Legislature(1993 - 1994)

02/04/1994 01:33 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                        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                 
 SB 248 - See Health, Education & Social Services minutes dated                
 SB 249 - See Health, Education & Social Services minutes dated                
 SB 250 - See Health, Education & Social Services minutes dated                
  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.                               
 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            
 CARROL CAROL, staff to Senator Kerttula, said that the total limit            
 is $150,000 or 50 percent of their tax liability, whichever is                
 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              
 (REVISE OLDER ALASKANS COMMISSION) as the next bills before the               
 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              
 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             
 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              
 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                
  (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                
 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              
 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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