Legislature(2011 - 2012)CAPITOL 106

02/22/2011 03:00 PM House HEALTH & SOCIAL SERVICES


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03:06:13 PM Start
03:07:00 PM Presentation: Commission on Aging
03:50:36 PM Long Term Care Ombudsman
04:18:44 PM Community Care Coalition
04:59:47 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentations by: TELECONFERENCED
- Denise Daniello, Commission on Aging
- Diana Weber, Long Term Care Ombudsman
- Sandra Heffern, Community Care Coalition
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       February 22, 2011                                                                                        
                           3:06 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Wes Keller, Chair                                                                                                
Representative Alan Dick, Vice Chair                                                                                            
Representative Bob Herron                                                                                                       
Representative Paul Seaton                                                                                                      
Representative Bob Miller                                                                                                       
Representative Charisse Millett                                                                                                 
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Sharon Cissna                                                                                                    
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION(S):  COMMISSION ON AGING                                                                                           
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
LONG TERM CARE OMBUDSMAN                                                                                                        
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
COMMUNITY CARE COALITION                                                                                                        
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
DENISE DANIELLO, Executive Director                                                                                             
Alaska Commission on Aging                                                                                                      
Division of Senior and Disabilities Services                                                                                    
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a PowerPoint during a                                                                          
presentation by the Alaska Commission on Aging.                                                                                 
                                                                                                                                
DIANA WEBER, Ombudsman                                                                                                          
Long Term Care Ombudsman                                                                                                        
Alaska Mental Health Trust Authority                                                                                            
Department of Revenue (DOR)                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented a  PowerPoint during discussion of                                                             
the role of the Office of the Long Term Care Ombudsman.                                                                         
                                                                                                                                
SANDRA HEFFERN, Chair                                                                                                           
Community Care Coalition                                                                                                        
POSITION STATEMENT:  Testified about long term care in Alaska.                                                                
                                                                                                                                
PAT HEFLEY, Deputy Commissioner                                                                                                 
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified during  discussion of  long term                                                             
care in Alaska.                                                                                                                 
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:06:13 PM                                                                                                                    
                                                                                                                                
CHAIR  WES KELLER  called the  House Health  and Social  Services                                                             
Standing   Committee    meeting   to    order   at    3:06   p.m.                                                               
Representatives Keller,  Dick, Herron,  Millett, and  Miller were                                                               
present at the  call to order.  Representative  Seaton arrived as                                                               
the meeting was in progress.                                                                                                    
                                                                                                                                
^PRESENTATION:  Commission on Aging                                                                                           
               PRESENTATION:  Commission on Aging                                                                           
                                                                                                                              
3:07:00 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  first order of business would be                                                               
a presentation by the Alaska Commission on Aging.                                                                               
                                                                                                                                
3:08:46 PM                                                                                                                    
                                                                                                                                
DENISE DANIELLO, Executive Director,  Alaska Commission on Aging,                                                               
Division  of  Senior  and Disabilities  Services,  Department  of                                                               
Health  and  Social  Services   (DHSS),  presented  a  PowerPoint                                                               
entitled,   "Findings  from   the  Older   Alaskans  Survey   and                                                               
Elder/Senior Community  Forums."  She  spoke about slide  1, "Our                                                               
Purpose," and  shared that the  purpose of the Commission  was to                                                               
plan, educate, and  advocate on behalf of all  Alaskans, 60 years                                                               
and older, and ensure that  they had meaningful lives, had access                                                               
to  necessary   services,  and  remained   in  their   homes  and                                                               
communities as long as possible.   She stated that the commission                                                               
had to  provide information and  recommendations about  the needs                                                               
of  older Alaskans  to the  governor  and the  legislature.   She                                                               
shared that  the commission was formed  in 1982, and that  the 11                                                               
board members  were comprised of  appointed Alaskan  seniors, and                                                               
staff  from DHSS,  Department of  Commerce, Community  & Economic                                                               
Development (DCCED), and  the chair of the  Pioneer Home advisory                                                               
board.                                                                                                                          
                                                                                                                                
3:12:09 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO moved  on to  slide 2,  "Growth of  Alaska's Senior                                                               
Population,"  and spoke  about  the growth  surge  of the  senior                                                               
population in Alaska.  She  reported that there were about 85,100                                                               
Alaska  seniors, with  the majority  having lived  here for  some                                                               
time.                                                                                                                           
                                                                                                                                
MS. DANIELLO pointed to slide  3, "Comparison of Age Distribution                                                               
1977  and  2009,"  and  compared  the  changes  for  age  profile                                                               
distributions as the baby boomers aged.                                                                                         
                                                                                                                                
3:13:41 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO shared slide 4,  "The population of Alaskans age 85+                                                               
will  grow by  nearly 500%  from 2000  to 2034."   She  noted how                                                               
quickly this  age group would grow  with the arrival of  the baby                                                               
boomers.  She reported that it  was this group of seniors most in                                                               
need of health  care services, and would have  the highest health                                                               
care costs.                                                                                                                     
                                                                                                                                
MS. DANIELLO  reviewed slide  5, "Growth  of Alaska's  Senior and                                                               
Youth  Populations," and  compared that  from 2001  to 2009,  the                                                               
number  of youth  under  18  years of  age,  had  increased by  4                                                               
percent, whereas  the number of  seniors 60 years and  older, had                                                               
increased by  53 percent.   Currently, about 12.3 percent  of the                                                               
Alaska  population is  seniors,  and she  projected that  seniors                                                               
would comprise 20 percent of the state population in 20 years.                                                                  
                                                                                                                                
3:14:45 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO furnished  slide 6,  "Senior Growth  Rates Vary  by                                                               
Region,"  and  shared  that   Southcentral,  Anchorage,  and  the                                                               
Fairbanks/Interior  were  the  fastest   growing  regions.    She                                                               
confirmed  that every  region of  the state  had a  senior growth                                                               
rate of more than 20 percent in the past 8 years.                                                                               
                                                                                                                                
3:15:22 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO shifted  to slide 7, "There are  over 6,000 Alaskans                                                               
with  Alzheimer's   disease  and  related  dementias,   based  on                                                               
national prevalence rates."   She observed that  a consequence of                                                               
an aging  population was an  increase in Alzheimer's  disease and                                                               
related dementias  (ADRD).  She  estimated there were  about 6000                                                               
Alaskans,  age 65  and older,  with  ADRD, but  that this  number                                                               
could increase  to 17,000 in  20 years.   She stated  that health                                                               
care costs were three times higher for those with ADRD.                                                                         
                                                                                                                                
3:16:01 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO  offered slide  9,  "Needs  Assessment Efforts  for                                                               
State  Plan  Development Process,"  and  reported  that this  was                                                               
required for  all states using  federal funds.  She  listed these                                                               
programs to include  home and community based  services funded by                                                               
Title  III  of the  Older  Americans  Act, funds  for  vocational                                                               
training for low income seniors,  funds for elder protection, and                                                               
funds for nutrition, transportation,  and supportive services for                                                               
tribal organizations.   She presented  that the  needs assessment                                                               
would be done at community forums and by statewide survey.                                                                      
                                                                                                                                
3:18:09 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO  referred to slide  10, "Senior  Survey Methodology"                                                               
and  the 2010  Survey  of Older  Alaskans  [Included in  members'                                                               
packets]  and   explained  that   the  survey  had   been  widely                                                               
distributed.  She  shared that 3,222 responses to  the survey had                                                               
been received.   She  stressed that,  as this  was not  a random,                                                               
statistically-valid   sample    of   Alaska    seniors,   precise                                                               
conclusions  could  not be  drawn  from  it.   She  pointed  out,                                                               
however,  that  the  large number  of  responses  and  widespread                                                               
representation did offer valuable information.                                                                                  
                                                                                                                                
3:19:46 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO  turned to slide  12, "The great majority  of survey                                                               
responders  were seniors  (age 60+).  We received  responses from                                                               
every  senior age  group. The  oldest respondent  was 107."   She                                                               
noted that more  women responded, even though  the population was                                                               
equal, and that  the ethnicity tracked comparable  to the general                                                               
profile of Alaska.                                                                                                              
                                                                                                                                
3:20:46 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO supplied  slide 14,  "We received  survey responses                                                               
from every region  of the state," and slide 15,  "The majority of                                                               
seniors  who responded  have  lived  in Alaska  for  40 years  or                                                               
more."  She  shared that 56 percent of the  respondents had lived                                                               
in Alaska for more than 40 years.                                                                                               
                                                                                                                                
3:21:28 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO pointed out the findings  of the survey on slide 17,                                                               
"Alaskan seniors  are very  happy here.   More than  9 out  of 10                                                               
older Alaskans  (94%) would recommend  their community as  a good                                                               
place  to live  for seniors,"  and on  slide 18,  "Research shows                                                               
that social engagement  is an important correlate  of both mental                                                               
and  physical  health  for  seniors,"  which  indicated  that  33                                                               
percent got together four or more times each week.                                                                              
                                                                                                                                
3:22:15 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO directed attention to  slide 19, "Senior centers are                                                               
an important key to senior  community involvement.  Nearly six in                                                               
ten seniors visit  a local senior center  at least occasionally."                                                               
She reported  that only 9 percent  reported that there was  not a                                                               
senior center in their community.                                                                                               
                                                                                                                                
3:22:48 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO  indicated  slide  20,  "Many  older  Alaskans  are                                                               
struggling financially.   One in five cannot make  ends meet, and                                                               
another two in  five are just getting by."   She compared this to                                                               
the 2005 survey, which had a similar response.                                                                                  
                                                                                                                                
3:23:35 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO  move on to slide  21, "More than half  of the older                                                               
Alaskans who responded to the  survey indicated that they live in                                                               
a  household with  $2,000 or  less  of monthly  income," and  she                                                               
stated  that  this  was  176   percent  of  the  federal  poverty                                                               
guideline for  a one person household,  or 131 percent for  a two                                                               
person household.                                                                                                               
                                                                                                                                
3:24:11 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO  indicated  slide  22, "Three  out  of  five  older                                                               
Alaskans surveyed have  an illness or disability  that limits the                                                               
range  of activities  they can  enjoy."   She said  that many  of                                                               
these were physical disabilities.                                                                                               
                                                                                                                                
3:24:50 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO  summarized slide 23,  "Seven out of  ten responders                                                               
live in a home  they or a family member own.  Two  in ten live in                                                               
a rented home or apartment."                                                                                                    
                                                                                                                                
3:25:13 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO  commented on  slide 24, "One  in three  seniors say                                                               
their  home   needs  some  sort  of   modification-such  as  ramp                                                               
installation, grab  bars, or insulation-in  order for them  to be                                                               
safe and comfortable."                                                                                                          
                                                                                                                                
MS. DANIELLO  reviewed slide 25,  "Most older Alaskans  (69%) are                                                               
not having trouble  finding a primary care doctor.   Of those who                                                               
are, Medicare  payment issues are  the most  often-cited reason."                                                               
She stated  that the majority  of seniors having  difficulty were                                                               
in the  Anchorage area,  but that  Fairbanks, the  Aleutians, and                                                               
Southcentral  were also  areas of  difficulty.   She pointed  out                                                               
that these  seniors with difficulties reflected  an increase from                                                               
the 2005 survey.                                                                                                                
                                                                                                                                
3:26:40 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO  assessed slide  26,  "More  seniors rated  "health                                                               
care"  and  "financial security"  as  important  issues than  any                                                               
other topic.  These two issues  were also the top concerns listed                                                               
in our  2005 senior  survey."   She listed  other concerns  to be                                                               
fuel costs,  housing, enough food  to eat, in-home  services, and                                                               
transportation.                                                                                                                 
                                                                                                                                
3:27:34 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO  spoke about slide  27, "Most seniors have  not used                                                               
any of  the available senior services.   Of those who  have, most                                                               
are satisfied  with the service  they received."  She  noted that                                                               
only about  33 percent used any  of the services, similar  to the                                                               
results of the 2005 survey.   The two programs which gathered the                                                               
highest  satisfaction rating  were  adult day  programs and  home                                                               
delivered meals.   She opined  that the services were  only being                                                               
used when needed, and that they fulfilled the basic needs.                                                                      
                                                                                                                                
3:28:43 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO discussed  slide 28,  "Many seniors  included open-                                                               
ended comments  on a wide  range of  topics."  She  reported that                                                               
more  than  1,300  comments had  been  received,  which  included                                                               
thoughts on the increase in  rental and fuel costs, problems with                                                               
health care, senior housing and transportation, and home care.                                                                  
                                                                                                                                
3:29:31 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO  summarized slide  30,  "Findings  from the  ACoA's                                                               
elder/senior  community  forums  held  in  Anchorage,  Fairbanks,                                                               
Juneau,  Kotzebue,  Bethel, and  with  the  Alaska Native  Tribal                                                               
Health   Consortium   Elders    Committee   highlighted   similar                                                               
concerns:"   She said that each  forum was conducted in  the same                                                               
format, with the same questions  focusing on health care and long                                                               
term  supports,  financial  security  and  housing,  and  healthy                                                               
lifestyles  and social  wellbeing.   She  listed participants  to                                                               
include  elders,   seniors,  family   care  givers,   and  senior                                                               
providers.  She stated that the  issues raised at the forums were                                                               
similar to  the senior survey,  and included:  access  to primary                                                               
care and geriatric  specialists, and the need  for increased long                                                               
term support services.   She shared that the  rural forums stated                                                               
a need for the same services as  in the urban areas.  She cited a                                                               
need for hospice service and  family care giver training in rural                                                               
communities.   She reported that transportation,  senior housing,                                                               
and culturally  appropriate living facilities were  issues at all                                                               
of the  forums.  She  declared a need  for a "one-stop  shop" for                                                               
information and referral services.                                                                                              
                                                                                                                                
3:35:15 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO concluded  the PowerPoint  with  slide 32,  "Future                                                               
priorities  for addressing  senior needs  and concerns  include:"                                                               
She stated the  highest priority to be resolution  of the primary                                                               
health care access for Medicare recipients.                                                                                     
                                                                                                                                
3:36:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  asked for some strategies  to provide this                                                               
necessary access.                                                                                                               
                                                                                                                                
3:36:43 PM                                                                                                                    
                                                                                                                                
MS. DANIELLO,  in response, said  that two new  senior facilities                                                               
in Anchorage  would provide  services to  Medicare beneficiaries.                                                               
She  pointed to  legislation regarding  financial incentives  for                                                               
health care personnel to accept  Medicare patients.  She declared                                                               
that a  too small  health care  workforce was a  big issue.   She                                                               
advocated legislation  for both  loan repayment  and forgiveness,                                                               
and recruitment for health care providers to Alaska.                                                                            
                                                                                                                                
3:37:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  asked for details of  the administration's                                                               
strategy to  create opportunities for providers  to interact with                                                               
customers.   In response  to Chair Keller,  he explained  that he                                                               
had hoped  that Ms. Daniello,  as a professional, "had  the magic                                                               
wand."  He agreed that Medicare was a challenge for seniors.                                                                    
                                                                                                                                
3:40:06 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO, returning  attention to  slide 32,  emphasized the                                                               
need  for a  statewide long  term health  care plan,  which would                                                               
guide the  development of  quality senior care.   She  stated the                                                               
need for  a well-trained workforce,  more quality  senior housing                                                               
with  supportive   services  on  site,   expanded  transportation                                                               
service, a senior friendly  environment, and financial assistance                                                               
programs for seniors.                                                                                                           
                                                                                                                                
3:43:28 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER  asked  about  senior  centers  and  transportation                                                               
services in the  members' communities.  He opined  that there was                                                               
more federal funding than state grants.                                                                                         
                                                                                                                                
3:44:38 PM                                                                                                                    
                                                                                                                                
MS.  DANIELLO,  in response,  said  that  the state  did  receive                                                               
federal funding for transportation  services, as well as spending                                                               
state general funds for senior services.                                                                                        
                                                                                                                                
CHAIR KELLER  suggested that efficiencies  were a  necessary part                                                               
of the long term care program.                                                                                                  
                                                                                                                                
3:45:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON explained  that Homer  and Cooper  Landing                                                               
had  a senior  van, with  plans for  the development  of a  small                                                               
private bus system.   He noted that a  voucher system, contracted                                                               
with  the   local  taxi  companies,   had  been   another  senior                                                               
transportation solution.                                                                                                        
                                                                                                                                
MS. DANIELLO pointed out that  seniors contributed more than $1.7                                                               
billion to the state.                                                                                                           
                                                                                                                                
3:47:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON,  reflecting on an earlier  presentation to                                                               
HHSS  on  prevention  and disease,  suggested  working  with  the                                                               
senior community on these issues.                                                                                               
                                                                                                                                
3:48:17 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER reflected that he had  read that one dollar spent on                                                               
health prevention saved three dollars.                                                                                          
                                                                                                                                
3:48:37 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:48 p.m. to 3:50 p.m.                                                                       
                                                                                                                                
^Long Term Care Ombudsman                                                                                                     
                    Long Term Care Ombudsman                                                                                
                                                                                                                              
3:50:36 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced  that the next order of  business would be                                                               
a presentation from the long term care ombudsman.                                                                               
                                                                                                                                
DIANA WEBER,  Ombudsman, Long Term Care  Ombudsman, Alaska Mental                                                               
Health Trust  Authority, presented a PowerPoint  entitled "Office                                                               
of  the Long  Term  Care Ombudsman,"  [Included  in the  members'                                                               
packets].   She explained that the  Office of the Long  Term Care                                                               
Ombudsman (OLTCO) was  a small program with a small  budget and a                                                               
big mission.  She referred  to slide 1, "Authority" and explained                                                               
that the federal Older Americans Act  of 1965 gave the office its                                                               
authority.   She reported  that the job  was "to  investigate and                                                               
resolve complaints on behalf of  seniors in long term care," with                                                               
the idea  of protecting  elders who  were not  able to  speak for                                                               
themselves.    She  directed attention  to  AS  47.62.015,  which                                                               
authorized OLTCO  to investigate  and resolve complaints  made by                                                               
or  on  behalf of  older  Alaskans  in  long  term care,  if  the                                                               
complaint relates  to a decision, action  or failure to act  by a                                                               
provider or  by a  public agency or  social services  agency that                                                               
may adversely  affect the health,  safety, welfare, or  rights of                                                               
an  older   Alaskan.     She  explained   that,  as   her  office                                                               
investigated  complaints  in  all   agencies,  it  could  not  be                                                               
administered in Department of Health and Social Services.                                                                       
                                                                                                                                
3:54:41 PM                                                                                                                    
                                                                                                                                
MS. WEBER,  referring to slide 2,  "OLTCO Enforcement Authority,"                                                               
clarified that  her office was  not a regulatory agency,  and did                                                               
not have enforcement authority.   She declared that the OLTCO had                                                               
broad powers  to investigate, but  did not take away  licenses or                                                               
enforce changes.   She added  that the Older Americans  Act (OAA)                                                               
offered a  broader mandate  which allowed  for the  monitoring of                                                               
conditions in  long term care  facilities.  She reflected  on the                                                               
difficulty of monitoring all of  the long term care facilities in                                                               
Alaska on a regular basis.                                                                                                      
                                                                                                                                
3:56:51 PM                                                                                                                    
                                                                                                                                
MS. WEBER referred to slide 3,  "OAA Mandate to OLTCO" and stated                                                               
its  charge of  advocating  for vulnerable  seniors, which  could                                                               
include  legislative   advocacy,  and   the  raising   of  public                                                               
awareness to  the needs of elders.   She pointed out  that Alaska                                                               
included  OLTCO to  be responsible  for  investigating long  term                                                               
abuse and neglect in long term care facilities.                                                                                 
                                                                                                                                
3:57:08 PM                                                                                                                    
                                                                                                                                
MS.  WEBER addressed  slide  4,  "Administration," and  explained                                                               
that  the OLTCO  was a  part of  the Alaska  Mental Health  Trust                                                               
Authority operations, and  was represented in court  by the state                                                               
Attorney General.                                                                                                               
                                                                                                                                
3:57:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  asked if the Attorney  General always came                                                               
to its defense.                                                                                                                 
                                                                                                                                
MS.  WEBER replied  that although  the Attorney  General was  the                                                               
lawyer for  the OLTCO  it was her  responsibility to  ensure that                                                               
the Attorney  General had reviewed  the policies  and procedures,                                                               
and that OLTCO was not going beyond its mandate.                                                                                
                                                                                                                                
3:58:42 PM                                                                                                                    
                                                                                                                                
MS. WEBER  returned attention to  slide 4, explained  the sources                                                               
of  funding,   and  stated  that   the  OLTCO  funding   was  not                                                               
increasing.                                                                                                                     
                                                                                                                                
3:59:14 PM                                                                                                                    
                                                                                                                                
MS. WEBER, summarizing slide 5,  "Staff and Volunteers," conveyed                                                               
that  the  five  OLTCO  staff were  responsible  for  unannounced                                                               
"friendly visits"  to monitor  facilities, consultation  with the                                                               
public, and training for providers  and volunteers.  She reported                                                               
that there were 12 volunteer ombudsmen in 23 facilities.                                                                        
                                                                                                                                
4:00:38 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER  asked  for more  information  about  the  provider                                                               
training.                                                                                                                       
                                                                                                                                
4:00:52 PM                                                                                                                    
                                                                                                                                
MS. WEBER,  in response to  Chair Keller, said that  the assisted                                                               
living provider training was supplied under the OAA mandate.                                                                    
                                                                                                                                
4:01:59 PM                                                                                                                    
                                                                                                                                
MS.  WEBER reported  that the  OLTCO was  busier, as  the average                                                               
number  of  complaints  had  increased,  as  shown  on  slide  6,                                                               
"Complaints  and  Cases."   She  clarified  that these  could  be                                                               
multiple complaints about the same  incident.  She pointed to the                                                               
increase  in average  number  of  cases opened  each  month as  a                                                               
better indicator of the number of people served.                                                                                
                                                                                                                                
4:02:59 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER asked  if the  complaints typically  came from  the                                                               
family.                                                                                                                         
                                                                                                                                
MS. WEBER  replied that the  complaints were received  from every                                                               
possible source.                                                                                                                
                                                                                                                                
4:03:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  reflected that this report  indicated that                                                               
the ombudsman was doing their job.                                                                                              
                                                                                                                                
4:04:05 PM                                                                                                                    
                                                                                                                                
MS. WEBER  shared that complaints  to OLTCO had dropped  in other                                                               
states, and she  attributed this to a larger  number of volunteer                                                               
ombudsman.                                                                                                                      
                                                                                                                                
4:04:42 PM                                                                                                                    
                                                                                                                                
MS. WEBER  referenced slide 7,  "Complaints FY 2011,"  and stated                                                               
that  90 percent  of the  complaints were  about assisted  living                                                               
facilities, and the  top three complaints were:   poor medication                                                               
management practices;  falls and improper handling  of residents;                                                               
and shortage of staff.                                                                                                          
                                                                                                                                
4:05:50 PM                                                                                                                    
                                                                                                                                
MS.  WEBER   directed  attention  to  slide   8,  "Resolution  of                                                               
Complaints  July  1,  2010-January  31, 2011,"  and  stated  that                                                               
outcome data was important to review.   She stated that OLTCO had                                                               
resolved 67 percent of the  complaints to the satisfaction of the                                                               
resident or  the complainant.   She noted  that OAA  had mandated                                                               
that resolution be to the satisfaction of the senior.                                                                           
                                                                                                                                
REPRESENTATIVE  HERRON   asked  to   clarify  how  many   of  the                                                               
complaints were just a need for attention.                                                                                      
                                                                                                                                
MS. WEBER replied  that these were real complaints,  and that she                                                               
was  impressed that  the elder  generation did  not ask  for more                                                               
than they  needed.   Returning to  the resolution  of complaints,                                                               
she reported that  23 percent of the complaints  were referred to                                                               
another  agency for  resolution, while  only 1  percent were  not                                                               
resolved to the satisfaction of the residents or complainants.                                                                  
                                                                                                                                
4:08:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked for a distinction  between cases and                                                               
complaints.                                                                                                                     
                                                                                                                                
4:09:07 PM                                                                                                                    
                                                                                                                                
MS. WEBER,  in response, said  that the cases opened  referred to                                                               
the  people served,  and could  include many  people experiencing                                                               
the same  problem.  She  explained that the computation  of cases                                                               
and complaints was  determined by the OAA.  She  agreed that this                                                               
was complicated.   She  replied that many  people could  have the                                                               
same  complaint, or  one individual  could have  many complaints.                                                               
She clarified  that the number  of cases reflected the  number of                                                               
people making complaints.                                                                                                       
                                                                                                                                
4:11:41 PM                                                                                                                    
                                                                                                                                
MS. WEBER  moved on to slide  9, "Improving the System  of Care."                                                               
She explained  that volunteer ombudsmen  received about  20 hours                                                               
of  training and  practicum, and  were assigned  between two  and                                                               
five homes.  She noted that  they visited residents once or twice                                                               
each month in order to  identify problems and resolve them before                                                               
someone  was  hurt.    She  listed  some  of  the  problems  that                                                               
volunteers  resolved:   home too  cold,  medications not  managed                                                               
properly, meals not adequate, and dirty bathrooms.                                                                              
                                                                                                                                
4:13:21 PM                                                                                                                    
                                                                                                                                
MS. WEBER considered slide 11,  "Collaboration," and informed the                                                               
committee that  OLTCO was reaching  out to the  Filipino American                                                               
ALH Provider Association for mutual problem-solving.                                                                            
                                                                                                                                
MS. WEBER  indicated slide  12, "FY  2012 Budget,"  and explained                                                               
that the OLTCO operating budget  was in the Department of Revenue                                                               
(DOR),  and in  the  Mental Health  bill, also  under  DOR.   She                                                               
requested a  continuance of funding for  an existing investigator                                                               
position,  which  would  allow  OLTCO  to  pursue  its  statutory                                                               
mandate.                                                                                                                        
                                                                                                                                
4:15:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MILLETT asked  about the length of  tenure for the                                                               
volunteers.                                                                                                                     
                                                                                                                                
MS. WEBER  replied that the tenure  had not been longer  than one                                                               
year,  possibly  because  there  was not  enough  support.    She                                                               
established  that she  had reorganized  to add  more support  and                                                               
supervision for the volunteers.                                                                                                 
                                                                                                                                
4:16:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HERRON, referring  to  the  OLTCO website,  asked                                                               
about the catalyst for "Watch Your Language."                                                                                   
                                                                                                                                
MS. WEBER  explained that this  was a gentle reminder  to respect                                                               
the seniors' dignity.                                                                                                           
                                                                                                                                
4:16:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HERRON  offered  his  opinion  that  "Watch  Your                                                               
Language" implied that  staff in the assisted  living homes spoke                                                               
languages other than English.                                                                                                   
                                                                                                                                
4:17:24 PM                                                                                                                    
                                                                                                                                
MS.  WEBER, in  response,  said that  "Watch  Your Language"  was                                                               
developed prior to  her arrival, and she did not  know the reason                                                               
for  its creation.    She acknowledged  an  ongoing concern  that                                                               
staff  did  not  speak  English  well enough  to  respond  in  an                                                               
emergency, and she pointed to  the necessity of understanding the                                                               
elders and being able to respond.                                                                                               
                                                                                                                                
REPRESENTATIVE HERRON asked to clarify  that this referred to the                                                               
caregivers.                                                                                                                     
                                                                                                                                
MS.  WEBER  confirmed that  it  was  a licensing  regulation  for                                                               
caregivers  to have  the [language]  ability to  make a  coherent                                                               
emergency report.                                                                                                               
                                                                                                                                
^Community Care Coalition                                                                                                     
                    Community Care Coalition                                                                                
                                                                                                                              
4:18:44 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced  that the next order of  business would be                                                               
a presentation by the Community Care Coalition.                                                                                 
                                                                                                                                
SANDRA  HEFFERN,   Chair,  explained  that  the   Community  Care                                                               
Coalition  was a  newly formed  coalition of  trade associations,                                                               
which   included:       Alaska   Association   on   Developmental                                                               
Disabilities,  AGENET,  and  Personal Care  Assistant  Provider's                                                               
Association.   She summarized  that the  common issues  for these                                                               
organizations   allowed   for   the  efficiency   of   collective                                                               
representation.   She identified  the primary  problem to  be the                                                               
need for  long term  care plan,  as it  was a  complex fragmented                                                               
system  which needed  to become  comprehensive and  viable.   She                                                               
pointed out  that the  highest single  cost for  providing health                                                               
and human  services was  labor.   She reflected  on the  need for                                                               
additional  labor support  as the  Alaska population  aged.   She                                                               
reported  that the  retirement industry  brought $1.7  billion to                                                               
the  state economy.   She  opined that  the infrastructure  of an                                                               
efficient long term care system  was necessary for people to stay                                                               
in the  state.  She  offered her  belief that enough  studies had                                                               
been done and  she reflected on the history of  human services in                                                               
Alaska.   She  spoke  about the  waiver  system for  individuals,                                                               
normally going into  a nursing home, to choose  a community based                                                               
setting.  She pointed out that  the cost was less to serve people                                                               
living in the community.                                                                                                        
                                                                                                                                
4:26:44 PM                                                                                                                    
                                                                                                                                
MS.  HEFFERN  endorsed  the  jobs  provided  by  community  based                                                               
services  and personal  care assistant  services for  people with                                                               
disabilities.   She  referred to  page  3 of  the handout  "Brief                                                               
Overview of the Long Term Care  System in Alaska: We need a Plan"                                                               
[Included  in members'  packets].   She listed  the groups  which                                                               
comprised the  current long  term care system  to include:   home                                                               
and community  based grantees, Medicaid home  and community based                                                               
providers,    private   pay    provider   companies,    Veteran's                                                               
Administration, and  mental health  providers.  She  also pointed                                                               
out the boards and commissions,  which included the Alaska Mental                                                               
Health Trust Authority and the Alaska Commission on Aging.                                                                      
                                                                                                                                
4:31:01 PM                                                                                                                    
                                                                                                                                
MS. HEFFERN  offered her belief  that all of these  groups needed                                                               
to  be  coordinated.    She  directed  attention  to  the  recent                                                               
studies,  page 4  of the  handout,  and elaborated  on the  Lewin                                                               
Group: Long Term Forecast of  Medicaid Enrollment and Spending in                                                               
Alaska: 2005-2025;  and the  Public Consulting  Group-Alaska Long                                                               
Term Care and  Cost Study February 2006.  She  declared that long                                                               
term care was not only  about aging people, but included patients                                                               
with dementia,  traumatic brain injuries,  physical disabilities,                                                               
and  developmental disabilities.   She  ascertained that  none of                                                               
the reports offered a vision of  direction:  "where it is that we                                                               
are going, so  that we can actually  get there.  What  is it that                                                               
we want, what is  it that the system needs to  have and then have                                                               
a road map for how we're going to actually get there."                                                                          
                                                                                                                                
4:34:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DICK asked  for  a definition  of the  government                                                               
role  and  the  individual  role and  he  reflected  on  personal                                                               
responsibility.                                                                                                                 
                                                                                                                                
4:35:47 PM                                                                                                                    
                                                                                                                                
MS.   HEFFERN   agreed   that    the   acceptance   of   personal                                                               
responsibility was  important.  She  reflected on long  term care                                                               
insurance  as  one  piece  of   the  system  that  needed  to  be                                                               
redesigned.                                                                                                                     
                                                                                                                                
4:37:37 PM                                                                                                                    
                                                                                                                                
MS. HEFFERN referred to the  HCBS Strategies: Recommendations for                                                               
the Alaska Long Term Care Plan,  2008 Report.  She indicated that                                                               
the study had good recommendations  and guidance, and she pointed                                                               
out the necessity of "knowing who  you're serving, who is it that                                                               
belongs to  the long term care  system."  She suggested  a review                                                               
of  this study  as a  start for  a comprehensive  long term  care                                                               
plan.    She expressed  her  concern  that  none of  the  studies                                                               
contained a vision  statement for "what the system  needs to look                                                               
like."   She  directed attention  to  page 8  and page  9 of  the                                                               
handout, and spoke  about the current considerations  in the long                                                               
term care  industry.  She spoke  about the Department of  Labor &                                                               
Workforce  Development  Alaska   Economic  Trends  report,  which                                                               
declared that health  care and social assistance  was expected to                                                               
experience the  largest amount  of growth  of any  industry, 26.5                                                               
percent  or  9,400 jobs,  through  2018.   She  reviewed  another                                                               
analysis  by the  Department of  Commerce,  Community &  Economic                                                               
Development, which identified community  and social assistance as                                                               
an economic driver, and a key area for additional attention.                                                                    
                                                                                                                                
4:41:03 PM                                                                                                                    
                                                                                                                                
MS.  HEFFERN   summarized  that   the  Alaska   Health  Workforce                                                               
Development Plan,  Health Workforce Coalition, May  2010 reported                                                               
that  health  care  was  one  of the  largest  and  most  dynamic                                                               
industries in  Alaska, with a  payroll of more than  $1.4 billion                                                               
in 2008.   She  noted that  the Health  Care Commission  was also                                                               
exploring long  term care, and  that the Medicaid task  force was                                                               
reviewing cost containment for long term care.                                                                                  
                                                                                                                                
4:42:20 PM                                                                                                                    
                                                                                                                                
MS.  HEFFERN, referring  to  page  10 of  the  handout, issued  a                                                               
challenge from the Community Care  Coalition to the Department of                                                               
Health and  Social Services, Department of  Commerce, Community &                                                               
Economic   Development,   Department   of   Labor   &   Workforce                                                               
Development, Department  of Education and Early  Development, and                                                               
the Administration to  work in concert for a long  term care plan                                                               
to  "address a  vision  for quality,  accessible, available,  and                                                               
sustainable services."   She opined  that a long term  plan would                                                               
include  cost  containment,  as  it would  be  a  more  efficient                                                               
system.                                                                                                                         
                                                                                                                                
4:44:37 PM                                                                                                                    
                                                                                                                                
MS. HEFFERN, in response to  Representative Herron, said that two                                                               
weeks  prior  she  had  met   with  the  governor's  office,  and                                                               
presented this challenge to them, as well.                                                                                      
                                                                                                                                
4:45:00 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER  asked  what  percentage  of  long  term  care  was                                                               
Medicaid.                                                                                                                       
                                                                                                                                
4:45:47 PM                                                                                                                    
                                                                                                                                
MS. HEFFERN  replied that 30  percent of the Medicaid  budget was                                                               
for long term care.                                                                                                             
                                                                                                                                
4:46:18 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked  how this cost would project in  the next five                                                               
to ten  years.  He declared  that it was necessary  to define who                                                               
was being served.                                                                                                               
                                                                                                                                
4:47:04 PM                                                                                                                    
                                                                                                                                
MS. HEFFERN agreed that it was  necessary to define who was being                                                               
served in the long term care system.                                                                                            
                                                                                                                                
4:47:32 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  final order of business would be                                                               
a response from the Department of Health and Social Services.                                                                   
                                                                                                                                
PAT  HEFLEY, Deputy  Commissioner,  Office  of the  Commissioner,                                                               
Department of  Health and  Social Services,  said that  there was                                                               
not a magic  wand to increase access to primary  health care, and                                                               
he stated that  Alaska was not the only state  with this problem.                                                               
He detailed the need for a  skilled work force, a balanced demand                                                               
for providers, and more community  health centers.  He stated the                                                               
need to resolve the financial  issues around the Medicaid budget.                                                               
He stated that DHSS was ready  to address a long term health care                                                               
plan, and  he agreed with  the suggestion to review  the existing                                                               
plans for recommendations.                                                                                                      
                                                                                                                                
4:53:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DICK asked why the health care costs were rising.                                                                
                                                                                                                                
4:55:25 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked  if the earlier description to the  make up of                                                               
the long term health care system was comprehensive.                                                                             
                                                                                                                                
4:56:42 PM                                                                                                                    
                                                                                                                                
MR.  HEFLEY agreed  that  the existing  studies  would offer  the                                                               
"backbone to start from."                                                                                                       
                                                                                                                                
4:56:53 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER asked for a defined  break down of all the providers                                                               
in the current long term care  system, and the related costs.  He                                                               
opined  of the  difficulty for  making decisions  without knowing                                                               
who each was affecting.                                                                                                         
                                                                                                                                
MR. HEFLEY  replied that he would  get those provider costs.   He                                                               
reflected on the difficulty of  recognizing the impacts of budget                                                               
cuts.                                                                                                                           
                                                                                                                                
4:58:47 PM                                                                                                                    
                                                                                                                                
MR.   HEFLEY,   in  response   to   an   earlier  question   from                                                               
Representative  Dick, explained  that until  a financial  cap was                                                               
put  on  the insurance  industry,  the  provider system,  or  the                                                               
customer base then costs would continue to rise.                                                                                
                                                                                                                                
4:59:47 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:59 p.m.                                                                                                          

Document Name Date/Time Subjects
OLTCO Feb 2011.pptx HHSS 2/22/2011 3:00:00 PM
ACoA House HSS Presentation 2011.ppt HHSS 2/22/2011 3:00:00 PM
Outline for HSS Presentation(a)Community Care Coalition.docx HHSS 2/22/2011 3:00:00 PM