Legislature(1993 - 1994)
02/04/1994 01:33 PM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 4, 1994
1:33 p.m.
MEMBERS PRESENT
Senator Steve Rieger, Chairman
Senator Bert Sharp, Vice-Chairman
Senator Loren Leman
Senator Mike Miller
Senator Jim Duncan
Senator Judy Salo
MEMBERS ABSENT
Senator Johnny Ellis
COMMITTEE CALENDAR
SENATE BILL NO. 225
"An Act relating to credits against certain insurance taxes for
contributions to certain educational institutions; and providing
for an effective date."
SENATE BILL NO. 248
"An Act relating to services for and protection of vulnerable
adults; and providing for an effective date."
SENATE BILL NO. 249
"An Act relating to assisted living homes; repealing references to
residential facilities for dependent adults; and providing for an
effective date."
SENATE BILL NO. 250
"An Act relating to the Older Alaskans Commission and staff of the
commission; changing the name of the Older Alaskans Commission to
the Alaska Commission on Aging and extending the termination date
of the commission; relating to the Alaska Pioneers' Homes Advisory
Board; relating to services and programs for older Alaskans; and
providing for an effective date."
PREVIOUS SENATE COMMITTEE ACTION
SB 225 - See Health, Education & Social Service minutes dated
2/2/94.
SB 248 - See Health, Education & Social Services minutes dated
2/2/94.
SB 249 - See Health, Education & Social Services minutes dated
2/2/94.
SB 250 - See Health, Education & Social Services minutes dated
2/2/94.
WITNESS REGISTER
Carrol Carol
Staff to Senator Kerttula
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Answered questions on CSSB 225.
Nancy Usera
Commissioner, Department of Administration
P.O. Box 110200
Juneau, Alaska 99811-0200
POSITION STATEMENT: Reviewed SB 248, SB 249, SB 250.
Connie Sipe
Director, Division of Senior Services
Department of Administration
P.O. Box 110209
Juneau, Alaska 99811-0209
POSITION STATEMENT: Reviewed SB 248, SB 249, SB 250.
Kristen Bomengen
Assistant Attorney General-General Civil Section
Department of Law
P.O. Box 110300
Juneau, Alaska 99811-0300
POSITION STATEMENT: Reviewed SB 248, SB 249, SB 250.
Rupe Andrews
Volunteer, American Association of Retired Persons
9416 Long Run Drive
Juneau, Alaska
POSITION STATEMENT: Supported SB 248, SB 249, SB 250.
Mary Raymond
P.O. Box 2335
Homer, Alaska 99603
POSITION STATEMENT: Urged action on SB 248, SB 249. SB 250.
Glenn Hackney
1136 Sunset Drive
Fairbanks, Alaska 99709
POSITION STATEMENT: Reviewed SB 249.
Charles McKee
1508 W 43rd #7
Anchorage, Alaska 99507
POSITION STATEMENT: Reviewed SB 248.
Ernest Line
2645 Whispering Wood Drive
Wasilla, Alaska 99654
POSITION STATEMENT: Reviewed SB 248, SB 249, SB 250.
Rose Palmquist
Box 870294
Wasilla, Alaska 99687
POSITION STATEMENT: Reviewed SB 248, SB 249, SB 250.
Dave Williams
Division of Medical Assistance
Department of Health and Social Services
P.O. Box 660
Juneau, Alaska
POSITION STATEMENT: Supported SB 248, SB 249, SB 250.
Pat O'Brien
Division of Family and Youth Services
Department of Health and Social Services
P.O. Box 110630
Juneau, Alaska 99811-0630
POSITION STATEMENT: Supported SB 248, SB 249, SB 250.
ACTION NARRATIVE
TAPE 94-5, SIDE A
Number 001
CHAIRMAN RIEGER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:33 p.m.
CHAIRMAN RIEGER introduced SB 225 (INSURANCE TAX CREDIT: GIFTS TO TO
COLLEGES) with the CS as the first order of business before the
committee. He noted that the CS included his requested change.
SENATOR SHARP moved to adopt CSSB 225 (HES).
SENATOR SALO asked for an explanation of the changes Chairman
Rieger had mentioned.
CHAIRMAN RIEGER explained that this CS makes the restrictions on
the foundation the same as those on the institution itself.
SENATOR SALO asked if there is a limit on the tax credit for these
contributions.
CARROL CAROL, staff to Senator Kerttula, said that the total limit
is $150,000 or 50 percent of their tax liability, whichever is
less.
SENATOR LEMAN asked if the change in the CS was only a
clarification of the language. CHAIRMAN RIEGER said that between
the CS and the bill it was only a clarification of language.
CARROL CAROL stated that the change only clarifies what is now
taking place.
SENATOR SHARP moved CSSB 225 out of committee with individual
recommendations. Hearing no objections, it was so ordered.
Number 075
CHAIRMAN RIEGER introduced SB 248 (ASSIST & PROTECT VULNERABLE
ADULTS), SB 249 (REGULATION OF ASSISTED LIVING HOMES) and SB 250
(REVISE OLDER ALASKANS COMMISSION) as the next bills before the
committee.
NANCY USERA, Commissioner of the Department of Administration,
stated that these three bills together provide a better and more
cost effective continuum of care for seniors in Alaska.
CONNIE SIPE, Director of the Division of Senior Services, gave an
overview of SB 248. She pointed out that this bill combines the
current state statutes on Elder Abuse and Abuse of the Disabled
into a protective system for all vulnerable adults. This bill
transfers the authority for all adult protective services from the
Division of Family and Youth Services to the Division of Senior
Services. She emphasized that SB 248 does not assume that all
elderly or disabled adults are vulnerable and need state
intervention. SB 248 stream-lines resources and offers a central
information, referral, and abuse reporting service for all
vulnerable adults and their care-givers. She explained that there
is authority in the law for the Division to enter into agreements
with local service provider agencies who already work with these
populations.
SENATOR MILLER asked why, on page 2, a "marital and family
therapist" were deleted from the list of professionals responsible
for reporting harm to vulnerable adults. CONNIE SIPE said that the
deletions were included in the definition of a mental health
professional and that they did not have to be listed separately.
Number 186
CONNIE SIPE explained the surrogate decision-maker which takes the
place of guardianship. The surrogate decision-maker allows a
family member to consent to protective services when the person is
incapable which should save judicial time and expense. Anything
long-term would require the judicial remedies of the guardianship
procedure.
SENATOR SALO mentioned a public opinion message from an older
Alaskan who felt that one or all of these bills takes away
decision-making ability from the older adults. She asked if this
section on surrogate decision-makers could be the point of concern.
CONNIE SIPE said that the surrogate decision-making only occurs in
life and death or irreparable harm situations when the person is
unable to consent. Any other aspect requires the due process of
the guardianship procedure.
NANCY USERA commented that all three of these bills together give
more ownership to the individual for making their own decisions
with more options to choose.
CHAIRMAN RIEGER requested more specifics regarding this surrogate
decision-maker and the situation in which they are used.
CONNIE SIPE stated that the department may honor consent from
listed family members for immediate protective services when the
individual cannot consent; this is for short periods of time. For
the long-term or an incapacitated individual, the family must
petition the court as stated in Sec. 47.24.019 of SB 248.
CHAIRMAN RIEGER asked if SB 248 enhances the ability to go to court
for guardianship against an individual's wishes. CONNIE SIPE
pointed out that the temporary surrogate decision-maker is current
practice and SB 248 only clarifies the procedures and tools to be
followed. She maintained that SB 248 follows proper due-process
and does not infringe on the individual.
Number 315
CONNIE SIPE cited the changes in the definitions of abuse, neglect,
and exploitation in SB 248. She further noted that the end of SB
248 provides for smooth transfer between the departments with an
effective date of July 1, 1994.
CHAIRMAN RIEGER referred to page 3 line 17-25, when he stated his
concern for the sweeping definition of exploitation. CONNIE SIPE
explained that this definition speaks to the risk of immediate harm
requiring immediate action, much like the current law.
CHAIRMAN RIEGER inquired as to the type of liability this may put
on the police in this state when someone has a wrongful death
action in order to collect damages.
Number 392
KRISTEN BOMENGEN, Assistant Attorney General-General Civil Section
in the Department of Law, said that the language in SB 248 does not
change the law. The language does expand the circumstances in
which one should report, but not their responsibilities. The
general test will continue to be whether the reporting individual
responded reasonably and exercised due care.
CHAIRMAN RIEGER asserted his dissatisfaction with this section due
to a recollection of a case where the test of reasonableness was
greatly expanded.
SENATOR MILLER requested the rationale for changing "shall" to
"may" on page 3 line 22. KRISTEN BOMENGEN stated that those
obligated to report now have the option to turn to the local
police, currently one is obligated to report. CONNIE SIPE
reiterated that the reporter has the option to go to the division
or if they feel the danger is imminent, to go to the police.
SENATOR MILLER pointed out that this rewritten section states that
if an individual cannot immediately report the action the
individual "may" report it to the police or village officer.
NANCY USERA asked if Senator Miller wanted mandatory reporting to
either the police or the department. SENATOR MILLER said yes.
CONNIE SIPE and NANCY USERA agreed to review this section.
Number 453
SENATOR LEMAN related an experience he had regarding the issue of
reporting to the police. He asked if there was an option to report
to someone other than the police. CONNIE SIPE informed the
committee that there will be an 800 number to report to the
division. In order to put this issue into perspective, NANCY USERA
noted that there were 147 reports of elder abuse in 1993.
SENATOR LEMAN asked if the definition of exploitation in SB 248
would cover cases of special selling "deals". CONNIE SIPE said
that this type of case is usually reported to normal law
enforcement, the Consumer Protection Agency, or the Unfair Trade
Practices. She did not view this as the primary focus of this
section of SB 248.
SENATOR SALO inquired of potential problems with the surrogate
decision-maker if that individual happened to also be the abuser.
CONNIE SIPE said that page 8 lines 15-20 addresses that concern.
KRISTEN BOMENGAN stated that the aforementioned deletion of
"marital and family therapist" is not included in the statutes
referenced on page 2 line 1. She said this would be reviewed.
Number 532
CONNIE SIPE noted that SB 249 has three main changes in philosophy.
She emphasized that SB 249 attempts to change from a medical model
to a mixed model that is a social model of care with limited health
related services that can be provided in a more cost effective and
homelike setting. SB 249 will be used by the Department of
Administration in the Division of Social Services and by the
Department of Health and Social Services to license homes.
TAPE 94-5, SIDE B
Number 572
CONNIE SIPE commented that SB 249 allows assisted living as a less
restrictive and more cost efficient alternative. SB 249 would
allow more private contracts between families and one person care-
givers and would ease finding foster homes in rural Alaska if full
licensure was not required for the one person foster homes. SB 249
only applies to assisted living homes serving three or more adults.
She explained the SB 249 definition of an assisted living home.
SENATOR SALO asked if under SB 249 a person could take in two older
persons needing care without any license. CONNIE SIPE said that
usually taking in under three persons does not constitute a
business and no license is required. This deregulation should help
rural Alaska in finding foster care. The state can impose
requirements on the home when the state is paying for the foster
care. Ms. Sipe referred to certification of providers allowing
flexibility as opposed to uniform licensing and regulatory sections
for everyone.
Number 520
RUPE ANDREWS, Volunteer for the American Association of Retired
Persons, stated strong support of these three bills by the AARP in
Alaska. He was concerned with the enforcement of the transfer of
positions called for in SB 248.
MARY RAYMOND, testifying from Homer, urged action on these bills.
SENATOR SALO asked what Mary Raymond thought was the best provision
of these bills or the best practical application of them. MARY
RAYMOND stated that the most practical aspect of these bills is the
individual having a choice in their own care.
GLENN HACKNEY, testifying from Fairbanks, asked if these bills
would be moved out of committee today. CHAIRMAN RIEGER said no.
MR. HACKNEY was concerned that an individual who wanted to stay at
home alone and who needed some assistance could not get the
assistance under SB 249.
NANCY USERA explained that SB 249 allows people to stay in their
own home and when that is not possible, allows people to stay in
their home town or community.
Number 438
CHARLES MCKEE, testifying from Anchorage, expressed his desire to
add "retroactive to September 10, 1983 " on page 4 line 8 of SB
248. He explained his situation in 1983 in which he was made
liable when attempting to raise additional funds for the Pioneer
Home.
NANCY USERA reiterated that SB 249 moves away from the medical
model to the social model of assisted living homes. She noted that
SB 249 is adaptable to the range of communities present in Alaska
to meet individual needs. She informed the committee that
demographically the senior population is increasing which will
require more services. As more services are required, they create
the need to be more cost efficient for the individual as well as
the state finance systems.
Number 367
CONNIE SIPE stated that the health related services are the heart
of SB 249. This bill allows the foster home, no matter the type,
to decide what type care or health related service they want to
offer as Section 47.33.020 sets forth in SB 249. SB 249 recognizes
adult's right to make their own choices regarding where they want
to live and the care they receive. She pointed out that the
remainder of the bill speaks to the landlord tenant relationship.
Number 277
CHARIMAN RIEGER asked if there were any restrictions on the
security payments. CONNIE SIPE said that security payments are the
same concept as in the Landlord Tenant Act; the security deposit
money has to be put into a trust account in the bank and they must
know where it is.
CHAIRMAN RIEGER referred to page 6 lines 22-24 of SB 249, when
asking about a practical implementation of the Uniform Act. CONNIE
SIPE explained that a consumer disclosure type of requirement known
in advance will be used. A practical application would be the
pushing back and forth of rights and remedies which currently
happens under the House Rules section of the Landlord Tenant Act.
In response to Chairman Rieger, CONNIE SIPE said that the Uniform
Act attempts to balance the rules in assisted living homes and
reasonable access rights of the individual. CHAIRMAN RIEGER
commented that he did not see the value of listing the House Rules
if they still have to be considered reasonable. MS. SIPE noted
that this section is the landlord's rights and there is a separate
section addressing consumer's rights.
Number 195
NANCY USERA explained that the listing of House Rules is not an
inclusive or an exclusive list. She considered this list a comfort
zone for the consumer, the elder adult.
SENATOR SALO asked if the list under House Rules actually stated
"included but not limited to". She explained her concern that when
a list is present there is potential for a court case regarding
items not on the list, perhaps intentionally not included. NANCY
USERA said that they would review this issue.
SENATOR SHARP inquired about cohabitation in the assisted living
homes. CONNIE SIPE said that this was addressed in the consumer
rights section.
CONNIE SIPE emphasized that SB 249 is not a Medicaid option. SB
249 does not itself guarantee state or public payment for assisted
living care for any person. SB 249 is only a licensing structure.
CHAIRMAN RIEGER requested explanation of the requirement for an
assisted living plan. CONNIE SIPE stated that the intent is to
have a minimal plan of care for an individual which is renegotiated
as the individual's needs change. She mentioned the standard form
that will be used to identify the individual's needs and wishes.
Number 085
NANCY USERA gave an overview of SB 250. She mentioned that SB 250
is primarily a house-keeping measure; however, it does further
integrate the delivery of services.
Specifically SB 250:
(1) renames the Older Alaskans Commission to the Alaska
Commission on Aging,
(2) reduces the number of mandatory meetings ,
(3) coordinates the Commission on Aging and the Pioneer Homes
by making the chairman of each a board member of the other,
(4) enhances advocacy of the program through the Governor
appointment of the chair person in each group,
(5) clarifies that the Executive Director does the
administration while the board approves and sets the policy
for the administration,
(6) allows the flexibility to reduce or waive local match
requirements for grantee and waivers in the public interest.
MS. USERA acknowledged that the Pioneer Advisory Board and the
Older Alaskans Commission would prefer to elect their own chairman.
SENATOR SALO asked for other examples of Governor appointed chair
persons. She agreed that a Governor appointed chair person may be
more effective in working with the Chief Executive Officer, but not
necessarily more effective in working with the committee.
NANCY USERA stated that the Alaska Commission on Aging, unlike many
other boards and commissions, have an advocacy responsibility for
their program. This advocacy means that the structure has to allow
for access to the Governor to be most effective.
TAPE 94-6, SIDE A
Number 001
SENATOR SALO asked if there were any age requirements for the
members of the Division on Aging or the Pioneer Homes. CONNIE SIPE
said that there are no age requirements on the Pioneer Homes, but
the Division of Aging does have age requirements for the Governor
to follow in his appointments.
ERNEST LINE, testifying from Mat-Su, reiterated the gap in these
bills regarding individuals who want to stay home, but do not have
the skills listed by Medicare standards and are not receiving
Medicaid health care. He expressed the desire to add relative and
friend to the list of those who can report abuse.
Mr. Line suggested that SB 249 require a reasonable cost limitation
on the assisted living homes and a regularly scheduled physician's
visit for the residents of the assisted living homes.
He questioned the following aspects of SB 249:
(1) the resident's ability to appeal after the assisted living
home's final decision regarding a grievance,
(2) after the home discharges a resident, what happens
after 60 days,
(3) does chronically ill include alzheimer in any of its many
stages,
(4) regarding licensing, are the boarding homes mentioned the
same as the older consider boarding houses,
(5) certificates of need, what does it require to satisfy the
need.
Number 121
NANCY USERA mentioned that there will be an administrative
teleconference through the LIOs for any questions.
CONNIE SIPE agreed with Mr. Line in his observance that these bills
do not take care of moderate income people, but she noted that
there are some state services available now. She stated that the
listed reporters in SB 248 are professionals who have a mandatory
duty to report which a relative does not. The bill intends to let
the market dictate the fees for assisted living homes and the
deregulation should also help. She explained that arranging a home
health nurse to regularly visit is hoped to be developed by the
private sector. Regarding the grievance appeal, the resident could
contact the licensing agency, a legal attorney, or advocacy agency
if they were unsatisfied with the home's decision. She said the
boarding houses referred to in SB 248 are similar to the boarding
houses Mr. Line spoke of, but they offer additional personal care
services. She clarified that the certificate of need exempts these
homes from having to get a certificate of need as a home for the
disabled.
Number 190
ERNEST LINE asked what would be classified as a chronic mental
situation. CONNIE SIPE stated that something like schizophrenia,
which has behavior patterns the home cannot handle.
ROSE PALMQUIST expressed concern with the administrative costs of
SB 249. There is no fiscal note. She said that to think the state
would not incur additional costs with SB 249 is an illusion. She
asked if their were provisions to handle possible grievances. She
also noted that lower and middle income individuals are not
addressed in these bills.
NANCY USERA pointed out that there is a fiscal note for licensing
in Health and Social Services for the Developmentally Disabled in
Assisted Living Homes. She explained that this will be
administered by the Division of Senior Services which would shift
administrative responsibilities. This shift would be a more
efficient system that would free other resources which could be
done within existing resources.
ROSE PALMQUIST commented that SB 250 could reduce senior power
while increasing the power of the bureaucracy.
Number 299
DAVE WILLIAMS, Division of Medical Assistance in the Department of
Health and Social Services, emphasized that these bills are phase
two. He stated support of the Department. He highlighted the
definition of an assisted living home in SB 249 on page 2. He
referred to page 18 line 19, when pointing out the regulatory
assurances for homes of more than three persons. He stated that
they do not expect cost in the first year because things will
remain much the same. Regarding the certificate of need, he said
that this eliminates the conversion of assisted living facilities
to nursing homes after construction and without the required $1
million expenditure.
CHAIRMAN RIEGER asked Mr. Williams to clarify his thoughts on the
fiscal note issue. MR. WILLIAMS said that he felt certain about
this year having a zero fiscal note; however, it is part of the
three phase plan to pay.
CHAIRMAN RIEGER stated that Mr. Williams could submit language
guarding against the conversion of land into a certificated
facility after construction and the committee would consider that.
Number 365
PAT O'BRIEN, Division of Family and Youth Services, supported these
bills. The transfer of services would improve the service.
CHAIRMAN RIEGER held SB 248, SB 249, and SB 250. There being no
further business before the committee, the meeting was adjourned at
3:30 p.m.
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