Legislature(1999 - 2000)
02/04/1999 03:34 PM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 4, 1999
3:34 p.m.
MEMBERS PRESENT
Senator Mike Miller, Chairman
Senator Pete Kelly, Vice-Chairman
Senator Gary Wilken
Senator Drue Pearce
Senator Kim Elton
MEMBERS ABSENT
All Members Present
COMMITTEE CALENDAR
Briefing by the State Independent Living Council
PREVIOUS SENATE COMMITTEE ACTION
None
WITNESS REGISTER
John Woodward, Chair
State Independent Living Council
Anchorage
David Jacobson, Director
ACCESS Alaska
Fairbanks
Joyanna Geisler, Member
Task Force on Long-Term Care
Homer
Cindy Lynn
Petersburg
Ruth L'Hommedieu, Board Member
State Independent Living Council
Fairbanks
Jerie Best, Board Member
State Independent Living Council
Soldotna
Patrick Reinhart, Executive Director
State Independent Living Council
Anchorage
David Maltman, Executive Director
Governor's Council on Disabilities
& Special Education
PO Box 240249
Anchorage, AK 99524-0249
ACTION NARRATIVE
TAPE 99-03, SIDE A
Number 004
CHAIRMAN MILLER called the Senate Health, Education and Social
Services (HESS) Committee to order at 3:34 p.m. and announced the
Committee would be briefed by the State Independent Living
Council(SILC). He invited John Woodward and Patrick Reinhart to
introduce themselves for the record.
JOHN WOODWARD, SILC Chair, Anchorage, introduced himself and
Patrick Reinhart, SILC Executive Director. He stated that he
suffers from a traumatic brain injury resulting from a car accident
with a "large furry Alaskan critter" many years ago. He thanked
the committee for allowing the SILC to present some ideas for
improving the lives of Alaskans with disabilities, and hoped the
committee could act on some of the ideas this legislative session.
He stated the SILC is a body appointed by the Governor with 10
members, the majority of whom experience a disability. The SILC
mission is to promote the independence of persons with disabilities
so that they can live and work in their community. The relatively
small council has a limited budget of 100% Federal funds, but it
has an important role to play in the development of State policies
relating to people with disabilities. MR. WOODWARD referred the
committee to the Independent Living report in their packets for
additional information about the council and its services. He then
introduced David Jacobson.
Number 064
DAVID JACOBSON, Fairbanks North Star Borough, thanked the Committee
for the opportunity to talk about Assisted Living, part of a
continuum of care that will help people with disabilities and the
elderly to continue living in the least restrictive environment.
The model is aptly described in the Long-Term Care report which
identifies the genesis of the Assisted Living program. In 1994,
Governor Hickel promoted the concept of available, affordable long-
term care in the state, and believed that the care should be in a
"homelike setting." We've made dramatic progress in a short time.
Now over 200 Assisted Living homes exist in the State, mostly
located in Anchorage, Fairbanks and Juneau, with a few in Soldotna.
The rural areas of the State do not have this type of service
available to individuals.
Number 093
MR. JACOBSON stated the Long-Term Care Task Force addressed some
recommendations to apply to the Assisted Living Care model. These
included standardization of services; that the services be in the
least restrictive environment for the individualized needs of
individuals; and a definition of services provided in "a homelike
setting" when establishments in Anchorage have up to 80 residents.
MR. JACOBSON discussed the lack of consistency in the issuing of
licenses by both the Department of Administration and Division of
Developmental Disabilities. The HESS Committee in the task force
report targeted licensure for standardization. The report also
encouraged entrepreneurs to take on Assisted Living as a viable
business, and it identified a need for additional training. Now
there is a minimum level of one-day training offered through the
Division of Senior Services that is required to become an "Assisted
Living Home Administrator." Other needed training would involve
helping residents to live in the least restrictive environment.
MR. JACOBSON concluded by saying that expanding the Assisted Living
services to more communities would keep people from having to leave
their home community in order to find services unavailable locally.
Number 125
SENATOR WILKEN asked Mr. Jacobson if he just got this new job, and
what he did before.
MR. JACOBSON described his earlier background. He has been both a
peer counselor and administrator, and now he is Director of Access
Alaska's offices and programs in Anchorage and Fairbanks. He
stated his wholehearted belief in Independent Living as a true
investment in our own communities with manifold returns, both in
reduction of expenses and an increase in the quality of life to
citizens of Alaska.
SENATOR WILKEN remarked that Mr. Jacobson is very visible in the
Interior and does a great job representing his people.
Number 150
SENATOR ELTON asked Mr. Jacobson how much an investment like this
returns in savings later on, on the assumption that Assisted Living
is a much cheaper way to provide services to some Alaskans than
institutionalized care.
MR. JACOBSON replied the current reimbursement that business people
receive is $34 per day for individuals residing in their home
under this model. A Medicaid waiver averages about $13,000 a year,
versus $80,000 to $90,000 when an individual resides in a nursing
home. Joyanna Geisler will elaborate further when she discusses the
personal care assistance model.
CHAIRMAN MILLER stated he's worked closely with the Assisted
Living providers in trying to raise their rates. Significant steps
have been taken, with the providers now talking about licensing and
training, and a trade-off where they would help with their
insurance costs now that the State self-insures.
MR. JACOBSON responded he's confident that with Chairman Miller and
others like him, this model will improve.
Number 180
SENATOR WILKEN asked the status of the Assisted Living report.
SHARON CLARK, Committee Aide, responded the HESS Committee still
hasn't received it from Anchorage, but it is en route.
Number 188
JOYANNA GEISLER from Homer asked HESS to draft legislation that
will change Personal Care service delivery in the State. Personal
Care services are the backbone in the continuum of the long-term
care services mentioned by Mr. Jacobson. Some services people need
in order to stay in their home may be just bathing and dressing
assistance to go to work or shopping, to church or to social
activities. Personal Care attendants in Alaska are underpaid and
underappreciated. There's a real shortage of them, and in most of
rural and Bush Alaska, the services don't even exist. Without
these services, people might stay in an unsafe home environment
that will force them to a more restrictive setting that is more
costly, and may be outside of their own community.
Number 217
The task force has studied the system for a couple of years, trying
to keep the good and looking at other states' models to fix the
bad. MS. GEISLER stated one needed change would eliminate the model
of personal care services and replace it with the self-directed
model, allowing a recipient to direct their own services - that is,
to recruit, hire, manage and fire their own personal care
attendant. A lot of individuals are capable of that management.
Accompanying the self-directed model is a limited exemption to the
Nurse Practices Act, allowing the individual to direct the personal
care attendant to perform some limited health maintenance tasks
such as bowel/bladder care.
Other states using the self-directed model find it a "win-win
situation" because it's cost-effective, because those recipients
who are capable can direct their own care, and because a fiscal
agent would act as a pass-through and a supportive umbrella. The
personal care attendant has their liability insurance and workman's
compensation paid, and has some financial security and a career
ladder established so they can advance in their profession.
For individuals who cannot do the self-directed model, a personal
care agency model helps with the hiring, recruitment and scheduling
of the personal care attendant. This system exists now, but only
one provider is allowed in a region. MS. GEISLER advocated
multiple providers in a region to provide a choice and to develop
a work force in local communities.
Number 264
MS. GEISLER continued, stating another need is to study the true
cost of personal care services, and to change the reimbursement
rate to reflect it. Currently, a supplemental grant goes to
provider agencies to supplement the cost of care. Under this
change, the supplemental grant would return to its original intent,
allowing personal care services to be purchased on a sliding scale
by non-Medicaid eligible folks.
MS. GEISLER repeated that legislation is needed for full
implementation of the self-directed model, and regulatory changes.
She or Patrick Reinhart would be glad to help with any of the
changes.
Number 280
CHAIRMAN MILLER mentioned SENATOR PEARCE's arrival for the record.
SENATOR ELTON stated that a big problem in Juneau has been turnover
of personal care attendants because of low pay. He expressed
concern that easing the Nurse Practices component may open the door
to "some scary things."
MS. GEISLER replied that in other states, that was initially a
concern to some providers, and definitely to nurses. Over a time
of using this, nurses felt it left them "off the hook." This
limited exemption is only for the person whose health care
professional feels can take care of himself, and the self-directed
model is an individual's choice. After a year of using it in
Montana, the nurses really like it.
CHAIRMAN MILLER asked Ms. Geisler and Mr. Reinhart to work with
Sharon, the committee aide, in drafting legislation. He stated
that HESS would be happy to introduce it as a committee bill.
Number 312
SENATOR WILKEN remarked that Ms. Geisler taught the long-term
health care task force a lot about Personal Care Attendants, and
the need to build the foundation to keep people in their homes
instead of institutions. He thanked her for her contribution.
Number 325
CINDY LYNN, Petersburg, discussed the Certificate of Need, stating
a two-year moratorium on adding nursing home beds is now up. The
history of requirements for a Certificate of Need have only
included accessibility, quality, and any project over $1 million in
cost. The number of seniors in Alaska will increase and the state
will need more money to care for them. Community-based services
have been documented to cost less and save the State money. These
include the Choice Waiver Program, Personal Care Assistance,
Assisted Living Centers, Adult Day Care Centers, Home Modification,
Independent Living Services, and Meals on Wheels. Approximately
80% of long-term care patients end up on Medicaid after they've
exhausted their resources. Medicare and private medical insurance
like Blue Cross will not pay for non-skilled care, which long-term
care is. Skilled care includes tasks like physical therapy, IVs
and procedures. Most old age conditions include Alzheimer Disease,
Parkinson's Disease, strokes and dementia, and none are covered by
private insurance or Medicare, so that Medicaid or Alaskan
taxpayers inadvertently have to pay. Most seniors don't know that.
MS. LYNN referred to a study that showed 50% of patients in long-
term care didn't need to be there for the level of care. Each
additional bed added to a long-term care facility is a permanent
cost to our State. With a Certificate of Need, long-term care is
asking for a mortgage, with the State of Alaska as the bank.
MS. LYNN described what it would be like to leave your home for a
4-bed ward. You'd give up the privacy to eat or watch T.V. when
you want; all of your possessions; a visit from a friend without
everyone listening; and private phone conversations. Some dignity
and pride is lost, as well as independence and quiet. It's a big
decision, and it's not for everyone. Many steps can happen before
a person needs that level of care.
Petersburg doesn't have an Assisted Living facility yet but there
are two options for people. A 23-bed HUD housing facility had to
solicit ten of the beds to out-of-state people because there
weren't enough people in town to qualify. The long-term care
facility costs $9,000 a month. People have the option of paying
that, but MS. LYNN knows a woman who was wiped out financially
after paying for 18 months. Most people end up having to go on
Medicaid. One family had a qualified Nurse's Aide who lived in
their home for $3,000 a month. The average cost of Wrangell's
Assisted Living facility is $2,000 a month.
Number 399
MS. LYNN stated that long-term planning is not so different than
estate planning, and can involve a variety of community-based
services. A long-term care facility often isn't needed until the
end of life, if a person is terminally ill and doesn't want to have
Hospice in their home. The long-term care facility can be used
intermittently, but then with proper supports the person can return
to their home. A Personal Care attendant coming in and helping
them bathe, talking to them and keeping them oriented can keep
people safe enough to be in their home. Medicare will fund
programs for nursing visits to the home for skilled procedures,
also keeping the person out of long-term care. The Choice Waiver
program has a long waiting list, and needs more funding. It makes
more sense to fund those programs than to increase nursing beds.
Number 420
MS. LYNN asked the Committee to adopt the draft amended legislation
in the appendix, and the recommendation in Mr. Lindstrom's letter
from the Department of Health & Social Services that follows.
These are practical and logical requirements for a Certificate of
Need.
Number 433
RUTH L'HOMMEDIEU, Fairbanks, stated she has served on the SILC
since 1995. One area of concern for the disabilities community
relates to Medicaid Co-Pay, also known as the Medicaid Buy-In Bill.
HB 459 passed last year, but there have been delays and the program
has not yet been implemented. She asked the Committee's help in
encouraging DHSS to implement it.
SENATOR KELLY asked her to describe the Medicaid Buy-In. MS.
L'HOMMEDIEU replied it allows people to buy in on their insurance
coverage, so they could go to work but not lose their insurance
coverage that keeps them maintained to work.
MS. L'HOMMEDIEU brought up the necessity to maintain the health
coverage through Medicaid, the health care financing program for
the categories of Alaskans who are poor or who have disabilities.
Kidney dialysis is not available in Juneau, only in Anchorage and
Fairbanks. Southeasterners go to Anchorage or Seattle for this
service. Some people are forced to relocate near the area where
they can obtain care, and others can't afford the care and end up
dying.
She requested a survey of the private sector to encourage a kidney
dialysis business in Juneau. A price quote she obtained from the
Alaska Kidney Center in Anchorage for a kidney dialysis machine
starts at $13,000.
Number 499
MS. L'HOMMEDIEU concluded by asking the committee's support for the
Governor's budget funding level for the Division of Vocational
Rehabilitation, and to retain the Maintenance of Effort Agreement
between the State and Federal governments for matching funds.
SENATOR ELTON promised he would talk to the CBJ Assembly about the
dialysis machine.
Number 518
JERIE BEST, Soldotna, said she's served on the SILC since 1995 and
thanked the Committee, stating she had watched the Governor sign
two bills HESS had sponsored last year. She brought up the
Americans with Disability Act improvements, and asked the Committee
to follow last year's budget of $1.5 million to try to come into
compliance. It's very difficult for a person with a disability to
gain access to many of the state facilities. Alaska needs to come
into compliance, it's the law.
MS. BEST suggested adding a disclaimer on all state-generated
paperwork that states "this is available in alternative formats
upon request." If an 8-1/2" x ll" format was enlarged 137% on a
photocopying machine on 11" x 17" paper, people with visual
problems could read it. It is relatively inexpensive to do many
things that are needed by people with disabilities.
Number 560
MS. BEST brought up the need for more stringent laws dealing with
disability parking permits. Her concern is in having enough room
to get her wheelchair out of her car in a direct line to the curb
without having to jump up the curb. The bill coming out would
require photo identification on the blue hanger, making it invalid
for anyone else to use it. She has handicapped plates, but travel
requires the blue hanger for rental cars. She suggested tightening
up the dates, using the Bureau of Vital Statistics to check deaths,
and making it a moving violation instead of just a parking ticket.
Senator Donley's bill would remove 2 points from the driver's
license.
Number 585
PATRICK REINHART, Executive Director, referred to the report in
the Committee packets, Independent Living for Alaskans With
Disabilities. Highlights include activities in FY 98 such as
passage of the Assisted Technology Lemon Law and the Puppy Guide
Dog law (HB 170). SILC found numerous state or federal agencies
involved in doing or funding housing modifications to help people
remain in their homes SILC clarified the housing modification
providers in the State, and streamlined the eligibility criteria,
hoping to build efficiency into the system with the same amount of
money. SILC has led in coordinating transportation between
providers in communities; for an example, when a van for the
Headstart Program is finished for the day, it could be used to
transport seniors to social and recreational activities.
MR. REINHART stated that the five Independent Living Centers in the
State are a little different in each community but are required to
be consumer-controlled. The majority of the board of directors and
the staff are people with disabilities. The services provided in
FY 98 include information and referral, advocacy, transportation,
interpreters and recreation. The State contributes about 21% of
the $2.8 million in funding from various sources; 44% comes from
the Federal government. The Centers are non-profit and do
fundraising and collect fees for services. He offered to answer
questions.
SENATOR WILKEN asked what caused the large jump from $45.0 to
$375.0 in the category "Other" on page 2, Budget Analysis?
MR. REINHART replied he's not sure; it's the Mental Health Trust
Board.
MR. JACOBSON responded that in Governor's Council on Disabilities
& Special Education, over $125,000 in grant money from the Mental
Health Trust was received for accessible home modifications.
DAVID MALTMAN, Executive Director, Governor's Council on
Disabilities & Special Education, stated that SILC and his council
work closely together. The enabling statute requires his council
to do a budget analysis every year to help the public and the
Committee understand the programs funded to serve people with
disabilities. He clarified that the $45.0 in FY 98 was to study
the closure of Harborview and personnel issues arising from its
closure, and to determine the satisfaction of the residents and
their families about their current placements. The funds for next
year, FY 99 Authorized, is to study the dis-incentives of people
with disabilities to go to work. They lose much of their public
assistance and Medicaid, which the Council tried to address last
year with the Medicaid Buy-In Bill. They also lose housing
subsidies and other benefits that provide a large barrier to go
back to work.
CHAIRMAN MILLER announced that copies were faxed and are now
available of the Alaska Rate Study in the Assisted Living report.
He stated that HESS would not meet next Tuesday. Next Thursday,
February 11, HESS will take up SB 31, the Mental Health bill on
capital and operating appropriations, and move it on to Finance.
The following Thursday, February 18, Jeff Jesse, Executive Director
of the Mental Health Trust Authority will brief the Committee.
There being no further business, CHAIRMAN MILLER adjourned at 4:35
p.m.
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