our state law is predicated on family councils having physical space, physical space to meet in the facility, physical space to announce their meetings, and post bulletins on an actual old school bulletin board that didn't work during the time when family Members probably most needed to be banded together.

So what we're trying to do is modernize, make it certain so that they can have the ability to communicate electronically virtually, meet virtually, and spread the news about their work virtually, and do the great work that family councils do. So I feel like that's where we are with this Bill, and I really would appreciate your support. Thank you.

So we have another great advocate for long-term care, and that's Blanca Castro with the State Long-Term Care Ombudsman. Thank you very much for being here.

Okay, good afternoon. Thank you, Madam Chair, Members of the Aging and Long Term Care Committee, and Assemblymember Alvarez. Thank you for this Bill. Just want to say my name is Blanca Castro, State Long-Term Care Ombudsman. And on behalf of the 300,000 people who are in a long-term care facility, on any given day here in California, we have 1200 skilled nursing facilities and another 7000 residential care facilities and growing, also known as assisted living.

I just wanted to touch on a couple of things, and that is that one primary role we have is to advocate for residents based on what their wishes are or their representative or their identified family. And the only time that facilities really find that they need family councils, and I'm going to mention resident councils in this case, but the only time they really find they need them is when a facility is closing or when there's been a major shift.

For example, we just recently in California are implementing MediCal as a managed care for long-term services and supports. And our sister agency wanted to know what is the best way to get information in person to residents and their families. This would be a perfect forum. Right before the pandemic, we had about 3000 resident councils that we worked with. So one of our jobs is to help organize them. After the pandemic, as recent as 2021, that number went down to almost 1600.

So there was a real challenge. Even just gathering online, as my colleague Tony said, opened up a huge opportunity. But I do want to mention that in this Bill it is important that we also recognize resident councils. And if there is a consideration to amend it to add resident councils, we would be grateful. We are still supporting AB 979 as written, but we would like for your consideration.

The last point I want to make is that with regard to these organized groups, it's not just the benefit to the resident and their families. Administrators and staff can hear firsthand what are some of the challenges that they're having and then mitigate anything before it gets out of hand. It's also a great way to clarify some misunderstandings that oftentimes happen. So again, on behalf of all the residents who are voiceless at this point, we're urging your aye vote on AB 8979 and I apologize for my delay.

Thank you. So is there anyone in the room who wishes to add on in support?

Move the Bill?

Thank you.

Hi, good afternoon. Jason Sullivan-Halpern with the California Long-Term Care Ombudsman Association in support.

Karen Jones with the Long-Term Care Ombudsman Services of San Luis Obispo County also in support.

Heather Harrison with the California Assisted Living Association. I just want to thank the author and the sponsors and the Committee staff for all of their work on this Bill.

Amber King with Leading Age California. I also want to thank the author, sponsor, and Committee consultant for all of their work on this Bill. Thank you.

Jennifer Snyder on behalf of California Association of Health Facilities, I'm just echoing great Committee work. We raised some concerns both with the author. Really commend the author for his willingness to work with us and the know when family councils, when they are good, they're really good. And so we're excited to see some good cleanup in the Bill that we can provide the opportunity for family councils to work better in nursing facilities. So thank you to everybody and to getting us to a good place. Thanks.

Thank you. Is there anyone in the room wishing to add on an opposition? All right, seeing none. Operator, please open the line for any additional support, but limit your support to name and affiliation only. As a reminder, our call number is 877-692-8957 and the PIN is 1315444.

For comments in support or opposition, please press one, then zero at this time. And first we'll hear from line 12.

Good afternoon. Yasmin Pellet on behalf of justice and aging in support.

And we have a few more people queuing up. One moment, please, while we provide them with line numbers. And now we'll go to line 10.

Yes. David Feinberg, representing AARP. We stand in support of this Bill.

Line 16.

Deborah Gonzalez, current Long-Term Care Ombudsman Program, in support.

And line 15.

Melody Taylor Stark. I am a resident designated support person for two people in long-term care and a member of Essential Caregivers Coalition. And I am in support.

And we have no further comments at this time.

All right. Operator, is there anyone in opposition?

If you would like to voice opposition, please press one, then zero at this time. We have no comments in queue.

Okay, and then just for clarification, we are moving the Bill as the analysis is written, but commit my staff to coordinating meetings to consider amending in resident councils. Just want to put that there. Are there any questions from the Committee on AB 979? All right. Assembly Member Alvarez, would you like to close?

Just thank you for again, to staff and to everybody who has worked along the way in order to make this possible and that we can provide a voice for families for their loved ones. And I ask for your Aye vote. Thank you very much.

Thank you. Assembly Member Alvarez, I wanted to thank you so much for putting together such a wonderful Bill. It's very very important, advocating for your patients, advocating for your loved ones. No one's going to do it better than you. And having more ways for them to be able to partake. And also culturally and linguistically, it's easier to provide those services.

I think a lot of times with aging, long-term care, culture gets in the way and understanding and how do we move things along, how to have family conferences so everybody's on the same page, so nobody feels uneasy and nobody feels like their voice is not heard. So as a physician, I thank you for putting this Bill together. All right? And then I have also been informed that your staff worked collaboratively to ensure the amendments taken last week are reflective of all interests.

So thank you for that work. And we have a motion by Assembly Member Rubio and a second by Assembly Member Ta. The motion before us is do pass and re-refer to the Appropriations Committee. Secretary, please call the roll.

[Roll call].

All right, we have six Ayes. That Bill is out. Congratulations. We will be leaving it open for absent Members. There. Awesome.

So with that, Assembly Member Mckinnon, please present your bill, AB 1006.

Good afternoon, Chair and Members. First, I would like to accept the Committee's amendments and thank the Chair and her staff for the work on the Bill. Across 21 Regional Centers, California's Department of Development Services serves 370,000 consumers serviced by 120,000 direct support professionals. Despite this incredible reach, there are still many barriers to families who are in need of respite services, both within and beyond the DDS universe. DDS has struggled to fully reduce barriers to accessing care, including being able to pair families with culturally competent providers.

And Regional Centers do not all offer consumer direct respite, a cost effective care option that allows for greater comprehensive care options at home. Families who provide long term care for disabled and elderly loved ones benefits from having access to respite. And importantly, they benefit from having simple ways of getting access to services. Well, I can vouch for this personally. I watched my mother and my aunt take care of my 89 year old grandmother for 10 years. They worked really hard every day.

These are two retired women, so they're elderly women as well. We all worked so we could only give so much help. They would have really benefited from having respite services to take a break because, as you know, respite is a healthcare giver who steps in when the primary giver needs a break. And so that's why we came up with AB 1006.

It will mandate that the Department of Aging partner or contract within its No Wrong Door Program with a referral registry that will match Medicaid-funded consumers with culturally competent respite providers, maintain a registry of vetted and trained respite providers, and work within a consumer-directed program entity that will serve as a co-employer to respite providers. Today I have with me Rachel Gonzalez and Les Tilgner, who is an in-home support service provider who is in need of respite. Thank you.

Good morning, and thank you so much for having me today and allowing me to speak to you about the importance of respite care. My name is Rachel Gonzalez. I'm an IHSS worker. And that little girl in the back is my daughter Grace. Grace is 12 years old. She has down syndrome. She is nonverbal. She is unable to bathe herself, brush her teeth, or perform any normal menial tasks that we take for granted by herself.

According to AARP's 2020 caregiving report, more than one in five Americans, 21.3%, provides care to an adult or a disabled child with special needs at some time in the past 12 months. 12 months. Yet it's hard to find respite caregivers versus someone who has the skills they're culturally competent to provide a break for family caregivers who provide 24-hour care. It's especially difficult for people of color. For example, those that live in multigenerational homes who tend to be disproportionately people of color.

They have lower and have lower incomes, are assumed to have unpaid caregivers in their home. So their hour assignment will be less than that of someone who does not live in a multigenerational home. Our legislation would create a registry to help consumers find these workers. The economic and logistic basics of caring for my daughter is overwhelming. It's absolutely overwhelming. I found out about Alta Regional in 2018. I had the choice of four or five caregivers. I was interviewing people to take care of my daughter.

I am now at a place after losing our wonderful primary caregiving respite worker, Veronica, who was with me for several years. Five days a week, 3 hours a day. Important time for me as a parent. Important. It never stops. I have an infant 24 hours a day. I have a newborn. If you have children and you've lived the newborn life, you understand the demands that that places on a family. And I'm a single parent. So, we lost Veronica.

She moved out of the country, and I was thrown back into the respite program. I attempted SDP, the Self Determination Program, where you are given the funds and you then go outside and hire your own caregiver. However, you must join a financial management company and they have to oversee your finances. I emailed and phoned for a total of six months. Every single management company that was given to me by Alta Regional and didn't receive a response. So I was without care for six months.

I then returned to the registry and I was given no one to interview for four months, calling frequently. No one was able to meet my daughter's needs. She signs, she uses basic sign language. No one was able to meet her needs. We finally found Sarah, and Sarah was supposed to work today, but she doesn't start until 3:30. So I had to take my daughter out of school for the entirety of the day because she doesn't transition well.

So I can't pick her up from school and break her routine and bring her here. I had to keep her out of school all day and bring her here and then take her home. AB 1006 is so important for us. We need it. We need your help. We need your support. And this Bill offers me the help that I've been looking for for two years now. So thank you for your consideration, and thank you so much for listening to me today.

Um, I ask that you have a moment. Listen with your open mind and open heart. Words may be very technical, but hopefully, you get to feel what I'm trying to express for you. Good afternoon, Assembly Members, and thank you for the opportunity to speak about the importance of AB 1006, that providers like me and. My name is Daoud Mershedi and I care for my 21-year-old son, Abraham, who's Down syndrome. Abraham is a lovable kid, vibrant personality. He's an author.

He was number one on Amazon for his book for a few weeks. He's a TV personality, he's played sports for olympics, but he has specific cares throughout the day that he needs help with, that he can't maintain, and training is necessary to his skills to ensure that all his needs are met. Right now, I'm super happy and grateful that my aunt is helping him. However, if she was not there, it is almost impossible to have somebody else to replace that position.

I've interviewed several people over the years, and at the beginning when we did get respite, I would have people come in, but they would be from cities further out. I live in Fremont, so after a week or two, they would quit because the distance and the rate of pay just didn't makeup. And in Fremont, it's very difficult to hire someone at that rate.

But even when her support with Abraham, I need to have access to respite work, and the AB 1006 would actually help to alleviate that problem. We've tried to use current respite care system, and as I said in the past, but it's nearly impossible to find a respite caregiver who are able to provide the specific care for Abraham's needs and are willing to do the low wage that is currently offered.

And one of the things that's, I think, important, rate is important, definitely, but also training that person to be able to take care of the individual, I believe would retain them in the positions much longer than currently what it is. And this is largely because of the list of providers that I received from the respite care in neighboring cities. They come out with no training, as I was mentioning.

So AB 1006 has the potential to uplift the quality of care consumers will receive by allowing providers and consumers to ensure respite workers are culturally competent, background checked, and trained. And I prefer you be in your scrubs and vote yes for us than be in your suit and say no. Thank you.

My scrubs are popular. Thank you. Thank you so much. Is there anyone in the room who wishes to add on in support?

I never know if this thing is on. Femia Contrera, San Joaquin County. I am an IHSS provider and I support, I know there's a word in there, AB1006.

Hi. My name is Tracy Hammond. I'm from Marysville, which is Yuba County, and I support AB 1006. I also have a respite worker, though, and it's very important that we have one. So thank you.

Hi, I'm Karen. I'm from Carmichael. I'm a respite worker and I accept the support. Thank you.

Good afternoon. My name is Les Tilgener and I'm in San Jose. I care for my son through IHSS Program and I totally support this Bill. Thank you.

All right, anyone in opposition? Seeing none. Do we have anything, Operator, online in support?

For comments in support, please press one zero at this time. And first we'll hear from line 10. Line 10, your mic is open.

David Feinberg, AARP, in support of the Bill.

And line 15. Line 15, your mic is open.

Work essential with caregivers coalition and I am in support of this Bill.

And we have no further comments at this time.

Thank you, operator. Anyone in opposition?

For comments in opposition, you may press one zero at this time. We have no comments.

Thank you. Assembly Member Mckinnon would you like to close? Oh, sorry. Any comments from the Committee? Yes.

I just want to acknowledge your work in this space. Thank you for thinking about people who care for others and the testimony. Thank you for sharing your personal stories outside of what this Bill will accomplish. Just your testimony today is a tremendous public service so that those who perhaps are unaware that this type of opportunity might be available to them for those who are caring for their loved ones.

And along the way, by the way, saving our state a lot of money by caring for them, they deserve this. And so I just want to acknowledge all of your work and your advocacy, and thank you for bringing this forward.

Any other comments? All right, would you like to close Assembly Member Mckinnor?

Yes. Just as I was telling you the story about my mother and my grandmother, well, my grandmother passed away about three years ago, and those last two years were very difficult, and we didn't know about respite workers. And, boy, I wish we would have, because sometimes my mother and my aunt just needed an hour to themselves to take a break because it's very difficult taking care of the people you love, your elderly loved ones, 24 hours a day. So with that, I respectfully ask for your Aye vote.

Thank you. We share the same story Assembly Member Mckinnor. I took care of my grandma five years ago, and things went south in the last two years. And I was in residency. I worked all day in residency, and I would have to come home oftentimes having to resuscitate her as I would enter home. She had end-stage lung disease. And I worry about the mental health of caregivers.

They need a break, and they need to feel secure in that break with people that are properly trained so that you can literally just take a break and feel that everything will be taken care of. So thank you so much for this super, super amazing bill. When I first started working at the Kern Regional Center on the board, this was one of the things I had brought up to increase the respite care. It's something that I, as the board President, had brought up. So thank you.

Thank you so much for this. You have my support. There were amendments referenced in the Committee analysis. Thank you for accepting the date-related amendments. And we do have a motion by Assembly Member Ta and seconded by Assembly Member Alvarez. The motion before us is do pass as amended, and re-refer to the Appropriations Committee. Secretary, please call the roll.

[Roll call].

Seven Ayes. This bill is out. Congratulations.

Thank you. Thank you so much.

All right, Assembly Member Reyes, please present your Bill on AB 1309. It's cold in here. I know.

Thank you. Madam Chair Members, I present AB 1309 which will provide greater protection for nursing home residents who are being discharged or transferred. I am happy to accept the Committee's amendments and I thank your staff for working with my staff and with the stakeholders to make it a better Bill. The Bill requires facilities seeking to transfer or discharge a patient from a nursing home to provide additional documentation justifying the reasoning for this.

Under current law, nursing homes only need to check a box on the discharge notice to justify the reason for discharge. There is no requirement to provide any details to support its reasoning. Over 309,000 nursing home residents discharged are discharged every year, and oftentimes they are done with incomplete notice or no notice at all. The Ombudsman receives approximately 1400 complaints per year regarding nursing home discharges.

Just in 2018, nursing homes in California have been cited by the California Department of Public Health 1,800 times for deficient discharge practices, 614 of which were specifically tied to defective discharge notices. AB 1309 is intended to discourage facilities from pursuing unwarranted discharges, prompt residents to appeal their discharge if they feel the discharge was unjust, and enhance the quality of resident appeals.

Here to testify and support are Tony Chicotel, who is a Staff Attorney with the California Advocates For Nursing Home Reform, and Blanca Castro from the California State Long-term Care Ombudsman.

Hi, good afternoon again. Tony Chicotel with California Advocates for Nursing Home Reform. We move from the sort of warm and fuzzy world of family councils to the sometimes prickly world of nursing home discharges and evictions. Again, commend the staff, the Committee staff, for working with us and the stakeholders on this Bill. We've got some amendments, I think they will be coming along soon, that I think actually improve the Bill, make it stronger for resident protections.

As the Assembly Member said, evictions are a significant problem in nursing homes and a lot of it's motivated by financial considerations. As residents have Medicare coverage when they come in, 95, 96% of the time, pays a pretty high rate, daily rate, but the clock is ticking. You get up to 100 days of coverage and most of the time it's a lot less. And at that point, the rate of reimbursement goes way, way down.

So there's some financial incentives to move residents along, maybe before they feel that they're completely ready. The law has a lot of protections in these situations. The discharges are supposed to be very deliberative, collaborative, thoughtful, ultimately safe. But in this rush, sometimes it doesn't work out that way.

So what we've tried to do is take documentation that the nursing homes are already required to prepare that, explain what the discharge plan is, and get that to the residents so that they have, one, they have some notice about what is being said about them, but two, they have some potential information that could be useful for them if they feel that they want to resist the discharge and exercise their appeal rights.

So this will give them definitely a leg up in terms of transitioning and also staying longer if they feel that that's what they need to do and get that information in front of an administrative law judge. Another thing is that this brings nursing home residents in line with what assisted living facility residents already have, which is some additional details that back up the reason to give them this really important information for them going forward. So with that, really appreciate an Aye vote on AB 139. Thank you.

Again. Blanca Castro, State Long-Term Care Ombudsman and I'm not going to repeat what has already been said, but if I may just tell you a brief story, but what happens when someone is ill-informed or evicted without proper care planning? And I'm going to call him Mario. And he is 70 years old. He only speaks Spanish and was in a large-scale nursing facility recuperating from a hip surgery.

The facility was trying to reduce their census as part of multiple non-compliance issues with the feds and state licensing. So Mario was notified two days before he was dropped off by the SNF staff at what they call a navigation center, but it's really a homeless shelter. Mario was there and contacted the Ombudsman. We continued to advocate for Mario. We worked with a social worker who in the community who was assigned to work with him and try to find permanent housing.

Mario was most upset because he was unable to continue his therapy sessions, and the walker he used was difficult to maneuver at the homeless shelter. He also did not have his guitar or the tools that he uses for drawing and painting, which are his favorite activities. It took nine months to finally identify a secure and small independent living home on the ground floor because of the dedication of a social worker and Ombudsman team.

So Mario now lives alone with support services in the community, and he shared his excitement with us, letting us know that now he's going to be able to make healthy meals for himself and he's going to enjoy playing his guitar. I also want to share that what we are seeing a trend in California, where skilled nursing facilities are converting into mental health facilities and they're not providing adequate discharge planning or notification to residents.

So we really need AB 1309 to improve documentation that should be required when a facility decides to discharge a resident. There are valid reasons, but when we get involved, we find that the reason given is not accurate. And when we review the documentation and medical records and actually speak to the resident in their language, we find that they can stay or they should stay. So we urge your Aye vote on AB 139. Thank you.

Thank you so much. Is there anyone in the room who wishes to add on in support?

Hello. Jason Sullivan Halpern with the California Long-Term Care Ombudsman Association, in support.

Hi. Karen Jones, Long-Term Care Ombudsman Services of San Luis Obispo County, in support.

Good afternoon. Leza Coleman with the California Commission on Aging and in support.

Anyone in opposition?

Not in opposition, just Jennifer Snyder, on behalf of the California Association of Health Facilities, want to thank the author, staff, and the Committee for working with us on the amendments. I think it really makes a much better Bill. So thank you very much.

Seeing no other opposition, that last one was in support. Operator, anyone in support online?

For comments in support, please press one zero at this time. And first, we'll go to line 20.

Good afternoon. Yasmin Pellet on behalf of justice and aging, in support.

Line 16. Sorry, line 10.

David Feinberg, AARP in support of the Bill.

Line 15.

Melody Taylor Stark, Essential Caregivers Coalition, in support of the Bill.

Line 16.

Hello.

Hello. Your mic is open.

Devora Gonzalez, current Ombudsman Program, absolutely in support.

And line five.

Carlene Ancheta with Empowered Aging, in support.

And we have one more person queuing up. One moment, please, while we provide them with their line number. Oh, I'm sorry, we lost them. There are no further comments at this time.

Thank you, operator. Anyone in opposition?

For comments in opposition, please press one zero at this time.

And we have no comments.

Thank you, operator. Any questions from the Committee on AB 1309?

Move the Bill.

Would you like to close Assembly Member Reyes?

Yes. As we know, nursing home residents are already in a vulnerable position. I think anything we can do to protect them when they're going to be discharged. Some people call it an eviction, but it's a discharge or transfer, and we want to make sure we protect them. With that, I respectfully ask for your Aye vote.

Thank you so much, Assembly Member Reyes. Thank you so much again for this measure.

Parity between RCFE's and SNFs relating to discharge and transfer of planning is common sense. You have my support. There were amendments that were developed last week and were agreed upon yesterday, referenced in Committee analysis. They referenced the collaborative effort between your staff, Committee staff, CANHR and CAHF. Thank you for accepting the Committee's amendments. Thank you. And we do have a motion by Assembly Member Ta, seconded by Assembly Member Alvarez.

The motion before us is do pass as amended, and re-refer to the Appropriations Committee. Secretary, please call the roll.

[Roll call].

Thank you, Assembly Member.

Seven Ayes. Bill is out. Congratulations. Assembly Member Ortega. Yes. We'll present your Bill on AB 1313.

It's cold in here.

I know, it's freezing.

Good afternoon, Chair and Members, for the opportunity to present AB 1313 before you all today. First, I want to start by thanking the Chair and the Committee staff for all the work on this measure. And I agree with the amendments recommended in the analysis. AB 1313 would establish a pilot program administered by the California Department of Aging, CDA, to expand case management services for older individuals to maintain their health and economic stability.

The CDA lacks proper funding to support the rapidly growing population of older Californians, especially low-income seniors, who need community-based supportive services, such as case management programs. Currently, these programs are only funded with federal Older Americans Act funding that has remained essentially flat for the past decade, and the state offers no matching funds. This lack of support has led to economic insecurity for older adult households in California, resulting in high risk for repeat hospitalizations, falls, depression, anxiety, housing loss, and homelessness.

Case management and visiting programs are extremely effective in improving health outcomes and preventing crisis among seniors. By expanding these services, California can help reduce the risk of negative health outcomes for older adults and improve their overall quality of life. Today I have testifying with me Lee Poolin, Director of Aging and Adult Services with Marin County, and we have Wendy Peterson for the Senior Services Coalition of my county, Alameda County. Thank you.

Thank you. Thank you, Assembly Member. Thank you, Madam Chair. I appreciate the opportunity. Senior services Coalition in Alameda County represents 45 organizations that serve older adults. The flat federal funding for the Case Management Program and no state funding that the Assembly Member talked about really has resulted in fewer clients being served in California with each passing year. And this just doesn't make sense. In our county, the fastest growing segment of the population is people age 65 and older, age 85 and older, even faster.

The numbers of people who are diagnosed with Alzheimer's and mild cognitive impairment is increasing. As the population is aging, it has become poorer. In our county and in California, almost 40% of people age 65 and older are living below the California Elder Index, and this is driving increasing numbers of older adults who are becoming housing and food insecure. These trends are increasing the need for case management, and especially among older adults who don't neatly fit into the eligibility criteria of other programs.

Case management is often the glue that makes everything else work, navigating complex and fragmented systems, ensuring that medical care actually happens, connecting clients with coverage and benefits and supportive services, and helping to build or reconnect family and friends. Instead of talking more, I think I want to share a client story that was given to me by a case manager at a nonprofit organization in my county. She writes, Mr. M is 72, blind, and has health issues.

When we first met him, he was homeless, particularly challenging as he was fearful of danger given his blindness and being Asian. We helped him get on MediCal, IHSS, CalFresh, into low-income housing, Berkeley Rides, Meals on Wheels, A Friendly Visitor. We work cooperatively with his IHSS worker and department manager as needed, complete required paperwork. You can fill in any blanks. We probably do it. Mr. M now feels safe. His living condition is secure. His IHSS worker is caring and dependable.

He has regular medical care, and his friendly visitor is now a good friend of 10 years. Our coalition is excited about AB 1313 and the opportunity to demonstrate the power and impact of the Case Management Program. Thank you very much.

Thank you. Good afternoon, Chair Baines and Members of the Committee. My apologies to those who my back is facing you. Okay, thank you. Lee Fulham, County of Marin. And in Marin, over 30% of our population is over age 60 or more, which is the federal definition of older Americans.

7% of them are living at the federal poverty level and nearly one quarter are in the economic gap, meaning they don't qualify for public assistance but don't have the funds for things such as home repairs, caregiving, or case management. It's a similar situation in Sonoma county, where 28% of residents are over the age of 60, again, seven plus percent living at the federal poverty level, with 30% there in the economic gap.

So in neither county do we have services sufficient to support those residents in need, especially those in the economic gap. As you know, without support, an illness, relationship loss, cognitive issue or other stressors can be destabilizing. Such impairments can hamper one's ability to afford and manage care, and this is especially true when one spouse dies and the other is left to manage on one's own.

Case management would assess the person's situation, develop a plan, coordinate with any family or professionals, and follow up on a regular basis. This level of support improves health outcomes and reduces the cost of nursing home or assisted living. This would be a substantial help for someone like Ms. Guterres, not her real name, but a real situation. She is 64 years old, blind in her left eye, nearly blind in her right eye, is insulin-dependent, oxygen-dependent, and has recently had a foot amputation.

She cannot manage independently, and she cycles in and out of the hospital with brief, intermittent home health when she returns. Her income does not qualify her for Medi Cal, but does not provide enough for her to hire someone to help with care coordination.

You've heard today she must rely on family, but they too have their own life demands and are financially under-resourced and cannot pay for a case manager for Ms. Guterres. My office has had six adult protective services reports in the last five years alleging self-neglect. But Ms. Guterres is not self-neglecting. Rather, she and her family are overwhelmed. But imagine if she had a case manager to coordinate medical and social service needs.

She would likely have a better quality of life, better health outcomes, and the state could mitigate future cost of institutional care. So thank you for your consideration of supporting a case management demonstration to help the lives of older adults and families in our counties. Thank you.

Thank you. Is there anyone in the room who wishes to add on in support?

Izzy Swindler with Shaw Yoder Antwih Schmelzer and Lange on behalf of Sonoma Board of Supervisors, in support thank you.

Good afternoon. Leza Coleman with the California Commission on Aging, in support.

Madam Chair and Members, Monica Miller on behalf of Alameda County, in support and one of the co-sponsors, excuse me. Thank you.

Thank you. Anyone in opposition? Seeing none. Operator, anyone in support online?

For comments in support, please press one zerp at this time. And we have a comment from line 15.

Melody Taylor Stark, I'm in support of this bill, and I strongly suggest that it include long-term care, particularly skilled nursing, where case management is sorely lacking. Thank you.

And we have one more comment coming through. Now we'll hear from line 19. It looks like line 19 dropped. There are no further comments.

Operator, anyone in opposition?

For comments in opposition, please press one zero at this time. And we have no comments.

Thank you so much. Are there any questions from the Committee on AB 1313? Okay. All right. Assembly Member Ortega, would you like to close?

Yes. Thank you again to the Chair and Committee staff for all your work on this Bill. We really appreciate it and I respectfully ask for your Aye vote.

Thank you, Assembly Member Ortega. Thank you for this measure. You have my support. There were amendments that were referenced in the Committee analysis that sunset this pilot and have yearly reporting requirements. Thank you for accepting the Committee's amendments. While I always raise my voice, as we all know, for Kern County, I understand that there are three counties chosen, so because of their ability to quickly put case management into action.

But as a resident in a severely underserved county, I want to highlight the need across the state for programs like this for case management and would argue those in the underserved and underserved counties need the assistance most. So thank you guys for this. We do have a motion by Assembly Member Ta, seconded by Assembly Member Alvarez. The motion before us is do pass as amended, and re-refer to the Appropriations Committee. Secretary, please call the roll.

[Roll call].

Seven ayes. It's out. Congratulations.

Thank you.

Thank you.

Then, Assemblymember Wood, thank you for joining us all the way from the Health Committee. If you like to, please present your bill on AB 1417.

Thank you very much for the opportunity to stroll across the street and get a little exercise. Pleasure to present AB 1417, Madam Chair and members, I'd like to thank you and the committee staff for your work on this bill. Thank you. Mandated reporters and the protection they provide are critical to the safety of California's most vulnerable communities.

Studies show that older adults are disproportionately victims of abuse, finding that at least one in 10 older adults in community living situations experience some form of abuse in the prior year. Elder abuse is also chronically underreported. For every incident reported, it's estimated nearly 24 cases remain undisclosed. While there are many reasons why such abuse is not more widely reported, our state's current mandated reporting process for elder abuse in long-term care facilities undeniably adds to the problem.

The timelines for reporting lists of agencies to which the reports must be submitted, and required reporting methods differ depending on the type of abuse or neglect. The complex process creates confusion for mandated reporters and can inadvertently result in noncompliance and delays in reporting. AB 1417 will require mandated reporters to follow a simplified, streamlined, and timely reporting process.

By making the process easier to follow and requiring reports be submitted in a timely manner, the bill will ensure that residents of long-term care facilities have the same protections against elder abuse as persons who reside in their own homes. Here to testify in support are Jason Sullivan-Halpern of the California Long-term Care Ombudsman Association and Karen Jones of the Long Term Care Ombudsman Services of San Luis Obispo County

Thank you, Assemblymember Wood. Thank you, Assembly members. My name is Jason Sullivan-Halpern and I'm the director of the California Long-term Care Ombudsman Association, also known as CLTCOA, and we are the proud sponsors of AB 1417. CLTCOA represents all 35 of the local long-term care ombudsman programs across the state. Those program staff and volunteers not only advocate for residents with complaints and long-term care facilities, but they also investigate every report of elder independent adult abuse and neglect in long-term care facilities.

California arguably has the most complex, illogical, and protracted reporting process in the nation. Reporters must follow different timelines and report to different agencies depending on the type of abuse, and the same type of abuse can even be reported in multiple ways. In some instances, the abuse does not even have to be reported to law enforcement at all, and this can put residents in danger. AB 1417 will simplify the mandated reporting process without creating any new mandates.

It will ensure California's system is more in line with current federal requirements for federally funded facilities, and it will speed up the timelines for reporting abuse in most cases. Assembly members, we shouldn't wait to report abuse, and we shouldn't make the process any more complicated than it has to be for well-intentioned, mandated reporters working in facilities. For these reasons, we strongly urge your aye vote. Thank you so much.

Hello. My name is Karen Jones and I run the Long Term Care Ombudsman Program in San Luis Obispo County. I've been a coordinator for that program for 24 years. I'm also the treasurer for the CLTCOA, so I've been around this little block a few times. I'm seeking your aye vote for AB 1417. It's a bill that will make it a lot easier for mandated reporters to correctly report abuse that occurs in care facilities. It does not create a new mandate.

The system we have now was created to resolve federal and state ombudsman consent issues. We require consent from the victim or the responsible party. It's not always easy to get. Unfortunately, the current system requires mandated reporters to use very subjective judgment to determine if, how, and when to report abuse and to where. The current system is not fair to mandated reporters because it leaves them vulnerable, because it's so easy to make a mistake in that subjective judgment, even with a very colorful flowchart that is just obnoxiously crazy. It's not fair to the residents either, because these mandated reporters want to report correctly, it's just nearly impossible, and we need to fix that. The current system was created to deal with our consent issue, and now we have an opportunity to make it actually a workable system. So I gratefully accept your aye vote and happy to answer any questions.

Thank you so much. Is there anyone in the room wishing to add on in support?

Good afternoon. Leza Coleman with the California Commission on Aging. And as one who worked on that colorful flow chart, I agree it's time for it to be updated and ask for your aye vote.

Blanca Castro, state long-term care ombudsman, and we support it.

Tony Chicotel for California Advocates for Nursing Home Reform, in support.

Joshua Thubei, on behalf of the California Continuing Care Residents Association, in support.

Thank you. Anyone in opposition? Seeing none. Operator, anyone in support online?

Comments in support, please press one zero at this time. And line 20, please go ahead.

Good afternoon. Yasmin Peled, on behalf of Justice in Aging, in support. Thank you.

Line 15.

Melody Taylor Stark, Essential Caregivers Coalition, in support.

Line 16.

Good afternoon. Devora Gonzalez, Kern Long-Term Care Ombudsman program, in support.

Line 17.

Christina Farnham with Empowered Aging, in support.

And we're at line 24.

Good afternoon. This is Libby Anderson, director of the Orange County Long-Term Care Ombudsman program, in strong support.

There are no further comments at this time.

Operator, anyone in opposition online?

For comments in opposition, please press one zero at this time. And we have no comments.

Thank you so much. Are there any questions from the committee on AB 1417? Awesome. Assemblymember Wood, would you like to close?

Just a comment. I have to admit, when I heard about this issue, I was quite frankly surprised. I'm a mandated reporter as a dentist, you as a physician, and I know there are others in the room here as well, and I didn't imagine teachers. Yes, exactly. I never imagined it was so difficult to do the right thing, but apparently it is so I think it's time to change that. And I respectfully ask for your aye vote.

Thank you. Thank you so much, Assemblymember Wood. I would like to thank you deeply for this. You definitely have my support and I agree. I mean, even as a physician, trying to report is so hard. Especially, I remember when COVID first hit, the amount of cases that were coming in, the domestic abuse cases and neglect, that were just skyrocketing, especially in rural areas. I had CPS on speed dial and oftentimes they were suffering healthcare workforce issues. Trying to just get someone on the line was so difficult.

So I can only imagine how difficult it is just to get the paperwork processed. So thank you. Thank you so much. And we do have a motion on the bill by Assemblymember Ta, seconded by Assemblymember Alvarez. The motion before us is do pass and we refer to the Appropriations Committee. Secretary, please call the roll.

[Roll Call]

Seven ayes. Bill is out. Congratulations.

Thank you, members.

For absent Members. Item one, AB 979, do pass and re-refer to the Committee on Appropriations. [Roll Call]

Okay, so, seeing no further business before us, this hearing is adjourned. How do I do that? I'm going to learn this on one time. And every time I come here, I take a picture of this and I never look at it.