2010 California Code
Welfare and Institutions Code
Chapter 7. Comprehensive Act For Families And Caregivers Of Brain-impaired Adults

4362.  The Legislature finds all of the following:
   (a) That state public policy discriminates against adults with
brain damage or degenerative brain disease, such as Alzheimer's
disease. This damage or disease is referred to as "brain impairments"
in this chapter.
   (b) That the Legislature has declared state public policy and
accepted responsibility to ensure that persons under the age of 18
years who are developmentally disabled pursuant to Division 4.5
(commencing with Section 4500), receive services necessary to meet
their needs, which are often similar to those of persons who suffer
from brain impairments.
   (c) That persons over the age of 18 who sustain brain impairment
have a variety of program and service needs for which there is no
clearly defined, ultimate responsibility vested in any single state
agency and for which there are currently a number of different
programs attempting to meet their needs.
   (d) That the lack of clearly defined ultimate responsibility has
resulted in severe financial liability and physical and mental strain
on brain-impaired persons, their families, and caregivers.
   (e) That terminology and nomenclature used to describe brain
impairments are varied and confusing, in part because of different
medical diagnoses and professional opinions, as well as differences
in terminology used by the various funding sources for programs and
services. Uniformity is required in order to ensure that appropriate
programs and services are available throughout the state to serve
these persons.
   (f) That the term "brain damage" covers a wide range of organic
and neurological disorders, and that these disorders, as identified
below, are not necessarily to be construed as mental illnesses. These
disorders include, but are not limited to, all of the following:
   (1) Progressive, degenerative, and dementing illnesses, including,
but not limited to, presenile and senile dementias, Alzheimer's
disease, multiinfarct disease, Pick's disease, and Kreutzfeldt-Jakob'
s disease.
   (2) Degenerative diseases of the central nervous system that can
lead to dementia or severe brain impairment, including, but not
limited to, epilepsy, multiple sclerosis, Parkinson's disease,
amyotrophic lateral sclerosis (ALS), and hereditary diseases such as
Huntington's disease.
   (3) Permanent damage caused by cerebrovascular accidents more
commonly referred to as "strokes," including, but not limited to,
cerebral hemorrhage, aneurysm, and embolism.
   (4) Posttraumatic, postanoxic, and postinfectious damage caused by
incidents, including, but not limited to, coma, accidental skull and
closed head injuries, loss of oxygen (anoxia), and infections such
as encephalitis, herpes simplex, and tuberculosis.
   (5) Permanent brain damage or temporary or progressive dementia as
a result of tumors (neoplasm), hydrocephalus, abscesses, seizures,
substance toxicity, and other disorders.
   (g) That brain damage frequently results in functional impairments
that adversely affect personality, behavior, and ability to perform
daily activities. These impairments cause dependency on others for
care and decisionmaking. The manifestations of brain damage include
impairments of memory, cognitive ability, orientation, judgment,
emotional response, and social inhibition. Brain damage can strike
anyone regardless of age, race, sex, occupation, or economic status.
   (h) That Family Survival Project for Brain-Damaged Adults of San
Francisco, a three-year pilot project established pursuant to former
Chapter 4 (commencing with Section 4330), has demonstrated that the
most successful, cost-effective service model is one which allows a
nonprofit community agency to provide a full array of support
services to families that have a member who suffers from a brain
impairment. This agency provides direct services, coordinates
existing resources, and assists in the development of new programs
and services on a regional basis.
   (i) That respite care services provide a combination of
time-limited, in-home, and out-of-home services that significantly
decrease the stress of family members and increase their ability to
maintain a brain-impaired person at home at less cost than other
alternatives. This ability is further increased when complemented by
case planning, care training, and other support services for family
members.
   (j) That, since 1977, the State Department of Mental Health has
attempted to identify service gaps and determine a cost-effective,
feasible approach to funding and providing services to brain-damaged
adults, their families, and caregivers. That department has the
experience of offering more in the continuum of programs and services
than any other state agency and is willing to continue in the lead
state agency capacity.
   (k) That providing services to brain-impaired adults, and to their
families and caregivers, requires the coordinated services of many
state departments and community agencies to ensure that no gaps occur
in communication, in the availability of programs, or in the
provision of services. Although the services may include mental
health interventions, they cannot be met solely by services of the
State Department of Mental Health.



4362.5.  As used in this chapter:
   (a) "Brain damage," "degenerative brain diseases," and "brain
impairment" mean significant destruction of brain tissue with
resultant loss of brain function. Examples of causes of the
impairments are Alzheimer's disease, stroke, traumatic brain injury,
and other impairments described in subdivision (f) of Section 4330.
   (b) "Brain-impaired adult" means a person whose brain impairment
has occurred after the age of 18.
   (c) "Respite care" means substitute care or supervision in support
of the caregiver for the purposes of providing relief from the
stresses of constant care provision and so as to enable the caregiver
to pursue a normal routine and responsibilities. Respite care may be
provided in the home or in an out-of-home setting, such as day care
centers or short-term placements in inpatient facilities.
   (d) "Family member" means any relative or court appointed guardian
or conservator who is responsible for the care of a brain-impaired
adult.
   (e) "Caregiver" means any unpaid family member or individual who
assumes responsibility for the care of a brain-impaired adult.




4363.  The director shall administer this chapter and establish
standards and procedures, as the director deems necessary in carrying
out the provisions of this chapter. The standards and procedures are
not required to be adopted as regulations pursuant to the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).



4363.5.  The director shall do both of the following:
   (a) Contract with a nonprofit community agency meeting the
requirements of this chapter to act as the Statewide Resources
Consultant, to be selected through a bid procedure.
   (b) With the advice of the Statewide Resources Consultant and
within four years from the effective date of this chapter, contract
with nonprofit community resource agencies, selected in a manner
determined by the director, to establish regionally based resource
centers in order to ensure the existence of an array of appropriate
programs and services for brain-impaired adults. Each resource center
shall place a high priority on utilizing community resources in
creating opportunities for families to maintain a brain-impaired
adult at home when possible and in other community-based alternatives
when necessary.


4364.  The Statewide Resources Consultant shall do all of the
following:
   (a) Serve as the centralized information and technical assistance
clearinghouse for brain-impaired adults, their families, caregivers,
service professionals and agencies, and volunteer organizations, and
in this capacity may assist organizations that serve families with
adults with Huntington's disease and Alzheimer's disease by reviewing
data collected by those organizations in their efforts to determine
the means of providing high-quality appropriate care in health
facilities and other out-of-home placements; and shall disseminate
information, including, but not limited to, the results of research
and activities conducted pursuant to its responsibilities set forth
in this chapter as determined by the director, and which may include
forwarding quality of care and related information to appropriate
state departments for consideration.
   (b) Work closely and coordinate with organizations serving
brain-impaired adults, their families, and caregivers in order to
ensure, consistent with requirements for quality of services as may
be established by the director, that the greatest number of persons
are served and that the optimal number of organizations participate.
   (c) Develop and conduct training that is appropriate for a variety
of persons, including, but not limited to, all of the following:
   (1) Families.
   (2) Caregivers and service professionals involved with
brain-impaired adults.
   (3) Advocacy and self-help family and caregiver support
organizations.
   (4) Educational institutions.
   (d) Provide other training services, including, but not limited
to, reviewing proposed training curricula regarding the health,
psychological, and caregiving aspects of individuals with brain
damage as defined in subdivision (f) of Section 4362. The proposed
curricula may be submitted by providers or statewide associations
representing individuals with brain damage, their families, or
caregivers.
   (e) Provide service and program development consultation to
resource centers and to identify funding sources that are available.
   (f) Assist the appropriate state agencies in identifying and
securing increased federal financial participation and third-party
reimbursement, including, but not limited to, Title XVIII (42 U.S.C.
Sec. 1395 and following) and Title XIX (42 U.S.C. Sec. 1396 and
following) of the federal Social Security Act.
   (g) Conduct public social policy research based upon the
recommendations of the Director of Mental Health.
   (h) Assist the director, as the director may require, in
conducting directly, or through contract, research in brain damage
epidemiology and data collection, and in developing a uniform
terminology and nomenclature.
   (i) Assist the director in establishing criteria for, and in
selecting resource centers and in designing a methodology for, the
consistent assessment of resources and needs within the geographic
areas to be serviced by the resource centers.
   (j) Conduct conferences, as required by the director, for
families, caregivers, service providers, advocacy organizations,
educational institutions, business associations, community groups,
and the general public, in order to enhance the quality and
availability of high-quality, low-cost care and treatment of
brain-impaired adults.
   (k) Make recommendations, after consultation with appropriate
state department representatives, to the Director of Mental Health
and the Secretary of Health and Welfare for a comprehensive statewide
policy to support and strengthen family caregivers, including the
provision of respite and other support services, in order to
implement more fully this chapter. The Statewide Resources Consultant
shall coordinate its recommendations to assist the Health and
Welfare Agency to prepare its report on long-term care programs
pursuant to Chapter 1.5 (commencing with Section 100145) of Part 1 of
Division 101 of the Health and Safety Code.
   (l) Conduct an inventory and submit an analysis of California's
publicly funded programs serving family caregivers of older persons
and functionally impaired adults.



4364.5.  The Statewide Resources Consultant, pursuant to subdivision
(c) of Section 4362.5, shall do the following:
   (a) Develop respite care training materials, with consultation by
other appropriate organizations including the California Association
of Homes for the Aging, and under the direction of the director, for
distribution to all resource centers established under this chapter.
   (b) Provide the respite care training materials described in
subdivision (a) to other appropriate state entities, including the
Department of Aging, the State Department of Health Services, and the
State Job Training Coordinating Council, for distribution to their
respective services and programs.
   (c) Pursuant to the requirements of Section 4365.5, report on the
utilization of the respite care training materials, developed
pursuant to subdivision (a), by all the resource centers for the
period ending December 31, 1990, only, and make recommendations for
the future use of these materials.



4365.  In choosing an appropriate nonprofit community agency to act
as the Statewide Resources Consultant, the director shall give
priority to an agency which meets both of the following:
   (a) An agency that has a proven record of experience in providing
information, technical assistance and direct services to adults with
all types of brain impairments, their families, and caregivers.
   (b) An agency that includes family members and caregivers of
brain-impaired adults on its board of directors.



4365.5.  (a) The Statewide Resources Consultant shall submit
progress reports on its activities as required by the director. These
reports shall include, but not be limited to, a summary and
evaluation of the activities of the resource centers. Client,
caregiver, service, and cost data shall be provided for each
operating resource center.
   (b) The department, in consultation with the Statewide Resources
Consultant, shall report to the Legislature annually on the
effectiveness of the resource centers. The report shall be submitted
within six months after the end of each fiscal year. The evaluation
shall include, but not be limited to, all of the following:
   (1) The costs and amount of each type of service provided.
   (2) An assessment of the nature and extent of the demand for
services which provide respite, and an evaluation of their success in
meeting this demand.
   (3) Recommendations for improving the effectiveness of the program
in deterring the institutionalization of brain-impaired adults,
allowing caregivers to maintain a normal routine and promoting the
continuance of quality care for brain-impaired adults.
   (4) Recommendations for ensuring that unmet needs of
brain-impaired persons and their families are identified and
addressed with appropriate programs and services.



4366.  Resource centers shall serve all of the following functions:
   (a) Provide directly or assist families in securing information,
advice, and referral services, legal services and financial
consultation, planning and problem-solving consultation, family
support services, and respite care services, as specified in Section
4338.
   (b) Provide centralized access to information about, and referrals
to, local, state, and federal services and programs in order to
assure a comprehensive approach for brain-impaired adults, their
families, and caregivers. Nothing in this chapter shall prohibit
access to services through other organizations which provide similar
programs and services to brain-impaired adults and their families,
nor shall other organizations be prevented from providing these
programs and services.
   (c) Assist in the identification and documentation of service
needs and the development of necessary programs and services to meet
the needs of brain-impaired adults in the geographic area.
   (d) Cooperate with the Statewide Resources Consultant and the
Director of Mental Health in any activities which they deem necessary
for the proper implementation of this chapter.
   (e) Work closely and coordinate with organizations serving
brain-impaired adults, their families, and caregivers in order to
ensure, consistent with requirements for quality of services as may
be established by the director, that the greatest number of persons
are served and that the optimal number of organizations participate.




4366.5.  (a) Agencies designated as resource centers by the director
after consultation with the Statewide Resources Consultant shall
include in their governing or advisory boards, or both, as required
by the director, persons who are representative of the ethnic and
socioeconomic character of the area served and the client groups
served in the geographic area.
   (b) Criteria to be used in selecting resource centers shall
include, but not be limited to, the following:
   (1) Fiscal stability and sound financial management, including the
capability of successful fundraising.
   (2) Ability to obtain community support for designation as a
resource center with the region recommended by the director.
   (3) Demonstrated ability to carry out the functions specified in
Section 4366, particularly in delivering necessary programs and
services to brain-impaired adults as defined in subdivision (c) of
Section 4362.



4367.  Resource centers shall carry out the functions specified in
Section 4366 through the administration and provision of programs and
services that reflect the most progressive care and treatment
alternatives available for brain-impaired adults, their families, and
caregivers. These programs and services may be provided directly or
through the establishment of subcontracts as specified in their
contract and within the limitations imposed by budget appropriations.
The department shall make efforts to achieve a goal that not less
than 90 percent of the funds appropriated through contracts with
resource centers shall be utilized for direct services, including,
but not limited to, the following:
   (a) Information, advice, and referral and family support services,
including, but not limited to, all of the following:
   (1) Information and counseling about diagnostic procedures and
resources.
   (2) Long-term care planning and consultation.
   (3) Legal and financial resources, consultation, and
representation.
   (4) Mental health interventions.
   (5) Caregiving techniques.
   (b) Respite care services through the flexible and creative use of
existing local resources, including, but not limited to, all of the
following:
   (1) In-home care.
   (2) Adult day health and social day care services.
   (3) Foster and group care.
   (4) Temporary placement in a community or health facility.
   (5) Transportation.
   (c) Training and education programs for brain-impaired adults,
their family members, caregivers, and service providers that will
lead to the high-quality, low-cost care and treatment of service
clients.



4367.5.  The director shall establish criteria for client
eligibility, including financial liability, pursuant to Section 4368.
However, persons eligible for services provided by regional centers
or the State Department of Developmental Services are not eligible
for services provided under this chapter. Income shall not be the
sole basis for client eligibility. The director shall assume
responsibility for the coordination of existing funds and services
for brain-impaired adults, and for the purchase of respite care, as
defined in subdivision (c) of Section 4362.5, with other departments
that may serve brain-impaired adults, including the Department of
Rehabilitation, the State Department of Health Services, the State
Department of Social Services, the State Department of Developmental
Services, the Department of Aging, the Office of Statewide Health
Planning and Development, and the State Department of Alcohol and
Drug Programs.


4368.  Persons receiving services pursuant to this chapter may be
required to contribute to the cost of services depending upon their
ability to pay, but not to exceed the actual cost thereof. The
criteria for determining client contributions which may be paid to
the resource center under this chapter and standards for their
utilization by the resource center in developing new programs and
services shall be determined by the director after consultation with
the Statewide Resources Consultant.



4368.5.  In considering total service funds available for the
project, the director shall utilize funding available from
appropriate state departments, including, but not limited to: the
State Department of Health Services, the State Department of Social
Services, the Department of Rehabilitation, the Department of Aging,
and the State Department of Alcohol and Drug Programs. The director
in conjunction with the Statewide Resources Consultant shall
coordinate his or her activities with the implementation of the
Torres-Felando Long-Term Care Reform Act (Chapter 1453, Statutes of
1982) in order to further the goal of obtaining comprehensive,
coordinated public policy and to maximize the availability of funding
for programs and services for persons with brain impairments.