Legislature(1997 - 1998)
03/09/1998 09:06 AM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
March 9, 1998
9:06 a.m.
MEMBERS PRESENT
Senator Gary Wilken, Chairman
Senator Loren Leman, Vice-Chairman
Senator Lyda Green
Senator Jerry Ward
Senator Johnny Ellis
MEMBERS ABSENT
None
COMMITTEE CALENDAR
SENATE BILL NO. 331
"An Act regulating licensed professional counselors; regulating use
of the titles 'licensed professional counselor' and 'licensed
counselor'; amending Rule 504(a)(3), Alaska Rules of Evidence; and
providing for an effective date."
HEARD AND HELD
SENATE BILL NO. 321
"An Act relating to assisted living homes."
MOVED CSSB 321(HES) OUT OF COMMITTEE
PREVIOUS SENATE COMMITTEE ACTION
SB 331 - No previous Senate committee action.
SB 321 - No previous Senate committee action.
WITNESS REGISTER
Beth Hagevig
Staff to Senator Wilken
Alaska State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Testified for the sponsor of SB 331
Ann Henry
3347 Park Place
Juneau, Alaska 99801
POSITION STATEMENT: Supports SB 331
Pamela Watts
American Counseling Association of Alaska
P.O. Box 240554
Douglas, Alaska 99824
POSITION STATEMENT: Supports SB 331
Robert Pound
Southcentral Counseling Center
3725 Spinnaker Drive
Anchorage, Alaska
POSITION STATEMENT: Supports SB 331
Allan Morotti
Alaska School Counselors' Assn.
791 Goldstreak Road
Fairbanks, Alaska 99712
POSITION STATEMENT:
Dixie Hood
222 Seward St., Suite 210
Juneau, Alaska 99801
POSITION STATEMENT: Supports SB 331
SENATOR MIKE MILLER
Alaska State Capitol
Juneau, Alaska 99081-1182
POSITION STATEMENT: Sponsor of SB 321
John Pierce
430 4th Street
Fairbanks, Alaska 99701
POSITION STATEMENT: Supports SB 321
Dwight Becker
Division of Senior Services
Department of Administration
3601 C Street, Room 310
Anchorage, Alaska 99503
POSITION STATEMENT: Supports SB 321
Rose Heyano
Bristol Bay Native Association
P.O. Box 310
Dillingham, Alaska 99576
POSITION STATEMENT: Supports SB 321
Cathy Westling
329 D Street
Fairbanks, Alaska 99701
POSITION STATEMENT: Supports SB 321
Monta Lane
109 E 5th Street
North Pole, Alaska 99705
POSITION STATEMENT: Supports SB 321
Debbie Cask
3291 Jefferson Drive
Fairbanks, Alaska 99709
POSITION STATEMENT: Supports SB 321
Helen Powell
1913 Jack Street
Fairbanks, Alaska 99709
POSITION STATEMENT: Supports SB 321
Sharon Kenamon
2106 Flight Street
North Pole, Alaska 99705
POSITION STATEMENT: Supports SB 321
Judith Townsend
120 Pepperdine Drive
Fairbanks, Alaska 99709
POSITION STATEMENT: Supports SB 321
Derrill Johnson
Department of Health & Social Services
P.O. Box 110620
Juneau, Alaska 99811-0620
POSITION STATEMENT: Commented on SB 321
Sharon Clark
Legislative Aide to Senator Mike Miller
Alaska State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Commented on SB 321
ACTION NARRATIVE
TAPE 98-22, SIDE A
Number 001
CHAIRMAN WILKEN called the Senate Health, Education and Social
Services (HESS) Committee to order at 9:06 a.m. Present were
Senators Wilken, Leman, Ward, and Green. CHAIRMAN WILKEN announced
the committee was waiting for a committee substitute for SB 321 to
arrive, therefore SB 331 would be heard first.
SB 331 - PROFESSIONAL COUNSELOR LICENSING
CHAIRMAN WILKEN informed committee members a new draft version of
SB 331 was prepared (version B).
SENATOR WARD moved to adopt CSSB 331 (version B) as the working
document of the committee. There being no objection, the motion
carried.
BETH HAGEVIG, legislative aide to Senator Wilken, gave the
following explanation of the measure. CSSB 331 establishes a board
to license and regulate experienced Masters and Doctoral level
professional counselors whose education and experience do not fall
within the existing behavioral health specializations of Licensed
Clinical Social Worker, Licensed Marriage and Family Therapist,
Psychologist, or Psychological Associate. This bill benefits
counselors because it opens doors to employee assistance programs
that currently require that service providers be licensed to
qualify for their programs; it broadens career opportunities for
counselors who wish to work for entities that require licensure; it
provides incentive for Masters level behavioral health graduates of
Alaska's university system to stay in state and take advantage of
licensing opportunities that already exist in 44 other states; and
it includes licensed professional counselors under Rule 504,
protecting them from contempt of court, in cases where client
confidentiality must be protected.
MS. HAGEVIG explained CSSB 331 is good for Alaska's consumers
because it establishes a minimum standard of education and
experience that clients can trust, eliminating the buyer beware
situation that currently exists. It institutes grievance
procedures and gives legal recourse for clients of licensed
professional counselors who feel they have been victims of
fraudulent, unethical, or negligent practices. It gives clients,
who require mental health services, greater choice and comfort in
choosing a provider that best suits their needs, both emotionally
and financially, and it increases the availability of licensed
mental health providers who practice statewide, giving rural
residents better access to mental health care. This bill has the
support of the American Counseling Association (ACA), the ACA of
Alaska, the Alaska School Counselor Association, numerous
professional counselors and clients.
Number 082
CHAIRMAN WILKEN pointed out a two-page document in committee
members' packets shows where Alaska fits into the scheme of
counselor licensing nationwide. The remainder of the packet
contains letters of support.
SENATOR LEMAN noted SB 122, dealing with family and marriage
counselors, is currently in the House. He asked Ms. Hagevig if any
thought was given to combining the counseling and marriage and
family therapy boards into a common board, instead of creating a
new board. He commented he serves on a professional board made up
of architects, engineers and land surveyors, and although the
professions differ, their common board is able to take care of the
professional interests of all three groups.
MS. HAGEVIG replied the counselors support combining the boards
and are working with the marriage and family therapists' board
members on creating a joint board. She suggested asking Pamela
Watts and Ann Henry, from the American Counseling Association of
Alaska, to address that question.
Number 122
ANN HENRY, a member of the American Counseling Association of
Alaska (ACAA), gave the following testimony. SB 331 is a title
restriction bill, rather than a practice restriction bill, which
means that people can continue to practice counseling in Alaska if
they are practicing now. That arrangement will especially benefit
the bush areas where counselors might now be practicing without the
required education. Nationally, 44 states have some kind of
licensure certification and 80,000 licensed professional counselors
are nationally recognized. As a private practitioner, clients are
often referred to her, but because she is not a licensed
practitioner, employee assistance programs will not provide
insurance coverage for her services. Managed care programs also
require licensure. Ms. Henry believes clients need to be able to
choose their counselor.
MS. HENRY noted that in regard to Senator Leman's question about
combining the two boards, the marriage and family therapists' board
supports SB 331 and discussed, at its last meeting, the need to
speak to ACAA about the possibility of combining the boards. The
ACAA definitely favors combining the boards. She assumed that
counselors will not be a viable group for the family and marriage
therapists' board to deal with until they get licensing
certification in Alaska.
Number 172
PAM WATTS, President of the American Counseling Association of
Alaska, gave the following testimony. When ACAA began efforts to
require counselor licensure, it heard from several University of
Alaska graduates who were having difficulty obtaining and
maintaining employment or advancing in their positions. They
support licensure because the lack of licensure requirements is
limiting employment opportunities for them after they graduate. A
second issue is that hundreds of Masters and Doctoral level
counselors are currently providing counseling services around the
state. ACAA is concerned that without licensure, they will not be
able to practice, and in some cases, they are the only people
available in those areas to do this work. Because they are trained
to provide a range of counseling services that are not necessarily
limited to the specialty licenses that Alaska currently has, such
as marriage and family, or psychology or social work, they do not
fit anywhere in the licensure scheme. SB 331 offers consumer
protection, easier access to mental health services, and will
provide Alaskans the opportunity to pursue occupations within the
state for which they have been trained.
MS. WATTS reiterated that ACAA is interested in looking at
combining with the marriage and family therapists' board. She
agreed that closely related fields can function very well on
combined boards. She pointed out that other states, such as
Georgia, have an omnibus board that includes social workers,
chemical dependency counselors, licensed professional counselors
and marriage and family therapists. She thought creating a similar
board in Alaska in the future would be fiscally responsible.
Number 227
SENATOR LEMAN encouraged Ms. Watts to further the dialogue about
combining the two boards because he thought SB 331 would be a good
vehicle in which to do so this year. He advised that if they do
not combine boards, counselors will incur all of the initial costs
of establishing a separate board which will increase the fees.
CHAIRMAN WILKEN asked about the status of SB 122.
SENATOR LEMAN stated it is in the House and he believes it is
scheduled to pass.
ROBERT POUND, a counselor with Southcentral Counseling Center in
Anchorage, testified in support of SB 331. The Southcentral
Counseling Center has developed a system in which a person must be
licensed to reach the highest level of clinician. SB 331 would
enable him to obtain a license and become a senior clinician.
Without a licensing requirement in Alaska, agencies are forced to
find people outside of the state to fill these positions.
Requiring experience and education will ensure better quality
treatment to clients. He received a professional counselor license
in the State of Colorado around 1989. That license allowed him to
do contract work, EAP work, and to have a private practice. The
certification process requires a disclosure statement to be filled
out by clients. He found clients responded very positively and the
ability to do so relieved clients of worry. Mr. Pound believed SB
331 will have positive results on both counselors and consumers.
Number 308
ALLAN MOROTTI, representing the Alaska School Counselors'
Association, and the counseling program at the University of Alaska
Fairbanks, gave the following testimony. The Alaska School
Counselors' Association supports SB 331. Many rural counselors
feel that passage of SB 331 will improve the delivery of mental
health services. Students from the UAF program who end up
counseling in rural areas often find themselves functioning in the
role of a crisis counselor. As they move from site to site, the
majority of their work is dealing with crisis issues, rather than
the more traditional school counseling issues. Passage of SB 331
will allow those counselors to get the additional supervision
necessary to provide quality mental health services, and passage
will allow many of UAF's graduates to move out into the mental
health agencies. Once employed by those agencies, the graduates
feel pressured to acquire some type of licensure. Many agencies
hire out-of-state because of the lack of licensed practitioners in
the state. He believes the course work for Masters level
counselors nationwide, in the area of supervision, clinical hours,
diagnosis and appraisal, compares favorably with the requirements
for clinical social workers and marriage and family therapists. He
concluded by saying he strongly supports the bill both as an
individual and on behalf of the Alaska School Counselors'
Association.
Number 371
CHAIRMAN WILKEN asked Mr. Morotti his opinion of combining the
counselors' board with the marriage and family therapists' board.
MR. MOROTTI said he thinks it is a good idea because he sees no
need to have a proliferation of boards providing mental health
services.
DIXIE HOOD, a licensed marriage and family therapist from Juneau,
and a member of the Board of Marital and Family Therapy, gave the
following testimony. As a 23 year Alaska resident and psychology
professor at the University of Alaska Southeast, she moved to
California to complete a Masters in Counseling program for two
years. That program required 3,000 supervised hours and an oral
and written exam. She was licensed in California and upon
returning to Juneau in 1985, contacted the Division of Occupational
Licensing to find out what requirements she needed to meet to
practice. Purchase of a business license was the only requirement
until 1992. She commented that marriage and family therapy is not
a specialty field. It is a theoretical approach in terms of
counseling individuals, couples, or family members within the
family systems approach and their interrelationships. Marriage and
family therapists also treat people with alcohol problems, serious
chronic mental illness, and depression and anxiety.
MS. HOOD indicated at the February 10, 1998 Marital and Family
Therapy Board meeting, the Board expressed interest in supporting
standards and licensure for professional counselors in Alaska, and
in discussing with them consideration of a combined board. The
board has sought information from other states with omnibus boards
to find out how their systems work.
MS. HOOD commented she has testified on and followed SB 122; it is
scheduled before the House Labor and Commerce Committee this
afternoon for a second hearing. During the first hearing, held
last week, information was requested and an amendment was
discussed. The same amendment failed the Senate last year and
would have added licensed marriage and family therapists to a list
of health care providers who cannot be discriminated against in
third party reimbursements. MS. HOOD believes it is important for
consumers to have some trust in the amount of training and
experience required of mental health providers. Licensure
requirements are also important for the professional in terms of
standing in the professional community and employee assistance
programs and insurance companies.
SENATOR LEMAN noted his memory of what happened regarding the
amendment differed from Ms. Hood's. He recalled the amendment
passed the Senate but its passage created challenges in the bill
that some did not want to address at the time, therefore the
amendment was removed and the bill passed.
MS. HOOD added the amendment created a furor from chiropractors,
dentists and other professionals. The Omnibus Insurance Reform Act
did not take up that amendment, therefore the Board of Marital and
Family Therapy is hoping it will be taken up in SB 122 or in
another venue.
There being no further testimony on SB 331, CHAIRMAN WILKEN
announced the committee would hold the bill to investigate whether
it can be incorporated into SB 122 or vice versa.
SENATOR LEMAN stated whether SB 122 is the right vehicle in which
to combine the boards or not, he thought the Legislature should
consider combining the two boards and use a separate piece of
legislation if necessary.
CHAIRMAN WILKEN indicated the bill would be brought before the
committee on Wednesday and a report on SB 122 would be provided.
SB 321 - ASSISTED LIVING FACILITIES
CHAIRMAN WILKEN announced a committee substitute had been prepared
for SB 321.
SENATOR WARD moved to adopt CSSB 321 (version F) as the working
document of the committee. There being no objection, the motion
carried.
SENATOR MIKE MILLER, District Q, discussed the reason he introduced
SB 321. His father was placed in an assisted living care facility
in North Pole as a private pay client. Through the course of his
father's stay, the family saw the type of loving care given to his
father until he passed away and to the other clients. One other
client was a private pay; the other clients were paid for by the
state for which the caregiver received $34.50 per day. Senator
Miller cautioned that if the current amount paid to assisted living
caregivers is not increased, more and more caregivers will quit
providing services because the care provided in these homes is very
demanding upon the caregivers. If fewer caregivers are available,
families will have to send elderly relatives to places like Denali
Center, which costs the state a couple of hundred dollars per day.
Assisted living facilities are a less expensive alternative, and
they provide a different type of environment which some people
prefer.
SENATOR MILLER maintained he was not sure how the increased cost
associated with SB 321 will be paid, but he felt dialogue on long
term care issues must begin. He concluded by saying he cannot
speak highly enough about the caregivers who provide this service
and the type of care his father received and he believes increasing
the amount of funds they receive is the right thing to do.
CHAIRMAN WILKEN questioned how the $70 amount was calculated.
SENATOR MILLER replied his staff worked with a number of assisted
living caregivers to come up with that number. Since the last
increase in 1983, many expenses have increased, such as insurance
rates.
CHAIRMAN WILKEN asked if assisted living homes require licensure
and if they take more than one client at a time.
SENATOR MILLER answered this particular home was licensed by the
State of Alaska to house up to five individuals at a time. He
added that private pay clients go to the top of the waiting list
because they pay more. His father's care cost $100 per day, but
had he been in an institution, the cost would have been much
higher. He noted a number of the individuals who live in assisted
living facilities do so until they pass on.
CHAIRMAN WILKEN pointed out that Mr. Kohn of the Pioneer Home
estimated there will be 30,000 s and enter an educational
institutional setting eniors in the State of Alaska in the year
2000 or 2005 while only be 600 Pioneer Home beds will be available.
Number 552
JOHN PIERCE, Vice President of Senior Quality Care Incorporated,
which owns and operates an eight-bed facility named "Summer Shade,"
made the following remarks. One cannot even find a good motel room
in Fairbanks for $34.50, yet assisted living facilities offer 24
hours per day of care for that amount. In his facility everyone is
licensed as at least a CNA. His clients need various levels of
care; some need borderline nursing home services; some are taken in
emergency situations. The paperwork submitted for clients who
qualify for state monies normally takes 60 to 90 days to process.
He asked that the amount of payment be dependent upon the level of
care needed. Mr. Pierce thought assisted living facilities are
competing unfairly with Pioneers Homes because Pioneers Homes do
not accept clients for $34.50 per day. After he does the paperwork
for some of his clients, and their health improves, they are often
transferred to a Pioneer Home.
TAPE 98-22, SIDE B
Number 580
DWIGHT BECKER, Program Coordinator with the Division of Senior
Services, stated he supervises programs of adult protection and
assisted living facility licensing, and he administers the general
relief program statewide. He maintained assisted living providers
are a very important part of the senior services network. They do
not only provide services for seniors, they also provide services
to anyone 18 years of age and over who is a vulnerable adult with
a mental or physical impairment. He believes providers are long
overdue for some type of increase. The clientele they are now
serving are becoming more difficult to provide for. More clients
have mental health problems, alcohol and substance abuse related
problems, and are violent. Many clients have multiple health care
needs requiring a whole array of services. In Alaska the assisted
living providers market rate for taking care of such clients runs
about $2500 to $3000 per month. The general relief program pays a
base rate of $30 in Anchorage; a cost of living differential is
applied to other areas around the state. He supports some type of
increase. Everyday, his agency receives calls from hospital
discharge planners, police departments, and others looking for
facilities in which to place people who are at risk of becoming
homeless and/or are at risk of abuse, neglect, or self-neglect.
Alaska has almost 100 assisted living homes statewide, and rarely
do they refuse to take a client, even at the low rates.
Number 550
ROSE HEYANO, the social services director for the Bristol Bay
Native Association (BBNA), informed committee members that BBNA is
currently assisting in the development of a ten bed facility to be
located in Dillingham. Funding for that facility is contained in
the senior citizen housing development fund in the Governor's
capital budget request. BBNA is relying on medicaid choice funds
and the daily base rate paid by DHSS for adults in residential care
for this operation. This funding is not adequate to make the
facility self sufficient. BBNA needs at least $1400 per month per
client to be self-supporting. The goal of the region is to develop
a ten-bed facility in Dillingham and then smaller facilities in
Togiak and New Stuyahok. BBNA found that in 1996, 16 elders left
the region, yet everyone of them could have been placed in assisted
facilities if the space was available. Local residents want to
keep their elderly relatives close by. BBNA estimates that nine
out of 10 beds will be filled by low-income people on fixed
incomes. The operational costs in rural Alaska are much higher
than in urban areas. BBNA determined from a survey it conducted
last year there are 80 elders in the region. It currently has a
home care program that has placed over 50 personal care attendants
in over 70 elders' homes in the region. An assisted living
facility will provide one more level of care for elders who need to
make that transition. It will be less expensive in the long run to
keep elders closer to home. MS. HEYANO encouraged committee
members to help BBNA in its endeavor to develop more assisted
living facilities in its region.
CATHY WESTLING, representing Downtown Care Assisted Living, and the
secretary of the Alaska Caregivers' Association, stated that
assisted living is a model of care in the State of Alaska.
Essentially, foster care turned into assisted living two to three
years ago. Caregivers are a self-governing body of independent
business owners who are required to be licensed, monitored and
accountable. The goal of assisted living is to deinstitutionalize
care as long as possible; assisted living caregivers need
recognition and support. These business owners are required to pay
insurance and workers' compensation, yet the base rate has not
changed since 1983. Downtown Care Assisted Living is a ten-bed
facility that employs seven employees: often native employees,
employees off of welfare roles, and employees who are related to
clients. It has housed many displaced elders who come from rural
areas to Anchorage for medical care. Ms. Westling indicated that
many of her clients have alcohol and substance abuse problems,
and/or have been abused and exploited. These clients need help
learning how to deal with relationships. She gets involved in
restraining orders, guardianship issues, probate court, and getting
people into counseling. Clients in assisted living facilities need
care 24 hours per day. With a higher base rate for clients, she
would like to hire more escorts to get clients active in the
community. She added the State of Washington pays $55 per day as
its base rate.
MS. WESTLING indicated she has many clients with mental health and
developmental disability problems. These clients can be very
disruptive and sometimes it takes up to one year to receive funding
for those clients. She believes the homeless population with
mental illness or developmental disabilities will suffer the most
if the rates are not raised.
MONTA LANE, owner of a five-bed facility in North Pole, and
President of Alaska Caregivers' Association, thanked Senator Miller
for his efforts and made the following statements. She started her
business in 1991, which was known as adult foster care at that
time. The rate of pay in 1991 for general relief clients was
$30.91; the amount increased by $2.60 in 1992. Nursing homes are
not designed to take care of people who have reached a point to
where they need to be in an assisted living type of setting. As
clients get older, they usually deteriorate and often die in the
assisted living facility. Clients become part of a family, and it
is difficult to lose them. Regarding the question about the
increase to $70 per day, Ms. Lane said she originally requested
$100 per day with a sliding fee for people who require more care.
She has detoxed clients. The Legislature appropriated $21 million
for alcohol and substance abuse problems, yet none of that money is
available to assisted living homes or the adult protection agency.
Almost every assisted living home in the Interior has alcohol
related dementia seniors in their homes. Ms. Lane emphasized
assisted living facility owners work 24 hours per day yet they get
no overtime pay nor do they have insurance, retirement funds or
vacations. She noted she had a client for seven years who recently
passed away. After making several attempts to find his family over
the years, she located his children in Portland, Oregon, who
thought he had passed away. This client did pass away two weeks
later after speaking to his family for the first time in 12 years.
She repeated her request for a base rate of $100 per day with a
sliding fee scale for clients with chronic alcohol or mental
illness problems.
Number 374
DEBBIE CASK, owner of Debbie's Fireside Homes, stated she is having
a difficult time keeping employees because she cannot compete with
the wages offered by nursing homes. She noted assisted living
facilities owners are receiving $1.44 per hour per client which is
barely enough to buy food. To keep employees, she needs to offer
health insurance and competitive wages. She recently hired three
people from the welfare roll but had to let them go because she
could not afford to keep them. She said many clients need to be
hand fed, changed daily, and turned every few hours, among other
things.
CHAIRMAN WILKEN clarified that language on lines 9-12 allows the
department, by regulation, to provide for a daily rate higher than
$70 if the additional care justifies the additional reimbursements.
SELMA ROBINSON, owner of Robinson Care, stated at present she has
a limited number of clients, and is concerned that the $34.50 is
not sufficient to take care of a person in her home. She has part-
time help but can afford no more.
HELEN POWELL, owner of a five-bed assisted living home, stated it
is very difficult for her to keep her business open if she is not
full all of the time. She serves three meals and snacks each day,
hires employees, pays higher utility bills, and provides an array
of services for her elderly clients.
Number 313
MS. B JARVI, a professional guardian, stated the minimum wage is
over $5 per hour, yet caregivers only receive $1.44 per hour which
is an injustice. Often she must plead with caregivers on short
notice to take clients because they are in intolerable living
situations. The assisted living facility caregivers find room for
these clients every time and sometimes without knowing if they will
get paid at all. Pioneers Homes and similar facilities will not
take people on short notice and are often full. Ms. Jarvi said she
could not even put a client in a hotel room for $34.50 per night,
let alone hire someone to watch the client. She noted when clients
who are in the Denali Center for recuperative purposes are able to
leave, she moves them to an assisted living facility as quickly as
possible because the clients do better in a home environment. They
are treated with dignity and are included in family life. She
stated her support for a substantial raise to caregivers.
SHARON KENAMON, an assisted living facility owner, stated she has
been in business for 1+ years and is barely paying her bills. She
is unable to provide any transportation to clients other than for
medical visits and cannot afford to provide any activities. Two
clients she housed were recently released and she never received
payment for them. Caregivers need an increase in the pay rate in
order to be able to provide activities for their clients.
JUDITH TOWNSEND, owner of Center of Care, stated she opened her
facility one year ago after working as an RN in a hospital for six
years. She believes many people have a bad feeling about nursing
homes, and many elderly want to stay in their own homes, so
assisted care facilities are the next best thing because clients
live in a family atmosphere. Clients often need assistance with
daily care, but they do not have the money to pay for such care.
The base rate of $34.50 does not cover the cost of providing for
these clients. Direct costs alone can run $170 per day. She
believes a base rate of $100 per day would be much more appropriate
to ensure clients receive adequate care from trained caregivers.
CHAIRMAN WILKEN thanked all participants for testifying today and
stated that although the money is an important issue, caregivers
are motivated by more. He thanked them for their services to a
needy group of people.
DERRILL JOHNSON, Division of Mental Health and Developmental
Disabilities in the Department of Health and Social Services,
stated assisted living facilities are probably one of the most
important new industries in the state and are necessary as part of
the state's long term care plan. DHSS recognizes that the
compensation system needs to be revised, whether that be the fee
structure or in the compensation methodology which determines the
true cost of care. DHSS would like to see the fee structure based
on an individual's needs rather than a fixed rate. DHSS also
believes a public hearing process should be held before determining
the rate because Alaska has a variety of vendors with different
needs.
MR. JOHNSON stated the assisted living home industry is relatively
new and is a combination of the adult foster care program and the
adult residential care program. DHSS has been aware of problems
that have occurred with the combination of those two programs and
of the low rate, but it has not had the resources to adjust the
fees to a $70 minimum.
CHAIRMAN WILKEN asked if a sliding fee scale based on need is used,
whether a method to grade the needs will have to be created at an
additional expense to the state.
MR. JOHNSON replied that individualized funding is used with
developmentally disabled clients. The cost of care is negotiated
based on a care coordinator's plan and with an independent third
party who works with the family of the consumer. The necessary
services are costed out with a vendor. Mr. Johnson thought using
a tiered fee schedule which allows flexibility to individualize
each plan would work best. In some of the outlying areas where
assisted living facilities need further development, staff and
expertise may not be available to determine individually negotiated
costs. If a tiered system with parameters was available to use as
a baseline to explain what costs are associated with what needs,
caregivers could more easily determine realistic costs. Mr.
Johnson said the need for quality care is the driving force behind
assisted living facilities therefore comparable wages need to be
paid for that care.
CHAIRMAN WILKEN gave the gavel to Senator Leman and excused himself
to attend another hearing.
SENATOR WARD referred to Section 7 of the committee substitute and
said he understood that section to mean that $70 is established as
the base rate but that rate could be increased if a client requires
extra care. Senator Ward commented he was pleased to see this
legislation because this is what he came to Juneau to do, not to
spend $120 per day to house prisoners.
SHARON CLARK, legislative aide to Senator Mike Miller, sponsor of
SB 321, informed committee members the two lists in committee
members' packets were provided by DHSS, and DHSS staff has been
very helpful in drafting this bill. She pointed out there are 138
assisted living homes throughout the state. The Alaska Caregivers'
Association resolution contains a breakdown of the amount provided
on a daily basis to each caregiver, compared to what each one
should receive. Committee packets also contain a resolution from
the Alaska Commission on Aging.
MS. CLARK commented this summer she spent a lot of time speaking
with people in rural areas about this approach. They were excited
about creating assisted living homes in their areas so their
elderly do not have to leave. She noted many elderly are sent to
Denali Center or other facilities in urban areas and can no longer
see family members because the cost of travel is prohibitive.
ALISON ELGEE, Deputy Commissioner of the Department of
Administration, which administers the senior services programs,
gave the following testimony. The base rate being discussed is the
rate for general relief funds. Once an individual qualifies for a
medicaid waiver, which requires the individual to need a nursing
home level of care, the department has the ability to negotiate
the amount of compensation paid to the assisted living home
facility. She cautioned there will always be individuals in a
general relief category who do not meet the nursing home level of
care but are incapable of living independently. Many come through
adult protective services and need emergency placement. The
department has discovered that people who move into an assisted
living environment before their needs get to a nursing home level
of care can generally be maintained in a less expensive environment
for much longer. The department's primary concern with SB 321 is
the fiscal note because the cost of paying the base rate of $70 per
day for existing clientele alone will be substantial.
VICE CHAIR LEMAN stated he shares Ms. Elgee's concern about how to
address the costs, but he also shares Senator Ward's concerns.
TAPE 98-23, SIDE A
MONTA LANE repeated that caregivers need to receive a minimum of
$70 per day for general relief clients in their homes, and more for
clients who need special services. She informed committee members
it sometimes takes five months to get clients on a medicaid choice
waiver. During that time the caregiver must provide for the client
out of pocket and is then retroactively reimbursed only to the date
the plan of care was signed which may have occurred two months
after the client arrived at the home. She added that non-profit
organizations can get grants to build assisted living care
facilities but private owners get no assistance to maintain their
homes.
SENATOR WARD commented he worked on similar legislation in 1982 and
that he will have no trouble finding enough money to fund SB 321.
He moved to pass CSSB 321 out of committee with individual
recommendations and its accompanying fiscal note. There being no
objection, the motion carried.
SENATOR WARD informed committee members he has not yet received the
final legislative bill on child support enforcement provisions from
the Idaho Legislature.
VICE-CHAIR LEMAN announced the next HESS meeting is scheduled on
Wednesday at 9:00 a.m. He adjourned the meeting at 10:45 a.m.
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