Legislature(2019 - 2020)DAVIS 106
02/25/2020 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Alaska Health Care: a Changing Landscape | |
| Presentation: Bethel Coalition on Housing & Homelessness | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
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
Landscape."
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." To begin, he
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 that it be
made 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 (Mat-Su).
He described that these beds came with very specific behavioral
health services, including psychiatry, within a secure
environment. He declared that the lack of the API beds was "a
true crisis."
3:31:23 PM
MR. KOSIN shared, on 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 asked the question, "the real story is how do you get down
from that," offering as an example the 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 a 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 would be severely underfunded, for continuing
the patient's care while waiting. System inefficiencies drive
and trap patients' care at the highest cost point. He
emphasized that significant capacity challenges had to be
factored in 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
conditions
? 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 has 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 deliver care on the street before it
came into the hospital. He declared 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 ASHNA was working
toward specific solutions and "trying things new" with different
approaches. He declared it was necessary to focus on treating
people more efficiently and effectively in the right
environment.
REPRESENTATIVE DRUMMOND inquired as to what the problem was with
Medicare.
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; 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 65 percent of the mental health
treatment and medication was provided within the prison
population in Alaska, about 5,000 inmates. She asked if ASHNA
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 ... 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
intervention.
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 like 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 said that
there had been many opportunities in health care reform. She
asked what he would do to drive the system redesign without
integrated care.
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 ASHNA was
interested in exploring similar projects.
MR. KOSIN stated that his success had come, not from home run
projects, but from singles that have added 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 &
Homelessness.
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 who 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
Anchorage
HMIS: Homeless Management Information System, a U.S.
Department of Housing and Urban Development (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 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 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 CoC 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 &
Reports
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
region
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 CoC
funding, which came through HUD 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
projects.
$3,829,763 was awarded to 15 Anchorage-based projects
$858,736 was awarded to the Balance of State for 11
projects
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 start
one. 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
read:
? 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 TWC had been in existence for more
than 40 years, adding that, in 2009, a new shelter which
increased capacity to 33 beds had been built, 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 and
181 overnight guests served. 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 nights.
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 it was "pretty shocking"
that there were that many people who came. 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
consecutively.
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 [Winter House] was a
"band-aid," a mat on the floor, two hot meals, and then back on
the street. He added: "We're not a solution to the problem at
all, but we are keeping people alive and we're looking to take
that next step."
4:21:20 PM
MS. DEWITT shared that the component of data was very important
because there was sort of a belief in Rural Alaska there was not
homelessness and this data was "compelling;" and proved there
are in fact unsheltered people who rely on Winter House and TWC.
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
individuals.
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 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 it 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 "where did you sleep the night before?" She pointed
out 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
night.
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 most attendees
were rural Alaskans. She reported that no other communities
were working with data like 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 villages
or to Anchorage.
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 if they needed 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
helped with first month's 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
illuminating."
4:48:44 PM
ADJOURNMENT
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 |