Legislature(2001 - 2002)

04/29/2002 02:20 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
         SB 55-PIONEERS' AND VETERANS' HOME/ADVISORY BD                                                                     
                                                                                                                                
COMMISSIONER  JIM  DUNCAN,  Department  of  Administration  (DOA),                                                              
informed  members that  SB  55 is  designed  to  fulfill what  the                                                              
Administration  considers  to  be a  long-standing  commitment  to                                                              
veterans in  Alaska to  recognize the service  they have  given to                                                              
the United States  and Alaska. Veterans would  be given preference                                                              
for a certain  percentage of the beds in the  Pioneers Home system                                                              
and representation on the Pioneer  Home Advisory Board in statute.                                                              
                                                                                                                                
COMMISSIONER DUNCAN  gave the following  background of  the issue.                                                              
In  1992,  legislation was passed  that gave authority to  the DOA                                                              
to construct a  stand-alone veterans home. However,  no action has                                                              
been taken  in that  regard. The  legislation prohibits  any state                                                              
dollars from  being used  on either  construction or operation  of                                                              
that  home. Recognizing  that no  movement has  gone forward,  the                                                              
Governor  proposed using  Alaska's  six Pioneer  Homes around  the                                                              
state to  house Alaska's  veterans and allow  them to  receive the                                                              
benefits they should be receiving.                                                                                              
                                                                                                                                
COMMISSIONER  DUNCAN  explained   that  CSSB  55(STA)  amends  the                                                              
composition of the Alaska Pioneers  Home Advisory Board from seven                                                              
to  five public  members and  two  veterans. It  also allows  DOA,                                                              
statutorily, to establish a veterans'  preference for admission to                                                              
the homes. It specifies  that no more than 30 percent  of the beds                                                              
in a single institution  and no more than 21 percent  of the total                                                              
beds in the Pioneer Home system can  be reserved for veterans. DOA                                                              
is to  establish those  procedures by  regulation. He pointed  out                                                              
the  Pioneer  Home system  has  about  100  vacant beds.  If  this                                                              
legislation passes,  about 125 of the total 600 beds  would have a                                                              
veterans'  preference.  At  present,  about  95  veterans  are  in                                                              
residence  in the Pioneer  Homes throughout  the state,  therefore                                                              
another 25 veterans could be admitted.  The Pioneers Homes have an                                                              
active waiting list of about 185,  of which about 55 are veterans.                                                              
He stated  the bill  would benefit  both veterans  and the  senior                                                              
citizen community.                                                                                                              
                                                                                                                                
COMMISSIONER DUNCAN said the bill  also provides for a study by an                                                              
outside consultant  to determine  the needs of Alaska's  veterans.                                                              
The  age  requirement  for  entry  into  a  Pioneer  Home  is  65,                                                              
therefore the  veterans' preference in  that system will  not meet                                                              
the needs  of all  veterans. DOA  has requested  $250,000 for  the                                                              
study.  It  is DOA's  intent  to  ensure  that the  Pioneer  Homes                                                              
continue to  be owned and managed  by the State of Alaska  and not                                                              
be subject to restrictions associated  with federal guidelines and                                                              
control. Mr. Jim Kohn of DOA and  Mr. John Taber of the Governor's                                                              
Washington,  D.C.  Office  are  currently   negotiating  with  the                                                              
Veterans  Administration. They  have  arrived at  a memorandum  of                                                              
understanding (MOU) to go forward  and negotiate an agreement that                                                              
will maintain the integrity of the  present system and ensure that                                                              
state  ownership   and  control   is  maintained  while   allowing                                                              
veterans' benefits  to flow  to veterans  residing in the  Pioneer                                                              
Homes.  He believes  substantial progress  is being  made in  that                                                              
regard. He noted the bill has a substantial  fiscal note: to fully                                                              
fund the beds will cost about $5.2  million - $2.6 million of that                                                              
will be paid from  the general fund and $2.6 million  will be paid                                                              
from  Pioneer Home  receipts (payments  that individual  residents                                                              
make to  help pay  for their  cost of  care). If this  legislation                                                              
passes and  the negotiations with  the VA are successful,  federal                                                              
money  will  not  flow directly  to  the  Pioneer  Home.  Instead,                                                              
veterans will  be able to  receive benefits that  veterans receive                                                              
elsewhere in  the country, including  per diem. The  veteran would                                                              
use the per diem to help pay the cost of care.                                                                                  
                                                                                                                                
COMMISSIONER  DUNCAN pointed  out  to members  that the  committee                                                              
substitute does not  change the name of the Alaska  Pioneer Homes.                                                              
The intent of  the original legislation was to change  the name to                                                              
the Alaska  Pioneer and Veterans Homes  to show a true  and strong                                                              
commitment to both pioneers and veterans.  The removal of the name                                                              
change is  cause for  concern. DOA has  discussed the  name change                                                              
with the VA and  does not have a clear response  yet, but the VA's                                                              
initial response was  that the name change to  include veterans is                                                              
critical in moving negotiations forward.  He thanked the committee                                                              
for  hearing the  bill and  said  it is  important, maintains  the                                                              
integrity of  the Pioneer  Home system,  and recognizes  the great                                                              
contribution that pioneers and veterans have made to this state.                                                                
                                                                                                                                
VICE-CHAIRMAN LEMAN  referred to a letter from  Secretary Principe                                                              
and said Commissioner  Duncan already addressed  how the committee                                                              
substitute will affect the Secretary's support.                                                                                 
                                                                                                                                
COMMISSIONER  DUNCAN repeated  that, regarding  the memorandum  of                                                              
agreement, DOA has not received a  final answer on the name change                                                              
yet. The VA has said the name change  is critical but has not said                                                              
what the change needs to be.                                                                                                    
                                                                                                                                
VICE-CHAIRMAN LEMAN asked what Commissioner  Duncan will recommend                                                              
the Governor do if this version of the legislation passes.                                                                      
                                                                                                                                
COMMISSIONER DUNCAN  said the Administration continues  to support                                                              
legislation that  would recognize the contribution  of veterans in                                                              
this state  and continue  to support  legislation that  would give                                                              
them  a preference  to at  least  21 percent  of the  fully-funded                                                              
beds. DOA also continues to support  a name change to give further                                                              
recognition  to the  veterans. He  said what would  happen  if the                                                              
bill passes  both bodies  without a name  change is a  question he                                                              
will have to get  back to the committee on. He  maintained that he                                                              
is clearly advocating a name change during this process.                                                                        
                                                                                                                                
VICE-CHAIRMAN  LEMAN  said  that while  it  is  not early  in  the                                                              
session, the  bill is still in  an early committee of  referral so                                                              
that  question can  be better  answered  toward the  close of  the                                                              
session.                                                                                                                        
                                                                                                                                
COMMISSIONER  DUNCAN hoped  to be  able  to give  the committee  a                                                              
better answer within several days  after receiving a response from                                                              
the  VA. He  repeated  that  if the  name  change is  critical  to                                                              
getting an agreement  so that veterans can get  veterans benefits,                                                              
he will let the committee know.                                                                                                 
                                                                                                                                
VICE-CHAIRMAN  LEMAN  asked  Commissioner  Duncan to  explain  the                                                              
difference in the  amount requested in the  Governor's transmittal                                                              
letter ($200,000) and the $250,000 he referred to.                                                                              
                                                                                                                                
                                                                                                                                
COMMISSIONER DUNCAN indicated the  $200,000 figure was based on an                                                              
estimate  made  last  year  by  the  Department  of  Military  and                                                              
Veterans Affairs.  DOA has conducted  studies along this  line and                                                              
based the $250,000 on similar studies done by other states.                                                                     
                                                                                                                                
SENATOR WILKEN asked what the capacity of the Pioneer Homes is.                                                                 
                                                                                                                                
COMMISSIONER DUNCAN  replied the capacity is 600 and  about 500 of                                                              
those beds are filled,  95 by veterans. DOA has a  waiting list of                                                              
about 185. That number changes from  day-to-day but about 55 to 60                                                              
on the waiting list are veterans.                                                                                               
                                                                                                                                
SENATOR WILKEN  asked if  there is a  way to funnel  the veteran's                                                              
stipend to the Pioneer Home to ensure  that it gets to the Pioneer                                                              
Home.                                                                                                                           
                                                                                                                                
COMMISSIONER DUNCAN said that payment  needs to go directly to the                                                              
individual  veteran.  He  then  asked  that Mr.  Kohn  explain  to                                                              
members how a veteran's resources are evaluated.                                                                                
                                                                                                                                
MR. JIM  KOHN, Director  of Alaska  Longevity Programs,  explained                                                              
the residents of the Pioneer Homes  are asked to pay a fair amount                                                              
of the cost  of their care. About  half of the residents  are able                                                              
to pay the full  amount of care. The veterans'  monthly VA benefit                                                              
will help  lower-income veterans to  pay the monthly  rent payment                                                              
at the Pioneer Home.                                                                                                            
                                                                                                                                
SENATOR  WILKEN asked  if the  payment amount  is a  discretionary                                                              
decision or  whether the Pioneer  Home will know the  money coming                                                              
from the federal government to a  veteran will be used to pay part                                                              
of his or her care every month.                                                                                                 
                                                                                                                                
MR. KOHN said  the money coming from the federal  government would                                                              
not immediately increase the Pioneer  Home's overall budget but it                                                              
would increase it's revenues.                                                                                                   
                                                                                                                                
SENATOR  WILKEN asked,  "On  the capital  side,  does the  federal                                                              
government bring  us any  assets in order  to upgrade  our Pioneer                                                              
Homes, perhaps to get them Medicaid  qualified or can this help us                                                              
on the capital side if they become veterans' homes?"                                                                            
                                                                                                                                
MR. KOHN said he has talked to Marcia  Goodwin (of the VA) to some                                                              
degree.  The  federal  government  offers,  when  using  buildings                                                              
already  owned  by   states,  a  40/60  match   with  the  federal                                                              
government paying  60 percent of the cost of  renovation. Alaska's                                                              
situation differs from other states  so both parties are trying to                                                              
work through  this, but Ms. Goodwin  feels very strongly  that the                                                              
capital money  available to  other states  should be available  to                                                              
Alaska.                                                                                                                         
                                                                                                                                
SENATOR  WILKEN  asked if  Alaska  is  the  only state  without  a                                                              
veterans' home.                                                                                                                 
                                                                                                                                
MR. KOHN said it  is the only state that does not  at least have a                                                              
veterans' home planned.                                                                                                         
                                                                                                                                
SENATOR WILKEN stated:                                                                                                          
                                                                                                                                
     And so now, if there are some  capital monies available,                                                                   
     jumping then to  the name change - maybe a  quid pro quo                                                                   
     is if we  indeed do this, and we don't  change the name,                                                                   
     then we take the pressure off  of the federal government                                                                   
     to  come in  and  do a  veterans'  home or  a  veterans'                                                                   
     hospital and  that seems to be maybe the  tradeoff, that                                                                   
     we've  set that push  aside, or  that effort aside,  for                                                                   
     the federal government to come  spend money in our state                                                                   
     by using existing facilities. Does that work?                                                                              
                                                                                                                                
COMMISSIONER  DUNCAN said the  VA is not  moving forward  to build                                                              
stand-alone homes.  In fact, it prefers  to look at a  system like                                                              
Alaska's  in  which  it  has six  homes  that  are  geographically                                                              
dispersed  so that veterans  can  be served closer  to their  home                                                              
communities. Part of what DOA is  requesting in the $250,000 study                                                              
is to evaluate  what unmet needs exist. The age  requirement of 65                                                              
would not apply  in a veterans' home in another state  but it does                                                              
in the Pioneer  Home. There may be  a lot of younger  veterans who                                                              
will not  have access to  these homes.  He noted the  Governor has                                                              
requested $4 million for future needs  for a veterans' facility in                                                              
his deferred maintenance bill. It  has not been determined whether                                                              
that facility will be a stand-alone  home or a wing to an existing                                                              
nursing home or hospital. Clearly,  $4 million will not do the job                                                              
so  the  idea   is  to  leverage  $6  million   from  the  federal                                                              
government. Once the  unmet needs are identified,  he believes the                                                              
state could move ahead to address  them. He pointed out that SB 55                                                              
does not meet all of the needs of the veterans.                                                                                 
                                                                                                                                
SENATOR WILKEN commented  that Alaska is the only  state without a                                                              
veterans'  home but  it  is the  only state  with  a Pioneer  Home                                                              
system so it is sort of out-of-sync.                                                                                            
                                                                                                                                
COMMISSIONER DUNCAN said that is  why he believes this proposal is                                                              
so attractive.                                                                                                                  
                                                                                                                                
SENATOR  WILKEN noted  the Pioneers  of Alaska  were rather  vocal                                                              
about this bill last year. He asked  if they have been briefed and                                                              
whether they have reached a consensus position on this bill.                                                                    
                                                                                                                                
COMMISSIONER  DUNCAN said  he cannot  answer for  the Pioneers  of                                                              
Alaska but he spoke with them about  a month ago and believes they                                                              
still have concerns about the name change.                                                                                      
                                                                                                                                
SENATOR WILKEN  asked when a representative of  the Administration                                                              
last spoke with the Pioneers of Alaska.                                                                                         
                                                                                                                                
COMMISSIONER DUNCAN was unsure.                                                                                                 
                                                                                                                                
MR.  KOHN said  it  is his  understanding  that  not everyone  who                                                              
belongs to the Pioneers of Alaska  believes the same thing so they                                                              
do not have a uniform position on this issue.                                                                                   
                                                                                                                                
SENATOR WILKEN said there was some  discussion in the Senate State                                                              
Affairs Committee  about doing a pilot  program in one of  the six                                                              
Pioneer Homes. He  asked if the Administration  has discussed that                                                              
idea.                                                                                                                           
                                                                                                                                
COMMISSIONER DUNCAN  said it was not discussed because  the MOU is                                                              
to do a demonstration project to  see if this system will work and                                                              
what kind  of benefits  Alaska can pull  into its present  system.                                                              
Identifying one  home was  not discussed and  he does  not believe                                                              
that is the best  approach because, for one reason,  not all homes                                                              
have  vacant beds.  The  beauty of  allowing  veterans  to have  a                                                              
preference in  all facilities is  that veterans can  remain closer                                                              
to home.                                                                                                                        
                                                                                                                                
VICE-CHAIRMAN  LEMAN asked if  the fiscal  note reflects  how much                                                              
veteran residents will be able to  pay and that VA funds will flow                                                              
to the veterans and then to the Pioneer Homes.                                                                                  
                                                                                                                                
MR. KOHN said DOA did not assume  there will be VA funds coming to                                                              
individuals to help pay their bills  because that is not a fact at                                                              
this point  in time.  DOA did not  want anyone  to think  it would                                                              
have  revenues   beyond   what  it  can   collect  under   present                                                              
circumstances.                                                                                                                  
                                                                                                                                
VICE-CHAIRMAN  LEMAN asked  if  that plan  is  successful and  the                                                              
revenue increases, how much the increase might be.                                                                              
                                                                                                                                
MR. KOHN  said each veteran will  receive about $1200 in  per diem                                                              
per month  so if half  of the 125 veterans  are unable to  pay the                                                              
full bill, the increase will be about $70,000 per month.                                                                        
                                                                                                                                
2:45 p.m.                                                                                                                       
                                                                                                                                
MR. LADDIE SHAW,  Director of the Veterans Affairs  Program in the                                                              
Department  of Military  and Veterans Affairs,  offered to  answer                                                              
questions on behalf of the veterans.                                                                                            
                                                                                                                                
There being  no questions,  VICE-CHAIRMAN  LEMAN thanked  Mr. Shaw                                                              
for  his  services  and  announced   that  he  would  take  public                                                              
testimony.                                                                                                                      
                                                                                                                                
MS.  MARTY  MARGESON,  testifying  on  her own  behalf,  said  her                                                              
father, a  WWII veteran,  is ready  for discharge from  Providence                                                              
Hospital in Anchorage after a bronchial  infection but the Pioneer                                                              
Home  has not  yet  readmitted him  to  his room.  After  previous                                                              
hospital stays, she has had to seek  legislative assistance to get                                                              
her  father readmitted  to the  Pioneer  Home. Today  he is  being                                                              
evicted from the Anchorage Pioneer  Home. Both the Assisted Living                                                              
Licensing agency  and the Office  of the Long Term  Care Ombudsman                                                              
have  called this  termination retaliation  for complaints  filed.                                                              
The  termination  letter  stated  her  father  requires  too  much                                                              
medical care. Her  disabled father is still able  to attend church                                                              
weekly  and  social  events  with her  family.  The  Pioneer  Home                                                              
provides  medical care  to other  residents. In  August 2001,  her                                                              
father was  left alone in his  room strapped by a  mechanical lift                                                              
to a body  chair for an hour.  She filed a complaint  and Assisted                                                              
Living Licensing issued the Pioneer  Home a violation. The Pioneer                                                              
Home  never  apologized   and,  instead  of  improving   care,  it                                                              
retaliated  against her  father by  taking away  his services  for                                                              
medical   transportation,   outpatient   and   physical   therapy,                                                              
administration of  nutritional supplements and threatened  to move                                                              
him to a  higher cost area. Now  she must provide for  his medical                                                              
transport and  the administration of nutritional  supplements. The                                                              
Pioneer Home  retaliated against her  by attempting to  malign her                                                              
character. She is a former commissioner  and has received an award                                                              
for public service.                                                                                                             
                                                                                                                                
MS.   MARGESON  said   the  Pioneer   Home  staff   is  rude   and                                                              
uncommunicative  regarding   her  father's  care.   She  continued                                                              
discussing poor treatment  of her father and accidents  her father                                                              
has had and how she placed a video-camera in his room.                                                                          
                                                                                                                                
VICE-CHAIRMAN LEMAN  asked Ms. Margeson to direct  her comments to                                                              
the legislation before  the committee. He said he  is aware of her                                                              
father's case.                                                                                                                  
                                                                                                                                
MS. MARGESON said  she is opposed to CSSB 55(STA)  as she believes                                                              
it  is more  important  to re-establish  the  nursing license  and                                                              
protect all  residents from  hardship, such  as her father's.  She                                                              
then said  that veterans  and pioneers would  be better  served if                                                              
the $6  million attached  to this bill  was instead attached  to a                                                              
new bill reinstating the nursing  license so the state could begin                                                              
addressing  the systemic problems  detailed by  the Office  of the                                                              
Long  Term   Care  Ombudsman  and   restore  good   quality  care.                                                              
Attempting  to get  federal money  by using  Alaska's veterans  is                                                              
wrong. A  better way to obtain  federal money would be  to abolish                                                              
the residency requirement  so the home could qualify  for Medicaid                                                              
and  federal assistance.  Her  father has  paid  $200,000 for  the                                                              
services  and is now  broke. She  asked members  to support  a new                                                              
bill to  reinstate the  nursing license.  She  added that she  was                                                              
told  by  the  VA that  veterans,  unless  they  were  70  percent                                                              
disabled in service,  would not qualify for federal  assistance in                                                              
the new Pioneer Homes.                                                                                                          
                                                                                                                                
MS. LISA CARESS-BEAU,  said she is the president  of Alaska's only                                                              
senior advocacy  group, CARING, and  that for the last  four years                                                              
she has  advocated strongly for  protection and better  quality of                                                              
life for residents  of long term care in Alaska,  and specifically                                                              
for the  residents of the Anchorage  Pioneer Home. She  has strong                                                              
concerns  about CSSB 55(STA)  and does  not believe  it is  in the                                                              
best interests  of pioneers  or veterans.  The Pioneer  Homes have                                                              
been the  subject of controversy over  the last few years.  In may                                                              
of  2000  a resident  fell  from  a  second  floor window  of  the                                                              
comprehensive  care unit  of the  Anchorage home.  That unit  will                                                              
probably be  home to  many veterans because,  as Mr.  Kohn stated,                                                              
the new veteran residents will probably  be very incapacitated. In                                                              
February, the Anchorage  Daily News reported the  Pioneer Home was                                                              
given an  ultimatum by Assisted  Living Licensing that  stated the                                                              
Pioneer Home would  not be allowed to admit new  residents until a                                                              
plan of corrections was made to address  systemic problems. During                                                              
that same  time, Commissioner Duncan  was announcing that  care of                                                              
the  residents  in that  home  was  excellent.  She said  she  can                                                              
understand  why   Commissioner  Duncan   does  not   want  federal                                                              
oversight of the home. To her knowledge,  that plan of corrections                                                              
has not yet been submitted.                                                                                                     
                                                                                                                                
MS. CARESS-BEAU  asked  that the  bill be amended  to require  the                                                              
level  of  care  at  the  Pioneer   Homes  be  scrutinized  before                                                              
additional revenue  is added. She  is proposing that  a realistic,                                                              
neutral  assessment be  done by  local care  coordinators. In  the                                                              
year  2000, the  DOA  paid a  University  of California  geriatric                                                              
expert for  an assessment of the  care needs of  current residents                                                              
in the  AD/RD unit and  the comprehensive  care unit.  He reported                                                              
there were  no nursing  home level care  residents at  the Pioneer                                                              
Home. These experts  have collaborated with Mr. Kohn  on behalf of                                                              
the Division  of Longevity  Programs for  many years. An  assisted                                                              
living  home  in Alaska  is  not  mandated  to offer  regular  and                                                              
appropriate  physical, occupational  or  recreational therapy  for                                                              
residents.  An assisted  living  home in  Alaska  has no  standard                                                              
level of staff to resident ratios.  She asked that those things be                                                              
considered before the state offers  additional beds to residents -                                                              
a place to go  that does not offer them the  skilled services they                                                              
would receive in a licensed nursing  home. Pioneer Homes were once                                                              
a place that Alaskans could trust  and a place of comfort in their                                                              
golden years. They could be that  again, and for veterans as well,                                                              
but not  without a well  thought out plan  and a critical  look at                                                              
the  levels of  care,  the  realistic cost  of  that  care, and  a                                                              
licensing agent.                                                                                                                
                                                                                                                                
MS. AILEEN  HERRING said  she is very  much against bringing  more                                                              
people into a situation fraught with  problems. She asked everyone                                                              
to take  a hard look  at the current  problems that are  not being                                                              
addressed.                                                                                                                      
                                                                                                                                
VICE CHAIRMAN  LEMAN asked  Commissioner  Duncan whether  he would                                                              
like to address the previous speakers comments.                                                                                 
                                                                                                                                
COMMISSIONER DUNCAN  said he would be happy to speak  to the Vice-                                                              
Chair about them in a different forum.                                                                                          
                                                                                                                                
SENATOR  DAVIS commented  that previous  testifiers have  said the                                                              
Pioneer Homes have  vacancies because of a staffing  shortage. She                                                              
noted if that shortage cannot be  alleviated, veterans will not be                                                              
able to move in.                                                                                                                
                                                                                                                                
VICE-CHAIRMAN LEMAN  asked if the  change in the  legislation from                                                              
15 years  to one year was  made to incorporate the  court decision                                                              
regarding residency. He noted a previous  testifier commented that                                                              
the state  should do away with  the residency requirement  so that                                                              
residents could  become Medicaid  eligible. He stated,  "It's more                                                              
than  that, it's  to make income,  or  lack of it,  the basis  for                                                              
getting  in which would  make us  Medicaid eligible.  Is that  not                                                              
correct?"                                                                                                                       
                                                                                                                                
MR. KOHN said  that is one factor,  the other is age.  The Pioneer                                                              
Homes would  have to accept  residents of  any age to  be Medicaid                                                              
eligible.                                                                                                                       
                                                                                                                                
SENATOR WILKEN asked  for a grid that shows the  disadvantages and                                                              
benefits of this  legislation. He stated that a  lot of discussion                                                              
has revolved around rumor and anecdote rather than fact.                                                                        
                                                                                                                                
COMMISSIONER DUNCAN agreed to do so.                                                                                            
                                                                                                                                
VICE-CHAIRMAN LEMAN referred to a  change from the word "state" to                                                              
"United States"  in the bill that  applies when a person  dies and                                                              
leaves an estate.  He assumed that was a drafting  correction that                                                              
reflects  the  current  practice  of collecting  on  an  Alaskan's                                                              
estate no matter  what state the person died in.  He asked if that                                                              
is current practice.                                                                                                            
                                                                                                                                
COMMISSIONER DUNCAN said that is correct.                                                                                       
                                                                                                                                
SENATOR DAVIS moved CSSB 55(STA)  from committee with its attached                                                              
fiscal notes and individual recommendations.                                                                                    
                                                                                                                                
VICE-CHAIRMAN LEMAN  announced that without objection,  the motion                                                              
carried.  There  being no  further  business  to come  before  the                                                              
committee, he adjourned the meeting at 3:05 p.m.                                                                                

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