Legislature(1993 - 1994)
02/23/1994 01:40 PM 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
CHAIRMAN RIEGER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:40 p.m. He introduced SB 249 (REGULATION OF ASSISTED LIVING HOMES) as the first order of business before the committee. SENATOR MILLER moved to adopt the CS of SB 249, Lauterbauch 8- GS2002\E. Hearing no objections, the CS was adopted. CONNIE SIPE, Director of Senior Services, referred to page 25, line 29 of the CS when noting the insertion of the definition of a "terminally ill resident." She noted that this definition is commonly accepted and used by Medicaid. CHAIRMAN RIEGER noted that this language was before the committee because the CS had been adopted. There was no objection to the language of the inserted definition. CONNIE SIPE pointed out the new definition of "resident" on page 25, line 23 of the CS. There was no objection to this language change. She noted that on page 24, line 14 of the CS the words "to the resident's self, to the staff of a home, or to others;" had been added to the definition of "imminent danger." There were no objections to that language change. Ms. Sipe highlighted the new sections that Lauterbauch had added. Page 26, Section 2 and Section 3 added assisted living homes to the list of licensed centers where it is a crime to possess weapons on such properties. These sections also discuss the results of misconduct of weapons on such properties. She explained that this addition was due to the assisted living homes being licensed by Department of Family and Youth Services. Ms. Sipe stated that subsection (b) on page 3 intends to avoid assisted living homes from becoming primarily nursing homes. She mentioned that on line 11 of subsection (b), the word "only" seems too restrictive. She suggested deleting the word "only." She explained that the regulating agency should have more flexibility to give waivers for rural conditions or to allow other health care. She noted that the word "only" on line 12, page 3 addresses those individuals trying to operate as a mini-nursing home or rehabilitation home with no intent of long term care. Number 191 CHAIRMAN RIEGER moved to adopt Amendment 26. AMENDMENT 26 Page 3, line 11: Delete "only" Hearing no objections, Amendment 26 was adopted. Chairman Rieger pointed out that page 6, line 22 incorporated a previous amendment, but the change did not include the words " but not limited to." He assumed that was not included because the wording was implicit. CHAIRMAN RIEGER expressed concern with the Residents' Rights language. He was concerned that the use of the word "rights" would require the assisted living home to expend money beyond what is in the residential services contract. He cited examples of this possible problem: page 11, paragraph (3); page 12, paragraph (6) and (10). He explained that those examples seem to create an obligation of the home that are not in the contract. He expressed the need to have clarification on this issue. CONNIE SIPE stated that this bill attempts to address past abuses. She suggested adding language which clarifies that the home does not have an obligation to provide these "rights", but that the resident has access to these "rights." She also reiterated Chairman Rieger's previous suggestion to change them from "rights" to "standards" that must be present in the contract. She also suggested adding language that would not require the facility to expend funds or guarantee that a resident has all the benefits and services; however, that resident would not be restricted from receiving them. SENATOR SALO noted that the resident must be informed of their rights. CONNIE SIPE explained that this Residents' Rights section was meant to be a balance. Ms. Sipe likened this section to the Tenant Landlord law. She recommended adding a subsection (c) or regrouping of the paragraphs in order to alleviate Chairman Rieger's concerns. Number 283 SENATOR SALO stated that a generic subsection would be difficult to add. She pointed out that there are qualifiers, such as the word "reasonable" on line 14 of page 12 which are already present on some of the rights. She explained that her main concern was with upholding the residents' rights. CHAIRMAN RIEGER explained that he did not want to create a right without knowing what was being created. He pointed out that the fiscal note includes state facilities which often times means that the court will have an open checkbook. He suggested taking the rights separately and where appropriate adding Ms. Sipe's clause. SENATOR SALO agreed that taking the rights separately would be more appropriate than a general clause. CHAIRMAN RIEGER asked if after the word "resident;" on page 11, paragraph (3) the language stating "this subsection does not create an obligation for the assisted living home to provide these items" would be satisfactory to the intent. CONNIE SIPE said it would work, but pointed out that if an individual does not own the items then it is not theirs. She agreed that in order not to create new rights Chairman Rieger's suggested language would work. CHAIRMAN RIEGER cited paragraphs (3), (4), (12), and (14) as rights that needed qualifiers stating that, "these do not create an obligation for the home to expend resources to provide the items unless specified in the contract." He felt paragraphs (6) and (10) were different. SENATOR LEMAN recommended that paragraph (7) should have a qualifier in order to be consistent. CHAIRMAN RIEGER stated that if paragraph (7) said "possessed" money it would be the same case as paragraph (3). SENATOR SALO suggested eliminating the words "possess and" in paragraph (3) which would parallel paragraph (7). CHAIRMAN RIEGER agreed that deletion would work for paragraph (3). CONNIE SIPE noted that "the possession of" on line 29 should also be deleted. CONNIE SIPE asked for clarification of Chairman Rieger's concerns with paragraph (4) of the Residents' Rights section. CHAIRMAN RIEGER suggested adding following clause: "this subsection does not create an obligation for the assisted living home to provide these items or to expend resources to provide these items" at the end of paragraphs (3), (4), (12), and (14). SENATOR SALO referred to page 12, line 4 when recommending changing "visits with" to "visits from." CHAIRMAN RIEGER agreed with Senator Salo's suggestion and believed that the generic clause would not be necessary. Chairman Rieger reconsidered and believed that the possibility that the home would become obligated was still present in Senator Salo's language change. Number 401 CHAIRMAN RIEGER stated his proposed disclaimer, "this subsection does not create an obligation for the assisted living home to expend money to provide these items, unless provided for in the residential services contract." This language would be inserted at the end of paragraphs (3), (4), (7), (12), and (14). Chairman Rieger moved to adopt this language, Amendment 27. AMENDMENT 27 Page 12, at the end of paragraphs (3), (4), (7), (12), and (14): Insert " this subsection does not create an obligation for the assisted living home to expend money to provide these items, unless provided for in the residential services contract " SENATOR SALO objected. After a hand vote, Amendment 27 was adopted. CHAIRMAN RIEGER recommended that paragraph (6) should have a qualifier. After the word "from" the following clause ", at the resident's own expense unless provided for in the residential services contract," should be inserted. Chairman Rieger moved to adopt this language insertion, Amendment 28. AMENDMENT 28 Page 12, line 8, after "from": Insert " , at the resident's own expense unless provided for in the residential services contract," SENATOR SALO clarified the clause with an example. She stated that a home could have a van to carry residents to activities, but the home would not be required to provide a van. CHAIRMAN RIEGER agreed with that example. Hearing no objections, Amendment 28 was adopted. CONNIE SIPE said that paragraph (10) could be put into programmatic standards. She emphasized that the crucial part of paragraph (10) is the resident's right to go outdoors. Having a "reasonable opportunity" must remain. She explained that without this right, arguably homes could lock residents inside. CHAIRMAN RIEGER asked why there is a comma after "week" on line 15, page 12; does a "reasonable opportunity" only apply to exercise but not outdoors. CONNIE SIPE suggested deleting "to exercise at least several times a week, and" in paragraph (10). SENATOR SALO asked Ms. Sipe how that would read. SENATOR SALO suggested deleting "at least several times a week," from paragraph (10). CHAIRMAN RIEGER moved to adopt Amendment 29. AMENDMENT 29 Page 12, line 14: Delete "at least several times a week," Hearing no objections, Amendment 29 was adopted. SENATOR SHARP suggested adding, "subject to the consent of the resident," after "home" on page 13, line 25. He was concerned that "shall" mandates that the resident must allow the advocates in the home. CONNIE SIPE explained that on page 23, the definition of an advocate requires that in order to be an advocate one must be designated by the federal or state statute, like the long term care Ombudsman and the Alaska Advocacy Services program. Number 507 SENATOR SHARP asked if Veteran's Services Officers would meet the definition of an advocate. CONNIE SIPE said yes and asserted that any individual would have to be official. SENATOR SHARP explained that the "shall" aspect would infringe on the residents privacy. He did not want anyone to be routed to individual resident's rooms; it should be subject to the resident's consent. CONNIE SIPE asked if there could still be group meetings which the residents could choose to attend or not. SENATOR SHARP said yes. CHAIRMAN RIEGER moved to adopt Amendment 30. AMENDMENT 30 Page 13, line 24, after "home": Insert " , subject to the consent of the resident, " Hearing no objections, Amendment 30 was adopted. CONNIE SIPE referred to page 14, line 26 when noting that at present, that sentence implies that there may be other times when the home could physically restrain residents. She suggested changing the sentence to read: "An assisted living home may not physically restrain a resident unless the resident's own actions presents an imminent danger to the resident or others, in which instance," and leave the remainder of the sentence in tact. This change would basically clarify the standard of imminent danger. SENATOR LEMAN asked if subsection (b) on page 14 imposed a burden on other services that may not be intended. He questioned the necessity to report to the listed personnel during short limited instances of restraint. CONNIE SIPE pointed out that the assisted living home has to have a written policy that would have to be approved by the licensing agency. Each instance will be different depending on the size and location of the home. She said that the licensing agency would determine what was appropriate in the different facilities. SENATOR LEMAN asked if current practice is to always report physical restraint to emergency personnel even if it is a one or two minute incident. CONNIE SIPE pointed out that the last sentence in subsection (b) addresses that issue. If the restraint is short term then the physical restraint could stop as well as the reporting of it, but there must be a procedure for ongoing restraint. She explained that these homes are not correctional facilities and if they physically restrain residents, professional help should be present. SENATOR SALO agreed with Senator Leman's interpretation of the language in subsection (b). She believed that there would be instances that would waste the time of the listed personnel due to the lack of physical restraint standards regarding reporting. CONNIE SIPE stated that someone more familiar with restraint protocols would be able to answer Senator Leman and Senator Salo's concerns with subsection (b). TAPE 94-12, SIDE B Number 591 CHAIRMAN RIEGER recommended that this issue be discussed further at another hearing. He also noted that paragraphs (17) and (18) on page 12 should have qualifiers. He suggested holding SB 249 until Monday. Chairman Rieger stated that Amendment 28 should precede paragraphs (17), (18), and (6) on page 12. CONNIE SIPE suggested deleting all of subsection (b) on page 14 except the first sentence, in order to address Senator Leman and Senator Salo's concerns regarding physical restraint. The reporting aspect would be dealt with through the individual home working out their own procedure that would have to meet appropriate protocol standards on restraint. SENATOR SALO explained that the last sentence of subsection (b) should be retained in order to address the termination of the physical restraint when it is no longer necessary. CHAIRMAN RIEGER held SB 249 until Monday. He requested that Mr. Williams be present at the next meeting to discuss the fiscal note.
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