Legislature(1995 - 1996)
03/07/1996 04:12 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
March 7, 1996
4:12 p.m.
MEMBERS PRESENT
Representative Con Bunde, Co-Chair
Representative Cynthia Toohey, Co-Chair
Representative Gary Davis
Representative Norman Rokeberg
Representative Al Vezey
Representative Caren Robinson
Representative Tom Brice
Representative Al Vezey
MEMBERS ABSENT
None
COMMITTEE CALENDAR
*HOUSE BILL NO. 318
"An Act relating to advance directives for mental health
treatment."
- PASSED OUT OF COMMITTEE
HOUSE BILL NO. 515
"An Act relating to grants for residential services for certain
minors for whom the state has assumed responsibility; and providing
for an effective date."
- PASSED OUT OF COMMITTEE
*HOUSE BILL NO. 528
"An Act relating to applications for certificates of need and
licensing of nursing homes; amending the standard of review for
certificates of need for health care facilities in the state;
establishing a moratorium with respect to new applications by
prohibiting the issuance of a certificate of need or a license for
additional nursing home capacity in the state until July 1, 1998;
and providing for an effective date."
- HEARD AND HELD
(* First Public Hearing)
PREVIOUS ACTION
BILL: HB 318
SHORT TITLE: MENTAL HEALTH TREATMENT DECLARATIONS
SPONSOR(S): REPRESENTATIVE(S) TOOHEY,B.Davis
JRN-DATE JRN-PG ACTION
04/21/95 1427 (H) READ THE FIRST TIME - REFERRAL(S)
04/21/95 1427 (H) HES, JUDICIARY
03/07/96 (H) HES AT 4:00 PM CAPITOL 106
BILL: HB 515
SHORT TITLE: USE OF YOUTH SERVICES GRANTS
SPONSOR(S): REPRESENTATIVE(S) WILLIAMS
JRN-DATE JRN-PG ACTION
02/12/96 2729 (H) READ THE FIRST TIME - REFERRAL(S)
02/12/96 2729 (H) HES, JUDICIARY, FINANCE
02/29/96 (H) HES AT 3:00 PM CAPITOL 106
02/29/96 (H) MINUTE(HES)
03/07/96 (H) HES AT 4:00 PM CAPITOL 106
BILL: HB 528
SHORT TITLE: NURS.HOME MORATORIUM/CERTIFICATES OF NEED
SPONSOR(S): FINANCE
JRN-DATE JRN-PG ACTION
02/26/96 2884 (H) READ THE FIRST TIME - REFERRAL(S)
02/26/96 2884 (H) HES, FINANCE
03/07/96 (H) HES AT 4:00 PM CAPITOL 106
WITNESS LIST
DOROTHY PEAVEY, Executive Director
Mental Health Consumers of Alaska
430 West 7th Street, Suite 220
Anchorage, Alaska 99501
Telephone: (907)277-3817
POSITION STATEMENT: Testified on behalf of Mental Health Consumers
of Alaska, in support of HB 318
LEONARD ABEL, Program Administrator
Community Mental Health Services
Division of Mental Health & Developmental Disabilities
Department of Health & Social Services
State of Alaska
P.O. Box 110620
Juneau, Alaska 99811-0620
Telephone: (907)465-3370
POSITION STATEMENT: Testified on behalf of the Division of
Mental Health, in support of HB 318
JAN MCGILLIVARY, PRESIDENT
Alaska Mental Health Association
4050 Lake Otis Parkway, #202
Anchorage, Alaska 99508
Telephone: (907)463-0880
POSITION STATEMENT: Testified on behalf of the Alaska
Mental Health Association, in support
of HB 318
BILL CROSS
Mental Health Consumers of Alaska
17346 Meadow Creek Drive
Eagle River, Alaska 99577
Telephone: (907)696-1269
POSITION STATEMENT: Testified in support of HB 318
KATHERINE A. JOHNSON
Alaska Mental Health Board
3100 West 71 Avenue
Anchorage, Alaska 99524-0067
Telephone:
POSITION STATEMENT: Testified on behalf of the Mental Health
Board, in support of HB 318
STEPHEN ESSLEY, Attorney
Disability Law Center of Alaska
615 East 82nd, #101
Anchorage, Alaska 99518
Telephone: (907)344-1002
POSITION STATEMENT: Testified on behalf of the Disability
Law Center, in support of HB 318
BERRY JACK
Mental Health Consumers of Alaska
P.O. Box 141593
Anchorage, Alaska 99514
Telephone: 8\(907)338-0515
POSITION STATEMENT: Testified as a mental health consumer,
in support of HB 318
ROBIN COE, President
Mental Health Consumers of Alaska
430 West 7th Street
Anchorage, Alaska 99501
Telephone: (907)277-3817
POSITION STATEMENT: Testified as President of the Board of
Directors of MCHA, in support of HB 318
DIANE WORLEY, Director
Division of Family & Youth Services
Department of Health, Education & Social Services
State of Alaska
P.O. Box 110630
Juneau, Alaska 99811-0630
Telephone: (907)465-3191
POSITION STATEMENT: Testified on behalf of the Division
of Family & Youth Services, in
support of HB 318
JAY LIVEY, Deputy Commissioner
Department of Health, Education & Social Services
State of Alaska
P.O. Box 11601
Juneau, Alaska 99811-0601
Telephone: (907)465-3030
POSITION STATEMENT: Testified on behalf of the Department of
Health, Education & Social Services,
in support of HB 528
CONNIE SIPE, Director
Division of Senior Services
Department of Administration
State of Alaska
3601 C Street
Anchorage, Alaska 99503-5984
Telephone: (907)563-5654
POSITION STATEMENT: Testified on behalf of the Division
of Senior Services, in support of
HB 528
DENNIS MURRAY, Administrator
Heritage Place
232 Rockwell Avenue
Soldotna, Alaska 99669
Telephone: (907)262-2545
POSITION STATEMENT: Testified via teleconference from
Kenai, in opposition to HB 528
LEANNA SMITH
P.O. Box 3103
831 South Chugach
Palmer, Alaska 99645
Telephone: (907)745-3037
POSITION STATEMENT: Testified via teleconference from
Mat-Su, with concerns regarding HB 528
GLORIA SIMEON, Executive Director
Calista Elders Council
601 West 5th Avenue, Suite 200
Anchorage, Alaska 99501
Telephone: (907)279-8358
POSITION STATEMENT: Testified via teleconference from
Anchorage, with concerns regarding
HB 528
HELEN KEIM, Home Care Coordinator
Homer Senior Citizens
P.O. Box 1263
Anchor Point, Alaska 99556
Telephone: (907)235-7655
POSITION STATEMENT: Testified via teleconference from
Homer, in support of HB 528
BRENDA STEENBLOCK
Homer Senior Citizens
P.O. Box 808
Homer, Alaska 99603
Telephone: (907)235-8075
POSITION STATEMENT: Testified via teleconference from
Homer, in support of HB 528
ALYSHA MATHEWSON
Homer Independent LIving Center
4556 Early Spring
Homer, Alaska 99603
Telephone: (907)235-4046
POSITION STATEMENT: Testified via teleconference from
Homer, in support of HB 528
JOYANNA GEISLER
P.O. Box 2474
Homer, Alaska 99603
Telephone: (907)235-5401
POSITION STATEMENT: Testified via teleconference from
Homer, in support of HB 528
JOE ALTER, Chairman
Pioneers' Home Advisory Board
P.O. Box 20304
Juneau, Alaska 99802
Telephone: (907)586-6680
POSITION STATEMENT: Testified on behalf of the Pioneers'
Home Advisory Board and Alaska
Commission on Aging, in support of
HB 528
ACTION NARRATIVE
TAPE 96-23, SIDE A
Number 014
CO-CHAIRMAN CON BUNDE called the meeting of the House Health,
Education & Social Services Committee to order at 4:12 p.m.
Members present were Representatives Bunde, Toohey, and Vezey.
Representatives Rokeberg, Davis, and Brice arrived shortly after
the meeting started.
HB 318 - MENTAL HEALTH TREATMENT DECLARATIONS
CO-CHAIR BUNDE announced that the first order of business would be
House Bill 318. He called on the sponsor, Representative Toohey,
to introduce the bill.
Number 060
REPRESENTATIVE CYNTHIA TOOHEY stated that HB 318 would allow an
individual to make advance directives regarding his or her mental
health treatment. The person would need to be of sound mind when
making the declaration, which would designate an attorney-in-fact
who would act only when the individual was determined to be
incapable. The directive would address the use of psychotropic
medications, electro-convulsive therapy, and the length of short-
term admission, up to 17 days, into a treatment facility. The
declaration would be in effect for three years, unless the
individual became incapable. In that case, the declaration would
continue in effect until the individual was no longer incapable.
While an individual is capable, he or she can revoke the
declaration in whole or in part at any time. This declaration
gives the individual the opportunity to make his or her wishes
known about treatments--ones that have worked in the past, as well
as ones that would be desired in the future, as well as treatments
that have not worked in the past and would not be desired in the
future. It provides for a substitute decision-maker with whom the
doctor would consult should the declaration not be specific enough,
or should the doctor recommend a treatment not specified. HB 318
is similar to an Oregon law. In Oregon they have found that
individuals who have fought hospitalization and medication in the
past, now were more willing to go to the hospital, because they had
a declaration in place, and they felt their decisions would be
heeded. HB 318 is supported by Charter North, Alaska State
Hospital & Nursing Home Association, South Central Counseling
Center, the Mental Health Association of Alaska, and the Mental
Health Consumers of Alaska, and the Department of Health, Education
& Social Services. There is a zero fiscal note attached.
REPRESENTATIVE TOOHEY stated that there were a number of
individuals present who wished to testify, including Dorothy Peavey
of the Mental Health Consumers of Alaska, and Leonard Abel from the
Department of Health, Education & Social Services. Representative
Toohey noted that she remembered as a child receiving a very urgent
letter from her cousin, who was schizophrenic, asking never to let
her doctor use electro-shock therapy.
CO-CHAIRMAN BUNDE acknowledged the presence of Representatives
Robinson and Rokeberg. He stated that because of the lack of time,
and the large number of persons wishing to testify, the committee
would first hear all testimony, then address any questions. He
then called on the first witness, Dorothy Peavey.
Number 331
DOROTHY PEAVEY, Executive Director of the Mental Health Consumers
of Alaska (MCHA), stated that MCHA is a nonprofit organization
composed of individuals who suffer from mental illness. When her
organization became aware of Oregon's law concerning advance
directives for mental health treatment, it seemed like a natural
thing for them to support. This proposed legislation gives a voice
to people suffering from mental illness, at a time when their
opinion would not normally be heard. It empowers consumers to make
responsible decisions about their care, and provides a mechanism
for those decisions to be carried forward at a time when they are
incapable. She emphasized that the correct term is incapable, not
incompetent. Incompetency is decided by a judge. To become
incapable under this legislation, a person would have to at one
point have filled out a declaration. Then, in the opinion of two
physicians (one of whom is a psychiatrist), or a physician and a
professional mental health clinician, the person would be found to
be incapable, and the mechanism would take effect. At that point,
upon the advice and council of the attorney-in-fact, the individual
could be hospitalized for a period of up to 17 days, without having
to go to court to be found incompetent. Decisions about treatment
would also take effect. If a person had a history with a
medication, then they could make their wishes known, and the doctor
would have to pay attention to those wishes.
MS. PEAVEY stated that she has discussed HB 318 with providers from
across the state, and that it has been endorsed by the Mental
Health Providers Association, as well as the groups and individuals
named by Representative Toohey. The bill has support from
families, consumers, and providers. One question that came up in
the Senate hearing was why 17 days was chosen for the time period
a person could be hospitalized. She emphasized that this was a
reasoned number. If a person were to be hospitalized on a Friday
afternoon, the 17 days would provide 10 days of evaluation and
treatment, if one of the weekends was a three day holiday. At that
point, the doctors could decide if the individual had made a
significant improvement, or whether the individual needed to be
held. Ms. Peavey then invited questions from the committee.
Number 609
CO-CHAIRMAN BUNDE noted for the record that Representative Brice
had joined the meeting. Co-Chairman Bunde then called on the next
witness, Leonard Abel.
LEONARD ABEL, Ph.D., Community Mental Health Services Program
Administrator, Department of Health, Education & Social Services
(State of Alaska), stated he would testify in support of HB 318.
Dr. Abel stated that he previously worked for Southcentral
Counseling Center in Anchorage. About 11 years ago, a client came
to him and asked if there was a document she could sign, so that if
she became incapable, she would receive the proper treatment. At
the time, there was no such document. Dr. Abel recognized that the
client understood her illness, and knew that if she became
incapable, she might resist treatment, and would have to be
involuntarily committed. If, on the other hand, she had signed a
declaration such as embodied in HB 318, this could be prevented.
Persons with mental illnesses, when stabilized on medication, can
make reasonable decisions. When the illness is out of control, the
capacity to make such decisions is gone. Dr. Abel reiterated that
he very strongly supports the bill. It seems to have good
safeguards for the patient, for the attorney-in-fact, and for the
mental health professionals.
Number 946
CO-CHAIRMAN BUNDE called on the next witness, Jan McGillivary.
JAN MCGILLIVARY stated she would speak as President/CEO of the
Alaska Mental Health Association (AMHA), and also on behalf of the
Building Bridges Campaign, and the Alaska Mental Health Program
Director's Association. As President of AMHA, she represents 600
Alaskans. These kinds of advance directives are very common for
persons suffering from HIV and other grave illnesses. As President
of AMHA, she believes the proposed bill is long overdue. The
Building Bridges Campaign and the Alaska Mental Health Program
Director's Association also strongly support the bill. Ms.
McGillivary noted that she has an allergy to codeine, and therefore
she has a personal advance medical directive on file. She stated
that in her 15 years in the mental health field, she has
encountered many consumers who know they are allergic to certain
medications. The proposed legislation would address that problem.
She urged the committee to pass the bill.
Number 1075
CO-CHAIRMAN BUNDE called on the next witness, Bill Cross.
BILL CROSS, a member of the Mental Health Consumers of Alaska,
stated that he was once determined to be mentally "incontinent,"
but had recovered from the condition. He further stated that he
supports HB 318, because he is aware that there are some treatments
he does not respond well to. By signing such a declaration, he can
help his doctors, by letting them know what he has responded well
to in the past.
Number 1153
KATHERINE A. JOHNSON, a member of the Alaska Mental Health Board,
stated that the board supports HB 318. The board applauds the work
of MCHA in developing this legislation. The Advance Directives
bill extends to consumers of mental health services an important
control mechanism over their own treatment. Control of personal
destiny is essential to human dignity. HB 318 provides a means by
which difficult situations may be anticipated and addressed, giving
consumers a voice they have previously lacked. The board joins the
mental health community in urging the House Health, Education &
Social Services Committee to move HB 318, with favorable
recommendations.
Number 1201
STEVEN ESSLEY, an attorney with the Disability Law Center of
Alaska, stated that the center supports HB 318. He noted that
there may actually be a negative fiscal impact from the bill, since
it would preclude the need for an involuntary commitment hearing.
The Office of Public Advocacy has said that there are about 180
involuntary medication hearings each year. This bill might also
eliminate the necessity for a number of those hearings. He
reiterated that the Disability Law Center of Alaska supports HB
318.
Number 1294
BERRY JACK, a consumer with Mental Health Consumers of Alaska,
stated he does not have a family which is legal defined by law. He
does have a power of attorney. This bill would allow him to
complete all avenues of his life. HB 318 would give him a voice
and protect his rights. He asked that the committee support the
bill.
Number 1350
ROBIN COE, President of the Board of Directors for the Mental
Health Consumers of Alaska, testified that the proposed legislation
was vital.
Number 1375
CO-CHAIRMAN BUNDE asked if anyone else wished to testify regarding
HB 318. Seeing there were no further witnesses, Co-Chair Bunde
closed the public testimony on HB 318. He then asked for questions
or comments from the committee.
REPRESENTATIVE TOM BRICE commented that the proposed legislation
was long overdue.
REPRESENTATIVE NORMAN ROKEBERG moved that the House Health,
Education & Social Services Committee pass HB 318 from committee,
with individual recommendations and a zero fiscal note. There
being no objections, HB 318 was passed out of the House HESS
Committee.
HB 515 - USE OF YOUTH SERVICES GRANTS
Number 1469
CO-CHAIRMAN BUNDE announced that the next order of business to come
before the committee was HB 515.
KYLE JOHANSEN, staff to Representative Bill Williams, stated that
a hand-out on the bill had been delivered to each committee
member's office, and that Tom Lane, of the Department of Health &
Social Services, was available to answer questions.
Number 1580
DIANE WORLEY, Director, Division of Family & Youth Services,
Department of Health, Education, & Social Services, State of
Alaska, stated that the division supports HB 515. She previously
worked for a direct service provision agency. Because the agency
was prohibited from using grant funds to purchase a building, they
had to move frequently. This resulted in confusion for clients.
To remedy the situation, her organization established a private,
non-profit foundation, which purchased the building, and then
rented it to the agency. This was appropriate and legal, but a
direct route would have been much easier. Ms. Worley emphasized
that the proposed legislation would strengthen client services by
providing consistency, and represents good business practice for
nonprofit organizations. She invited questions from the committee.
Number 1659
CO-CHAIRMAN BUNDE asked for further testimony. There being no
further testimony, public testimony on HB 515 was closed.
REPRESENTATIVE ROBINSON asked if previous problems relating to the
bill had been solved.
CO-CHAIRMAN BUNDE replied that they had.
Number 1707
REPRESENTATIVE BRICE stated that this bill would actually result in
a reduction in costs to the state. He moved HB 515 with zero
fiscal notes and individual recommendations be passed out of the
committee.
REPRESENTATIVE ROBINSON asked how maintenance needs would be dealt
with, once a building was purchased.
CO-CHAIRMAN BUNDE responded that whether a building is purchased or
rented, there are still maintenance needs. There being no
objections, House Bill 515 with zero fiscal notes and individual
recommendations was passed out of the House Health, Education &
Social Services Committee.
HB 528 - NURS.HOME MORATORIUM/CERTIFICATES OF NEED
Number 1835
CO-CHAIRMAN BUNDE announced that the next order of business to come
before the committee was HB 528.
JAY LIVEY, Deputy Commissioner, Department of Health & Social
Services, that stated he would give a brief overview of the bill.
The certificate of need process is a planning process by which the
state reviews the appropriateness of the development of hospitals
and nursing homes in the state. Applications are made to the state
for projects in excess of one million dollars of capital cost, and
the state reviews them against criteria which are established in
the existing certificate of need law. A project must have a
certificate of need from the state in order to proceed.
MR. LIVEY further explained that if the one million dollar
threshold is not exceeded, then existing beds can be converted. In
the past, hospital beds have been converted to long-term care beds.
As long as one million dollars is not expended, this process is
allowable under current law. HB 528 makes two changes to existing
law. First, it defines a criteria by which applications for
certificates of need are reviewed. Currently, the review criteria
is primarily based on the need for a particular service. If an
application shows that a particular service area lacks enough
nursing home beds, then the certificate will most likely be
granted. One of the changes in HB 528 would be to apply a cost
effectiveness criteria to the request. In addition to surveying
need, the division could also determine if the proposed service
would be the most cost effective way to meet the need.
MR. LIVEY stated that the proposed bill would also propose a two-
year moratorium on the granting of a certificate of need or the
licensing of additional long-term care beds in the state. This
section is needed to stop the conversion of nursing home beds. He
noted that the proposed moratorium would not apply to extended care
or sub-acute care beds. Mr. Livey explained that the Department
of Health & Social Services supports HB 528, because the department
expects to spend about $54 million on nursing home care during the
current fiscal year, which represents care for about 640 Alaskans
in nursing homes. Nursing home care costs an average of about $86
thousand per year per patient. Of all nursing home revenues in the
state, 85 percent come from Medicaid. In contrast, the cost of
supporting a person in the home and community-based waiver program
is about $30 thousand per year. Over the next few years, there is
a potential for 160 new nursing home beds to be added in the state,
both through conversions and new construction. If this were to
happen, the annual total cost to the state would be about $47
million. The department believes that the state cannot control the
Medicare budget, given this kind of growth in long-term care beds.
Thus, HB 528 would help the state in its cost containment efforts.
Number 2055
CONNIE SIPE, Director, Division of Senior Services, Department of
Administration (State of Alaska), stated that the proposed
moratorium was also a response to the changing budget situation,
both state and federal. The division believes that putting a
moratorium on the licensing of nursing home care beds will give the
home and community care system time to grow and catch up, which
will benefit everyone. Home and community care is not only less
expensive for the state, it is also more often cost affordable by
the family or individual, which means they can carry a larger
proportion of the cost of care. The growth of the home health care
system means that public money is being better spent.
MS. SIPE also commented that professionals in the field of aging
are trying to move away from the idea that long-term care is an
unavoidable part of the continuum. Long-term care is now viewed as
part of a network, which also includes home care and assisted
living alternatives. If home health care and assisted living are
added on to family care, many people may never need a nursing home
bed.
Number 2190
REPRESENTATIVE TOOHEY asked what would happen to pending
certificate of need applications under the proposed legislation.
MR. LIVEY responded that the applications would be reviewed under
the new criteria.
REPRESENTATIVE TOOHEY then asked what would happen if a certificate
had already been granted.
MR. LIVEY replied that if a certificate had already been granted,
then the project could go forward.
CO-CHAIRMAN BUNDE announced that teleconference testimony would now
be taken. He called on the next witness, Dennis Murray, via
teleconference from Kenai.
DENNIS MURRAY, Administrator of Heritage Place in Soldotna, Alaska,
stated that he had a different perspective on HB 528. For example,
he said, the legislation references a low occupancy rate for
nursing homes in Alaska. However, this is not true in southcentral
Alaska. Both facilities in Anchorage are at near 100 percent
occupancy. His own facility has run between 97 and 100 percent
occupancy for the past 12 months.
TAPE 96-23, SIDE B
Number 001
MR. MURRAY further noted that the state has, in fact, two nursing
home systems, which include private facilities and the Pioneer Home
system. He also observed that Alaska has one of the lowest per
capita nursing home populations in the country. But, we also have
an exploding elderly population. He commented that the proposed
legislation appears short-sighted.
Number 037
LEANNA SMITH, of the Palmer Senior Center, testified via
teleconference from Mat-Su. She agreed with Ms. Sipes that the
cost of home and community-based care was much lower than nursing
home care. She stated, however, that only a small number of people
can currently receive help from the state for the cost of home
care. She stated that if nursing home beds are available, Medicaid
will pick up the cost for people who cannot afford to pay.
However, if no beds are available, and assisted living funds are
also unavailable, people will be left without care. Ms. Smith
asked if there would be some way to transfer funds from Medicaid to
help with assisted living.
Number 074
GLORIA SIMEON, Executive Director of the Calista Elders Council,
testified via teleconference from Anchorage. Ms. Simeon stated
that since 1986 the elders of the Calista region have worked to
organize themselves so that the regional entity could provide
services and programs to them responsive to their needs. The
council is concerned that too many elders have to leave the region
to receive the medical care and services they require. She stated
that elders are forced to leave their homes, families, friends, and
most important their language. They are relocated to unfamiliar
environments, and exposed to a language and way of life that is not
their own. No roads link the Calista region to the rest of the
state, and the cost of a ticket from one of the regional villages
to Anchorage is in excess of seven hundred dollars. The region is
also one of the most economically depressed in the state, and most
families cannot afford the cost of even an annual visit to their
elderly relatives in nursing homes. Left alone in an unfamiliar
environment, the elders lose their will to live and often come home
in a short period of time, to be buried. This conflicts with the
values and traditions of the Yupik culture.
MS. SIMEON stated that while she understands the reasoning behind
the proposed legislation, she is also aware that the majority of
nursing homes are located in urban centers. She further
understands that the rural health corporations are developing and
expanding programs to offer home care delivery, and are considering
assisted living centers as a viable option on a community level.
However, the reality is that there is a need for a nursing home
facility in the Calista region, and the regional hospital is an
ideal place to locate such a facility.
MS. SIMEON further stated that a study done by the state of Alaska
in 1993 showed 41 Calista elders in nursing facilities throughout
the state, and that being forced to relocate resulted in poor
adjustment and a much higher death rate. The study also indicates
that the two fastest growing segments of our population are elders,
age 65 and over, and children age 5 and under. With the number of
elders increasing, the state needs to examine how future needs will
be met. She proposed that, rather than putting a moratorium on
nursing homes and beds, the state should take a serious look at the
present and future needs of its elders, and focus on how these
needs can be met. In closing, Ms. Simeon suggested that elders
should be involved in the development of any plan, and that they
should be able to live out the remainder of their lives as close to
their homes as possible.
Number 219
HELEN KEIM, Care Coordinator, Homer Senior Citizens, testified via
teleconference from Homer. Ms. Keim stated that she supports HB
528. She urged the committee's support for the Choice medicaid
waiver program for the elderly, and asked the committee not to cut
funding for the program. The average cost of a Choice client is
$25 to $30 thousand annually, as opposed to $100 thousand or more
for each long-term care patient. Also, the Choice program keeps
clients in their own homes, as opposed to an institution.
CO-CHAIRMAN BUNDE announced that a number of people still wished to
testify. He stated he would attempt to hear the bill again on
Tuesday, March 12.
Number 293
BRENDA STEENBLOCK, Administrative Assistant, Homer Senior Citizens,
testified via teleconference from Homer. Ms. Steenblock stated
that Homer's new, 40 unit assisted living facility is scheduled to
open in May. She stated that Homer Senior Citizens supports HB
528.
Number 325
ALYSHA MATHEWSON, of Homer Independent Living Center, testified via
teleconference from Homer. Ms. Mathewson stated that she supports
HB 528 because the state needs to develop home and community-based
services as an alternative to costly nursing home facilities. Each
person receiving extended care has their own personal
circumstances. Some would choose to stay at home, but cannot
afford to pay the cost of a home health aide. These fees would
total approximately $240 per day, but Medicaid doesn't cover this
service. In the Palmer area, Medicaid pays about $12 thousand per
month for long-term care. If this amount were instead paid
directly to the certified home health aides, there would be a
savings of $4800 per month.
MS. MATHEWSON stated that she would also like to see further
development of the Medicaid Choice program. She urged the
committee to pass the bill, keeping mind that changes in the health
care delivery system are urgently needed.
Number 400
JOYANNA GEISLER, of Homer, testified that she provides services for
people with disabilities throughout the entire Kenai Peninsula.
She stated that she supports HB 528. All of her clients with
disabilities would definitely prefer to receive community-based
services, rather than live in nursing homes. She noted that such
community-based services cost about one-third the amount of
institutional care. Ms. Glyser stated the bill seems to be a win-
win situation, as it would reduce costs to the state and improve
the quality of life for disabled and elderly Alaskans. She further
noted she supports limiting the growth of long-term care beds, and
diverting the resulting funds into community-based services.
Number 462
REPRESENTATIVE TOOHEY mentioned the handout received from Homer
Senior Citizens. She noted that the handout compares the price of
services available, and contrasted this with materials received
from Providence Hospital, which do not mention cost.
CO-CHAIRMAN BUNDE responded that information on cost of services
could most likely be obtained before the bill was heard again.
Number 504
JOE ALTER, Chairman of the Pioneer's Homes Advisory Board and a
member of the Alaska Commission on Aging (ACOA), stated that the
Pioneers' Homes Advisory Board represents roughly half of the long-
term care beds in the state. On behalf of the Commission on Aging,
Mr. Alter read a resolution, as follows: "Alaska Commission on
Aging Resolution 96-3, In support of a moratorium on construction
of additional facility beds:
"WHEREAS Alaska's existing long-term care system is now largely
made up of institutional, long-term care services; and
"WHEREAS the current availability of nursing home beds in many
areas exceeds the actual need for nursing home beds in the state;
and
"WHEREAS Alaska's seniors have indicated through surveys an
overwhelming preference for alternatives to nursing homes, and they
want to live in the least restrictive setting close to family and
friends; and
"WHEREAS seniors often have to choose nursing home care, which is
the most intensive, restrictive and expensive type of care, because
there is no community-based service available; and
"WHEREAS the future of Medicaid financing is under discussion at
the federal level; and
"WHEREAS the state Medicaid financing is finite, and is forcing
choices among Medicaid programs; and
"WHEREAS the growth and maintenance of much needed community-based
care is threatened by construction of unnecessary nursing home
beds; and
"WHEREAS if new nursing home beds are added, senior's choices will
be restricted, because new nursing home beds compete directly for
public funds available for community-based services; and
"WHEREAS HB 528 will encourage the development of home and
community-based services, and allow time for Alaska to move toward
a more balanced, long-term care system;
"NOW, THEREFORE, BE IT RESOLVED that the Alaska Commission on Aging
strongly encourages the Alaska legislature to enact HB 528, which
would place a two year moratorium on new, nursing home beds.
"Adopted this 5th day of March, 1996.
Donald M. Hoover, Chair, Alaska Commission on Aging" This
concluded Mr. Alter's testimony.
Number 653
HARLAN KNUDSON, representing the Alaska State Hospital and Nursing
Home Association, stated that he is a strong proponent of home and
community-based care, but that his organization opposes HB 528.
The association shares the concerns about cost, but disagrees with
this approach to solving the problem, and with the findings of the
bill. They do not agree that there is an overabundance of nursing
home beds in the metropolitan areas of the state. He referred to
a January 31, 1992, census report on licensing and certification,
which shows 764 beds being reimbursed in the Medicare system. He
stated this is important, because it disputes other figures
relating to the number of licensed beds in the state.
MR. KNUDSON further stated that the 1992 report shows 100 percent
and 98 percent occupancy for nursing homes in Anchorage. One of
the pending certificates of need, which would be impacted by the
proposed legislation, is for a nursing home in the Palmer/Mat Su
area. Mr. Knudson pointed out that the 1996 census report shows
that rates for nursing home care in Anchorage have actually shown
a slight decrease since 1992, in one center, and have only
increased about $20 per day in another center. He also noted that,
of the two centers in Anchorage, one is 98 percent full, and the
other 96 percent. He stated that the bill proposes a solution
which is far too simplistic. When nursing home beds are full,
there is no place open for acute care and convalescent patients.
They then have to stay in the hospital, which is the most expensive
setting. Mr. Knudson also pointed out that in 1992, there were 764
licensed beds. In 1996, there are 768. This represents an
increase of only four beds in five years. He summed up his
testimony by calling the committee's attention to Section 2 of the
bill, which changes the word "shall" issue a certificate of need to
"may" issue a certificate of need. This refers to situations where
the criteria have already been met. Mr. Knudson reminded the
committee that there is a big difference between "shall" and "may".
The proposed statue would allow the department to deny a
certificate, even when need has been proven. This represents a
major change in public policy.
MR. KNUDSON also stated that providers feel shut out of the policy-
making procedure, with respect to long-term care. Perhaps a one
year moratorium would be appropriate. The HESS Department should
be required to work with advocacy groups, providers, bush and rural
Alaska, and propose a bill that will meet the people's needs. He
referred to a report by the American Association of Retired Persons
which raises serious questions about the cost of home and
community-based care. He reiterated that HB 528 does not
effectively deal with problems in the system.
CO-CHAIRMAN BUNDE announced that HB 528 would be scheduled for
further hearing.
ADJOURNMENT
There being no further business to come before the House Health,
Education & Social Services Committee, the meeting was adjourned at
5:30 p.m..
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