Legislature(2001 - 2002)
02/08/2001 03:30 PM STA
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SB 55-PIONEERS' AND VETERANS' HOME/ADVISORY BD CHAIRMAN THERRIAULT asked Major General Oates if he would like to testify on SB 55. MAJOR GENERAL OATES said he was in support of SB 55 and would testify after Commissioner Duncan. Number 1787 JIM DUNCAN, Commissioner of Administration, said that SB 55 was introduced by the Governor and would require a number of changes to the current Pioneer Home system. It would rename the present Pioneer Home system to Pioneer and Veterans' Home system; it would provide, in statute, a preference for veterans admission; it would change the name of the Pioneer Home Advisory Board to the Pioneer and Veterans' Home Advisory Board; it would require at least two members of the board to be veterans; and finally it would require that one of those board members be the chairman of the Veterans' Advisory Council. COMMISSIONER DUNCAN then gave some background information explaining why the Governor has introduced the bill. In 1992, legislation was passed to establish a veterans' home in Alaska. It was to be operated by the Department of Administration but would meet federal requirements so that the residents payments and federal funding would cover the costs of operation. In 1998 the legislature amended the 1992 statute to allow the proposed veterans' home to provide nursing care. The idea behind this was to increase federal funding so that the state didn't have to make up operational shortfalls. However, this wasn't successful. State funding would still be required because federal funding and veterans payments wouldn't cover the nursing costs in Alaska. Thus, there is still the unrealized intent and definite need to serve the veterans. Number 1914 Governor Knowles recently appointed a cabinet level team comprised of the Commissioner of Administration, Major General Oates and Commissioner of Health and Social Services to explore options to fulfill the commitment made to veterans in the 1992 and 1998 legislation. One of the options explored was to determine the cost of a stand-alone veteran's home. The capital construction costs for an 80-bed facility would be about $24 million with federal funding providing about 65 percent. This would require state funding of about $8.5 million for construction and then an additional $7.2 million annually for operational costs. The federal government would contribute about $4 million, residents would pay about $900,000 and the state would have to contribute the balance, which is about $2.4 million per year. Number 2000 Looking at other options, the team determined that using the current Pioneer Home infrastructure would be more fiscally responsible. There are six Pioneer Homes located throughout the state and they are not being fully utilized. Using this infrastructure would make it easier to provide long term care needs, closer to the veterans' homes and communities, than if there was just one veterans' hospital in the state. COMMISSIONER DUNCAN emphasized the quality of the Pioneer Home System and pointed out that it is a system that is not fully utilized. There are 600 beds in the six homes and there are about 90 vacant beds at any given time. SB 55 designates 125 beds or 21 percent of the total beds for veterans. It would say veterans have a preference in statute, while the 125-bed designation would be instituted through regulation. In the system now, there are about 78 veterans. Of the 167 people on the active waiting list, 44 are veterans. If funds were made available to fill the empty beds, those 44 veterans would be accommodated as well as close to 50 pioneers who are on the active waiting list. SB 55 would provide needed funding for 24 hour nursing care, which is the level of care that is needed for those beds. The fiscal note accompanying the bill indicates $2.6 million in general funds and about the same in pioneer home receipts which would provide the funding to hire necessary staff to fill the 90 vacant beds. COMMISSIONER DUNCAN explained that the fiscal note intentionally does not include federal receipts. Care has been taken so that the Pioneer Home system is not changed to require federal regulation such as would happen if it were under the Veterans Administration system. Otherwise, many Pioneer Home requirements such as residency, age and building codes would have to be changed. Number 2225 While federal dollars aren't being solicited, they are actively exploring options with the federal government to discover what might be available in terms of federal assistance and federal support. COMMISSIONER DUNCAN said that they had worked closely with affected interest groups and that there were a number of supporting letters in the committee packets one of which was from Senator Ted Steven's office. He went on to point out a paper giving the background and history of the proposal as well as a number of frequently asked questions. COMMISSIONER DUNCAN concluded his testimony and said that Major General Oates had some comments on SB 55. CHAIRMAN THERRIAULT asked for questions first. There were none so he asked Major General Oates to address his comments to the committee. Number 2300 MAJOR GENERAL OATES thanked Chairman Therriault for the opportunity to testify. He went on to say that it was important to consider why Alaska does not have a veterans home since Alaska ranks second of the 50 states in terms of its number of veteran residents. In addition, Alaska is the only state in the Union that does not have, or is not in the process of building, a state veterans' home. He assured members that the lack of a veterans' home was not due to apathy, but rather due to uncertainty of where such a home should be located and how you afford such a facility when you already have a costly pioneer home system. Because of the size on the state, it would also be very difficult to meet veterans' needs state wide with just one facility. Veterans would be displaced from their communities when they needed care. Side B Number 2320 Looking for creative solutions, they came up with the idea to use existing resources. There are Pioneer Homes in Ketchikan, Sitka, Juneau, Palmer, Anchorage and Fairbanks with empty beds due to under staffing. If these facilities were utilized, there would be no new construction costs, the problems associated with one regional center would be ameliorated and there would be more beds for less operating costs than if a single 80-bed home were built. Senator Stevens has expressed a willingness to help but says he can't move ahead until the state takes the first step. He will do all he can to help make this a model of federal/state cooperation on veteran's issues. Senator Frank Murkowski is bringing Secretary of Veterans' Affairs, Anthony Principi, to Alaska and one of the important items on his agenda is to visit the Anchorage Pioneer's Home and discuss the merits of this proposal. The Veterans' Administration is looking for creative proposals to meet the needs of its veterans because the current veterans' home system is expensive, not regionally located and isn't meeting the care needs of veterans. This proposal is a first step in meeting those needs. Number 2237 MAJOR GENERAL OATES said that veterans need to be shown that they are important. Providing for their care needs is one way to show the measure of their importance. He went on to say that many of the veteran organizations statewide have indicated support for this proposal. There is also support from many of the state pioneer organizations. He reiterated the need to take the first step to provide for veterans living in Alaska and said that the state could have a nationally recognized model program. CHAIRMAN THERRIAULT asked for questions. He said that although there were letters of support there were some seniors that have questions and it is the duty of the committee to ensure that the move is advantageous. Some of the letters of support indicated a very limited understanding of the details. COMMISSIONER DUNCAN said that the proposal wasn't easy to understand but that the Department of Administration is in the process of organizing statewide visits to provide information and answer questions. He emphasized that this proposal should benefit both pioneers and veterans in the state. Number 2103 CHAIRMAN THERRIAULT asked for a breakdown on the vacancy rates in each of the homes and number of veterans in each of the homes. COMMISSIONER DUNCAN said that a portion of the information was in the packet but that he would provide the number of veterans in each home and the information about which home each of the 44 veterans on the active waiting list had requested. CHAIRMAN THERRIAULT wanted information on how many individuals might have to move to a different location due to lack of bed space in the community of first request. COMMISSIONER DUNCAN said that the vacancies are primarily in Palmer, Anchorage and Sitka. MAJOR GENERAL OATES added that the plan stipulates that if a bed isn't available in the community of your choice you may enter the home in another community then move to the community of your choice when a bed becomes available. CHAIRMAN THERRIAULT called for teleconference testimony. MR. MERRILL HAKALA testified via teleconference saying that he was a veteran and was opposed to the pioneer homes becoming pioneer/veteran homes but was in favor of a stand-alone veteran's home. If the proposal were adopted, there would be a "complete change in what the pioneer homes were meant to be." He said all veterans are welcome as long as they meet the current entrance requirements and it should stay this way. He went on to say that if the state would recognize Alzheimer's disease and related dementia as a mental disease there would be Medicaid coverage and therefore costs to the state and individual residents would be reduced. MR. GERALD BOHMS testified via teleconference saying that he too was a veteran and not in favor of changing the current Pioneer Home System. He didn't think it was fair for veterans to be given preference. He pointed out that the state could fund the vacant beds now and they wouldn't be empty. MR. GARY BERRY testified in person and said that he was representing the American Legion, Veterans of Foreign Wars and Disabled American Veterans. These Alaska service organizations are in favor of designating 125 beds in the Pioneer Homes for veterans. They feel that all Alaskan veterans deserve long term care for physical and mental disabilities. It is time to show appreciation to these men and women. CHAIRMAN THERRIAULT called upon Lt. Colonel (Retired) Pat Caruthers to testify. LT. COLONEL PAT CARUTHERS said that he supports this proposal because it benefits both veterans and pioneers. If this proposal is passed, critical care nursing will be funded and it is the lack of funding for this highest nursing tier that is causing the vacancies. Number 1474 MR. JOHN DAPCEVICH said he was a member of the American Legion, Veteran of Foreign Wars, Disabled American Veteran, Pioneer of Alaska and has served the last four governors on the Pioneers Advisory Board. The Pioneer Advisory Board has unanimously given its support to SB 55. He said that veterans are just as eligible in the current pioneer homes as non-veterans and their entry requirements will be the same as non-veterans. This proposal isn't going to displace pioneers who are not veterans. SENATOR PHILLIPS asked for the make up of the Pioneer Advisory Board. MR. DAPCEVICH said that the Governor appoints a member from every community having a home; there is one at large appointment and the chairperson of the Older Alaska Commission serves on the board. Number 267 MR. JIM KOHN, Director of Alaska Longevity Program that includes the Pioneers' Homes, wanted to comment on two points made earlier. First was preference. It should be understood that Pioneer Home beds are currently filled with about 17 percent veterans and over 30 percent of those on the waiting list are veterans. Looking at the statistical makeup of the waiting list, it is apparent that, over time, there will be more than 21 percent of the beds filled with veterans whether they are given a preference or not. After the 125 beds are filled, it is unlikely that a veteran would ever need to be given preference. The second issue he wanted to address was about Medicaid funding for the home. He said that the homes would be changed completely with Medicaid funding because residency and age requirements would have to be abolished. They would no longer be Pioneer Homes. This needs to be understood if you're looking at other sources of revenue. CHAIRMAN THERRIAULT asked, "If you're the next person on the list and you weren't a veteran and a veteran space was open would you get that spot?" MR. KOHN said that it was more complicated than that. He explained that people generally apply to the waiting list in their own communities. If an opening was to occur in Anchorage, for example, and veterans were occupying 124 beds, the veteran priority list would be given preference. If there were no veterans on the Anchorage waiting list then the next person would be given the bed. Then, the next bed opening in any community would be given veteran priority. If the number of veterans filling the beds rose to more than 125, there would be no veterans preference given until that number fell below 125. ALFREDA DORE asked the chair if she could address a question to Mr. Kohn. She came forward and asked if widows and widowers of eligible veterans would be given preference in the Pioneer Homes as they are in Veteran Homes in the Lower 48. MR. KOHN said that the Pioneers' Homes have always made an effort to keep spouses together when one needs to enter the home and they would continue to do so. However, this issue would have to be looked at carefully to decide whether or not spouses and other family members of qualified veterans were given preference. He said to keep in mind that in Veterans' Homes, family members of veterans may not occupy more than 25 percent of available beds. He went on to say that this should be resolved through regulation as the process moves forword. CHAIRMAN THERRIAULT asked if a regulation packet was being developed for this legislation. MR. KOHN said none had been started officially but that an outline was being prepared. CHAIRMAN THERRIAULT asked for a copy of what had been developed. He then asked for any other questions. Number 665 SENATOR DAVIS asked them to address the question as to whether or not it is a regulation to give spouses and other family members preference. MR. KOHN said that they want to make sure that the Pioneer Home System not come under federal regulation. They have made this clear to both the Alaska Delegation and Secretary of Veterans' Affairs Principi who has expressed interest in innovative programs for veteran homes. He said that perhaps the Veterans Administration would be able to waiver funds designated for a Pioneer/Veteran Home. Number 549 CHAIRMAN THERRIAULT said that when looking at the fiscal note for SB 55 it shows it to be general fund and program receipts so all the vacant beds could be opened with these funding sources to anyone on the waiting list. MR. KOHN said that is correct. The vacant beds are general care beds and the people on the waiting list need high level care so providing additional funding for high level care would fill those beds. However, if that were done there would be a missed opportunity to work with the Veterans Administration to find innovative ways to care for veterans in assisted living programs. Number 381 SENATOR PHILLIPS asked if the opportunity became available recently and whether there is urgency to act. MR. KOHN said he does believe that time is of the essence. The Governor has given a mandate to find a program that will work and this is what the three commissioners have devised and it is a program that has ignited the interest of the Veterans Administration. CHAIRMAN THERRIAULT asked if there was anyone else who wanted to testify either in person or via teleconference. There was no one. He said that if there is a bill requiring more work or if work needs to be done on the wording of an amendment the bill will be brought up again as bills previously heard. However, because of the level of interest in this bill he will give generous notice before this bill is heard again.