Assembly Standing Committee on Aging and Long-Term Care

Good afternoon. Welcome to the April 22nd Assembly Aging and Long Term Care Committee hearing. We are hearing five measures today. Our hearing will be brief, should be brief. And once we establish a quorum, we will need to adopt our Committee rules for the 2023-24 session.

A very big, big welcome to Assemblymember Ellis as the new Vice Chair and also my colleague from Kern. County. Thank you. Assemblymember Ahrens, who has agreed to fill in today for Assemblymember Arambula and who could not be here today. So with that, let's call the roll to establish a quorum. Please call the roll.

[Roll Call]

All right, so with quorum established, we will need to adopt our Committee rules. Can I get a motion and a second? Bless you. Bless you. The Committee rule. So the Committee rules for Committee on Aging and Long Term Care has been moved by Assembly Member Ellis and seconded by Gonzalez. Welcome. Please call the roll.

[Roll Call]

All right, Committee rules are adopted. This is just added from the Speaker's Office to be set at each hearing. As a reminder, primary witnesses in support must be those accompanying the author or who otherwise have registered a support position with the Committee, and the primary witnesses and opposition must have their opposition registered with the Committee.

All other support and opposition can be stated at the standing mic when called upon to simply state name, affiliation and position. So we have Assemblymember Correa, please present your Bill AB450. Welcome.

Thank you, Madam Chair, Members, thank you for allowing me to present Assembly Bill 450. I also want to thank and recognize Ruby Arceo work from from the office and her work. She's a fellow in the office and this is a work that she did in the office.

AB 450 would establish a task force with the Department of Aging to develop policy recommendations on how we can better support undocumented adults who are 55 years or older and often overlooked yet deeply integral population in our communities.

This task force will bring together subject matter experts and key stakeholders to examine the challenges aging undocumented Californians. Like housing instability, affordability, access, health, and social services, and the long term pressures of caregiving. The insights and recommendations developed through this process will be reflected in the 2028 Master Plan of Aging.

California is home to more than 2.7 million undocumented immigrants, including 293,000 who are over the age of 55. And notably over 856,000 have lived in our state for more than 20 years, contributing, working, raising families and building California alongside the rest of us.

As an immigrant myself and as someone who cares for my mother, I understand this level of care in long term and it gets increasingly difficult over time. Driving down the hill, as we say in Palmdale, from Palmdale to my mother's house to spend some time with her.

It's just a small part of providing support and care for as she ages. So many undocumented older adults do not have access to the safety nets many others rely on. They're aging without the security that comes from retirement benefits, healthcare, or long term support systems.

Many continue to work long past the retirement age, whether in rural or urban areas. That is just to get by. And yet despite these hardships, undocumented immigrants contributed more than 8.5 billion in state and local taxes in 2022 alone. They have been and continue to be at the forefront when California needs the most.

From essential frontline work to rebuilding after disasters. And we can recall what the pandemic did to us throughout the world, but in California, essential workers during the pandemic at California moving forward. And many of them were seniors and are still seniors working in the fields.

This bill is a modest but meaningful first step towards honoring our commitment to people who have given so much to our state. Let me just share with you a personal story on why this measure is so dear and near to my heart. I myself came to California at the age of 15 years old and I'm proud of what the State of California provided me as an immigrant.

I feel no shame in saying that I crossed the border in search of a better life. And through working hard at the age of 15, my income taxes were deducted from my payroll for over five years when I was undocumented. And I never was able to get anything back because I lacked a Social Security number. So for me, this is very near and dear to my heart because I know what it's like to do this type of work.

Unfortunately, because there is no immigration reform yet, we do have a lot of seniors that have been here for 30-40 years who have not been able to benefit from the hard labor that they do every day. With that, I have a principal witness in support, Mr. Arturo Garcia Morales, a CHIRLA Member from the Antelope Valley. And Cynthia Gomez, Deputy Director of this of State Policy and Advocacy with CHIRLA

Good afternoon, Chair and members. My name is Cynthia Gomez. I'll be doing my testimony in English. Arturo will do his in Spanish and I will translate after. I'll begin with mine. Good afternoon, Chair and members. My name is Cynthia Gomez. I'm the Deputy Director of State Policy for the Coalition for Humane Immigrant Rights, CHIRLA.

CHIRLA is proud to sponsor AB 450 and thanks Assembly Member Carrillo for his continued leadership. In California nearly 30% of our state's population, or approximately 10 million individuals, identify as immigrants, and of this, nearly 3 million are undocumented. Immigrant and undocumented communities contribute significantly to the State of California.

From an economic standpoint, undocumented Californians contribute $8.5 billion in state and local taxes, and many have lived in California for more than 20 years. Moreover, California's population is rapidly aging. Nearly 300,000 undocumented individuals are 55 and older and lack status, which places undocumented older adults in uniquely vulnerable situations.

In recent years, California has made large strides to address the needs of undocumented immigrants. However, needs still remain. For example, immigrants are overrepresented in low wage jobs, many of which do not offer retirement benefits. And despite the years of contribution, they are unable to access federal Social Security benefits.

CHIRLA works directly with community members and our older adult members have also flagged issues with access to specialized medical care, language access, and the increasing transition to online and tech options as barriers in their lives.

AB 450 allows us to address these needs by bringing together experts that will provide policy recommendations to best address the needs of undocumented older adults. This is a crucial step forward in ensuring all Californians have what they need to age comfortably in our state.

Undocumented older adults in California have raised families, started jobs, and lived significant portions of their lives in our state, and as they continue to age, it is our duty to ensure that they are able to age with dignity and respect. We thank you for your consideration of this bill and ask for your support on AB 450.

[Spanish]

I will translate. My name is Arturo. I am a member of CHIRLA from the Antelope Valley. I have worked in construction in California for almost 35 years. I have paid my taxes every year. However, due to my immigration status. I do not qualify for the retirement benefits I have been contributing to.

Like me, thousands of people do not have any retirement benefits, nor do they have access to the resources they need to survive as we age. In 2023, Assembly Member Juan Carrillo introduced AB 1535.

And although it did not become law, it would have expanded access to the Cash, Cash Assistance Program for immigrants so we could have access to this program. Today I'm here to ask for your support of AB 450 that would create a panel comprised of immigration experts, seniors, and community leaders who would further investigate the needs of older immigrants.

This step is very important for you to get as much information as needed so you can help us and eventually find a solution so that people like me have the right to age with dignity. This task force would bring to light the different obstacles that the immigrant community faces when we can no longer work.

We don't receive help with housing, monetary assistance, and even though we have access to Medi-Cal, sometimes it's difficult for us because everything is digital and many of us cannot do it without someone's help. This is why it's so important that these studies are carried out.

This way, the state can have more knowledge on how to help our community. For years, we have contributed to the U.S. economy and more importantly, the state's economy. We deserve to have access to retirement programs and be able to age with dignity. Please vote for AB 450.

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

Monica Madrid with the Coalition for Humane Immigrant Rights, CHIRLA. Proud to sponsor and support.

Good afternoon. Whitney Francis with the Western Center on Law and Poverty, in support.

Good afternoon. Kei Yamamoto with the Having Our Say Coalition, in support.

Patricia Salazar...in support.

Gracias. All right, is there. We don't have any recorded opposition, but is there anyone here in opposition to this measure? Seeing and hearing none. I'll bring it back to the committee. Any comments or questions? Thank you. Thank you. Any comments or questions?

We'll go with Assembly Member Ellis and we'll go to Assembly Member Gonzalez right after

I really appreciate what you're doing here. I have a concern, and the concern is that I really respect the fact that this gentleman worked his whole life and paid his taxes. It bothers me that he is not eligible for these benefits because he's worked his tail off his whole life. There's a real concern.

I don't know that this bill. I guess what my concern is if someone comes over at 56, that's illegal. Should they have been entitled to the benefits that this gentleman is, and I think that's my concern here.

So when someone that is undocumented, it applies for the benefits, they would have to show that they've been here working for 20, 30 years, whatever that amount is. In today's technology world, it's fairly easy to do that.

You can have a lease agreement, you can have a bank account, you can have many other different ways to do that. Even car loans now they're being available. An ET number is something that is provided from other countries.

So they said mechanism already in place, that kind of test for those that have been here for that long, Being that the study will do what the bill is intended to do, then when that gets implemented through a CAPI program, for instance, which is the bill that AB 1536 that I introduced two years ago, that's when those mechanisms will be put in place.

So to your concern, anybody coming out that is 60 years old from other country, they won't be able to show that they've been contributing to the economy for so long. And those intricacies can be worked on once we go through this process, this is just a study bill so that we can find the right number of those that would qualify for the program. That'll be a separate process.

If this goes through and it does what it's intended to do, the study, then I'll come again and introduce legislation to ask that this population be included in an existing program called CAPI, Cash Assistance Program, which is already in place for other Californians with disabilities, for instance.

So this is the initial step so that we can again provide that information. Then I'll come back again and introduce the bill again where this population, once is identified to be part of the existing program. It's not a new program. It's already existing. That's what the last legislation did. Unfortunately, the Governor vetoed it the first time.

But this is just again, the initial steps to see we can include them in the, in the near future.

Yeah, I was concerned there wasn't any guidance in this committee for determining that, but thank you.

Assembly Member Gonzalez.

You know, we have to recognize the situation that we're in today. Right? And I'm proud to say that I'm working with, with the author and some members here, colleagues to find a solution. Look, we, we've passed the, the buck long enough when it comes to immigration. Right?

We can't do anything from a on the federal side, but we sure can do something on the state side. Right? And I'm glad to see that we are having these conversations in a bipartisan way that doesn't distract. And there's an empathetic solution to this. And there really is, I really believe there is a solution.

Anyone who says there isn't a solution and just send them away is not looking at the totality of all of this. I have friends and family members and former coworkers that have been here for years, working hard, going to their barbecues, family parties, the whole nine yards, and have done their service, if you will, to a community. And we have to fix these, these missing.

I mean, this is a, this is a, a big puzzle that we have to fix. Right? And I'm glad that we're starting to have these conversations in a, in a humane and ethical way so that we can solve this. Look, here's the reality. [Spanish] We need a solution. Right?

I would ask with the author a couple of things as you work through these things. Number one, in section or line 16 or section B and section C, I would respectfully ask that we add one member appointed by the minority leader of the assembly and one member appointed by the minority of the senate.

I think we need a balanced approach to this. Right? This, this is a good step forward, but I want to make sure that there's balance. That's what Californians are asking for, is balance. I'd love to help in, in finding a balanced approach to this where we can come up with, with a, you know, my heart.

You know, where I land. So I would love to see a more balanced approach to this. Yes, I agree. The other piece is process. I'd like to see something like how I'm a nuts and bolts kind of guy. Right? Just what does that process look like?

Yeah.

How do we determine this, the step by step, nuanced process so that we can come up with a solution. I'd be more than willing to sit with the author on this afterwards. You know, I'm willing to sit with you to find that.

I don't see it, you know, says during the process, I'd like to see what does that mean, right? What does that mean in the process so that we don't leave people out. Because I think like this gentleman right here. [Spanish] and he's working and he's working hard.

So I want to make sure that folks like this are, are, are recognized in an appropriate process. So that way down the road we don't have, where did this money go and what happened and all that. Just some checks and balance. So would you be willing to speak to that a little bit? And if you can't love to sit afterwards.

I just want to remind everyone that this is being re referred, dual referred so there is a chance to work later on. Yeah.

That's what I wanted to check with Ruby that this has been double referred. But I also want to hear from the sponsor. That's something that they're willing to do. I in my, my part. And I want to thank you for your comments. It is a bipartisan issue. It's about the economic movement of the state.

We work the fourth largest economy or fifth whatever number you want to pick. We're still very big part of the world economy. I agree with you. I thank you for those comments and for your willingness to work in this issue. And I do agree needs to be a bipartisan effort so that we can get to immigration reform.

Recognizing that yes it is a federal level but just like we in California do a lot of things for a veteran community which is also a federal level but we in California strive to do better. But I'd like to hear from the sponsor that's something that they would agree to. I would agree to.

I appreciate your comments. I want to say I think we have a shared goal in mind. Right? It's making sure that folks who have called California home for majority of their lives are able to age with the dignity that they deserve. They've been contributing significantly not just from an economic standpoint but for the fabric of our society.

We, you know, as we work towards this shared goal, I think dialogue is what really helps us get to a solution that we all can get behind. And I think dialogue is always welcomed.

Are there any other questions from the other committee members? Assembly Member Farias.

I want to thank the author on this bill. This is exactly the type of public policy that we need to dive into.

And as you eloquently stated, it's a bigger picture of what we need to do as the State of California and at the federal level of speaking up for marginalized voices. For speaking up for our undocumented community who are community members, who are essential workers that you know, we have all these definitions but we have 1.6 million in California and why it's predominantly the workforce.

And I really appreciate you elevating their voices in this perspective that as they contribute to our economy to allow them to age with dignity and grace and to be able to tap into services and have protections as they age is only the humane thing to do for anyone. But in particular the ones that have so much to risk because of their volatile status.

And I think you touch on what we all agree on the fact that we need to step up at the legislature and force the discussion of the unseen community members that no one has the political will to talk about and address these issues that have many tentacles beyond our broken immigration system nationally.

And so I'm supportive of this bill and look forward to tweaking the amendments and whatever process we need to do so. Thank you for bringing forward. [Spanish]

Assembly Member Ahrens. Oh, I'm sorry. Please. Awesome. Well, thank you so much. Assembly Member Carrillo, would you like to close on your bill?

Thank you. This bill recognizes the lifelong contributions of aging undocumented immigrants by ensuring that they have access to the resources they need to retire with dignity, maintain their health, and continue uplifting our communities. And Assembly Member Gonzalez, I think that this can be a milestone on the conversations that we've had. Excuse me.

Because with your support, I think that we'll be sending the signal. The signal that in California we recognize that this is an issue, that we all have to start those conversations because there's lives that are depending on what we do in California.

As, you know, other states and maybe even the federal level, they're looking at what California does. I want to thank you, but again, I just want to reiterate that if you're supporting this, it could be a signal and a milestone for us to continue to have those very conversations that we need to start doing. So. Thank you. With that, I simply ask for an aye vote. Thank you.

[Spanish] Cynthia, thank you so much for bringing this bill forward. Assembly Member Carrillo, we've had many discussions in the past on your story of coming to the United States.

You know, I just want to commend everyone on this committee for having a great, robust discussion, bipartisan, without it getting ugly. I think more and more discussions like this are proactive to finding solutions for everyone. Everybody wants to do what they can to help people in need.

I want to believe that, and I just want to share a story. I remember working in my clinic in Taft, and I remember coming into the clinic and one day my staff said, Dr. Bains, undocumented immigrant healthcare is going to be covered now.

And I remember not believing it because what led up to that day was me being a doctor in Taft, servicing an area where there were so many people that would come in that I desperately wanted to help. I'm talking about high stage levels of cancer, diabetes, things that I became a doctor to help my community.

And I felt so helpless being in the United States and not being able to help people that were breaking their back, working day in, day out, picking those crops in the hills of Cuyama. I've serviced all those people. And many people don't know the way the medical system happens is when you come in, there's a little, It's like a little speed light and there's red, yellow and green.

And when somebody comes in and it shines red, they have no access to be able to be seen by a doctor. Yellow means they might have it, but you need to look into it more. And then green means they have full access.

For so long, people were coming in and it would just say red. And you so desperately wanted to help those people. And I remember my staff that day when undocumented health care was covered, everything was green. And I remember all of my staff going, Dr. Bains, everything's green. And I'm like, what don't, come, come?

And I would be standing in front of them and they would be looking at everyone and what that feels to be a doctor who went into this career to help everyone, to help people.

And I remember that moment when all of a sudden those people that needed desperate help, I'm talking about life and death differences, all of a sudden got access to health care and I was able to see them in my clinic. That moment I will never forget. I will always be a staunch advocate for our immigrants.

I am the daughter of immigrants. We are all children of immigrants in this country. And standing up and making sure that people get help. These are our values. This is California. We don't cast people aside. And I became a doctor to help everyone. I don't care what political party you are. I don't care what race you are.

I took an oath to help everyone. And that day I will never forget. I was able to truly work to the extension of my license to help everyone. Thank you for this bill. Thank you for making me remember that day in Taft. And you have, of course, you have my support for the bill.

And the bill is duly referred and if passed out today will be re referred to the Assembly Committee on Human Services. The bill has been moved by Assembly Member Ahrens and seconded by Rubio. You can please call the roll.

[ROLL CALL]

That's five aye's. We will leave the roll open. Gracias. All right. Oh, perfect. Next we have some Assembly Member Aguiar-Curry on AB 508.

Good afternoon Madam Chair Members. I want to thank the Committee for their Thoughtful work on this bill and I will be accepting the Committee amendments. AB508 empowers consumers to make more informed long term care decisions. This bill is the consummate light touch.

It requires residential care facilities for the elderly, also known as RCFEs, to provide essential staffing information upon request at admission and when residents rates are increased. RCFEs, also known as assisted living facilities, provide congregate living settings with varying levels of care and supervision.

While some residents require minimal assistance, many now have complex health care needs with acuity levels similar to the residents of skilled nursing facilities, also known as SNFs. Under state and federal laws, SNFs are required to have healthcare professionals on staff, disclose their direct care staff to resident ratios and retain staffing data for at least 18 months.

RCFEs are not held to the same standards. California does not require minimum staffing levels at RCFEs and there is no requirement to collect or report staffing data today. RCFEs are only required to maintain a sufficient number of staff to meet resident needs.

This is a vague standard that leaves staffing decisions largely up to individual facility managers and administrators. As California's aging population grows, more people will need to receive care in RCFE. However, residents and their families have often have no way to evaluate and compare their quality of care in these facilities.

AB 508 does not Institute any new staffing requirements. AB 508 does not require the disclosure of a series of data points and information about the individual care received by each patient according to the conditions and needs. What it does it simply seeks to give California basic information to compare facilities based on the amount of care available.

And there is nothing about this bill that prevents any facility from establishing minimum standards of care or providing more information to the public, their residents, residents, families or potential residents.

Specifically this bill require licensed RCFEs to calculate and disclose their daily staffing levels and industry best practice so residents, prospective residents and their families may make the best decision for themselves and loved ones. With me today to testify is Tony Chikatelle, senior Staff Attorney with the California Advocates of Nursing Home Home Reform and Kathy Mogdragon. Sorry.

Who will share the her personal story. Thank you.

Motion to move the bill.

Go ahead. Good afternoon everybody. Thank you for this opportunity to testify on behalf of AB508. And thank you definitely to the Committee staff for their great analysis of the bill and all their help fashioning the bill. I'm Tony from California Advocates for Nursing Home Reform.

We've been around for over 40 years and during that 40 years we definitely have learned a few things and one of them is that the staffing levels and facilities definitely correlate with the quality of care in those facilities. The higher the staffing level, generally speaking, the more care is available to the residents.

When residents know their facility staffing levels, they are better positioned to choose the facility that is best for them. All of the care provided in RCFES is provided by staff. Adequate staffing is essential to resident well being.

Despite this connection between staffing levels and quality of care, residents, prospective residents and their families oftentimes have no reliable information as to the levels in their facilities, which makes assessing them very difficult, especially when they're in the position to select one. The staffing information required in AB 508 is pretty simple to calculate.

You take all the hours worked by the direct care staff in a day and you divide it by the number of residents. A little bit of addition one division facilities should know how many hours of care are being provided by staff each day and should be able to easily share that information with residents.

Direct care ratios won't tell us everything we need to know about the quality of care in a facility, but it will tell us how much care the average resident receives on any given day, which is vitally important.

People want to know if I need assistance, if mom or dad needs assistance, how many people are going to be available to take care of it? Please vote yes on AB508.

Hi, good afternoon. My name is Kathy Mondrigan. I'm here to support AB508 as well and I appreciate the opportunity to share my personal story. Over two years ago, my father, Francis Xavier Mondrigan, passed away at the age of 85 with dementia while living in a residential care facility.

His death was the direct result of negligence stemming from dangerously low staffing levels. He was a documented fall risk and had suffered numerous falls, both witnessed and unwitnessed while under the care under their care. On one occasion he fell and was left in pain until the next day before being taken to the emergency room.

There he was diagnosed with a non operable hip fracture. Despite this serious injury, the facility accepted him back fully aware that they lacked the staffing necessary to keep him safe. Less than 12 hours later he fell again and was returned to the ER the next day. I found him in his room in a deeply neglected state.

No food, water on the floor, dehydrated, no eyes on him, had been on him for many hours. He died less than four weeks later. After his death, I learned that the death could have been prevented.

Staff from the facility later testified that there were never enough caregivers on shift, that they lacked proper support from management, and that ownership refused to increase staffing due to their desire to increase profits. This chronic understaffing meant doctors were often not notified when residents experienced a fall or medical change, something they admitted was dangerous.

Without these updates, doctors could not adjust prescriptions or issue new care orders. Families, including mine, were also left in the dark. The staff testimonies under oath revealed that the facility could not maintain basic care practices. There were no time for creating care plans, conducting assessments, completing trainings or keeping logs.

They estimated that a safe ratio would be one caregiver for every seven residents. In reality, residents like my father, at best was once an hour. That hour long gap was already hard for the few staff present, many of whom were working exhausting 16 hour shifts without time to properly hand off care information on the next team.

When I found my father that day, he was lying in a fetal position on an uninjured hip, dressed in only a long sleeve shirt, one sock. His pull up and bedding were soaked in urine. And it was heartbreaking to see my father in those conditions. It was extremely angry.

Facilities also failed to be transparent about their staffing issues. During the tour the couple of years prior, I was shown a wall lined with all of their photos of staff, giving me the impression of a large, capable team.

But just two nights before my father died, while he was on hospice and actively transitioning, there was only two staff Members on duty for 40 residents. I had spent the days leading him to his death sleeping there.

It should not fall on me to advocate for facilities staffing needs, but I will continue to advocate in my father's name and for the sake of every vulnerable elder like him until real change is made. Thank you.

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

Andrew Mendoza, on behalf of the Alzheimer's Association and support.

Elisa Spivak, in support of the bill.

Seeing no one else. Anybody here in opposition of the bill?

Good afternoon, Madam Chair and Members. Danielle Parsons with the California Assisted Living Association. We represent residential care facilities for the elderly and continuing care retirement communities across California. Unfortunately, we must respectfully oppose the bill in its current form.

However, we've been having very fruitful discussions with Madam Majority Leader's office and we are very optimistic that we will come to an agreement on a pathway forward. We'd especially like to thank the author and her staff for the time that they've spent working with us on this topic.

And our C fees are resident focused and the care given to each resident depends on the needs of that person at that time. So we're confident that we can work with the author to find a legislative solution that will help a potential resident identify a community that meets their needs and their expectations.

We look forward to continued discussions. Thank you.

Good afternoon, Chair and Members. My name is Olivia Deanda and I am the Chief Financial Officer of Six Beds Inc. A statewide organization representing small licensed residential care facilities for the elderly. RCFE. I'm also an RCFE provider for 30 years in South San Francisco. We strongly oppose AB508.

While we support transparency and accountability in elder care, the bill places unrealistic and unnecessary burdens on small RCFE operators requiring the calculation and public posting of daily staffing ratios. These are home like environment, often family run where providers wear many hats and focus on hands on care, not daily website updates.

We are willing to disclose staff ratio upon request consistent with state statute of skilled nursing facilities. We urge you to oppose AV508. Thank you.

Anyone else in opposition? Just name, title and organization. Thank you.

Amber King with Leading Edge California, also in opposition. Thank you.

Ethel Gumbin, RCFE provider, we oppose this bill.

Thank you.

Okay, anybody else? Not seeing anyone else. I'll bring it back to the Committee. Any questions from the Committee on this bill? Seeing none. Assemblymember Aguiar-Curry. Would you like to close?

I would. As our population ages, we have friends and family who are facing decisions in long term care. And I brought this up because I have a very dear friend that her mother was in the same situation and it broke my heart. And she kept saying, what can I do? What can I do?

She sat there with her mom. Why is she in this situation? So I just want to say that this bill is transparency. It's not regulation and we could require minimum staffing requirements, but we chose not to do it at this time.

This bill gives Californians the information they need to make thoughtful, informed decisions about long term care for their loved ones. Decisions that are often emotional, they're complex and time sensitive.

In fact, the most frequent argument from those concerned about the bill is that we're not requiring more information in context, but any provider is free to give residents and potential residents as much information as they wish if they want to exceed the very minimal data points required under this bill.

And as our population ages and care needs become more demanding, our families deserve to know how much support a facility will provide a loved one. Walk into one of these facilities and get one of those pamphlets that they offer and you will not find out that much about who's taking care of who.

So with that, I respectfully ask your Aye vote and let's take care of our seniors.

Thank you Senator Aguirre Curie for this measure. Kathy, I'm so sorry to hear the story of your father. Deepest condolences. That's a very strong statement and a strong story to share. Thank you for being brave enough to share that story. As a physician, I think ratios are important and do tell the story of care and expectations.

While this bill doesn't mandate the ratios needed, it does present a tool to the consumer and their families. This is one tool of many that should be used to decide if the care facility is right for for the person or their family. And you have my complete support. Thank you for accepting the Committee amendments.

And there was a motion already on this bill. The bill was moved by Assembly Member Ellis and seconded by Assembly Member Ahrens. Please call the roll.

AB450. The motion is do pass as amended and re refer to the Committee on Appropriations. [Roll Call]

All right, ill has six votes and we'll leave the roll open. Thank you. Thank you. And we have Assembly Member Wallace for AB 1470.

Well, good afternoon chair and Committee Members. I have before you today AB 1476 that would allow our local senior food service programs to have the continued flexibility to provide to go meals that many seniors have come to rely on.

During the pandemic, we granted flexibility to the congregate meal programs by allowing meals to be picked up on a to go basis. Cities in my district and around the state saw positive results and seniors were able to stay safe while getting the nutrition they needed. This is a chance to take a lesson learned during the pandemic.

And improve service to our seniors. Many seniors are homebound, living alone or struggling with mobility issues that make congregate meals difficult to attend. With rising food costs, it's vital that we provide flexible solutions for our seniors who are vulnerable to food insecurity. This is about more than just nutrition. It's about dignity.

This bill is similar to a bill I had last year, and as we move forward, I look forward to working with the Administration, the area Agencies on Aging and the Department to find solutions for our seniors.

I respectfully request your support for AB 1476 and joining me today is Will Culbo from the City, the City Manager of Calamasa.

Move the bill.

Thank you, thank you good evening or good afternoon. Thank you for allowing me to speak in support of Assembly Bill 1476. It's an honor to be in front of you once again. My name is Will Koble, City Manager for the City of Calamasa, City of approximately 11,000 residents in Riverside County.

I spoke in support of AB 2410 in front of this Committee last year and although it was ultimately unsuccessful, I really appreciate the Committee's support and we are exceeding your support once again.

The COVID 19 pandemic was devastating on many fronts and it forced both public and private sectors to quickly pivot the way we do they do business. In this process, we discovered new and innovative ways to deliver services to our residents.

The senior meal program at the City of Calamisa Senior center is an excellent example of the pandemic forcing a change in program which resulted in something much better than it existed before. When the pandemic hit, our large senior community, many of which are in fixed incomes, needed alternatives to get the required nutrition.

Family Services Association, our senior services provider, instituted a grab and go meal program wherein our seniors could pick up without leaving their vehicle, nutritionally balanced meals that could then be prepared at their convenience.

Before it was discontinued, the program served over 160 people per week, far exceeding our usual attendance of 10 to 15 of our pre pandemic congregate meals.

Additionally, as our senior center reopened for in person activity, we had seen great increases in participation for our senior programs including bingo, arts and crafts and a very popular fit after 50, many of our new patrons learned of our programs as a result of their participation in the grab and go program.

Since they would not have otherwise come to our center, the grab and go meal program was only allowed under Covid rules which have set since sunsetted. We sustained our grab and go meal program until this past January when we reverted back to in Person meals.

As expected, participation has dropped off and once again has left many of our of those unable to attend in person meals in a position of food insecurity. AB 1476 would allow cities to reinstitute Grab and Go.

The grab and go option, which is vital to a community like ours that does not have access to delivery programs such as Meal on Wheels. Meals on Wheels. We appreciate Assembly Assembly Member Wallace's efforts in once again crafting this legislation to allow this critical program to be an option for our community.

I asked the Committee to support BB 1476 to provide additional nutrition options for seniors throughout the state. Thank you.

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

Andrew Mendoza on behalf of the Alzheimer's Association in support.

Good afternoon. Danny Ko on behalf of the City of Thousand Oaks in support. Thank you.

Peter Hansel, volunteer advocate for AARP California. AARP supports the bill.

Thank you so much. Seeing no one else in support. Anyone in opposition? Seeing no one in opposition. I'll bring it back to the Committee. Any questions from the Committee?

Thank you. Madam Chair. Really appreciate you bringing this this forward. Would love to be considered as a co author and like really appreciate the work that you're doing in this area and it's something that we need to be seeing more of.

The speaker has challenged us to focus on addressing the core services and needs of our constituents and really appreciate if I can work with you on this issue.

Yeah, we'd love to have you on board. Really appreciate that. We'll get you added. Thank you.

Perfect. See no other questions. So, Mayor Wallis, would you like to close?

I vote.

Thank you so much. Senator Wallace, thank you so much for your bill. You absolutely have my support. This bill was supported by this Committee last year in a similar form. And the concern for meeting the nutrition needs of older adults is only getting worse. With the elimination of the Administration on community living at the federal level.

This leaves many programs serving older adults in crisis. This makes sense. This bill makes sense and makes a change to a program that has been around and served generations to meet the current needs. Thank you so much for this bill. There is a. This bill was moved by some Member Gonzalez and seconded by Senator Council Member Rubio.

Can you please call the roll?

[Roll call]

Sharp-Collins bill is that we'll Leave the roll call.

Madam Chair, please present on Bill AB 1068.

Okay. Thank you so much. Good afternoon, Members. AB 1068 is long overdue. Countless emergencies, across the state and in my own district, have highlighted the need to include our most vulnerable residents into the greater Mutual Aid Plan for California.

As a Physician working throughout the Pandemic, I can relay the difficulties experienced in the healthcare field and the struggles I personally identified trying to locate openings and placement for those in greatest need.

Including a robust stakeholder process will ensure everyone who plays a role will do so with older adults, people with disabilities, and their care needs are included.

We all watched in horror during the recent Fires, as nursing homes and assisted living tried to evacuate our most vulnerable adults and continued as some were evacuated to shelters that could not meet their care needs. This is not the first time and if we do nothing, it would only continue. We must do better.

AB 1068 requires a Secretary of California Health and Human Services Agency to coordinate with various state departments, in order to develop a working group. This working group will make recommendations regarding the evacuation sheltering needs of older adults and people with disabilities living in long term care facilities during natural, technical, or man-made disasters and emergencies.

This Brain Trust Working Group must develop recommendations and report back best practices on how to implement this necessary mutual aid. With me today is Amber King, with Leading Age, as sponsor of AB 1068.

Thank you. Thank you, Chair, Members. Amber King, with Leading Age California, representing nonprofit providers of care services and housing for older adults, including residential care facilities for the elderly and skilled nursing facilities. We are pleased to sponsor AB 1068. This issue is more important now than ever before, as California is increasingly facing devastating natural disasters.

Unfortunately, older adults are often overlooked in emergency planning and preparedness, leaving them disproportionately vulnerable. Leading Edge California has long championed the creation of a statewide long-term care emergency response system to help facilities quickly and efficiently evacuate their communities, assisting them with surge capacity and resource distribution.

We believe that the Workgroup that is outlined in AB 1068 will really start the conversation and the process for creating such a system. We believe that it is important and essential for the discussion of state agencies, of existing emergency response long-term care providers and the older adults that they serve, and urge your Aye" vote today.

Thank you.

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

Danielle Parsons, with the California Assisted Living Association, in support. Thank you.

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

Peter Hansell, Volunteer Advocate with AARP California.

AARP supports the Bill.

Andrew Mendoza, on behalf of the Alzheimer's Association, in support.

Mr. Chair and Members, Monica Miller, on behalf of Alzheimer's Los Angeles, Alzheimer's Orange County, and Alzheimer's San Diego. And we apologize, our letter just got in, but we, we support the Bill. Thank you.

Is there anyone here in opposition to the—to this measure? Seeing none. We'll bring it back to the Committee. Madam Chair, would you like to close? Okay. All right. The bill's been moved by Assemblymember Gonzalez and seconded by Assemblyman Ahrens. Okay. Please call the roll.

[Roll Call]

The Bill is out. We'll leave the roll open for the other Members. Okay. Madam Chair, please present your Bill AB 1069.

Good afternoon, Members. As a physician, I have seen the needs of those in shelters who are struggling to meet their basic health needs. Allowing service providers into evacuation shelters enables trusted partners to provide continuity of care and will likely enfold more of the vulnerable communities towards services.

This is even more important in underserved areas who are already stretched thin with services for older adults and people with disabilities. Triple A's and ADRC's provide countless services to older adults and people with disabilities to allow them to live independently in their homes. Evacuations can disrupt these services and shelters which may not be able to meet their needs.

Services can include medically tailored nutrition, legal services, the critical work Ombudsman provides, access to medical supplies, auxiliary power and more.

AB 1069 requires as part of Disaster Planning and Response, an Area Agency on Aging, AAA, or an Aging and Disability Resource Connection ADRC program have access to an emergency shelter in order to ensure older adults and persons with disabilities receive continuous services and necessary support.

I would like to say the analysis includes an amendment I am committed to taking, but have asked the next committee to accept the amendment to allow this to be heard in the emergency management next week after passage today hopefully. This amendment will amend the Bill in the following Committee to include an MOU with local jurisdictions.

I appreciate the thoughtful conversation with the county welfare directors to ensure the well the needs are met for everyone and their privacy remains intact. With me today is Dr. Laura Trejo, Director of the Los Angeles County Department of Aging and Disabilities to speak and share her experiences in the Los Angeles fires and Christina Mills, Executive Director of C4A.

Good afternoon. I'm Dr. Laura Trejo, immediate Past President of the California Association of Area Agencies on Aging. Area agencies are designated by the state to address the needs of older persons by providing services that help people remain independent. We define an older adult as someone 60 years and older.

This can be somebody who is completely independent to someone who is frail and in need of significant assistance. For nearly 40 years I have served older adults, older persons living with disabilities and their family caregivers. I've coordinated responses to floods, fires, earthquakes, heat waves, tornadoes, hurricanes and a pandemic.

Older adults disproportionately experience the most negative outcomes during disasters. In a fast moving environment like an emergency, the needs of an older adult may not always be readily visible such as hearing, visual or cognitive difficulties. Even the stamina needed to stand in a line at a disaster center becomes problematic for some frail older adults.

Having access to personnel that understands their needs and the service networks available to respond to them is critical during and in the aftermath of an emergency. In January, Los Angeles experienced devastating fires. The majority of the lives lost were older adults and people living with disabilities.

We also experienced the largest evacuation of nursing homes and assisted living residents. AAA's currently have no standing when requesting to enter a disaster shelter to offer our services. Getting access takes time and effort. During the recent fires, the Pasadena Convention Center became a very large scale service shelter.

It took us days to gain formal access to provide services to the clients that were living there. As a result, we are now challenged to do extensive outreach to try to find clients and offer our assistance. During an emergency, the ability to respond in a timely manner is important to those in need.

AB 1069 will ensure that AAA's and our partnership with Independent Living Centers through our Aging and Disability Resource Connection programs have standing when seeking to respond to the needs of our communities.

In my experience, the ability to collaborate and coordinate our efforts on behalf of those in need always results in improved access to services when they are most needed. I thank you for the opportunity to address you today.

Dr. Baines, thank you so much for sponsoring this important Bill. Committee Members, great to see you. Thank you so much for your leadership. My name is Christina Mills and I am the Executive Director of the California Association of Area Agencies on Aging.

I want to briefly add to Dr. Trejo's testimony by emphasizing that we've seen the need for this legislation time and time again. From the Kern County floods to the Santa Rosa to the Paradise Fires. In each of these disasters, older adults and people with disabilities could have greatly benefited from AAA and ADRC'S being present in the emergency shelters.

Whether it's access to nutritious foods, incontinence supplies, access needs, navigation to support back in the community or simply talking to a trusted resource in the community, these services are needed. Having these programs engaged on site at shelters leads to better outcomes.

Advancing AB 1069 ensures we won't miss another opportunity to support Californians who are older adults and people with disabilities. Please support 1069. Thank you.

Is there anyone in the room that wishes to add on in support?

Amber King with Leading Edge California in support.

Dan Okenfuss with the California Foundation for Independent Living Centers In support.

Peter Hansell, volunteer advocate with AARP California. AARP is in support.

Andrew Mendoza on behalf of the Alzheimer's Association in support.

Tony Chicotel on behalf of California Advocates for Nursing Home reform. in support.

Mr. Chair and Members, Monica Miller on behalf of Alzheimer's Los Angeles, Alzheimer's Orange County and Alzheimer's San Diego in support. And we got this letter in on time.

Anyone here in opposition to this measure? Okay, so Madam Chair, Dr. Baines. Amazing person. I don't know how to address you. You're great. And I commend you for this and I commend you for the support in our community, my community. Just kind of a note, a side note.

Dr. Baines and I just learned about a month ago when I came to the Assembly that my goddaughter is one of her best friends and, and she's the Surgical Director at KMC. So anyway, I want to thank you for this and, and would you like to close?

You know, thank you so much for that flattery and when I stepped into this role as a politician. But thank you for that, Senator Ellis. Thank you the Doctor and further awards as well.

I was out there deployed at the Los Angeles shelters and I was out in Pasadena and I was out at Westwood, a couple other shelters. And I noticed the great need to make sure that there was competitive care for especially our elderly with dementia and also culturally competent care as well.

There was a case where there was an elderly, which they called me. They said Dr. Baines needs to get catheterized. And I get there and he was Hispanic and they had thought that he had dementia. He actually didn't have dementia. He totally knew himself well.

But he needed a urinal because he was in a wheelchair and couldn't ambulate to go to the bathroom. So he didn't actually need to be catheterized. And I actually drove 30 minutes over the shelter to translate for them.

So there's much need of competition care in the shelter, especially in emergencies, we've got to make sure we prioritize our vulnerable communities. So I respectfully ask for your aye vote.

The Bill has been moved by Assemblyman Gonzalez and seconded by Assemblyman Ahrens. Please call the roll.

AB 1069. Motion is due pass and rerefer to the Committee on Emergency Management. Dr. Baines. [Roll Call]

Do we need other Members to add on? Okay. Yeah, if needed, we okay to allow other Members of the Committee to add on. We'll leave the roll open until five more minutes. Here we go. Thank you.

[Roll Call]

Committee adjourned.