Legislature(1993 - 1994)
02/04/1994 01:33 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
CHAIRMAN RIEGER introduced SB 248 (ASSIST & PROTECT VULNERABLE ADULTS), SB 249 (REGULATION OF ASSISTED LIVING HOMES) and SB 250 (REVISE OLDER ALASKANS COMMISSION) as the next bills before the committee. 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 populations. 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 procedure. 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 Home. 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 stages, (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 need. 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 disabled. 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.