California: Proposed Changes to Dementia Care Regulations

A recent change has occurred in the approach to resident care. Especially when it comes to broad-brush rules. The problem with laws that address issues on a general level is that specific cases are not taken into consideration—leaving some residents suffering unnecessary restrictions on their rights. Recently, the California Department of Social Services proposed changes to government code as it relates to dementia care. These changes will not only help ensure residents can better age in place, but they will allow them to continue to make their own decisions for as long as possible. Here’s a look at the proposed changes to dementia care regulations in California.

Current Care Regulations

Currently, several California codes, including the The Residential Care Facilities for the Elderly (RCFE) Act, address care expectations and supervision for anyone diagnosed with dementia, alzheimer’s, or other memory care needs. Under these laws, RCFEs must meet certain requirements upon diagnosis. These laws include facility operations, as well as additional regulations imposed on the residents themselves. This broad-brush approach does not take into consideration each individual resident’s actual behavior, individual needs, and “behavioral expressions”. 

As a result, those in the earliest stages of dementia experience big changes, the loss of certain freedoms, and even possibly a complete change of environment upon diagnosis. 

The Proposed Changes

The proposed changes attempt to remedy this one-size-fits-all approach to dementia and memory care and includes the following goals:

• Promote resident retention by removing barriers, allowing seniors to age in place in the least restrictive environment;
• Acknowledge the spectrum of cognitive conditions prevalent in RCFEs;
• Address resident behaviors regardless of diagnosis; 
• Focus on person-centered care; and 
• Ensure regulatory requirements are carefully considered, reflecting a balanced approach to care that fosters and supports a robust provider community. 

Therefore, the proposed regulations will amend a few sections of the California Code of Regulations (CCR), Title 22. Specifically, the changes are:

1. Section 87101, Definitions – to add definitions for “behavioral expression,” “elopement,” “major neurocognitive disorder” due to the passage of Senate Bill 413 (Chapter 122, Statutes of 2017), “significant change in condition,” and “unsafe wandering,” and revise definitions for “dementia,” “nonambulatory person,” and “representative.”
2. Section 87208, Plan of Operation – to require that the plan include a description of the ways in which the licensee will address resident behavioral expression, including resident assessments, care practices, and safety measures.
3. Section 87219, Planned Activities – to incorporate activities from Section 87706, Advertising Dementia Special Care, Programming, and Environments and require that a licensee take precautions to prevent residents from unsafe wandering and elopement that do not conflict with residents’ personal rights.
4. Section 87307, Personal Accommodations and Services and Section 87309, Storage Space – to allow resident access to specified items with appropriate supervision.
5. Section 87455, Acceptance and Retention Limitations – to eliminate resident acceptance or retention criteria based on dementia diagnosis by requiring that residents be allowed to age in place in the least restrictive environment when appropriate, permit persons who display behavioral expression to be accepted or retained in a facility, and clarify that licensee assistance with managing money must not conflict with resident personal rights.
6. Section 87458, Medical Assessment – to require that medical assessment include cognitive conditions and description of any resident behavioral expression.
7. Section 87463, Reappraisals – to clarify that resident reappraisals must occur at least once every 12 months and document significant changes in condition, such as changes in cognitive functions; require a safety assessment if there is resident behavioral expression that has caused or may cause harm; and require consultation with specialized care providers.
8. Section 87705, Care of Persons with Dementia – to update dementia training requirements by cross-referencing updated Health and Safety Code due to the passage of Assembly Bill 1570 (Chapter 698, Statutes of 2014) and Senate Bill 911 (Chapter 705, Statutes of 2014); require that smaller facilities have at least one night staff person awake and on duty if any resident with dementia is determined to require awake night supervision; and update emergency preparedness requirements related to equipment needed to unlock exterior doors or perimeter fence gates due to passage of Assembly Bill 3098 (Chapter 348, Statutes of 2018).  Updates also move substantive portions of the section related to medical assessment, planned activities, and access to specified items to specific sections that address these aspects of care for all residents.
9. Section 87706, Advertising Dementia Special Care, Programming, and Environments  – to clarify additional information to be included in the plan of operation for these facilities and move substantive portions of the section related to planned activities to Section 87219, Planned Activities to address this aspect of care for all residents.

For more information about the changes, visit the California Department of Social Services webpage. 

If you or a loved one have been the victim of nursing home abuse or neglect, call Gharibian Law (877-460-1187) today for a FREE consultation and the best legal representation.