Legislature(1993 - 1994)

02/09/1994 03:00 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
           HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                         
                       STANDING COMMITTEE                                      
                        February 9, 1994                                       
                            3:00 p.m.                                          
  MEMBERS PRESENT                                                              
  Rep. Cynthia Toohey, Co-Chair                                                
  Rep. Con Bunde, Co-Chair                                                     
  Rep. Gary Davis, Vice Chair                                                  
  Rep. Al Vezey                                                                
  Rep. Pete Kott                                                               
  Rep. Harley Olberg                                                           
  Rep. Bettye Davis                                                            
  Rep. Irene Nicholia                                                          
  Rep. Tom Brice                                                               
  MEMBERS ABSENT                                                               
  COMMITTEE CALENDAR                                                           
  *HB 376:  "An Act relating to services for and protection of                 
            vulnerable adults; and providing for an effective                  
            PASSED OUT WITH INDIVIDUAL RECOMMENDATIONS                         
  *HB 377:  "An Act relating to assisted living homes;                         
            repealing references to residential facilities for                 
            dependent adults; and providing for an effective                   
            PASSED OUT WITH INDIVIDUAL RECOMMENDATIONS                         
  (*First Public Hearing.)                                                     
  WITNESS REGISTER                                                             
  NANCY BEAR USERA, Commissioner                                               
  Department of Administration                                                 
  P.O. Box 110200                                                              
  Juneau, Alaska 99811-0200                                                    
  Phone:  (907) 465-2200                                                       
  Position Statement:  Testified in Support of HB 376                          
                       and HB 377                                              
  CONNIE SIPE, Executive Director                                              
  Division of Senior Services                                                  
  Department of Administration                                                 
  P.O. 110209                                                                  
  Juneau, Alaska 99811-0209                                                    
  Phone:  (907) 465-3250                                                       
  Position Statement:  Testified in support of HB 376                          
                       and HB 377                                              
  PAT O'BRIEN, Social Services Program Officer                                 
  Division of Family and Youth Services                                        
  Department of Health and Social Services                                     
  P.O 110630                                                                   
  Juneau, Alaska 99811-0630                                                    
  Phone:  (907) 465-2145                                                       
  Position Statement:  Testified in support of HB 376                          
                       and HB 377                                              
  DENNIS MURRAY, Administrator                                                 
  Heritage Place                                                               
  232 Rockwell                                                                 
  Soldotna, Alaska 99669                                                       
  Phone:  (907) 262-2545                                                       
  Position Statement:  Testified in support of HB 377                          
  DAVE WILLIAMS, Health Planner                                                
  Division of Medical Assistance                                               
  Department of Health and Social Services                                     
  P.O. Box 110660                                                              
  Juneau, Alaska 99811-0660                                                    
  Phone:  (907) 465-3355                                                       
  Position Statement:  Testified in support of HB 377                          
  TOM BOLING, Administrator                                                    
  Our Lady of Compassion Care Center                                           
  4900 Eagle Ave.                                                              
  Anchorage, Alaska 99503                                                      
  Phone:  (907) 762-0220                                                       
  Position Statement:  Testified in support of HB 377                          
  PREVIOUS ACTION                                                              
  BILL:  HB 376                                                                
  SHORT TITLE: ASSIST & PROTECT VULNERABLE ADULTS                              
  SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR                                 
  JRN-DATE    JRN-PG                     ACTION                                
  01/14/94      2066    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  01/14/94      2066    (H)   HES, JUDICIARY, FINANCE                          
  01/14/94      2067    (H)   -4 FNS (3-DHSS, ADM)  1/14/94                    
  01/14/94      2067    (H)   -ZERO FISCAL NOTE (ADM)  1/14/94                 
  01/14/94      2067    (H)   GOVERNOR'S TRANSMITTAL LETTER                    
  02/09/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  BILL:  HB 377                                                                
  SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR                                 
  JRN-DATE    JRN-PG                     ACTION                                
  01/14/94      2069    (H)   READ THE FIRST TIME/REFERRAL(S)                  
  01/14/94      2069    (H)   HES, FINANCE                                     
  01/14/94      2069    (H)   -FISCAL NOTE (DHSS) 1/14/94                      
  01/14/94      2069    (H)   -ZERO FISCAL NOTE (ADM)  1/14/94                 
  01/14/94      2069    (H)   GOVERNOR'S TRANSMITTAL LETTER                    
  02/09/94              (H)   HES AT 03:00 PM CAPITOL 106                      
  ACTION NARRATIVE                                                             
  TAPE 94-12, SIDE A                                                           
  Number 000                                                                   
  CHAIR TOOHEY called the meeting to order at 3:05 p.m. and                    
  asked for a roll call.  She announced the calendar and asked                 
  for testimony on HB 376.                                                     
  HB 376 - ASSIST AND PROTECT VULNERABLE ADULTS                                
  Number 059                                                                   
  NANCY BEAR USERA, Commissioner, Department of                                
  Administration, testified in support of HB 376 and HB 377.                   
  She started by giving a brief overview of HB 376 and HB 377.                 
  She stated that the goal of the legislation was to foster                    
  independence and dignity for elderly and deal with them as                   
  individuals.  She continued to say that much of the proposed                 
  legislation resulted from input from the Elder Alaskan                       
  Commission and the Pioneer Advisory Board and other various                  
  senior organizations throughout the state.  Also, the                        
  Department of Health and Social Services (DHSS) and the                      
  Department of Administration (DOA) made a collaborative                      
  effort to put forth the legislation.                                         
  COMMISSIONER USERA said there are three initiatives, the                     
  first being consolidation of state provided senior services                  
  into a single division.  She stated there would be a single                  
  site of access where seniors could access a variety of                       
  programs.  She then addressed specifically HB 376, the adult                 
  protection bill.  She said adult protection services were                    
  being provided by DHSS, "where they were grouped together by                 
  the function.  It was the protective aspect of it and not                    
  the populations being served."  She stated that senior needs                 
  are unique and that they should not be grouped together with                 
  systems that also deal with children.                                        
  COMMISSIONER USERA stated that there is a large gap in the                   
  continuum of care.  She said that home care based services,                  
  senior housing services, and nursing homes are the only                      
  choices for seniors.  She inquired about people who only                     
  need help with daily living or people who don't need 24 hour                 
  nursing care, and if there were solutions to these                           
  situations.  She felt that the assisted living concept                       
  offers a wide range of opportunity for people to get the                     
  services they need in their communities and to have                          
  community-based services available to them.  She stated that                 
  it is a consumer-oriented program that will allow seniors to                 
  buy the appropriate services for themselves.  She further                    
  stated that the proposal would allow for licensing of                        
  facilities that offered services to the seniors.                             
  Number 310                                                                   
  CHAIR TOOHEY asked if the services would be obtainable by a                  
  senior who lives in his/her own home.                                        
  Number 322                                                                   
  COMMISSIONER USERA said that it was possible, but it was not                 
  the intent.  She said home care services are provided as                     
  part of Project Choice to Medicaid eligible Alaskans.  She                   
  said there are a number of other support services available,                 
  also.  She explained that generally the legislation would                    
  provide opportunities for people to move in to homelike                      
  facilities (facilities with four people or 40 people) and                    
  utilize the available services.                                              
  Number 372                                                                   
  CHAIR TOOHEY suggested the term "rooming house."                             
  Number 389                                                                   
  CONNIE SIPE, Director, Division Senior Services, Department                  
  of Health and Social Services, testified in support of HB
  376 and HB 377.  She stated that HB 376 is a revision of                     
  current law and it would transfer the authority for adult                    
  protective services from Dependent Family and Youth Services                 
  (DFYS) to the Department of Administration (DOA).  Ms. Sipe                  
  said that it was protection for all vulnerable adults above                  
  the age of 18 years old.                                                     
  MS. SIPE told the committee that HB 376 is a combination of                  
  two former bills, "an elder abuse reporting bill and a                       
  disabled abuse reporting bill."  She stated that the                         
  proposed legislation offers protection to vulnerable adults                  
  and tries to interfere less with capable adults whether they                 
  be elderly or handicapped.  The proposal, she said, would                    
  streamline abuse reporting and would reduce duplicate work                   
  done by state investigative agencies.  The legislation would                 
  allow for an investigation by the licensing agency and the                   
  long-term care ombudsman, hence decreasing the number of                     
  agencies involved in an investigation of an abuse report.                    
  MS. SIPE continued on by saying that a centralized                           
  information and referral office for vulnerable adults and                    
  care givers would be opened.  She said the proposal would                    
  enable the designation of local care providers as a                          
  preliminary outreach to the community.                                       
  MS. SIPE stated that the proposal would honor a competent                    
  adult's refusal of services or request to terminate an                       
  investigation of abuse.  Appropriate information on the                      
  status of an investigation would be shared with the reporter                 
  of the abuse.  She said that current confidentiality law is                  
  very strictly interpreted and many times the person or                       
  facility who reported the abuse finds it difficult to obtain                 
  information informing them that the abuse victim is safe or                  
  if the investigation is still continuing.                                    
  MS. SIPE said that HB 376 would allow family members as                      
  "surrogate decision makers" to consent to services if the                    
  vulnerable adult is temporarily or permanently incapable of                  
  making decisions.                                                            
  MS. SIPE further stated that the legislation would clarify                   
  when and for what relief the state may seek judicial                         
  intervention to protect a person, citing the domestic                        
  violence writ whereby an injunction may be obtained to stop                  
  a perpetrator from interfering with services to the                          
  vulnerable adult.                                                            
  Number 500                                                                   
  MS. SIPE indicated that some definitions would change with                   
  the new legislation.  Abuse would be redefined to focus on                   
  intentional or reckless, not accidental harm to adults.  She                 
  said that even accidental harm to a vulnerable adult must be                 
  reported, causing a "misuse of state resources."  She                        
  continued on and said that neglect would be redefined to                     
  focus on intentional failure to provide care, not inability                  
  to care.  Exploitation, she said, would include the                          
  exploitation of the victim's person as well as resources,                    
  giving an example of a caregiver helping a client deplete a                  
  bank account with numerous vacation trips.                                   
  MS. SIPE reminded the committee that any litigation would be                 
  in a civil context.  She said that the proposal is a new                     
  reporting system for abuse to vulnerable adults and that it                  
  allows for the state to interfere less with clients and                      
  offer more centralized services.                                             
  MS. SIPE stated that the final section of HB 376 would allow                 
  for a smooth transition and transfer between the                             
  Number 615                                                                   
  (CHAIR TOOHEY stated for the record that Rep.G. Davis                        
  arrived at 3:08 p.m. and Rep. Kott arrived at 3:18 p.m.)                     
  Number 632                                                                   
  REP. BUNDE asked what the financial impact would be on state                 
  revenues if HB 376 was enacted.                                              
  Number 642                                                                   
  MS. SIPE said that, "actually it's a total transfer.  The                    
  current resources now in Family and Youth Services are about                 
  $563,000 and those will transfer in total into the Division                  
  of Senior Services."  She added that there were "empty" job                  
  positions in the Division of Senior Services that would be                   
  filled and utilized for the new legislation.  Therefore,                     
  there would be no increase or decrease in state funding.                     
  Number 680                                                                   
  REP. VEZEY asked what the penalty would be for violating the                 
  proposed statute.                                                            
  Number 683                                                                   
  MS. SIPE responded that it would be a "Class B felony " if a                 
  professional fails to report an abuse.  She also said the                    
  failure to report could be reported to the professional's                    
  licensing board.  She reiterated that there would be no                      
  criminal action taken.                                                       
  Number 705                                                                   
  REP. VEZEY asked if Ms. Sipe knew if anyone had ever been                    
  prosecuted for failure to report an abuse.                                   
  Number 716                                                                   
  MS. SIPE replied that there have been investigations but                     
  that she knew of no prosecutions.                                            
  Number 724                                                                   
  CHAIR TOOHEY, speaking as a past medical provider, related                   
  how important it was to not only report any abuse but to                     
  follow through.  She also spoke of the obligation of the                     
  reporter to make sure that something was done.                               
  Number 725                                                                   
  REP. VEZEY felt that it may not be appropriate for the                       
  promotion of good health care for professionals to be put                    
  under the threat of a criminal penalty.                                      
  Number 748                                                                   
  MS. SIPE stated that along with the duty to report comes an                  
  immunity from being sued for reporting.  It is a balancing                   
  measure to ensure that people report but also that they feel                 
  protected against possible litigation.                                       
  MS. SIPE said that on page 3, line 5, of the proposal was                    
  the criminal penalty for failure to comply.                                  
  Number 782                                                                   
  REP. VEZEY asserted that the penalty was a violation and not                 
  a felony and was subject to a fine.                                          
  Number 786                                                                   
  MS. SIPE apologized and said that she should be using the                    
  word "misdemeanor" and not "felony."                                         
  Number 798                                                                   
  CHAIR TOOHEY stated that it was her intention to move HB 376                 
  out of committee, but she wanted Ms. Sipe to continue with a                 
  sectional analysis.                                                          
  Number 800                                                                   
  MS. SIPE stated that in fiscal 1993 there were a total of                    
  408 reports made to DFYS of harms done to vulnerable adults.                 
  Of those abuses, 200 were committed against elderly over the                 
  age of 60.  She said that over 38% were requests for                         
  services from concerned citizens within that person's                        
  community.  She further stated that 23% were reports of                      
  self-neglect (an elderly person not able to care for                         
  his/herself).  Economic abuse was 6% and physical abuse was                  
  20%.  She said that the statistics did not indicate a "huge"                 
  problem, but a growing problem.                                              
  Number 842                                                                   
  REP. BUNDE asked how many cases last year were there of                      
  persons guilty of failure to report?                                         
  Number 850                                                                   
  MS. SIPE said that, to her knowledge, there has been no                      
  Number 877                                                                   
  REP. BUNDE clarified by saying that the legislation was                      
  written in this case "to plug an eventual hole."                             
  Number 886                                                                   
  REP. B. DAVIS asked what kind of protection does the                         
  professional who reports an abuse have under the proposed                    
  Number 902                                                                   
  MS. SIPE responded by saying that the two previous bills                     
  that have been combined, resulting in HB 376, have immunity                  
  and liability sections.  She said the statute provides                       
  immunity from liability and prohibition against legal                        
  Number 915                                                                   
  REP. B. DAVIS asked "who pays the bill?"                                     
  MS. SIPE answered by saying that the state would not cover                   
  that cost, but because of the broad protection of absolute                   
  immunity, there are few law suits.                                           
  Number 931                                                                   
  REP. B. DAVIS wanted to know specifically what support would                 
  be provided to the reporter, explaining that the burden of                   
  proof would lie with that person.                                            
  Number 938                                                                   
  MS. SIPE said that the legislation does not provide legal                    
  support for the person who reports an abuse.                                 
  Number 949                                                                   
  CHAIR TOOHEY asked if there was someone in the room who                      
  could further address the issue.  There was no one at that                   
  Number 954                                                                   
  REP. B. DAVIS stated that she would like that information,                   
  but she would not hold up the bill for the requested                         
  Number 957                                                                   
  MS. SIPE said that the first sections of HB 376 define the                   
  protected vulnerable classes.  She said the legislation                      
  amended the list of people who are required to report,                       
  including new definitions and additional persons who would                   
  have to report.  She said that reporters are also allowed                    
  under subsection E, page 3, line 17, to report abuse to a                    
  police officer.                                                              
  MS. SIPE stated that page 3, line 26, would streamline the                   
  procedure of reporting abuse.  The proposal would protect                    
  the reporter who may report an abuse to the wrong                            
  MS. SIPE further stated that on page 4 of the proposal there                 
  were deletions of the immunity and retaliation sections that                 
  were combined and redefined in Section 6.                                    
  MS. SIPE said that Section 2, page 4, line 22, describes the                 
  duties of the Division of Senior Services and the amended                    
  law.  It outlines everything the department would be                         
  responsible for.  She indicated that page 5, lines 2-7,                      
  would allow other state agencies to serve as designees of                    
  the department.                                                              
  MS. SIPE said that page 5, line 8, would enable the                          
  reporting of abuse of persons over 60 years of age to be                     
  handled at two places -- the long term care ombudsman and                    
  the licensing branch in DHSS.  Reports of abuse to persons                   
  under age 60 would be reported to the licensing agency at                    
  DHSS.  Upon receipt of a report of abuse the ombudsman and                   
  DHSS would conduct an investigation, coordinate their                        
  investigations if jurisdiction overlaps, and provide results                 
  to the central information and referral service of the                       
  department (DOA) within 60 days.                                             
  MS. SIPE addressed the language on page 6, line 24.  She                     
  said it would allow the department to initiate a prompt                      
  investigation under appropriate guidelines.  She stated that                 
  subsection B, line 1, indicates the procedure the department                 
  would go through after the completion of an investigation.                   
  She added that a vulnerable adult who is the subject of a                    
  report may request at anytime that the department or                         
  designee terminate an investigation.  However, if the                        
  investigation, at that point, has resulted in reasonable                     
  cause for protection for the vulnerable adult, the                           
  department may petition the court for permission to give                     
  protective services for an injunction or the department may                  
  refer the report to the police for a criminal investigation.                 
  MS. SIPE continued on to say that page 7, line 23, would                     
  allow for surrogate decision makers for vulnerable adults.                   
  She said that after the department has determined that the                   
  vulnerable adult needs protective services, and for various                  
  reasons addressed within the bill the adult cannot consent,                  
  the department could select a suitable guardian listed on                    
  page 8, lines 1-27.                                                          
  Number 154                                                                   
  CHAIR TOOHEY said that "you're assuming that this person is                  
  surrounded by loving family."                                                
  Number 157                                                                   
  MS. SIPE stated that if they are not, then the department                    
  would go to the courts to obtain guardianship, which takes                   
  up to 90 days.                                                               
  MS. SIPE continued on with the analysis.  She said page 8,                   
  line 28, would assure that after it was determined that                      
  protective services were needed, the department would                        
  provide those services within ten working days after receipt                 
  of the report that indicated either abandonment,                             
  exploitation, abuse, neglect, or self-neglect.                               
  TAPE 94-12, SIDE B                                                           
  Number 000                                                                   
  MS. SIPE said that the legislation on page 9, line 16,                       
  stated that protective services are supposed to be delivered                 
  in a culturally relevant manner that would protect the                       
  vulnerable adult's right to the least restrictive                            
  environment and would maximize that person's own decision                    
  making capabilities.                                                         
  MS. SIPE stated that the guidelines for petitioning the                      
  court for certain protective services were contained on page                 
  9, line 20.  She further stated that the vulnerable adult                    
  could petition the superior court for an injunction that                     
  would restrain a caregiver or perpetrator from interfering                   
  with the provision of protective services to the vulnerable                  
  MS. SIPE stated that Section 3 ensures appropriate                           
  monitoring of the adult and that Section 4 ensures the                       
  confidentiality of all reports of abuse.  She said that                      
  Section 4 would allow other appropriate state agencies to                    
  obtain necessary information as it applies to the client.                    
  Number 100                                                                   
  MS. SIPE addressed subsection 5 of HB 376, stating that                      
  regulations must be provided to and reviewed by the Older                    
  Alaskans Commission.  She continued on, citing that Section                  
  6 would allow immunity from liability and the prohibition of                 
  MS. SIPE said that subsection 7 contains definitions and she                 
  highlighted the rewriting of definitions of abuse.  She                      
  stated the new definition of abuse as being "the willful,                    
  intentional, or reckless nonaccidental, and nontherapeutic                   
  infliction of physical pain, injury, or mental distress; or                  
  sexual assault..."  She said that currently abuse is the                     
  infliction of any physical pain.  In the proposed                            
  legislation, emotional pain was included.  She said it would                 
  protect the person who unintentionally causes pain and has                   
  never had a history of causing pain to a vulnerable adult.                   
  MS. SIPE informed the committee that protective services are                 
  defined on page 12, line 18.  She said that protective                       
  services "are those intended to prevent or alleviate harm                    
  resulting from abandonment, exploitation, abuse, neglect or                  
  self-neglect and that are provided to a vulnerable adult in                  
  need of protection."                                                         
  Number 200                                                                   
  MS. SIPE cited the circumstances under which vulnerable                      
  adults would be unable to consent pertaining to the                          
  guidelines of Section 7.  The vulnerable adult may be                        
  incapacitated, living under coercion or fear of reprisal                     
  from the perpetrator, dependent on the perpetrator for                       
  services, care or support, or the adult may not realize that                 
  the refusal of services may result in substantial death or                   
  irreparable harm to self or others.                                          
  MS. SIPE stated that Section 8 would ensure a gradual and                    
  smooth transition and that it would allow for an effective                   
  date of July 1, 1994.  She asked for questions from the                      
  Number 251                                                                   
  REP. VEZEY noticed that a substantial amount of existing                     
  statutes were being deleted and very similar wording was                     
  being inserted in other areas.  He asked what the reason was                 
  for that.                                                                    
  Number 261                                                                   
  MS. SIPE responded by saying there were two previous laws                    
  that had very similar language and HB 376 was a merging of                   
  those two laws.  Subsequently, part of one had to be deleted                 
  so the two could be combined.                                                
  Number 275                                                                   
  REP. VEZEY said he was unsure of the definition of abuse.                    
  He explained that the definition of abuse is very subjective                 
  and that he did not understand the term "therapeutic pain."                  
  Number 312                                                                   
  MS. SIPE answered that certain types of physical therapy                     
  necessary for rehabilitation could cause pain to the                         
  vulnerable adult.  There is pain involved, but it is                         
  Number 369                                                                   
  REP. VEZEY stated that he would be in favor of family                        
  guardianship and not state guardianship.                                     
  Number 387                                                                   
  CHAIR TOOHEY asked for further testimony on HB 376.                          
  Number 397                                                                   
  PAT O'BRIEN, Division of Family and Youth Services,                          
  Department of Health and Social Services, testified in                       
  support of HB 376 and HB 377.  She said that on behalf of                    
  DFYS she strongly supported moving the role of adult                         
  protection services over to the Division of Senior Services.                 
  She felt that the needs of the community would be better                     
  served in the division.                                                      
  Number 435                                                                   
  CHAIR TOOHEY asked who would pay the legal costs for a                       
  reporter if perhaps the family of the vulnerable adult sues.                 
  Number 448                                                                   
  MS. O'BRIEN said there has never been a case like that and                   
  she did not know how it would be handled if that situation                   
  was to arise.                                                                
  Number 456                                                                   
  REP. B. DAVIS stated that there are people who are fighting                  
  cases where they have reported abuse and the family has sued                 
  because the report was unsubstantiated.  She said it was her                 
  understanding that there is no assistance from the                           
  Number 470                                                                   
  MS. O'BRIEN said she was unaware of any such cases.                          
  Number 472                                                                   
  REP. B. DAVIS asked Ms. O'Brien to explain what would happen                 
  if that situation occurred under the proposed legislation.                   
  Number 475                                                                   
  MS. O'BRIEN replied that if an individual reported an abuse                  
  and subsequently experienced a law suit, she believed the                    
  current statute had a provision that would indemnify the                     
  reporter from being sued.  She said she would have to                        
  research it.                                                                 
  Number 488                                                                   
  REP. B. DAVIS asked what was meant by "indemnify" and would                  
  it pay the court costs for the reporter?                                     
  Number 500                                                                   
  MS. O'BRIEN said that she needed to research the issue                       
  Number 506                                                                   
  REP. BUNDE stated that Section 6 says that reporters are                     
  immune from civil or criminal liability, indicating that the                 
  judge would have to "throw the case out."  He asked if                       
  immunity meant that a reporter cannot be sued, period.                       
  Number 621                                                                   
  MS. SIPE said that there was nothing that could keep someone                 
  from being sued.  She said that someone may try to address                   
  the issue of whether the caller was reporting in "good                       
  faith" or not.  In that situation a reporter might have to                   
  incur legal fees to testify that the report was made in good                 
  faith (and the case would be dismissed).  She didn't think                   
  that the state had a system to indemnify the reporter.                       
  Number 549                                                                   
  REP. VEZEY commented that he felt there was a big difference                 
  between immunity and indemnity.  He said, as he understood                   
  the proposal, that the reporter would be immune from civil                   
  or criminal liability, period, and that there is no                          
  indemnification but there is immunity.                                       
  Number 677                                                                   
  REP. B. DAVIS wanted to make sure that this legislation                      
  would be stronger than current law regarding liability                       
  versus indemnification.                                                      
  Number 696                                                                   
  MS. SIPE felt that the new legislation did not address Rep.                  
  B. Davis' concern.                                                           
  Number 601                                                                   
  MS. O'BRIEN asked if the cases Rep. B. Davis was referring                   
  to were in Anchorage and were in the adult-care field.                       
  Number 604                                                                   
  REP. B. DAVIS responded yes, and that Ms. O'Brien could                      
  contact her office for that information.                                     
  Number 614                                                                   
  CHAIR TOOHEY closed HB 376 to public testimony and asked for                 
  further questions from the committee.                                        
  Number 619                                                                   
  REP. KOTT stated that he was unclear as to what the  current                 
  law is for notifying agencies of child abuse, what the                       
  provisions are, and what are the penalties.  He said that                    
  those who would be guilty of committing a violation under                    
  the proposed legislation would incur a $250 fine.                            
  Number 636                                                                   
  MS. O'BRIEN said that she would have to research that                        
  specific issue.                                                              
  Number 643                                                                   
  MS. SIPE said, "I think it's probably the same."                             
  REP. KOTT referred to page 2, line 12, and asked why a                       
  member of the clergy would be listed as a person with a                      
  professional duty to report abuse.                                           
  Number 665                                                                   
  MS. SIPE said that it was the current law for both children                  
  and vulnerable adults stemming from the late 1980's.  She                    
  said there was an eventual determination by the legislature                  
  that members of the clergy be included.                                      
  Number 697                                                                   
  REP. B. DAVIS made a motion to move HB 376 out of committee                  
  with individual recommendations.                                             
  Number 700                                                                   
  CHAIR TOOHEY, hearing no objections, stated that HB 376 was                  
  so moved.  She indicated that in the committee bill packets                  
  were copies of a letter from the Homer Senior Citizens.  She                 
  then asked for testimony on HB 377.                                          
  HB 377 - REGULATION OF ASSISTED LIVING HOMES                                 
  Number 737                                                                   
  CHAIR TOOHEY, after some discussion, asked to hear a                         
  sectional analysis from Ms. Sipe.                                            
  Number 738                                                                   
  CONNIE SIPE, Executive Director, Division of Senior                          
  Services, Department of Administration, stated that the                      
  proposed legislation would allow elderly and the disabled                    
  people choices, allowing them to remain in their community.                  
  She said that presently there are two types of licensing in                  
  the state for people who don't live at home, but do not live                 
  in a nursing home.  There is foster care and adult                           
  residential care (ARC), level I and II.  They are licensed                   
  facilities for "dependent adults" by DFYS.  She said that                    
  DHSS handles the licensing for any home that takes care of                   
  adults.  She said the licensure of the homes providing adult                 
  care would be moved to agencies that have adult programmatic                 
  responsibilities.  She further stated that the Division of                   
  Senior Services would handle the licensure and would deal                    
  with the needs of senior citizens and physically disabled.                   
  Licensing for group homes for the mentally disabled or                       
  mentally ill would be handled by the Division of Mental                      
  Health and the Developmentally Disabled (DMHDD).  She stated                 
  that "this licensing bill would be used by two different                     
  agencies... and there is a provision in it for how we deal                   
  with facilities that have mixed populations, so they only                    
  have to be licensed once."  She said that the department did                 
  not want to over-regulate.                                                   
  MS. SIPE stated that an important point in the legislation                   
  would allow people to access supportive services and                         
  personal care attendant services; e.g., bathing assistance,                  
  that would be incidental to their personal care or their                     
  supportive care within the group home.  She said that the                    
  services could not be obtained under current law.  She                       
  explained that it would be a consumer driven program that                    
  would allow people specific services when they are between                   
  the stages of living independently at home or living in a                    
  nursing home.                                                                
  MS. SIPE said Section 1 of the legislation would promote                     
  care in home-like settings and would set reasonable                          
  standards to protect residents while honoring their                          
  independence.  It would require an assisted living plan that                 
  residents would be encouraged to help design and carry out.                  
  Ms. Sipe likened the plan to a landlord/tenant relationship                  
  in regards to the reciprocal disclosures, rights, and                        
  responsibilities guaranteed to them.  She said this was not                  
  a state payment mechanism.  She hoped that it would be a                     
  licensure that would allow flexibility.                                      
  MS. SIPE stated that Section 47.33.010 would apply only to                   
  homes that serve two or more adults not related to the                       
  caregiver.  She said that assisted living homes that care                    
  for less than three individuals would be deregulated and                     
  left to private contract.  She said assisted living home                     
  indicated that an individual would receive room and board                    
  and one more type of service; i.e., assistance with                          
  activities of daily living, personal care assistance and                     
  health-related services.  She further stated that                            
  correctional facilities, alcohol treatment centers,                          
  emergency or runaway shelters are not included in the                        
  MS. SIPE continued on to say that Section 47.33.020 is the                   
  key section of the bill.  She said the section clarifies the                 
  understanding that home care facilities may provide health                   
  related services if they have the capacity, or they could                    
  allow the resident to bring in community health related care                 
  as if they were in their own home.  She said that the home                   
  care facility has the right to ask to the resident to move                   
  to another care setting if it is felt that the proper level                  
  of care cannot be or will not be provided for the resident.                  
  She stated that the section would allow for assistance for                   
  self-administration of medications; i.e., measuring and                      
  tracking of medications.  She further stated that the                        
  proposal would allow intermittent nursing care.  The section                 
  would enable home staff only, under a nurse's instruction,                   
  to perform certain nursing tasks.  The bill would allow for                  
  a nurse from outside the home's staff to provide skilled                     
  nursing care. Also, the legislation would provide for 24-                    
  hour skilled nursing care for up to 45 days, and at the                      
  discretion of the home, possibly beyond 45 days for a                        
  terminally ill resident.                                                     
  MS. SIPE stated Sections 47.33.030 through 47.33.360                         
  addressed the standards for residents' rights and homes'                     
  duties.  She said it was much like the landlord/tenant law,                  
  citing advance payments and trust accounts.  She mentioned                   
  temporary residents and house rules as consideration of the                  
  MS. SIPE continued with the sectional analysis.  She                         
  indicated that in Article 4 the legislation prohibits homes                  
  from operating without a license and would allow smaller                     
  homes to continue to refer to their homes as "adult foster                   
  care homes" despite their new licensing category.                            
  MS. SIPE stated that Section 47.33.410 divides up which                      
  homes will be licensed under which of the two agencies.                      
  DHSS will license homes which provide care for persons with                  
  a mental or developmental disability and the DOA will                        
  license care homes providing for people who are physically                   
  disabled, who are elderly, or have dementia (not chronic                     
  mental illness).                                                             
  In regards to licensing, MS. SIPE said that departments must                 
  produce standardized forms to help the facilities comply                     
  with regulations.  She further stated that state agencies                    
  may impose additional program or care requirements when the                  
  state is either paying for the care of the resident with                     
  state funds or when the state has the responsibility to                      
  certify a home for payment for resident care from federal                    
  TAPE 94-13, SIDE A                                                           
  Number 000                                                                   
  MS. SIPE said that Article 5 deals with procedures for                       
  complaints, investigations, adjudicatory proceedings,                        
  sanctions and penalties.  She said a great deal of research                  
  and effort was applied by the Attorney General's Office and                  
  DFYS.  As a result, the proposed legislation "is the current                 
  state-of-the-art of what you should do... you should be able                 
  to not close someone down, you should be able to have                        
  interim sanctions... other than saying we're going to take                   
  away your license."  She further stated that the Article                     
  provides for immunity to a complainant, defines                              
  investigative procedure and powers, and requires written                     
  notice of alleged violations.  Ms. Sipe said that the rest                   
  of Article 5 addressed sanctions that a licensing agency                     
  could invoke, citing $500 per day administrative fines (not                  
  to exceed $5000).  She said there are procedures to appeal                   
  the sanctions, and to suspend the sanctions until the appeal                 
  is completed.                                                                
  MS. SIPE stated that Section 47.33.560 specifies the                         
  constitutionally required due process procedures, citing                     
  right to notice, public hearings with ability to close                       
  hearings to protect peoples' privacy, rights of residents to                 
  intervene, and notice of the hearing to all residents.  She                  
  further stated that under Section 47.33.570, noncompliance                   
  with the licensure requirement would be a Class B                            
  MS. SIPE addressed Article 6, stating that it contains                       
  general provisions that allow agencies the ability to                        
  collect licensing fees and to promulgate regulations.  It                    
  also included general definitions used in the chapter.  She                  
  stated that the remainder of the bill contains a long                        
  transition section because much of the current law must be                   
  repealed.  She stated that page 25, lines 17-21, continues                   
  the exemption from the state procurement code for state paid                 
  contracts for adult residential services provided under                      
  regulation.  She said that the department amended the long                   
  term care ombudsman statute.  Ms. Sipe further stated that                   
  Section 5 through Section 10 amends the current licensing                    
  law and the only changes are deletions of all references to                  
  facilities for adults, not "dependent" adults.                               
  MS. SIPE indicated that Section 13 provides for transition                   
  between the old and new licensing systems and that Section                   
  14 provides for preparation of new regulations before the                    
  effective date.                                                              
  Number 172                                                                   
  CHAIR TOOHEY asked for questions.                                            
  Number 176                                                                   
  REP. BUNDE, in regard to the fiscal note, asked if there                     
  would be two people who would undertake the inspection and                   
  licensing procedures.                                                        
  Number 184                                                                   
  MS. SIPE responded yes.  She also stated that there were                     
  currently two empty positions within the department that                     
  would be utilized for the new legislation and would be                       
  absorbed by the department's budget this year.                               
  REP. BUNDE encouraged the department to charge a fee for                     
  licensing in light of the state's fiscal challenges.                         
  Number 224                                                                   
  CHAIR TOOHEY said that she assumed many homes would open                     
  their doors to this type of facility and that they would be                  
  able to pay for it.                                                          
  Number 237                                                                   
  MS. SIPE stated the department did have the power to set a                   
  licensing fee.                                                               
  Number 250                                                                   
  CHAIR TOOHEY asked if it would be paid not only by "private                  
  pay" but also by insurance and Medicare or Medicaid.                         
  Number 258                                                                   
  MS. SIPE responded, currently, Medicare does not cover                       
  assisted long term care, and it was not an option that                       
  Medicaid will cover. However, under Project Choice, there                    
  could be coverage by the department for residential support                  
  and living arrangements.  She explained that currently the                   
  department was providing for 100 elderly and approximately                   
  90 disabled adults.  She further stated that possibly                        
  Medicaid could be billed for personal care attendant                         
  services or for private duty nursing.                                        
  Number 323                                                                   
  CHAIR TOOHEY asked if the cost charged to the adult would be                 
  at the facility's discretion.                                                
  Number 326                                                                   
  MS. SIPE replied yes and added that adult foster homes in                    
  Anchorage range from $800 to $1000 per month, and private                    
  pay homes range from $2000 to $2500 per month.  She further                  
  stated that adult residential care facilities are charging                   
  between $1600 and $3000 per month.                                           
  Number 337                                                                   
  REP. BUNDE observed that if individuals were paying up to                    
  $3000 per month, an extra $10 dollars would pay for                          
  Number 355                                                                   
  REP. B. DAVIS asked if there were going to be any regulation                 
  that would put a cap on how much home care facilities could                  
  MS. SIPE responded by saying it was the intention of the                     
  legislation to allow the adult consumer to buy for their                     
  specific needs.  She said she wanted the market to develop                   
  without regulation.                                                          
  Number 377                                                                   
  REP. B. DAVIS said that the issue needs to be revisited                      
  because some people do not have much choice in where they                    
  can go and suggested that someone would have to monitor the                  
  Number 389                                                                   
  CHAIR TOOHEY said, "you wouldn't market... going to an                       
  apartment house.  If you can find an apartment for $300                      
  versus $800, I'll keep looking for the $300 one."                            
  Number 395                                                                   
  REP. B. DAVIS stated that assisted living was the middle                     
  ground between living independently and living in a nursing                  
  home, and as a private enterprise it needed to be monitored                  
  and reviewed.                                                                
  Number 419                                                                   
  CHAIR TOOHEY suggested that perhaps the monitoring is done                   
  by Medicaid.                                                                 
  Number 423                                                                   
  REP. B. DAVIS agreed, but said Medicaid would only pay a                     
  certain amount.                                                              
  Number 425                                                                   
  REP. VEZEY asked about the fines involved in violations.                     
  Number 435                                                                   
  MS. SIPE stated that the guidelines were on pages 20-21.                     
  Number 446                                                                   
  REP. VEZEY referred to Section 47.33.570 and asked Ms. Sipe                  
  if she felt that the state would really want to put a                        
  license violator in jail at considerable cost.                               
  Number 460                                                                   
  MS. SIPE felt that the state would prefer to have that                       
  ultimate decision if compliance through administrative                       
  sanctions could be obtained.                                                 
  Number 468                                                                   
  REP. VEZEY stated that a Class B misdemeanor fine seldomly                   
  exceeds $250, and to put someone in jail costs $70 to $100                   
  per day.  He suggested making a violation a civil penalty.                   
  CHAIR TOOHEY asked Dennis Murray to testify.                                 
  Number 500                                                                   
  DENNIS MURRAY, Administrator, Heritage Place in Soldotna,                    
  Alaska, testified in support of HB 377.  He indicated that                   
  the bill was to be a social model and pointed out that the                   
  structure of the bill contained medical terminology.  He                     
  felt that if the intent was to provide a nonmedical model,                   
  the language suggests differently.  He further stated that                   
  "terminally ill" is not defined in the proposed legislation                  
  and submitted that the department address this issue.                        
  MR. MURRAY stated that the way in which the legislation has                  
  been characterized is that there is no state dollars                         
  involved, encouraging private entrepreneurship.  He agreed                   
  that it was a laudable goal, but he felt that the needs of                   
  individuals were so many and so different that it would be                   
  difficult for the private market to service all of them.                     
  Number 588                                                                   
  CHAIR TOOHEY asked if clients in nursing homes who have                      
  minimal needs and are borderline dependent are charged less                  
  than a client in need of constant medical care.                              
  Number 593                                                                   
  MR. MURRAY said that currently under law there is no cost                    
  differential.  He further commented that the Pioneer Home                    
  system was not mentioned in earlier testimony and that it                    
  serves as the middle stage between independent home living                   
  and nursing home care.  However, he said the burden of cost                  
  is not on the individual.  He mentioned the authority of the                 
  state to provide Project Choice services that perhaps would                  
  allow for a 24 hour nurse.                                                   
  Number 651                                                                   
  CHAIR TOOHEY stated that it was her understanding that                       
  persons who utilized Project Choice could not reside in an                   
  assisted living home.                                                        
  Number 660                                                                   
  MS. SIPE responded by saying that Project Choice will cover                  
  personal care service within an assisted living home or                      
  residential facility.                                                        
  Number 683                                                                   
  MR. MURRAY again stressed his concerns about the medical                     
  terminology in the legislation.  Although, he said, he did                   
  want to see the bill pass out of the HESS Committee.                         
  Number 732                                                                   
  REP. VEZEY asked the committee if they felt the legislation                  
  was sufficient in defining terminally ill.                                   
  Number 746                                                                   
  CHAIR TOOHEY said that she did not see the relevance of the                  
  Number 753                                                                   
  REP. VEZEY asked who would make the determination within the                 
  facility if the client is terminally ill, citing that the                    
  person may live ten more years and still be terminally ill.                  
  MS. SIPE said that the department could further research the                 
  definition and incorporate it into the bill.                                 
  Number 770                                                                   
  REP. VEZEY reiterated that there is no single definition.                    
  Number 787                                                                   
  DAVE WILLIAMS, Health Planner, Division of Medical                           
  Assistance, Department of Health and Social Services,                        
  testified in support of HB 377.  He stated that last year                    
  Project Choice waivers were initiated, but there are people                  
  who will not qualify for a waiver, citing there are 401                      
  people slated to be served in the project's third year.  He                  
  highlighted the fact that on page 2, line 29, it was clear                   
  that an assisted living home does not mean a medical                         
  facility or nursing home or that it is not an institutional                  
  level provider.  He felt that it would not be covered by                     
  Medicaid.  He referred to Section 47.33.430 and stated that                  
  he would like to see the home assisted industry start and be                 
  promoted.  He said that the fiscal note for this year would                  
  be zero and that DHSS was working on the following fiscal                    
  notes.  He also mentioned that conversions of assisted                       
  living homes into nursing homes is a strong concern of DHSS.                 
  Number 897                                                                   
  TOM BOLING, Administrator, Our Lady of Compassion Care                       
  Center, testified in support of HB 377.  He encouraged                       
  passage of the bill out of committee.  He felt that there                    
  were definitions that needed to be researched further, but                   
  felt there were no major context changes to be made.                         
  Number 927                                                                   
  CHAIR TOOHEY stated that a letter from the Homer Senior                      
  Citizens was received by the committee and asked if Ms. Sipe                 
  had read it.                                                                 
  Number 930                                                                   
  MS. SIPE replied that she had not read it, but had spoken                    
  with them the previous week.                                                 
  Number 933                                                                   
  CHAIR TOOHEY said the letter indicated that the Homer Fire                   
  Department was instituting another set of fire codes for the                 
  home and suggested that Ms. Sipe address the concerns of the                 
  letter with the Homer Senior Citizens of Homer.                              
  Number 956                                                                   
  REP. B. DAVIS asked if the department had anything to say                    
  about the medical terminology issue.                                         
  Number 960                                                                   
  MS. SIPE stated that the language struck a balance between                   
  medical terminology and social terminology, and the uniform                  
  act was used for the language involved.  She said that the                   
  department was discussing some changes.                                      
  Number 993                                                                   
  REP. B. DAVIS made a motion to move HB 377 out of committee                  
  with individual recommendations.                                             
  Number 996                                                                   
  CHAIR TOOHEY, hearing no objection, moved passage of HB 377                  
  out of committee with individual recommendations.                            
  Seeing no further business before the committee, CHAIR                       
  TOOHEY ADJOURNED the meeting at 5:04 p.m.                                    

Document Name Date/Time Subjects