Legislature(1997 - 1998)

03/20/1997 03:45 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
 HB 152 - REGULATION OF HOSPICE CARE                                           
 Number 0000                                                                   
 CHAIRMAN BUNDE announced the next item on the agenda as HB 152, "An           
 Act regulating hospice care."                                                 
 REPRESENTATIVE JOE RYAN, Sponsor of HB 152, said the bill provides            
 for licensing of hospice care programs in Alaska, ensuring that               
 terminally ill persons receive comfort, support and care consistent           
 with hospice philosophy and concepts through a uniform level of               
 services.  There are no federal regulations or licensing                      
 requirements for hospice programs.  As of January 1997, 40 states             
 are licensing or regulating hospice programs.  Of the ten states              
 without hospice licensing, five have laws or regulations pending.             
 The licensing of hospice programs in Alaska will assure consumers             
 of consistent standards in the delivery of hospice services.                  
 REPRESENTATIVE RYAN continued, hospice is a unique component of the           
 health care delivery system, one that has evolved over the past 20            
 years in the United States.  Hospice provides care and support for            
 people with terminal illness.  The goal of hospice care is to                 
 enable patients to live an alert, pain-free life and to manage                
 symptoms so that the last weeks and months of life may be spent in            
 dignity and peace.  One out of every three people who die of cancer           
 or AIDS in this country is being served by a hospice program.                 
 REPRESENTATIVE RYAN said the annual growth in hospice programs                
 averaged about 8 percent in the early 1990s.  In the last five                
 years, growth has averaged 17 percent.  Hospice services are                  
 provided through a variety of means; independent community-based              
 organizations, divisions of hospitals or home-health services and             
 government agencies.  Rapid growth of hospice programs is due to              
 increased demands for home care services, the trend towards                   
 reimbursement for home-care services.  Consumers need to be aware             
 of specific characteristics that differentiate hospice from other             
 health care providers. Hospice offers comfort and care, not                   
 curative treatment.  It addresses emotional, spiritual and social             
 needs in addition to physical needs.  It considers the patient and            
 loved ones as the unit of care, affirms life and regards dying as             
 a normal process, seeking neither to hasten nor postpone death.               
 The care extends beyond a patient's death to include bereavement              
 care for grieving family members.                                             
 REPRESENTATIVE RYAN added that fear of painful suffering, of                  
 abandonment, and of losing control are primary concerns of people             
 experiencing terminal illness.  Hospice care is designed to address           
 these concerns by providing support, care and needed services to              
 help the terminally ill live their lives in maximum comfort and               
 control.  Passage of HB 152 will standardize hospice care and will            
 guarantee the Alaskan public the opportunity to access quality                
 hospice care.                                                                 
 JEAN HATFIELD, Founder, Hospice in Homer, President, Board of                 
 Directors of Hospice in Homer, testified next via teleconference              
 from Homer.  She requested that the licensing requirement for the             
 volunteer programs be deleted from the legislation.  Due to limited           
 funding and the size of the community, there is only one part-time            
 director.  Their concern is that services might be diminished if              
 requirements are placed on the program which would further stretch            
 the limited administrative resources.  Her organization follows the           
 National Hospice Organization guidelines, but are concerned that if           
 the funding is reduced and administrative staff have to be cut,               
 then the volunteer administrative staff would not be able to keep             
 up with all the requirements.  Since the major concern of hospice             
 is that relief be provided for the family members, her organization           
 wants to be sure they can provide services for those in need.                 
 MS. HATFIELD stated that she founded her organization because of              
 positive personal experiences with hospice.  Hospice is a wonderful           
 program and she would hate to see a reduction in services because             
 there was not enough funding or the agency couldn't meet just a few           
 of the guidelines that were required.                                         
 Number 0212                                                                   
 SHELBY LARSEN, Administrator, Health Facilities Licensing and                 
 Certification, Division of Medical Assistance, Department of Health           
 and Social Services, testified next via teleconference from                   
 Anchorage.  He referred to Senator Kelly's bill and said his office           
 assured him that HB 152 has the same language as the senate bill.             
 Number 0261                                                                   
 TROY CARLOCK, Researcher for Representative Ryan, confirmed that              
 the committee substitute had the same language as the senate bill.            
 MR. LARSEN understood that this bill was being presented to                   
 preserve the hospice philosophy and to ensure quality care.  It is            
 written in a way which would meet those needs.  There is no                   
 objection to this bill from the department.                                   
 Number 0350                                                                   
 CHARLES QUARRE, President, Hospice in Central Peninsula, testified            
 next via teleconference from Kenai.  His organization has been in             
 operation for the last ten years, has nine members and 50                     
 volunteers who take 16 hours of training.  The majority of their              
 clients are people who cannot afford free standing hospice.  His              
 organization also provides a free loan closet which has beds,                 
 wheelchairs and other things which can be needed in a hospital                
 room.  Referrals are given from doctors, hospitals and family                 
 members.  They are a member and adhere to the guidelines of the               
 National Hospice Organization.  Their organization is highly                  
 esteemed in the local area and directed the committee to speak with           
 Representatives Davis and Hodgins to confirm this statement.                  
 Grants have been given from the Rasmussen Foundation, UNOCAL and              
 ARCO, a main supporter is the United Way where they are required to           
 present their operations on a yearly basis.                                   
 MR. QUARRE said they have a part-time paid director, the rest of              
 the work is done by volunteers.  His organization conforms to all             
 the requirements in Article 2.  However it would place an                     
 additional burden on them in terms of time and resources.  The                
 proponents in this bill claim that they are not interested in                 
 hindering the efforts of the volunteer organizations or volunteer             
 hospices and questioned why there was a law in this proposal.  This           
 law would require additional paperwork which might take away from             
 efforts to take care of their clients.  "We also question (Indisc.)           
 it may be they're not our laws or regulations a way in effect that            
 would preclude any, any, any, a problems with good hospices that              
 are in effect now."  They requested that hospice providers like his           
 organization be deleted from this bill.                                       
 Number 0536                                                                   
 CAROLYN SMITH, Home Health Care Coordinator, Bristol Bay Area                 
 Health Corporation, testified next via teleconference from                    
 Dillingham.  She spoke in favor of HB 152 because, as a community,            
 they are trying to put together a hospice.  The guidelines listed             
 in the bill will help a lot in the planning process such as                   
 creating training guidelines.  Her organization is not sure whether           
 or not they will become a direct service provider or a volunteer              
 group, but she liked the guidelines that were set out.                        
 Number 0584                                                                   
 TINA KOCSIS, Director, Hospice in Tanana Valley, testified next via           
 teleconference from Fairbanks.  Her organization is a volunteer               
 hospice which served 16 terminally ill patients and over 700                  
 bereavement clients last year.  All of the proposed regulations in            
 HB 152 are already being adhered to in her organization.  In                  
 theory, hospice is in favor of this type of criteria.  The problem,           
 that many of the board members see with HB 152, is that a small               
 hospice has a limited budget, they don't get any enumeration for              
 any services and so fund-raising and limited time is a big factor.            
 The board is concerned that any kind of regulation, although it               
 might help with quality control and protecting consumers, might               
 also create hardships.  They would urge, at the very least, that              
 the licensing process be kept simple, inexpensive and would take              
 into consideration the volunteer status.  If these things can't be            
 done, her organization would have serious concerns about including            
 volunteer hospices in this bill.  Volunteer hospices and certified            
 hospices are quite different from each other.                                 
 Number 0709                                                                   
 BARBARA RICH, Board Member, Hospice in Tanana Valley, testified               
 next via teleconference from Fairbanks.  She stated that she was              
 speaking for herself and not as a board member.  She would like to            
 see HB 152 passed because she felt it was something that was                  
 necessary.  Currently her hospice program performs all the issues             
 that the bill addresses, in fact the requirements they have are               
 more strict and require more hours of training in addition to                 
 everything else.  Some members of the board were hesitant to                  
 support HB 152 for fear that it will be expensive and hard for the            
 hospice to pay for the license as well as maintaining the records             
 for the regulation.  The organization might have to hire someone              
 just to do this.  She hoped the legislature would instruct the                
 Department of Health and Social Services to make the reports for              
 volunteer hospices simple to produce in order to alleviate this               
 MS. RICH feared that her hospice had clients who were very                    
 vulnerable.  Her hospice deals with clients who are ill and                   
 families who are under a lot of stress.  It is an area which can be           
 easily exploited.  She would like to see that someone doesn't take            
 patients into their home and call it a hospice, which they can now.           
 It hasn't happened, but it certainly could.                                   
 Number 0789                                                                   
 KAREN LAIRD, Board Member, Hospice in Tanana Valley, testified next           
 via teleconference from Fairbanks.  She stated her support for HB
 152 for the reasons given by Ms. Rich.                                        
 PAULA McCARRON, Hospice of Anchorage, testified next via                      
 teleconference from Anchorage.  Until recently the hospice where              
 she works operated in a similar fashion to a volunteer hospice so             
 she shares some of the concerns expressed.  She shared comments               
 from a network of hospices across the country which addressed the             
 concerns from the Commonwealth of Virginia who enacted hospice                
 licensure in 1989.  This licensure limited the definition of                  
 hospice so greatly that it prohibited a volunteer hospice                     
 organization to operate in Virginia.  Now Virginia is trying to go            
 backwards, to try and find a way to get a mechanism that                      
 legitimizes the work which a volunteer hospice performs.  She hoped           
 that volunteer hospices could see this bill as a protection, so               
 there is a standardization of services for consumers and a way for            
 the state of Alaska to insure that there is compassion and care for           
 people being sent home who do not have adequate support services in           
 their communities.                                                            
 Number 0900                                                                   
 PATRICIA SENNER, Registered Nurse, Executive Director, Alaska                 
 Nurses Association, testified next via teleconference from                    
 Anchorage.  Her organization voiced their support for this bill,              
 the committee substitute.  They feel it is important to regulate              
 both those hospices who receive prior reimbursements and those that           
 are volunteer so there is consumer protection.  Her organization is           
 happy with the emphasis placed in the bill and the role played by             
 registered nurses.  She said she would fax any further comments to            
 the committee.                                                                
 Number 0939                                                                   
 MIKE SHIFFER, Board Member, Hospice of Anchorage, testified next              
 via teleconference from Anchorage.  He was one of the people who              
 first approached Senator Kelly about proposing this legislation.              
 He was in full support of HB 152 and hoped that the amendments that           
 have been added, as the bill works its way through the system, will           
 support the volunteer hospices as well.                                       
 Number 0966                                                                   
 RITCHIE SONNER, Executive Director, Hospice and Home Care of                  
 Juneau, said she was in support of HB 152.  Although she recognized           
 and understood the concerns that were voiced by the other voluntary           
 hospices, she did not agree with them.  She felt these standards              
 were minimum, clean, straightforward and the very least that we can           
 expect of anybody that calls themselves a hospice in the state of             
 Alaska.  This bill would protect the consumers and the people who             
 would wish to utilize the services.                                           

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