SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE February 16, 1994 1:42 p.m. MEMBERS PRESENT Senator Steve Rieger, Chairman Senator Bert Sharp, Vice-Chairman Senator Mike Miller Senator Jim Duncan Senator Johnny Ellis Senator Judy Salo MEMBERS ABSENT Senator Loren Leman COMMITTEE CALENDAR 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 248 - See Health, Education & Social Services minutes dated 2/2/94 and 2/4/94. SB 249 - See Health, Education & Social Services minutes dated 2/2/94 and 2/4/94. SB 250 - See Health, Education & Social Services minutes dated 2/2/94 and 2/4/94. WITNESS REGISTER Connie Sipe Executive Director, Division of Senior Services Department of Administration P.O. Box 110209 Juneau, Alaska 99811-0209 POSITION STATEMENT: Reviewed SB 248, SB 248, SB 250. Dave Williams Division of Medical Assistance Department of Health and Social Services P.O. Box 660 Juneau, Alaska POSITION STATEMENT: Reviewed SB 249. ACTION NARRATIVE TAPE 94-9, SIDE A Number 008 CHAIRMAN RIEGER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:42 p.m. He introduced SB 250 (REVISE OLDER ALASKANS COMMISSION) as the first order of business before the committee. He asked if there was any testimony or amendments for SB 250. SENATOR MILLER moved SB 250 out of committee with individual recommendations. Hearing no objections, it was so ordered. Number 020 CHAIRMAN RIEGER introduced SB 248 (ASSIST & PROTECT VULNERABLE ADULTS) as the next order of business before the committee. He offered his proposed amendment, Lauterbach 8-GS2001\A.1, as Amendment 1. He explained that his amendment was a type of indemnification so that the state can provide services to vulnerable adults without creating additional liability. Chairman Rieger moved to adopt Amendment 1. AMENDMENT 1 Page 3, line 25, after ".": Insert " A person may not bring an action for damages against a police    officer, village public safety officer, the state, te, a political subdivision of the state based on a decision under this subsection to take or not to take immediate action to protect a vulnerable adult. If a decision is made under this subsection to take immediate action to protect a vulnerable adult, a person may not bring an action for damages based on the protective actions taken unless the protective actions were performed with gross negligence or intentional misconduct; damages awarded in the action may include only direct economic compensatory damages for personal injury."  Page 7, line 22: Insert new subsections to read: "(e) A person may not bring an action for damages based on  a decision under this section to offer or not to offer protective services to a vulnerable adult. (f) A person may not bring an action for damages based on the provision of protective services under this section unless the action is based on gross negligence or intentional      misconduct. The damages awarded in an actio tio under this section may include only direct economic compensatory damages for personal injury." Hearing no objections, Amendment 1 was adopted. CONNIE SIPE, Director of the Division of Senior Services, introduced her February 15 markup of SB 248. She discussed her first amendment, Amendment 2, which would restore the language on lines 1 and 2 of page 2. Number 093 CHAIRMAN RIEGER moved to adopt Amendment 2. AMENDMENT 2  Page 2, lines 1, after "AS 47.30.915(11)": Insert "and including a marital and family therapist licensed under AS 08.63" Hearing no objections, Amendment 2 was adopted. CONNIE SIPE explained that the next amendment, Amendment 3, gives a degree of behavior to judge their harm against not a rectifiable civil cause. SENATOR MILLER stated that the problem was not corrected due to the previous change of "shall" to " may " on line 22 of page 3. He pointed out that Amendment 3 would specify "serious physical harm", but the reporting to the police is still optional due to line 22. CONNIE SIPE said that Kristen Bomengen of the Department of Law felt that " may " should remain because that subsection refers to th th average citizen not a person who is required to report. She proposed changing line 17 to "a person required to report under this section" and the " may " would become "shall." SENATOR MILLER did not have a preference regarding this issue. He asked what the penalties are if those required to report do not. CONNIE SIPE noted that there are no specific penalties, but there is a penalty if a required reporter does not make the initial report. If shall was put back in line 22, civil liability would come into play. She did agree that it would be acceptable to restrict line 17 to required reporters. SENATOR MILLER preferred restricting the section to required reporters. CONNIE SIPE stated that to restrict Subsection (e) to required reporters, the language on line 1 of page 3 would be parallel to line 17. Number 170 SENATOR SALO expressed concern with changing line 17. She explained that the change would speak twice to those required to report and not at all to others who may report. CONNIE SIPE stated that Subsection (d) eliminates some of the elaboration on other people reporting, but lines 6 and 7 are an invitation for others to report. SENATOR SALO questioned the difference in Subsection (c) and (e) if line 17 is changed to speak to those required to report. CONNIE SIPE noted that Subsection (e) with the change of line 17 would speak to those required to report in the event " of  serious physi ysi harm " when the department cannot be accessed. In such a case those se required to report can report to the police who can take immediate action to protect the vulnerable adult from the harm. SENATOR SALO said that this subsection was cumbersome. CONNIE SIPE informed the committee that this subsection was the result of insertions by the Legal Drafting. She suggested breaking the subsection into separate sentences to address the required reporter with shall and the other persons with may. SENATOR MILLER suggested leaving the language as changed in Amendment 3, but that the individual's packet should explain the options and requirements. Number 230 CHAIRMAN RIEGER moved to adopt  Amendment 3. AMENDMENT 3  Page 3, line 19, after " risk ": Insert " of serious physical harm " Hearing no objection, Amendment 3 was adopted. CONNIE SIPE explained that Amendment 4 came about due to concerns with the possibility that the state would have the ability to unduly take over these vulnerable adults based on the surrogate decision maker. She stated that Amendment 4 should explain the limits of the surrogate decision maker. SENATOR SHARP proposed changing the language of Amendment 4 from " is no longer unable to consent " to "regains the ability to consent." CHAIRMAN RIEGER inquired if the phrase " regains decision-making capacity " has some legal appropriateness and would be all that should be used. CONNIE SIPE explained the differences in the legal meaning of decision-making capacity and the inability to consent. She said that both should remain, but that the amendment could be redrafted as Senator Sharp had suggested. SENATOR MILLER suggested changing " no longer unable   to consent   " to "able to consent." CHAIRMAN RIEGER suggested having the legal drafter correct the phrase if Amendment 4 was adopted with the conceptual change. Number 287 SENATOR SHARP moved to adopt Amendment 4 with the conceptual change. AMENDMENT 4  Page 8, after line 27: Insert new subsection: "(d)  When the vulnerable adult regains the ability to consent or decision-making capacity, the department may no longer use the consent given by the surrogate decision maker as a basis for continuation of protective services to the vulnerable adult." CHAIRMAN RIEGER objected and explained that SB 248 should have a judicial referral due to the complexities that may be triggered with the surrogate decision maker issue. CHAIRMAN RIEGER removed his objection.   Hearing no objections Amendment 4 was adopted. SENATOR MILLER moved SB 248 as amended out of committee with individual recommendations. Hearing no objections, it was so ordered. Number 312 CHAIRMAN RIEGER introduced SB 249 (REGULATION OF ASSISTED LIVING HOMES) as the final order of business. DAVE WILLIAMS, Department of Health and Social Service in the Division of Medical Assistance, stated that SB 249 is a good bill and should move forward. SB 249 offers individuals the opportunity to chose something other than an institution. He noted that SB 249 would increase access to Medicaid. He informed the committee that he owed them a fiscal note. He believed that the fiscal note for 1995 would be zero and no impact on this year. Mr. Williams pointed out that line 29, page 2 will not allow assisted living homes to come under the rate setting methodology of the Medicaid Rate Advisory Commission. He referred to Section 47.33.430 on page 18 which he believed authorizes the Division of Medical Assistance to draft regulation specifically addressing assisted living facilities. He proposed a per day rate to be set rather than billing services separately; this would assure reasonable payment. He noted that Section 11 which speaks to certificates of need, is addressed in Amendment 1. CONNIE SIPE agreed with Amendment 1. Number 377 CHAIRMAN RIEGER moved to adopt Amendment 1, Lauterbach 8- GS2002\A.1. AMENDMENT 1  Page 1, line 1, after ";" Insert " relating to the conversion of an assisted living home t o a nursing home; and " Page 25, after line 16: Insert a new bill section to read: "* Sec. 2. AS 18.07.031 is amended by adding a new subsection to read: (b) A person may not convert a building or part of a building that is licensed as an assisted living facility under AS 47.33 to a nursing home that requires licensure under AS 18.20.020 unless authorized under the terms of a certificate of need issued by the office." Renumber the following bill sections accordingly. Page 28, line 16: Delete "16" Insert"17" Page 28, line 20: Delete "14" Insert "15" Page 28, line 21: Delete "1-13" Insert "1-14" Hearing no objections, Amendment 1 was adopted. CONNIE SIPE introduced her February 13, 1994 markup #1 of SB 249. She suggested that the changes in the definition of an assisted living facility spoke to the concern of assisted living facilities becoming nursing homes. She felt that the modifier on HEALTH- RELATED SERVICES would create a more distinct dividing line. Number 430 SENATOR ELLIS moved to adopt Amendment 2. AMENDMENT 2  Page 2, line 20 and 21, after "obtain,": Delete "one or more or the following" Insert " either " Page 2, line 22, after ";": Insert " or " Page 2, line 23, after "assistance": Delete ";" Insert " . " Page 2, line 24: Delete "(C) health-related services." Page 3, line 2, after "SERVICES": Insert " ALLOWED IN ASSISTED LIVING HOMES " and Insert new subsection to read: " (a) An assisted living home may provide or obtain, or offer to provide or obtain one or more of the following health-related services for the residents of the home, as a supplemental service to the long-term provision by the home to residents of assistance with the activities of daily living or personal assistance. " Renumber the subsections accordingly. Hearing no objections, Amendment 2 was adopted. CONNIE SIPE explained that the changes on page 3, lines 23-25 deletes the reference to a nurse aide because a nurse aide never does a task alone, they only do tasks nurses delegate to them. Such a delegation of a task is already addressed in the renumbered subsection (e). SENATOR SALO commented that this new language broadens the scope of who can do the health-related tasks. CONNIE SIPE clarified that there is no opposition to unlicensed individuals to get training and be delegated tasks. Ms. Sipe asserted that a nurse aide would not be doing nursing tasks. CHAIRMAN RIEGER asked if nursing services was defined in statutes. CONNIE SIPE stated that nursing services are defined by the Board of Nursing. CHAIRMAN RIEGER asked if any statutes say that only nurses can provide nursing services. CONNIE SIPE noted that the regulations in the Board of Nursing which specify the differences between a registered nurse and a licensed practical nurse. Only the registered nurse can make an evaluation, carry out a physician's diagnosis, monitor, and plan a plan of care for an individual. CHAIRMAN RIEGER asked if the Board of Nursing could hypothetically say that only a nurse could bring a patient a glass of water. CONNIE SIPE said that theoretically they could, but that is not the direction the Board of Nursing is taking. The general trend in nursing is to reserve the role of the evaluator and care planner for the nurse, while still having the ability to delegate. Ms. Sipe responded to Chairman Rieger's questioning if brain surgery could be permitted by the Board of Nursing. Ms. Sipe pointed out the reference that nursing is not the practice of medicine. There are licensure requirements for nurses and to do surgery there are Medical Board testing requirements. Number 510 SENATOR SALO moved to adopt Amendment 3. AMENDMENT 3  Page 3: Delete lines 24 and 24 Insert " an individual to whom a nursing task has been delegated under subsection (e) below. " Hearing no objections, Amendment 3 was adopted. CONNIE SIPE stated that the insertion on page 5, line 2 only clarifies the contract; the rental period is decided by the resident in their contract. CHAIRMAN RIEGER clarified the change further and suggested additional language. CONNIE SIPE agreed with that Chairman Rieger's language should be incorporated. SENATOR MILLER moved to adopt Amendment 4. AMENDMENT 4  Page 5, line 2, after "period": Insert " as the rental period is defined in the contract " Hearing no objections, Amendment 4 was adopted. CONNIE SIPE pointed out that Amendment 5 modifies the medical tone of SB 249. CHAIRMAN RIEGER moved to adopt Amendment 5. AMENDMENT 5  Page 6, line 1, after "a": Delete "bed" Insert " space " Hearing no objections, Amendment 5 was adopted. CONNIE SIPE stated that Amendment 6 also tones down the medical tone of the bill. SENATOR SHARP moved to adopt Amendment 6. AMENDMENT 6  Page 3, line 12: Delete "'s admission to" Insert " enters into a residential services contract with " Hearing no objections, Amendment 6 was adopted. CONNIE SIPE indicated that the changes in subsection (c) address landlords' concerns that they not be limited under House rules. SENATOR SALO asked if subsection (d) speaks to reasonableness of the rules. CONNIE SIPE said yes. CHAIRMAN RIEGER moved to adopt Amendment 7. AMENDMENT 7  Page 6, line 14, after "address": Insert " various issues, including but not limited to " Page 6, line 20 Delete "and" Page 6, line 21, after "alcohol" Insert " ;and " Page 6 Insert new paragraph to read: " (7) physical, verbal, or other abuse of other residents or staff. " Hearing no objections, Amendment 7 was adopted. CONNIE SIPE offered Amendment 8. AMENDMENT 8  Page 7, line 3: Delete "admission" Insert " residential services " Page 7, line 24: Delete "is discharged from" Insert " terminates residency at " SENATOR SALO moved to adopt Amendment 8. Hearing no objections, Amendment 8 was adopted. CONNIE SIPE noted that the changes on lines 7 and 8 of page 8 are awkward. She clarified that this section refers to when the individual moves into an assisted living home. TAPE 94-9, SIDE B Number 581 CHAIRMAN RIEGER moved to adopt Amendment 9. AMENDMENT 9  Page 8, line 7: Delete "ADMISSIONS" Insert " COMMENCEMENT OF RESIDENCY " Page 8, line 8: Delete "ADMISSION" Insert " COMMENCEMENT OF RESIDENCY " Page 8, line 8: Delete "be admitted to" Insert " commence to reside in " Hearing no objections, Amendment 9 was adopted. CONNIE SIPE explained that Amendment 10 clarifies that an individual comes in for assisted living and the physician's statement is addressed elsewhere. SENATOR SALO moved to adopt Amendment 10. AMENDMENT 10  Page 8: Delete lines 11-13 Hearing no objections, Amendment 10 was adopted. CONNIE SIPE noted that Amendment 11 was mainly language changes. CHAIRMAN RIEGER moved to adopt Amendment 11. AMENDMENT 11  Page 8, line 14: Delete "ADMISSION CONTRACTS" Insert " RESIDENTIAL SERVICE " Delete "not be" Insert " take up " Page 8, line 15: Delete "admitted as a resident of" Insert " residency in " Page 8, line 16: Delete "an admission" Insert " residential services " Page 8, line 17: Delete "admission" Insert " residential services " Page 8, line 20: Delete "An admission" Insert " A residential services " Page 8, line 26: Delete "discharge" Insert " termination " Delete "resident' Insert " residential services contract " Page 8, line 31: Delete "discharge" Insert " termination of the contract " Hearing no objections, Amendment 11 was adopted. CONNIE SIPE explained that the changes in Section 47.33.230 address concerns with the assisted living home's liability. CHAIRMAN RIEGER moved to adopt Amendment 12. AMENDMENT 12  Page 9, line 13: Delete "and" Page 9, line 14, after "responsibility": Insert " and right " Delete "shared" and "the home and" Page 9, line 15, after "evaluate": Insert "  and choose, after discussion with all relevant parties es including the home  ; " Page 9, line 16: Delete "." Insert " ; and " Page 9, after line 16: Insert new paragraph to read: " (3) recognize the right of the home to evaluate and to either consent or refuse to accept the resident's choice of risks as described in (2) above; " Hearing no objections, Amendment 12 was adopted. CONNIE SIPE noted that Amendment 13 clarifies that the resident can take care of their own needs to the extent that was possible. SENATOR SALO moved to adopt Amendment 13. AMENDMENT 13  Page 9, line 29, after "home": Insert " or the resident " Hearing no objections, Amendment 13 was adopted. Number 539 CONNIE SIPE explained that the changes in Amendment 14 reflect the assisted living home's ability to choose what level of services it would provide. SENATOR SALO asked if there was any other category of professional who could review and approve the health care plan. CONNIE SIPE stated that evaluating a health care plan is only in the scope of practice of registered nurses which includes nurse practitioners. Ms. Sipe noted that the task could be delegated up to a physician, but physicians usually do not know much about daily plans of care. Nurses are trained in daily plans of care. SENATOR SALO moved to adopt Amendment 14. AMENDMENT 14  Page 10, line 7, after "(c)": Insert " If the assisted living home provides or arranges for health-related services to be provided to a resident, the " Delete "assisted living home" Page 10, line 9, after ",": Insert " and shall ensure that a physician's statement about the resident is included in the plan. " Hearing no objections, Amendment 14 was adopted. CONNIE SIPE pointed out that changes in Amendment 15 take the burden of preparing the plan from the assisted living home and place the responsibility on the person preparing the plan. CHAIRMAN RIEGER expressed concern with the word prepared because that would be a mandate. He suggested deleting "prepared." CONNIE SIPE stated that would be acceptable. In response to Chairman Rieger, Ms. Sipe noted that "language that can be understood by the resident" covers illiterate persons. CHAIRMAN RIEGER moved to adopt Amendment 15 with his change.   AMENDMENT 15  Page 10, line 10: Delete "An assisted living home shall prepare a" Insert " The " Page 10, line 10, after "plan": Insert " must be " Hearing no objections, Amendment 15 was adopted. CONNIE SIPE said that Amendment 16 cleans up the language. CHAIRMAN RIEGER pointed out that the contract would have to be voluntarily entered into by the individual and the home. He suggested inserting language to that effect. CHAIRMAN RIEGER moved to adopt Amendment 16. AMENDMENT 16  Page 10, line 13: Delete "admit" Insert " enter into a residential services contract between " Page 10, line 13, after "individual" Delete "to that" Insert " and the " Hearing no objections, Amendment 16 was adopted. CONNIE SIPE explained that the evaluation of assisted living homes no longer focuses on an individual being admitted for health- related services, but rather it focuses on if the assisted living home provides health-related services. SENATOR SALO stated that the language in Amendment 17 which speaks to "other residents" is confusing. CONNIE SIPE suggested more specific language. Senator Salo also offered more specific language. CHAIRMAN RIEGER questioned the need for line 28 regarding evaluations being done as frequently as the resident requests. CONNIE SIPE believed that deleting line 28 would not hurt the bill due to the one year required evaluation and the previously discussed contract negotiations. CHAIRMAN RIEGER clarified the changes Amendment 17 entailed. SENATOR SHARP moved to adopt Amendment 17. AMENDMENT 17  Page 10, line 25: Delete "For a resident admitted for health problems" Insert " If the assisted living home provides or arranges for health-related services to be provided to the resident, " Page 10, line 26: Delete "a" Insert " other " Page 10, line 26,: Delete "admitted for reasons other than health problems" Insert " who do not receive health services from the assisted living home " Page 10, line 27: Delete "," Insert " . " Delete line lines 28 and 29  Hearing no objections, Amendment 17 was adopted. Number 402 CONNIE SIPE explained the clean up language of Amendment 18. SENATOR SHARP moved to adopt Amendment 18. AMENDMENT 18  Page 12, line 13: Delete "involuntary discharge" Insert " the intent of the home to terminate the residential services contract " Page 12, line 27: Delete "is admitted as a resident of" Insert " takes up residency in " Hearing no objections, Amendment 18 was adopted. CONNIE SIPE noted that the deletions of Amendment 19 were due to their broad nature. She emphasized that this section spoke to guaranteed access to the home. SENATOR SHARP moved to adopt Amendment 19. AMENDMENT 19  Page 13, line 12: Delete "representatives, of community organizations" Hearing no objections, Amendment 19 was adopted. CONNIE SIPE stated that Amendment 20 clarifies the consent involved when services are provided by the home. CHAIRMAN RIEGER moved to adopt Amendment 20. AMENDMENT 20  Page 13, line 30: Delete ";or" Insert " to provide services specified in the residential services contract; " Hearing no objections, Amendment 20 was adopted. CONNIE SIPE introduced Amendment 21. CHAIRMAN RIEGER moved to adopt Amendment 21. AMENDMENT 21  Page 14, line 25: Delete "is admitted as a resident of" Insert " takes up residency in " Hearing no objections, Amendment 21 was adopted. CONNIE SIPE noted that all the changes were language changes except the change regarding the termination of the contract. The exception inserts "the resident's self" due to liability concerns. SENATOR MILLER moved to adopt Amendment 22. AMENDMENT 22  Page 15, line 14: Delete "Discharge" Insert "  Termination " Page 15, line 14, after "resident": Insert " 's contract " Page 15, line 17: Delete "is admitted as a resident of" Insert " takes up residency in " Page 15, line 20: Delete "DISCHARGE" Insert " TERMINATION OF CONTRACT " Page 15, line 21: Delete "discharge" Insert " terminate a residential services contract with " Page 15, line 23, after "to": Insert " the resident's self, to " Page 15, line 25: Delete "discharge" Insert " transfer out of the home " Page 15, line 31: Delete "discharge" Insert " terminating the contract of " Hearing no objections, Amendment 22 was adopted. CONNIE SIPE said that Amendment 23 was a continuation of language changes. Subsection (c) was felt to be too much like a nursing home. She pointed out that the change allows for a case conference as part of a dispute resolution without requiring all the previously suggested assessments. Number 303 SENATOR SALO expressed concern with eliminating the details of terminating a contract. CONNIE SIPE asserted that this section speaks to involuntary termination with various reasons the bill addresses. Ms. Sipe noted that the homes were concerned that lines 14-22 would mandate that the home take on those assessment responsibilities, especially regarding line 18. SENATOR SALO asked what would the resident do when their contract was terminated and they had no place to go. CONNIE SIPE suggested that such individuals would probably turn to the Pioneer's Home, Home and Community Care Services, or calling Adult Protective Social Services. Ms. Sipe noted the requirement to discuss the alternatives. CHAIRMAN RIEGER asked who an "involved party" refers to in the new language in Amendment 23. CONNIE SIPE said that it referred to those listed after that sentence. She suggested changing the language to "the resident or the resident's representative." SENATOR SALO moved to adopt Amendment 23. AMENDMENT 23  Page 16, line 2: Delete "discharge" Insert " contract termination " Page 16, line 4: Delete "discharge" Insert " termination of the contract " Page 16, line 5: Delete "discharge" Insert " contract termination " Page 16, line 6: Delete "admission" Insert " residential services " Delete "; and," Insert " which must include the offer by the home to participate in a " Page 16, line 7: Delete "(3) the time and date of the" Delete "required" Insert " as described " Page 16, line 9: Delete "discharging" Insert " terminating the contract of " Page 16, line 10: Delete "hold" Insert " participate in " Delete "in which" Insert " if a conference is requested by the resident or the resident's representative " Page 16, line 12: Delete "determine" Insert "   who may discuss " Page 16, line 13: Delete "discharge based on an assessment of" Insert " contract termination. " Page 16: Delete lines "14-22" Page 16, line 23: Delete "discharge" Insert " terminates the residential services contract with " Hearing no objections, Amendment 23 was adopted. CONNIE SIPE stated that the change in Amendment 24 was a clarification of language. SENATOR SHARP moved to adopt Amendment 24. AMENDMENT 24  Page 19, line 15, after "home": Insert " which are relevant to the investigation " Hearing no objections, Amendment 24 was adopted. CONNIE SIPE explained that Amendment 25 allows restriction of the ability of an individual to give certain care or to take in residents with certain kinds of care needs. SENATOR SALO stated that Amendment 25 was a good change. SENATOR SALO moved to adopt Amendment 25. AMENDMENT 25  Page 20, line 22: Delete "suspend admissions" Insert " suspend the ability of the home " Delete "an" Insert " take in " Page 20, line 23: Delete "assisted living home" Insert " new residents or to take in residents' with specified conditions, restrict the type of care which the home may provide to residents, " Hearing no objections, Amendment 25 was adopted. Number 203 CHAIRMAN RIEGER referred to page 11 and Residents' Rights when he suggested changing the section to Residents' Standards. He then referred to page 12 line 26 when he suggested adding the clause that states "the above mentioned standards shall be set out in writing as part of the assisted living plan and shall be considered a contractual right." He explained that he was not sure what defining something as a right would entail. He expressed his preference for contractual rather than statutory rights. CONNIE SIPE inquired if one side of the contract feels that the contract has been breached, can the standards or rights be stopped. She mentioned the State Landlord Tenant Law which lists tenants' rights that regardless of landlord tenant contract disputes, the rights still stay in place. SENATOR SALO stated that moving towards standards shifts the discussion from the individual or the contract to the assisted living home. That could change the dynamics of the section. CHAIRMAN RIEGER reiterated his concern with the rights issue. He stated that a CS will be provided incorporating today's changes and the two remaining changes suggested by Connie Sipe. There being no further business before the committee, the meeting was adjourned at 3:06 p.m.