Legislature(2019 - 2020)DAVIS 106

02/25/2020 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:20:10 PM Start
03:20:48 PM Presentation: Alaska Health Care: a Changing Landscape
03:59:42 PM Presentation: Bethel Coalition on Housing & Homelessness
04:48:44 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed 15 Minutes --
- Alaska Health Care: A Changing Landscape by
Jared Kosin, Alaska State Hospital & Nursing
Home Assoc.
- Alaska Coalition on Housing & Homelessness by
Michelle DeWitt, Bethel Community Services
Eileen Arnold, Tundra Women's Coalition
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       February 25, 2020                                                                                        
                           3:20 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Tiffany Zulkosky, Chair                                                                                          
Representative Ivy Spohnholz, Vice Chair                                                                                        
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson                                                                                                   
Representative Lance Pruitt                                                                                                     
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
PRESENTATION: ALASKA HEALTH CARE: A CHANGING LANDSCAPE                                                                          
     - HEARD                                                                                                                    
PRESENTATION: BETHEL COALITION ON HOUSING & HOMELESSNESS                                                                        
     - HEARD                                                                                                                    
PREVIOUS COMMITTEE ACTION                                                                                                     
No previous action to record                                                                                                    
WITNESS REGISTER                                                                                                              
JARED KOSIN, President and CEO                                                                                                  
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a PowerPoint titled "Alaska                                                                    
Health Care: A Changing Landscape."                                                                                             
EILEEN ARNOLD, Executive Director                                                                                               
Tundra Women's Coalition                                                                                                        
Bethel, Alaska                                                                                                                  
POSITION  STATEMENT:    Presented  a  PowerPoint  titled  "Bethel                                                             
Coalition on Housing & Homelessness."                                                                                           
JON COCHRANE, President                                                                                                         
Board of Directors                                                                                                              
Bethel Winter House                                                                                                             
Bethel, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  during  a  presentation by  the                                                             
Bethel Coalition on Housing & Homelessness.                                                                                     
MICHELLE DeWITT, Executive Director                                                                                             
Bethel Community Services Foundation                                                                                            
Bethel, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  during  a  presentation by  the                                                             
Bethel Coalition on Housing & Homelessness.                                                                                     
ARIEL HERMAN, Project Analyst                                                                                                   
Bethel Housing and Homelessness Coalition                                                                                       
Wasilla, Alaska                                                                                                                 
POSITION  STATEMENT:   Testified  during  a  presentation by  the                                                             
Bethel Coalition on Housing & Homelessness.                                                                                     
ACTION NARRATIVE                                                                                                              
3:20:10 PM                                                                                                                    
CHAIR  TIFFANY  ZULKOSKY  called  the  House  Health  and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:20  p.m.                                                               
Representatives Zulkosky,  Spohnholz, Jackson, Tarr,  Claman, and                                                               
Drummond  were present  at  the call  to  order.   Representative                                                               
Pruitt arrived as the meeting was in progress.                                                                                  
^Presentation: Alaska Health Care: A Changing Landscape                                                                       
     Presentation: Alaska Health Care: A Changing Landscape                                                                 
3:20:48 PM                                                                                                                    
CHAIR ZULKOSKY announced  that the first order  of business would                                                               
be  a  presentation  titled  "Alaska   Health  Care:  A  Changing                                                               
3:21:23 PM                                                                                                                    
JARED  KOSIN,  President  and  CEO,  Alaska  State  Hospital  and                                                               
Nursing Home Association (ASHNHA),  presented a PowerPoint titled                                                               
"Alaska Health Care: A Changing  Landscape, directed attention to                                                               
slide 1, "A Changing Landscape,"  and stated that health care was                                                               
constantly changing.                                                                                                            
3:22:39 PM                                                                                                                    
MR. KOSIN paraphrased slide 2, "Why Health Care?" which read:                                                                   
     Hospitals and nursing homes contribute $4.5 billion to                                                                     
     Alaska's economy                                                                                                           
     ? 9% of Southeast's regional workforce                                                                                     
     ? 24% wage growth over past 3 years                                                                                        
     ? $569 million in economic impact to Southeast AK                                                                          
MR. KOSIN stated that health  care was economically relevant, and                                                               
he moved on  to slide 3, "What is Changing?"   He emphasized that                                                               
cost of care  was very high, and it was  possible to forecast the                                                               
demand by  looking at  the national level,  the state  level, and                                                               
the local  level.  He stated  that health care was  moving toward                                                               
an ambulatory setting whenever possible,  at a lower cost, and in                                                               
a way  that was far  more accessible.   He directed  attention to                                                               
Medicare,  stating that  it was  "a  huge driver  of health  care                                                               
policy  in the  country,  as it  should be."    He reported  that                                                               
Medicare had put  forward new rules for  total knee replacements,                                                               
which  had historically  been in-patient  procedures for  surgery                                                               
and recovery  but would now  fundamentally shift to  presume that                                                               
these were out-patient procedures.   He declared that all medical                                                               
professional groups believed that the  cost of care was too high,                                                               
a challenge that needed to be  solved.  He reported that Medicaid                                                               
funding  was   a  constant  dialogue.     He  pointed   out  that                                                               
transparency laws were happening  everywhere, and he acknowledged                                                               
the  difficulty for  understanding an  "explanation of  benefits"                                                               
and the  cost of  care.   He reiterated that  the demand  was for                                                               
care in  an ambulatory  setting, at  a lower  cost, and  far more                                                               
accessible to the consumer.                                                                                                     
3:27:17 PM                                                                                                                    
MR. KOSIN turned to slide 4,  "What Does Change Look Like in AK?"                                                               
He declared  that there are  capacity challenges in  Alaska which                                                               
will change the reflection of  the national changes.  He reported                                                               
that Alaska averages  two hospital beds per  one thousand people,                                                               
and that  only eight other  states have  a lower ratio  for acute                                                               
care beds.   He noted that,  however, many of those  other states                                                               
had  robust  community  systems  in place  to  provide  a  viable                                                               
alternative for hospital care, and  that Alaska did not have this                                                               
alternative.   He  added that  21 percent  of the  beds were  not                                                               
accessible  from the  road system,  another  challenge unique  to                                                               
Alaska.   He reported that Alaska  had the fewest long  term care                                                               
beds, regardless  of per capita  or facility size, in  the United                                                               
States.  He emphasized that this was a major problem.                                                                           
REPRESENTATIVE TARR  asked if  the 19  long term  care facilities                                                               
were only taking elderly patients,  and what would be the optimum                                                               
number to address the unmet need.   She asked if these were state                                                               
or privately run facilities.                                                                                                    
MR.  KOSIN  replied  that,  as  these  were  traditional  skilled                                                               
nursing care  facilities, it was  necessary to meet  the criteria                                                               
for this  care and that  age was not  a factor.   He acknowledged                                                               
that the Alaska Psychiatric Institute  (API) was not reflected on                                                               
the slide.   He reported that  Alaska was "by far  and away lower                                                               
than  anywhere else  in  the  country" for  acute  care beds  for                                                               
behavioral health, the  API type beds that  existed in Fairbanks,                                                               
in  Anchorage,  in Juneau,  and  in  the Matanuska-Susitna.    He                                                               
described  that these  beds came  with  very specific  behavioral                                                               
health services, including psychiatry  with a secure environment.                                                               
He declared that the lack of the API beds was "a true crisis."                                                                  
3:31:23 PM                                                                                                                    
MR. KOSINs shared slides 5 and  6, "What Does Change Look Like in                                                               
AK?" a graph which depicted a  continuum of care.  He stated that                                                               
it was  desired to  have robust  community services  because that                                                               
was the cheapest place to  receive health care.  Using behavioral                                                               
health as  an example,  he declared that  the best  investment in                                                               
community  care was  to have  counselors, peer  to peer  support,                                                               
supported  housing,  and  other   support  services.    If  those                                                               
services were not available, a person  would go to the primary or                                                               
specialty care doctor.  If there  was a crisis, a person would go                                                               
to the emergency  department.. He described this  as an efficient                                                               
access to  higher levels of  care as  necessary.  He  pointed out                                                               
that "the  real story  is how  do you  get down  from that?"   He                                                               
offered  the  example for  a  discharge  from  a hospital  to  an                                                               
assisted living care facility, which  was a lot cheaper; however,                                                               
as Alaska  did not  have that capacity  for assisted  living care                                                               
facilities,  a  bottleneck  was  created and  there  was  not  an                                                               
efficiency  to flow  within this  continuum of  care.   He shared                                                               
examples of  patient difficulties  for discharge  from hospitals,                                                               
as there was not long-term care  available.  He pointed out that,                                                               
if  the  patient did  not  meet  the  criteria  for care  in  the                                                               
hospital, but  was forced to  stay in  the hospital as  there was                                                               
not a facility  to which to release them, the  hospital would not                                                               
be paid,  or be severely  underfunded, for continuing  their care                                                               
while  waiting.   System inefficiencies  drive  and trap  patient                                                               
care at the  highest cost point.  He  emphasized that significant                                                               
capacity challenges had  to be factored when  addressing the cost                                                               
of health care in Alaska.                                                                                                       
3:37:26 PM                                                                                                                    
MR. KOSIN  moved on to  paraphrase slide  7, "What to  Focus On?"                                                               
which read [original punctuation provided]:                                                                                     
     Understand our Situation                                                                                                   
     ? Capacity is Fragile; Don't Undermine                                                                                     
     Support Innovation                                                                                                         
     ? Nuka System of Care                                                                                                      
     ? Crisis Intervention                                                                                                      
     ? Coordinated Care                                                                                                         
     Look at the Data                                                                                                           
       ? 73% of Medicaid spend is from those with chronic                                                                       
     ? Approx ? of the population drives ? of spend                                                                             
MR. KOSIN declared that it  was necessary to focus on innovation,                                                               
directing attention  to the tribal  health care system,  which he                                                               
described as "years ahead in many  respects of the work we see in                                                               
other aspects  of the  health care  system."   He pointed  to the                                                               
coordination and the ability to  transfer with a tertiary landing                                                               
spot.  He  referenced the Nuka System of Care  which had received                                                               
national awards for redesigning health  care delivery to focus on                                                               
the  patient and  their  needs.   He  spoke  about  a program  at                                                               
Bartlett  Hospital   in  Juneau  which  was   taking  its  crisis                                                               
intervention program  out to delivery  care on the  street before                                                               
it  came into  the hospital.   He  declared that  there was  real                                                               
progress  demonstrated  for  major  cost savings  when  care  was                                                               
coordinated,  especially with  avoided  visits  to the  emergency                                                               
room.     He  concluded,  stating  that   patients  with  chronic                                                               
conditions were about 25 percent  of the Medicaid population, but                                                               
accounted  for 73  percent  of the  costs.   He  shared that  the                                                               
Alaska State  Hospital and Nursing  Home Association  was working                                                               
toward specific solutions and "trying  things new" with different                                                               
approaches.   He  declared  that  it was  necessary  to focus  on                                                               
treating  people more  efficiently and  effectively in  the right                                                               
REPRESENTATIVE  DRUMMOND   asked  what   was  the   problem  with                                                               
MR. KOSIN replied  that the problem was capacity.   He pointed to                                                               
the states with  acute care bed capacity, noting  they had robust                                                               
health systems  with greater access  to care.  He  reported that,                                                               
although  Medicaid  paid,  on average,  26  percent  higher  than                                                               
Medicare in Alaska, this was very  nuanced as it was not true for                                                               
all Medicaid services as many costs  had been ratcheted down.  He                                                               
stated  that the  cost  of recruiting  specialties,  the cost  of                                                               
employing  people, the  access challenges  for Rural  Alaska, and                                                               
the small  population pockets were  all challenges which  did not                                                               
exist  in the  Lower  48  and made  the  Medicare  rate not  very                                                               
attractive in Alaska.                                                                                                           
REPRESENTATIVE  DRUMMOND shared  an anecdote  that 65  percent of                                                               
the mental  health treatment and  medication was  provided within                                                               
the prison population in Alaska,  about 5,000 inmates.  She asked                                                               
if Alaska State  Hospital and Nursing Home  Association was aware                                                               
of that in relation to the mental health services in the state.                                                                 
MR. KOSIN  stated that the  mental health stories  from hospitals                                                               
indicated  that, as  there was  no community  avenue for  people,                                                               
they ended  up in hospitals and  prisons.  He declared  that this                                                               
was not  good care for the  patient, not good for  the providers,                                                               
and very  expensive.  He  pointed out that hospitals  and nursing                                                               
homes  stood   united  with   the  community   behavioral  health                                                               
providers.     He  stated  that  building   in-patient  beds  and                                                               
increasing capacity would  still fail because there  were not the                                                               
services at  the community level  resulting in readmissions.   He                                                               
labeled  this as  "a  crisis in  the truest  sense,  and it's  an                                                               
expensive one, too."                                                                                                            
CHAIR ZULKOSKY shared a conversation  regarding the mental health                                                               
crisis  for capacity,  meeting needs  for  mental and  behavioral                                                               
health, and substance use treatment across the state.                                                                           
3:47:28 PM                                                                                                                    
REPRESENTATIVE  CLAMAN asked  about the  cost factors  for crisis                                                               
MR.  KOSIN said  that he  was  not able  to  speak to  this.   He                                                               
declared  that there  was support  for  investment from  hospital                                                               
systems to add in-patient behavioral  health beds, even though 68                                                               
- 70 percent  of patients with a primary  diagnosis of behavioral                                                               
health were  Medicaid patients,  a disproportionately  high payer                                                               
mix.  He  pointed out that, even though Medicaid  cuts would have                                                               
a huge affect on the  project's sustainability, there was a large                                                               
savings  from patients  not  staying in  the  emergency room  for                                                               
extended periods.   He added that this also  decreased the return                                                               
of  behavioral health  patients  to use  those  resources of  the                                                               
emergency rooms.   He stated that ideally, API would  "come up to                                                               
capacity and  ideally we would  have crisis  intervention centers                                                               
and they would work in tandem  and take the pressure off the rest                                                               
of the system."  He declared that  it was far cheaper to spend 23                                                               
hours in a crisis intervention center than an emergency room.                                                                   
REPRESENTATIVE  CLAMAN  noted that  this  seemed  similar to  the                                                               
corrections  problems of  cost drivers,  in that  it was  best to                                                               
deal with the  problem before the emergency room  or upon release                                                               
from the hospital with better services.                                                                                         
MR. KOSIN  offered his  belief that a  most profound  health care                                                               
project  in  the last  five  years  was  when the  Alaska  Native                                                               
Medical  Center, Providence  Alaska  Medical  Center, and  Alaska                                                               
Regional Hospital all came together  and invested in the creation                                                               
of respite care  at the Brother Francis Shelter.   He pointed out                                                               
that this  was three competitors  investing together  for respite                                                               
care  for a  safe  place  to discharge  homeless  patients and  a                                                               
chance for  sustained recovery outside  the hospital.   He stated                                                               
that this was cheaper for  the hospitals, cheaper for the system,                                                               
and cheaper for Medicaid, a win for everyone.                                                                                   
3:51:58 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ  clarified  that  it  was  Southcentral                                                               
Foundation  along  with  Providence  Alaska  Medical  Center  and                                                               
Alaska  Regional   Hospital  which  created   that  demonstration                                                               
project.    She  offered  her   belief  that  tribal  health  was                                                               
successful because  the system was  integrated, and that,  as the                                                               
funding structure  was different,  it allowed  them to  build out                                                               
the system  to meet the  needs and  to realize cost  savings with                                                               
the  investments.   She referenced  a managed  care demonstration                                                               
project in Alaska  that was recently pulled back,  and that there                                                               
had been  many opportunities  in health care  reform.   She asked                                                               
what he would do to  drive the system redesign without integrated                                                               
MR. KOSIN suggested funding  individual "cluster" projects before                                                               
working on shared savings to make it sustainable.                                                                               
3:56:06 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ  shared some  models that  split savings                                                               
between the state  and the community, which  were then reinvested                                                               
in social determinants  of health and asked  whether Alaska State                                                               
Hospital  and   Nursing  Home   Association  was   interested  in                                                               
exploring similar projects.                                                                                                     
MR. KOSIN  stated that his  success had  come, not from  home run                                                               
projects, but  from "singles that add  up over time and  make the                                                               
difference."   He  allowed that  an ASHNHA  member who  wanted to                                                               
work on  a project would  be supported  by the organization.   He                                                               
pointed out  that it was necessary  to do some modest  funding up                                                               
front, and  that small projects  could more easily  demonstrate a                                                               
return on investment, often in the second year.                                                                                 
3:58:19 PM                                                                                                                    
The committee took a brief at-ease.                                                                                             
^Presentation: Bethel Coalition on Housing & Homelessness                                                                     
    Presentation: Bethel Coalition on Housing & Homelessness                                                                
3:59:42 PM                                                                                                                    
CHAIR ZULKOSKY announced  that the final order  of business would                                                               
be  a  presentation   by  the  Bethel  Coalition   on  Housing  &                                                               
4:01:05 PM                                                                                                                    
EILEEN  ARNOLD,  Executive  Director, Tundra  Women's  Coalition,                                                               
directed attention to the  PowerPoint presentation titled "Bethel                                                               
Coalition  on  Housing &  Homelessness."    She shared  that  the                                                               
Bethel Coalition on  Housing & Homelessness had  started in 2017,                                                               
through  a  funding  requirement from  Tundra  Women's  Coalition                                                               
under  its basic  homelessness assistance  program.   She  shared                                                               
that there were many partners  involved with different aspects of                                                               
homelessness and  food security that were  eager to do work  in a                                                               
more comprehensive,  less siloed  way.   She reported  that since                                                               
the inception,  the goals and  the data collection  had increased                                                               
and there was "a lot of momentum right now."                                                                                    
4:02:31 PM                                                                                                                    
JON  COCHRANE,  President,  Board  of  Directors,  Bethel  Winter                                                               
House,  paraphrased  from slides  2  -  3, "Common  Terminology,"                                                               
which read:                                                                                                                     
     Balance-of-State:  All  areas   of  Alaska  EXCEPT  for                                                                    
     HMIS:  Homeless Management  Information System,  a HUD-                                                                    
     required database;  participation is mandatory  for HUD                                                                    
     homeless funding recipients                                                                                                
     Alaska  Coalition   on  Housing  &   Homelessness:  the                                                                    
     statewide  Coalition for  all  areas  of Alaska  EXCEPT                                                                    
     Anchorage  (the Anchorage  Coalition  is  known as  the                                                                    
     Anchorage  Coalition to  End Homelessness).  The Alaska                                                                    
     Coalition  is  located in  Juneau  and  staffed by  one                                                                    
     full-time and one part-time person.                                                                                        
     Project  Homeless Connect:  an  event  held to  provide                                                                    
     services to homeless individuals in a community                                                                            
     Point-in-Time:   An   effort   to  count   all   people                                                                    
     experiencing homelessness  on one  particular day  in a                                                                    
     community;  typically, this  count is  conducted across                                                                    
     the nation on one day in January                                                                                           
     Coordinated  Entry:  coordinated   entry  system  which                                                                    
     provides   a  process   for  conducting   comprehensive                                                                    
     entries of  housing and services needs  for individuals                                                                    
     and families.                                                                                                              
     Continuum of  Care: HUD designed the  Continuum of Care                                                                    
     (CoC) Program  to promote community-wide  commitment to                                                                    
     the goal  of ending  homelessness; provide  funding for                                                                    
     efforts  by nonprofit  providers, and  State and  local                                                                    
     governments  to  quickly rehouse  homeless  individuals                                                                    
     and families. Continuum  of Care is both  funding and a                                                                    
     coordinated community or  regional approach. In Alaska,                                                                    
     Anchorage is one Continuum of  Care and the rest of the                                                                    
     state is the Balance-of-State CoC (determined by HUD).                                                                     
MS. ARNOLD stated that, as time was limited, much of the                                                                        
information was included in the PowerPoint slides.                                                                              
4:03:30 PM                                                                                                                    
MICHELLE  DeWITT, Executive  Director, Bethel  Community Services                                                               
Foundation, stated that  when the group formed,  there were three                                                               
goals:   the  seasonal  homeless  shelter would  be  an all  year                                                               
shelter; explore  Housing First; and address  youth homelessness.                                                               
She said  that the goals had  grown and multiplied, as  there was                                                               
permanent support of Housing First which  had grown into a lot of                                                               
data  collection  in  order  to  know who  was  homeless  in  the                                                               
community and what services they  utilized.  She added that youth                                                               
homelessness had  recently grown.   She  reported that  there was                                                               
now a memorandum of understanding and a strategic plan.                                                                         
MS.    DeWITT   paraphrased    slide    6,   "Bethel    Coalition                                                               
Accomplishments, 2017  2019,which read:                                                                                         
      Project Homeless Connect and Point-In-Time Counts &                                                                       
      Data: Introduction of questions relevant to Bethel's                                                                      
        population and service development & first-ever                                                                         
     creation of a Bethel by-name list                                                                                          
     Housing First Research and Site Visit Trips                                                                                
     HMIS participation- Winter House and PHC; data-sharing                                                                     
     agreements completed with four organizations                                                                               
MS.  DeWitt reported  that  the safety  net  for homelessness  in                                                               
Bethel  was "extremely  thin"  with  an insignificant  investment                                                               
from the State  of Alaska.  She declared that  the incoming funds                                                               
were "used  extraordinarily well."   She offered two  examples of                                                               
funding  and paraphrased  slide  7,  "Current Homeless  Funding,                                                                
which read:                                                                                                                     
     Tundra Women's Coalition: AHFC HAP Funds: $52,609.85                                                                       
     Bethel Winter House Shelter: DHSS CIMG Funds $30,686                                                                       
     AVCP Regional Housing Authority: HUD VASH                                                                                  
     ONC: NAHASDA through IHBG.                                                                                                 
      NO Continuum of Care funds are entering the YK Delta                                                                      
MS.  DeWitt mentioned  that  there was  some  federal funding  to                                                               
address homelessness, which was  implemented through the Regional                                                               
Housing  Authority.   She  pointed  out that  there  was not  any                                                               
Continuum  of   Care  funding,  which  came   through  HUD  (U.S.                                                               
Department  of  Housing and  Urban  Development)  with an  Alaska                                                               
Housing Finance Corporation (AHFC)  match to address homelessness                                                               
at various levels.                                                                                                              
4:07:44 PM                                                                                                                    
MS. DeWITT  paraphrased slide 8,  "Current HUD Continuum  of Care                                                               
Funding in Alaska, which read:                                                                                                  
        The Last Round of HUD funding across the US for                                                                         
     Continuum of Care was more than $2 Billion.                                                                                
     Alaska's share, however, was only $4,688,499 across 30                                                                     
     $3,829,763 was awarded to 15 Anchorage-based projects                                                                      
      $858,736 was awarded to the Balance of State for 11                                                                       
        NO Continuum of Care funding is currently being                                                                         
     awarded in the YK Delta.                                                                                                   
4:08:41 PM                                                                                                                    
REPRESENTATIVE TARR  asked that the homeless  situation in Bethel                                                               
be placed in context.                                                                                                           
MR.  COCHRANE  shared  that  the Bethel  Winter  House  had  been                                                               
started six years  prior because there had  been several exposure                                                               
related  deaths that  winter.   Even  though no  one had  thought                                                               
about a shelter, a group from  the community was formed to do it.                                                               
He  shared that  there were  two  main types  of homelessness  in                                                               
Bethel, about  50 percent  of the guests  at Bethel  Winter House                                                               
were chronically  homeless, and  the other  50 percent  of guests                                                               
were situationally homeless.                                                                                                    
MS. ARNOLD  added that the  Winter House was a  seasonal homeless                                                               
shelter, noting that the guests could not be prioritized.                                                                       
4:10:33 PM                                                                                                                    
REPRESENTATIVE JACKSON asked about the number of homeless.                                                                      
MS. DeWITT  offered her belief that  there were between 60  - 100                                                               
homeless in the hub community of Bethel at any given time.                                                                      
MS.  ARNOLD added  that agencies  in Bethel  were often  regional                                                               
providers,  and, as  there  was  not any  data  collected in  the                                                               
village communities, it could be difficult to ascertain numbers.                                                                
REPRESENTATIVE  JACKSON asked  if  the coalition  was solely  for                                                               
Bethel or included the surrounding villages.                                                                                    
MS.  DeWITT  stated  that  the  coalition  had  regional  impact,                                                               
although they  were not  trying to  provide a  regional solution.                                                               
She  pointed out  that the  concentration of  data was  primarily                                                               
Bethel even  as there were  ripple effect impacts.   She reported                                                               
that they would  try to share the results of  the information, as                                                               
there  had  been  a  lot   of  myths  about  people  experiencing                                                               
homelessness.  She  pointed out that the coalition  had not fully                                                               
understood  the  experiences of  those  homeless  until they  had                                                               
asked "some very targeted questions."                                                                                           
4:13:19 PM                                                                                                                    
ARIEL HERMAN,  Project Analyst,  Bethel Housing  and Homelessness                                                               
Coalition,  presented  slide  10, "Completed  Data  Collections,                                                                
which read:                                                                                                                     
     Winter House 2018-2019 basic data                                                                                          
     ? January 2019 Project Homeless Connect                                                                                    
     ? Annual Point-in-Time Count                                                                                               
     ? Anonymous surveys                                                                                                        
     ? October 2019 Project Homeless Connect                                                                                    
     ? New, non-anonymous surveys                                                                                               
     ? Now tracking who is homeless (not just how many) in                                                                      
      order to better understand their needs and how this                                                                       
     group changes                                                                                                              
     ? Reports available for each collection                                                                                    
       ? Additionally, annual data available from Tundra                                                                        
       Women's Coalition (TWC), Bethel's only year-round                                                                        
     shelter (DV/SA)                                                                                                            
MS. HERMAN  shared slide 11,  "On-Going Data  Collections,which                                                                 
     ? Quarterly Project Homeless Connect                                                                                       
     ? Annual Point-in-Time Count done in January 2020                                                                          
     ? Non-anonymous surveys                                                                                                    
     ? Next event April 15, 2020 (Winter House's last week                                                                      
     for the season)                                                                                                            
     Winter House 2019-2020 season                                                                                              
     ? New intake paperwork and service tracking                                                                                
     ? Reports will be created and shared                                                                                       
4:15:20 PM                                                                                                                    
MS. ARNOLD  stated that  the Tundra  Women's Coalition  (TWC) had                                                               
been in existence  for more than 40 years, adding  that, in 2009,                                                               
a  new shelter  had been  built  which increased  capacity to  33                                                               
beds, with  a recent subsequent increase  to 43 beds.   She moved                                                               
on to slide  12, "Tundra Women's Coalition  Fiscal Year 2018-2019                                                               
Data,and    reported that  the TWC had  provided shelter  for 317                                                               
unduplicated people,  which included 137 children.   She declared                                                               
that this  was for almost  11,000 shelter nights, of  which, more                                                               
than 5,000 were children's shelter nights.                                                                                      
4:16:11 PM                                                                                                                    
MS.  HERMAN  declared  that slide  13,  "Winter  House  2018-2019                                                               
Data,reflected    the  data from  last year.   She  reported that                                                               
Winter  House was  open  for four  months,  with 216  individuals                                                               
served,  with  181  overnight  guests.   She  pointed  out  that,                                                               
although Winter House could not  serve children, and was not open                                                               
during  the day,  its  numbers had  increased  from the  previous                                                               
year.  She moved on to slide  14, "Winter House 2018   2019 Data:                                                               
Census,  and  reported that the  average number per night  was 17                                                               
guests, the  highest census  night was 32  guests for  dinner and                                                               
overnight, and 64 percent  of the nights had 1 -  19 guests.  She                                                               
added that more  than 20 guests were served on  25 percent of the                                                               
CHAIR  ZULKOSKY asked  to put  these figures  into context  for a                                                               
population sized similar to Bethel.                                                                                             
MS. DeWITT replied  that the population of Bethel was  a bit more                                                               
than 6,000 people.                                                                                                              
MS. HERMAN shared  that 200 distinct people over  the season were                                                               
served  at Winter  House, noting  that  "for many  of us,  pretty                                                               
shocking that  there were  that many people  that came  to Winter                                                               
House."  She addressed slide 15,  "Winter House 2018   2019 Data:                                                               
Time of Year," which read:                                                                                                      
     Averages are  slightly higher  in December,  but fairly                                                                    
     steady throughout the season,  including the night with                                                                    
     the most  people (overnights and  dinner-only combined)                                                                    
     being towards the end of March.                                                                                            
MS.  HERMAN  shared  slide  16,  "Winter  House  2018-2019  Data:                                                               
Weather, which read:                                                                                                            
     Temperature  does not  explain the  fluctuation in  the                                                                    
     number of guests each night.                                                                                               
     One of  the warmest  days was also  one of  the highest                                                                    
     census  days  (March 24).  The  week  in December  when                                                                    
     every  night  had  over  20  overnight  guests  had  an                                                                    
     average minimum temperature of -8 degrees.                                                                                 
     This  indicates  there may  be  a  need for  a  shelter                                                                    
     beyond  just  the  winter.  Even   though  it  is  more                                                                    
     dangerous to be homeless in  the winter due to weather,                                                                    
     the  need for  shelter/housing  is demonstrated  beyond                                                                    
     nights with dangerously cold temperatures.                                                                                 
MS.  HERMAN  shared  slide  17,  "Winter  House  2018-2019  Data:                                                               
Guests' Overnights,   and explained  that, as  35 percent  of the                                                               
overnight guests only stayed one  night during the entire season,                                                               
there was data  for two major groups of people.   She stated that                                                               
about 70 percent of the guests  stayed less than a week, while 12                                                               
percent  stayed  at  least  one  month,  though  not  necessarily                                                               
4:19:39 PM                                                                                                                    
REPRESENTATIVE TARR  asked if the  individuals who stayed  had to                                                               
pack up and move out during the day before returning that night.                                                                
MR. COCHRANE,  in response  to Representative  Tarr, acknowledged                                                               
this and  added that,  as they  only had this  space in  a church                                                               
from 9  p.m. until 7  a.m., there was no  means for storage.   He                                                               
directed  attention to  slide 18,  "Winter House  2018-2019 Data:                                                               
Costs,  and  reported that,  while it cost  about $80,000  to run                                                               
the shelter,  the state funding was  only for about $36,000.   He                                                               
noted  that  they applied  for  various  grants and  appealed  to                                                               
various companies  to raise the  balance of funding.   He pointed                                                               
to the costs for service.   He emphasized, "we are a band-aid, ya                                                               
know, we're a  mat on the floor  and two hot meals  and then back                                                               
on the street.   We're not a solution to the  problem at all, but                                                               
we are keeping  people alive and we're looking to  take that next                                                               
4:21:20 PM                                                                                                                    
MS. DeWITT shared  that the component of data  was very important                                                               
because "there is  sort of a belief in Rural  Alaska there is not                                                               
homelessness and  this data is  compelling, it tells us  there is                                                               
in fact  homelessness, there are  in fact unsheltered  people who                                                               
rely on  Winter House and TWC  and in a moment,  you'll see other                                                               
locations people  sleep in."   She declared that it  was critical                                                               
to understand  length of time  and the conditions  experienced by                                                               
the most  vulnerable people, in  order to design  the appropriate                                                               
approaches to provide services and interventions.                                                                               
MR. COCHRANE shared slide 19,  "Winter House 2018-2019 Data: Cost                                                               
Analysis, which read:                                                                                                           
     7 guests (3%)                                                                                                              
     accounted for                                                                                                              
     25% of total costs and                                                                                                     
     25% of all shelter nights                                                                                                  
MR. COCHRANE added that these  people needed permanent supportive                                                               
housing,  and,  although  Winter  House was  keeping  them  alive                                                               
during  the winter,  there  was  nothing being  done  to fix  the                                                               
problem.   He pointed  out that  these guests  were often  in the                                                               
emergency  room,  the  police  station,  or in  the  back  of  an                                                               
ambulance, all of which cost the state far more money.                                                                          
4:22:40 PM                                                                                                                    
REPRESENTATIVE  TARR asked  if extra  services  would help  those                                                               
MS. HERMAN  explained that  a simple  analysis revealed  the cost                                                               
per night  to stay  at Winter  House, and that  3 percent  of the                                                               
guests accounted for 25 percent of the costs and services.                                                                      
REPRESENTATIVE  DRUMMOND shared  a  comparison  to the  Anchorage                                                               
costs and pointed  out that Housing First was a  much cheaper way                                                               
to help with housing.  She acknowledged the value of the data.                                                                  
MS. HERMAN pointed out that there  was a deeper need for what was                                                               
currently  available.    She  opined  that  permanent  supportive                                                               
housing would meet  the needs of the high  utilizing guests while                                                               
the need for Winter House continued for many others.                                                                            
REPRESENTATIVE  DRUMMOND  asked  about the  nightly  capacity  at                                                               
Winter House.                                                                                                                   
MR. COCHRANE replied, "about 45."                                                                                               
4:25:00 PM                                                                                                                    
MS.  HERMAN addressed  slide 20,  "January 2019  Project Homeless                                                               
Connect Survey Results,which    had observed that  58 adults were                                                               
identified as  possibly or definitely  homeless.  She  added that                                                               
more than half  of those surveyed had stayed at  Winter House the                                                               
previous night.   She pointed  out that  the other half  may have                                                               
stayed in vehicles, with friends, or in abandoned buildings.                                                                    
MS. HERMAN moved  on to slide 21, "October  2019 Project Homeless                                                               
Connect  Survey Results,   which asked  more in-depth  questions,                                                               
was not anonymous, and allowed  for an understanding of the needs                                                               
to  specific  individuals  over  time.   She  pointed  out  that,                                                               
although  the number  of  possible homeless  was  lower than  the                                                               
January survey, it was nicer in  October and Winter House had not                                                               
yet  opened for  the season.   She  added that  fewer women  were                                                               
staying at TWC in October.                                                                                                      
MS.  HERMAN  shared  slide  22,   "October  2019  Survey  Results                                                               
Continued: Demographics,and   pointed to  the wide range of ages,                                                               
from 21 - 78 years, and the relatively even gender split.                                                                       
MS. HERMAN directed  attention to slide 23,  "October 2019 Survey                                                               
Results Continued: Disabling  Conditions,which   included alcohol                                                               
and  drug   use,  physical,  developmental,  and   mental  health                                                               
disabilities,  as  well  as  chronic   health  conditions.    She                                                               
reported that  69 percent  of those  surveyed reported  having at                                                               
least one disabling condition, with  an average of two conditions                                                               
per person.   She emphasized that, for those  people who reported                                                               
a  condition, about  half stated  that this  prevented them  from                                                               
having  stable housing  and  employment.   She  pointed out  that                                                               
these  people  had specific  barriers  that  had kept  them  from                                                               
housing and these barriers needed  to be addressed in addition to                                                               
supplying a roof over their heads.                                                                                              
MS. HERMAN directed  attention to slide 24,  "October 2019 Survey                                                               
Results  Continued:  Overnight   Location,which     included  the                                                               
question  for  "where did  you  sleep  the  night before?"    She                                                               
reminded that  Winter House  was not yet  open during  the survey                                                               
period.   About  one-third of  the people  stayed with  family or                                                               
friends,  and  about  one-quarter  were  staying  at  TWC.    She                                                               
declared  that 17  percent  stayed in  a vehicle.    She said  97                                                               
percent of  the individuals  had stayed  on the  streets or  in a                                                               
shelter at some point in their life.                                                                                            
MS. HERMAN  moved on  to discuss slide  25, "October  2019 Survey                                                               
Results  Continued: Length  of time  in  Current Situation,and                                                                  
reported that  the median for  time in the current  situation was                                                               
about 90 days, and that 51 percent  of the people had been on the                                                               
streets or  in an emergency  shelter for  more than 12  months in                                                               
the past  3 years,  often defined as  chronic homelessness.   She                                                               
noted that half  of the group were dealing with  a chronic issue,                                                               
and the  other half  "may be  dealing with  something, hopefully,                                                               
less chronic, which  indicates we need solutions for  both."  She                                                               
suggested a  shorter-term safety  net, such  as Winter  House, as                                                               
well as a longer-term solution for those in chronic situations.                                                                 
REPRESENTATIVE TARR  asked if there  was more information  on the                                                               
situations regarding the one night or less group.                                                                               
MR. COCHRANE replied that she would review the data.                                                                            
MS. HERMAN  explained that this data  did not mean that  prior to                                                               
this the individuals had not been without a place to live.  She                                                                 
explained  that this  was  a distinction  for  only the  previous                                                               
MS. DeWITT added that this was a HUD required question.                                                                         
4:31:26 PM                                                                                                                    
MS.  HERMAN introduced  slide 26,  "October  2019 Survey  Results                                                               
Continued:   Housing   Instability,detailing        the   federal                                                               
definitions  of homelessness,  which  included emergency  shelter                                                               
and  places not  meant for  human habitation,  such as  abandoned                                                               
buildings  and  vehicles.     She  pointed  out   that  for  many                                                               
individuals  the   definition  of  homelessness   included  couch                                                               
surfing  and staying  with friends  and  family, situations  that                                                               
were not stable  and were only temporary.  She  declared the need                                                               
for  a  broader  understanding  of  homelessness  in  the  Bethel                                                               
community and pointed  to housing instability as  a definition to                                                               
encompass other  situations beyond  the federal definition.   She                                                               
reported that the  average for housing instability  in the Bethel                                                               
community  was 5.7  years even  as  the range  covered almost  50                                                               
years and the median was almost  2 years.  She directed attention                                                               
to the  bar graph on the  slide, which reflected that  29 percent                                                               
had  housing instability  for less  than one  year, while  almost                                                               
half the  group had housing  instability for one to  three years,                                                               
and more  than 25  percent had  been in  this situation  for more                                                               
than four  years.  She emphasized  that it was necessary  to find                                                               
tailored solutions  for the community based  on these experiences                                                               
and needs.                                                                                                                      
CHAIR ZULKOSKY asked  if there had been any  benchmarking of this                                                               
data alongside other rural communities  in Alaska, larger cities,                                                               
or smaller communities.                                                                                                         
4:34:41 PM                                                                                                                    
MS. DeWITT replied that some of  the urban communities had done a                                                               
lot of work  with data, resulting in reports  centered on Housing                                                               
First based  solutions.  She  referenced a conference  on housing                                                               
and homelessness  in municipalities  and noted that  the majority                                                               
of attendees  were rural  Alaskans.  She  reported that  no other                                                               
communities  were working  with data  similar to  the project  in                                                               
Bethel.   She  offered  her  belief that  this  data was  "fairly                                                               
unique in  rural" and pointed  out that  she was cautious  in any                                                               
comparisons to  urban centers  as she was  not certain  that this                                                               
would be a comparison of "apples and apples."                                                                                   
CHAIR ZULKOSKY asked about the funding for the data collection.                                                                 
MS. DeWITT  reported that the  local community  foundation funded                                                               
all the data collection efforts.                                                                                                
MR. COCHRANE  explained that  the data was  almost ten  years old                                                               
and  had come  from the  previous census.   He  pointed out  that                                                               
overcrowding was  defined as more than  1.5 people per room  in a                                                               
house, which included  bathrooms and kitchens.   He reported that                                                               
the lowest overcrowding in Alaska  was in Southeast Alaska and it                                                               
was still  above the national  average of  3 or 4  percent, while                                                               
the Bethel  region was over  40 percent in  the last census.   He                                                               
stated that this was not even defined as homelessness.                                                                          
MS.  DeWITT shared  that the  following slides  dealt with  myths                                                               
about Rural Alaska homelessness.                                                                                                
4:37:06 PM                                                                                                                    
MS.  HERMAN  shared  slide  27,   "October  2019  Survey  Results                                                               
Continued: Where  people are  from and where  they have  been for                                                               
the past year."  She reported  that 77 percent of the people were                                                               
from villages around  Bethel, while 17 percent  were from Bethel.                                                               
She added  that 86 percent of  those surveyed had been  in Bethel                                                               
for the  previous year,  displacing the  myth of  people recently                                                               
being stuck in Bethel and wanting  to go back to their village or                                                               
MS. HERMAN  directed attention to  slide 28 "October  2019 Survey                                                               
Results  Continued:  Type  of  Assistance  Wanted,   which  asked                                                               
whether the  participant just  needed to get  back to  where they                                                               
had a permanent place to live  or did they need a permanent place                                                               
to  live.   She  reported  that 80  percent  of the  participants                                                               
stated that they wanted a permanent place to live.                                                                              
MS.  HERMAN moved  on to  slide 29  "October 2019  Survey Results                                                               
Continued: Where people want to  Be(thel),pointing   out that the                                                               
options  were  for  Bethel,  Anchorage,   or  a  Yukon  Kuskokwim                                                               
village.   She  reported that  71  percent stated  they wanted  a                                                               
permanent place  to live in Bethel.   When an option  was offered                                                               
to include  both Bethel or  someplace else, the  number increased                                                               
to almost  90 percent.   She  declared that  it was  necessary to                                                               
arrive at local solutions.                                                                                                      
4:39:37 PM                                                                                                                    
MS.  DeWITT moved  on to  slide 30,  "Bethel Coalition  Needs are                                                               
Statewide Needs.   She stressed  that Bethel needs were statewide                                                               
needs, including investments in  the Homeless Assistance Program,                                                               
the  Special  Needs  Housing Grant  program,  and  the  Community                                                               
Initiative Matching Grants programs.                                                                                            
MS.  DeWITT  shared  slide  31,  "Bethel  Coalition  Needs,   and                                                               
reported that recent legislation,  HB 206, had increased Homeless                                                               
Assistance Program  funding to $8.15  million, and  increased the                                                               
Special  Needs  Housing  Grant  program to  $3.7  million.    She                                                               
declared support for  these investments, even as there  was not a                                                               
guarantee that the local Bethel  groups would receive any of this                                                               
competitive  funding.   She pointed  out  that each  of the  four                                                               
presenters had other  full-time jobs, and that there  was not any                                                               
one person  strategically working  on homelessness in  the region                                                               
or the  community.   She stated  the need  for a  permanent year-                                                               
round  emergency homeless  shelter  with  permanent staffing,  as                                                               
well as an approach to  permanent housing, such as Housing First.                                                               
She  declared that  there  was  also a  focus  on youth  specific                                                               
homeless projects.                                                                                                              
MR. COCHRANE  pointed out that  although the  Homeless Assistance                                                               
Program funding had  been restored to 2009 levels,  that was flat                                                               
funding  for 12  years,  which was  a net  decrease  and did  not                                                               
address inflation or the increases in costs.                                                                                    
4:43:07 PM                                                                                                                    
REPRESENTATIVE TARR  relayed that lack  of housing was  always an                                                               
issue and asked if additional capacity would help.                                                                              
MS. DeWITT declared  that affordable housing, as  well as housing                                                               
stock,  was  a  major  issue  in Alaska  and  that  there  was  a                                                               
population  that  would  be substantially  helped  by  affordable                                                               
housing.   She pointed  out that  for voucher-based  services, it                                                               
was  necessary to  have available  housing stock,  reporting that                                                               
the Bethel area had "close to a zero percent vacancy rate."                                                                     
MR.  COCHRANE  shared  that  there   was  no  affordable  housing                                                               
available, and he pointed out that  there was a myth that all the                                                               
homeless were unemployed.                                                                                                       
MS.  DeWITT, in  response to  Representative Drummond,  explained                                                               
that HAP  funds were  the Homeless  Assistance Program  funds and                                                               
also helped  with first months  rent, utilities, and  deposits in                                                               
private market  rentals.  She  pointed out  that one of  the most                                                               
affordable avenues was in the prevention of evictions.                                                                          
REPRESENTATIVE  CLAMAN   said  that   the  data   was  incredibly                                                               
4:48:44 PM                                                                                                                    
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:48 p.m.                                                                                                          

Document Name Date/Time Subjects
ASHNHA - Alaska Health Care - A Changing Landscape.pdf HHSS 2/25/2020 3:00:00 PM
Alaska State Hospital and Nursing Home Association
Bethel Coalition on Housing & Homelessness.pdf HHSS 2/25/2020 3:00:00 PM
Bethel Coalition on Housing & Homelessness
Bethel HHC 10.26.19 PHC Summary Report.pdf HHSS 2/25/2020 3:00:00 PM
Bethel Coalition on Housing & Homelessness
Bethel Coalition on Housing & Homelessness V.2.pdf HHSS 2/25/2020 3:00:00 PM
Bethel Coalition on Housing & Homelessness V.2