COUNTY OF SAN MATEO

Inter-Departmental Correspondence

County Manager’s Office

DATE:

July 31, 2007

BOARD MEETING DATE:

August 7, 2007

SPECIAL NOTICE/HEARING:

None

VOTE REQUIRED:

Majority

TO:

Honorable Board of Supervisors

FROM:

John L. Maltbie, County Manager

SUBJECT:

County Manager’s Report #10

A.

Resolution in support of AB 399 (Feuer), Long-term health care facilities

RECOMMENDATION:

Adopt a resolution in support of AB 399 (Feuer), Long-term health care facilities

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): 8—Help vulnerable people including those who are elderly or have disabilities and others achieve a better quality of life.

BACKGROUND:

Abuse and neglect are growing problems in California nursing homes. An effective complaint investigation system is the foremost public safeguard against abuse and neglect of nursing home residents. The California Department of Public Health (DPH) is the responsible State agency that inspects nursing homes and enforces nursing home laws. Due to lengthy delays in investigating and resolving complaints, the complaint investigation system currently operated by DPH needs major reforms to be more effective in protecting nursing home residents.

DISCUSSION:

AB 399 will help fight abuse and neglect by improving the timing and quality of nursing home complaint investigations by requiring DPH to do the following:

a)

Complete complaint investigations within 40 working days;

b)

Send complainants a written summary of findings about their complaint, if it extends an investigation beyond 40 working days;

c)

Provide a complainant additional time to request an informal conference upon receipt of the determination of the investigation;

d)

Investigate facility-reported complaints of abuse and neglect within the same timeframes as public complaints.

FISCAL IMPACT:

No fiscal impact to the County.

B.

Resolution in support of AB 949 (Krekorian), Residential care facilities for the elderly: resident transfers

RECOMMENDATION:

Adopt a resolution in support of AB 949 (Krekorian), Residential care facilities for the elderly: resident transfers

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): 8—Help vulnerable people including those who are elderly or have disabilities and others achieve a better quality of life.

BACKGROUND:

In California, there are over 7,400 Residential Care Facilities for the Elderly serving approximately 160,000 older persons. In San Mateo County there are 307 RCFE’s serving 5,044 residents. Every year, RCFE’s close due to a variety of reasons, from the sale of the business to bankruptcy or voluntary closure. In addition, residents of these facilities are often displaced due to major renovations and remodeling projects. Under these circumstances, elderly residents are relocated and might suffer from transfer trauma due to a lack of planning and inadequate notice requirements. Residents are also faced with unplanned relocation costs such as visiting prospective care homes, transporting or storing personal belongings including furniture and pre-admission or deposit fees at the new facility. Present laws are inadequate to protect elderly residents who face relocation.

DISCUSSION:

AB 949 will establish relocation protections for elderly residents to require RCFE’s to do the following:

a)

Require RCFE providers to develop a transfer plan to minimize transfer trauma.

b)

Submit a relocation plan for approval to the licensing agency for transfers affecting 7 or more residents.

c)

Prohibit providers from accepting new residents and entering into agreements once they have decided to relocated existing residents and have submitted a plan to the licensing agency.

d)

Rebate proportional amount of prepaid monthly fees if resident leaves before the end of the month.

e)

Refund preadmission fees in excess of $500 paid two years before notice of closure on a proportional basis.

Daily fines would be automatically imposed if the provider fails to meet the relocation requirements.

FISCAL IMPACT:

According to the Assembly Appropriations Committee, costs for increased workload for DPH associated with reviewing relocation plans should be minimal and absorbable.

C.

Resolution in support of AB 1113 (Brownley), Medi-Cal: eligibility

RECOMMENDATION:

Adopt a resolution in support of AB 1113 (Brownley), Medi-Cal: eligibility

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): 8—Help vulnerable people including those who are elderly or have disabilities and others achieve a better quality of life.

BACKGROUND:

Under existing law, the California State Department of Health Care Services is required to adopt a federal option under which any employed individual with a disability who meets specified income and resource requirements, shall be eligible for benefits under the Medi-Cal program, subject to the payment of premiums. This is the CWD program which began in 2000. Working individuals with disabilities and with net countable family incomes below 250% of the Federal Poverty Level and assets limited to $2,000 for individuals and $3,000 for couples can enroll. These provisions are due to sunset on January 1, 2009. Continuation of this program is vital to enabling persons with disabilities to remain eligible for affordable health coverage while working.

DISCUSSION:

AB 1113 makes the following changes to the eligibility for the CWD program:

a)

Disregards the income of a spouse when determining eligibility and the premium amount.

b)

Exempts assets if those assets were accumulated while an individual was working and qualified for Medi-Cal under the program.

c)

Exempts spousal assets up to the amount allowed under the Medicare spousal impoverishment cap.

d)

Exempts retirement income received at and after 65 years of age for those individuals who qualified before 65 years of age.

This bill also permits individuals otherwise eligible for the CWD program, but who are temporarily not working, to remain in the program for up to 18 months, provided the individuals continue to pay the premiums during the temporary non-working period. In addition, AB 1113 deletes the September 1, 2008 sunset date for the CWD.

The CoD’s Legislation and Advocacy Committee, whose membership includes CoD Commissioners, representatives from the Mental Health Board, the AIDS Advisory Committee, the IHSS Public Authority Advisory Committee and other community-based advocacy organizations, has determined this bill to be one of the Committee’s top 10 legislative priorities.

FISCAL IMPACT:

According to the Assembly Appropriations Committee, the annual costs to make the current CWD program permanent would be between $1 million and $2 million (50% from the State’s General Fund.)

D.

Resolution in support of SB 489 (Steinberg), Continuing care contracts: retirement communities: closure

RECOMMENDATION:

Adopt a resolution in support of SB 489 (Steinberg), Continuing care contracts: retirement communities: closure

VISION ALIGNMENT:

Commitment: Ensure basic health and safety for all

Goal(s): 8—Help vulnerable people including those who are elderly or have disabilities and others achieve a better quality of life.

BACKGROUND:

CCRC provide elderly consumers with independent housing, residential care, skilled nursing care and other health related services in a single location, usually in incremental higher levels of care for the lifetime of the resident. California has 78 CCRCs and provide life-long care and services to close to 20,000 seniors. In San Mateo County, there are three such facilities providing care to approximately 512 individual seniors. Many of these residents make a major financial commitment to reside in these facilities. Collectively, in California, over $1 billion in entrance fees have been entrusted to providers in return for life-long care. However, there are limited legal protections for consumers when facilities close. A facility closure generally translates into serious investment loss for residents. Vulnerable displaced residents also face severe physical and psychological harm, such as transfer trauma. Present laws are inadequate to protect residents from the negative consequences associated with CCRC closures.

DISCUSSION:

SB 489 would provide the following protections:

a)

Define closure and temporary closure in order to establish circumstances for regulatory intervention.

b)

Create detailed closure and relocation plans for each level of care.

c)

Require assessments of residents in order to minimize transfer stress and trauma.

d)

Specify timeframes and advanced notice of closure to residents.

e)

Require comparable replacement accommodations and care.

f)

Create a fair financial formula to provide replacement accommodations and care.

g)

Prohibit closure or relocation until the requirements are met.

FISCAL IMPACT:

The Senate Appropriations Committee projects costs of $30,000 per year for the Department of Social Services to oversee the additional regulatory requirements.