Several years ago, it was becoming apparent that California’s model for assisted living for elderly adults (Residential Care Facilities for the Elderly – RCFEs) was breaking down.  Residents were more sick and more dependent and the staff members providing care were often poorly trained and unable to meet the basic needs of the residents.  During this time, the number of RCFEs and RCFE residents grew substantially and state oversight from the Department of Social Services (DSS) evaporated, withered by budget cuts and management that had surrendered its mission as a consumer protection agency.

The yawning disparity between residents’ needs and the ability of RCFEs to meet them grew until it could no longer be ignored.  Residents were suffering: neglect, abuse, injuries, and death.  The media became interested.  Several journalists contributed excellent reporting to the problems in RCFEs, including A.C. Thompson of ProPublica, Deborah Schoch of the Center for Health Reporting, and Will Kane and Jaxon Van Derbeken of the San Francisco Chronicle.  Their stories revealed an industry with major problems that was harming the frail and dependent residents it was entrusted to protect.

The media attention on RCFEs led to strong interest in legislative reform in Sacramento.  Legislators from all over the state wanted to be part of a comprehensive reform package, dubbed the RCFE Reform Act of 2014.  The reform bills focused on improving RCFE care, empowering residents, and providing DSS with new tools to ensure compliance with regulatory standards.

To their credit, the California Assisted Living Association (CALA) and LeadingAge, the two primary facility associations, recognized the need for reform and were largely supportive of the bills.  Several counties, including Riverside, San Diego, and Stanislaus added their support while the Long-Term Care Ombudsman programs throughout the state provided important grassroots assistance.

After a long spring and summer to shepherd the RCFE reform legislation through the legislature, we lost some important bills while others were weakened by amendments. Nonetheless, most of the bills were passed by the legislature and have now been signed by the governor.  The bills that were lost will be re-tooled and tried again.

As we know all too well, having good laws is not enough to ensure good care.  Implementation and enforcement must be comprehensive and robust or else nothing will change.  That is why CANHR will be vigilant in monitoring DSS to make sure it fulfills the mandate it has been given: to protect residents from neglect and abuse as if those residents were their own family members.

While much work remains to improve RCFE care and oversight, both in implementing the RCFE Reform Act and addressing the remaining policy shortfalls, we are very happy and appreciative to the legislature for its support.  It is a great day for California long-term care.

Legislative Advocates of RCFE Reform

• Senator Leno – a champion of RCFE legislation for years, Senator Leno authored SB 1153, giving DSS the ability to ban new admissions at RCFEs with significant problems. Senator Leno and his staff very helpful in coordinating the RCFE bills as a comprehensive reform package.
• Senator Block – authored two RCFE bills, SB 911 to increase staff training requirements and SB 1382 to raise licensing fees to pay for reform. Senator Block’s stout and unwavering voice for reform was critical to the passage of the RCFE Reform Act.
• Senator Corbett – when the Valley Springs crisis erupted in her district, Senator Corbett was driven to make sure that such a tragedy would never occur again. She authored SB 894 and SB 895, bills to increase the frequency of facility inspections and to improve the process for suspending or revoking a facility’s license.
• Assembly Member Wieckowski – authored and tirelessly guided perhaps the most controversial (and perhaps most important) bill of the RCFE Reform Act, AB 2171, which created the state’s first statutory bill of rights for RCFE residents. This bill was co-sponsored by Consumer Attorneys of California who supplied a great deal of support.
• Assembly Member Eggman – focused on empowering RCFE residents and their families, Assembly Member Eggman authored AB 1571 to create a much-needed on-line consumer information system and AB 1572 to strengthen family and resident councils at RCFEs.
• Assembly Member Atkins – tackled the lack of accountability in RCFEs by authoring AB 1523 (sponsored by CARR) requiring liability insurance for licensees. Assembly Member Atkins and her staff also brought the influence of Assembly leadership in support of broad RCFE reform.
• Assembly Member Skinner – authored AB 1554 to bring important improvements to the consumer complaint process. The bill was inexplicably lost in the Senate Appropriations Committee despite Assembly Member Skinner’s valuable leadership.
• Assembly Member Brown – addressed a void in the law by authoring AB 1899, calling for a permanent lifetime ban from RCFEs for licensees who abandon residents.
• Assembly Member Rodriguez – authored AB 2044 ensuring every RCFE has a manager or designee present 24 hours a day.
• Assembly Members Maienschein and Stone – graciously agreed to author AB 2236, to increase fines against facilities that abuse or harm residents, after the initial author was suspended from office.

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California Advocates for Nursing Home Reform (CANHR)
650 Harrison Street, 2nd Floor, San Francisco, CA 94107
www.canhr.org