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
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.
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