Legislature(1999 - 2000)
03/17/1999 01:35 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
March 17, 1999
1:35 p.m.
MEMBERS PRESENT
Senator Mike Miller, Chairman
Senator Gary Wilken
MEMBERS ABSENT
Senator Pete Kelly, Vice-Chairman
Senator Drue Pearce
Senator Kim Elton
COMMITTEE CALENDAR
Overview by Commissioner Karen Perdue, Department of Health and
Social Services
SENATE BILL NO. 73
"An Act relating to assisted living homes; and providing for an
effective date."
-HEARD AND HELD
PREVIOUS SENATE COMMITTEE ACTION
SB 73 - No previous action to report
WITNESS REGISTER
Senator Mike Miller
Alaska State Capitol
Juneau, AK 99811-1182
POSITION STATEMENT: Presented SB 73
Ms. Kay Burrows, Director
Division of Senior Services
Department of Health & Social Services
3601 C St. Suite 310
Anchorage, AK 99503-5984
POSITION STATEMENT: Commented on SB 73
Ms. Montafaye Lane
109 E 5th Avenue
North Pole, AK 99705
POSITION STATEMENT: Commented on SB 73
Ms. Lynn Branson
PO Box 948
Palmer, AK 99645
POSITION STATEMENT: Commented on SB 73
Ms. Leslee Orebaugh
309 E. 24th Avenue
Anchorage, AK 99503
POSITION STATEMENT: Commented on SB 73
Ms. Helen Powell
1913 Jack St.
Fairbanks, AK 99709
POSITION STATEMENT: Commented on SB 73
Ms. Debbie Cash
3291 Jefferson
Fairbanks, AK 99709
POSITION STATEMENT: Commented on SB 73
Ms. Frances Purdy
Long-Term Care Ombudsman
3601 C St., Ste. 260
Anchorage, AK 99503-5984
POSITION STATEMENT: Commented on SB 73
Mr. Les Westling
329 D St.
Fairbanks, AK 99701
POSITION STATEMENT: Commented on SB 73
ACTION NARRATIVE
TAPE 99-12, SIDE A
Number 001
CHAIRMAN MILLER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:35 p.m. and announced that
the committee did not have a quorum, with one member having
airplane trouble returning to Juneau and another attending the
ground-breaking for the new Juneau police station. He said the
committee would hear an overview by Commissioner Perdue, and take
initial testimony on SB 73 which he sponsored.
MS. KAREN PERDUE, Commissioner of the Department of Health & Social
Services, highlighted the department's programs for the next year.
She discussed Child Protection and said the department has had its
first termination case under the new law in effect since September
1998. A new training system has increased the number of calls that
can be answered. Challenges include the training and support of
workers who do this difficult work, and dealing with the heavy
caseload. She urged more funding this session for positions in
Fairbanks and Anchorage where the workers carry up to 35 or 40
cases and can't adequately do their jobs. Consequently, public and
child safety are impacted in two ways - by not getting out on the
calls to investigate the situations; and not ensuring the child's
placement in a safe, nurturing foster home or adoptive home. The
department is improving the foster care program.
Denali Kid Care has been launched with a new, private sector type
of approach. The insurance card for a parent signing up a child is
good for six months, cutting repeated paperwork. The application
is short, and can be accessed on the Internet and faxed or mailed
in. There is no walk-in office. Since opening on March 1, 3,000
calls and 900 applications have been taken, and 400 pregnant women
have been enrolled in the program.
Number 132
SENATOR WILKEN asked if the program is on track for projected
enrollment. COMMISSIONER PERDUE replied that it's early to know,
but the response has been beyond expectation.
COMMISSIONER PERDUE said that valid concerns were expressed in the
Legislature last year about people dropping insurance to sign on to
the program. The department revised its regulations so that a
person or business cannot drop their insurance and be qualified for
this program for one year's waiting period between the time the
insurance is lost or dropped and enrollment in this program. A
hardship section is tightly written, for bankruptcy. The
department expects the uninsured to use this program. The
financing is mostly federal, with the state paying about $530 per
child per year. The sicker children, particularly those with
disabilities, are already in the pool.
Immunization rates were second to the last in the nation a couple
years ago for up to two-year olds. The latest data showed Alaska as
22nd in the Nation and the department expects to be near the top in
a couple more years. Nearly every kid in the state was given a
shot during the measles outbreak.
In revamping the API building and its operations, she said API
could be much smaller if communities did more crisis service work
at the hospital level, like Fairbanks Hospital has always done.
Senator Kelly's bill on designated evaluation and treatment is very
important in this regard because it assures the hospitals of a
stable source of funding to get into the business of providing
emergency psychiatric care.
The issues of vulnerable adults and children fit into the work of
the Long-Term Care Task Force. The department is very supportive
of several task force recommendations. SB 73 addresses an issue of
safety by paying providers a decent wage to ensure continuity and
professionalism, and to attract more people into the business.
Regarding developmental disabilities, the department has asked for
funding this year to raise the wages of care givers. Because the
care givers are paid $6 to $8 an hour, the turnover in one program
is 133% "which is incredibly distressing on the clients, and not
good for the quality of care," COMMISSIONER PERDUE said.
The youth corrections system is gradually expanding with an
addition of 80 beds. The juvenile facilities have operated at 170%
over capacity. At the local Johnson Center dedication, there were
30 kids in the 8-bed facility. By next year, if things go as
planned, the department will have reduced the overcrowding.
Youth courts are very successful in the communities that have
invested in them and inexpensive for the department to start up. If
kids receive consequences as first-time offenders, it makes a big
difference in the direction they head in life. DHSS is also working
with tribal organizations to start elder courts, using the same
concept as youth courts but with elders making decisions. The
Native community often reports kids running around and something
needs to be done before the situation escalates to serious law
enforcement intervention.
Regarding welfare reform, Alaska is in the second year of a 5-year
lifetime limit and seeing a 27% drop in the caseload using the
system. With the help of day care and job training, about 40% of
the people on welfare are also working.
The department is starting the first Native organization public
assistance program with Tanana Chiefs Conference (TCC) in
Fairbanks. It will reduce dependency on welfare more than anything
the State can do in the villages. It's a challenge to help people
work in villages where there are no jobs, through community work
service or seasonal work. TCC has other job training and economic
opportunities to bring to this effort, and it's the largest program
in the country.
Number 267
COMMISSIONER PERDUE explained to Senator Wilken that it's located
in the TCC building, with workers in each of the communities. She
asked if the bill authorizing this program will come through HESS,
and CHAIRMAN MILLER said although he hasn't seen it, it should. She
said the department needs that legislation to clarify the
respective roles in the TCC public assistance program.
COMMISSIONER PERDUE mentioned the law that passed last year helping
people with disabilities join the workforce without losing their
medical benefits, and said the department needs to do more policy
work on it. Even relatively disabled people are willing to work as
long as they don't lose their benefits; loss of their prescriptions
alone would keep them from working.
The department is helping people make choices on planned
pregnancies. The teen pregnancy rate has declined by 25% over the
last three or four years- the greatest of any state in the nation.
If the department can prevent a young girl from having a child if
she's not ready to support it, COMMISSIONER PERDUE said "it's about
the best thing the state can do for the future of a young person."
She said everything seems to relate to substance abuse, with 70-80%
of the cases in Child Protection going back to it. In the work on
FAS prevention, pregnancy is a time when a lot of healthy behavior
can begin because women are highly motivated to make a change for
their children.
COMMISSIONER PERDUE, now into her fifth year as commissioner, said
it has been a real privilege to be in the job, and there are some
solid accomplishments that the department can look to.
SENATOR WILKEN remarked that she has done a good job in a tough
spot. He informed her that Chairman Miller has been supportive of
the long-term care legislation which is being pushed along and
received pretty well.
COMMISSIONER PERDUE said she's very pleased about that. She served
on the task force and it recognized all the work that had gone
before it, a phenomenal amount of work in this state. She said
there are "pockets of excellence," and if Alaska can strengthen
community care, which fits with the state philosophy, "it will be
one of the best places in the nation to be a senior or a person
with disabilities. That will be a real accomplishment for
everyone."
SENATOR WILKEN and CHAIRMAN MILLER thanked the Commissioner.
Number 334
CHAIRMAN MILLER brought up SB 73, a bill he also introduced last
year. He explained that SB 73 would essentially raise the rates
the state is currently paying to the "Mom and Pop" providers in
assisted living homes, from about $30 in Anchorage and $34.50 in
Fairbanks, to $70 a day. The Alaska Rate Study Report of December
1998 put $70 right on target. CHAIRMAN MILLER said it's kind of
funny because they considered a lot of numbers and didn't have much
basis for that number at the time, other than it doubled the rate
in Fairbanks.
CHAIRMAN MILLER related that his father was in a private-pay home
in North Pole where he observed the level of care. He said "quite
frankly, it was a very good level of care for a very inexpensive
amount." Charts show that if the rate increased to $100 a day, it
would be less than half what the state pays in hospitals and
facilities around the state like the Denali Center. In his opinion,
older residents are getting a very good deal for what is being
paid, and he's afraid if the rate stays low the state will begin to
lose providers. As the population continues to age, Alaska cannot
lose its providers. CHAIRMAN MILLER said his goal is to pass the
rate increase this year, in order to keep the current assisted
living providers and attract new providers to the market.
Fortunately, fellow legislators are supportive of the concept but
the problem will be to find it in the budget. He said he will work
hard to find it in the budget. CHAIRMAN MILLER thanked the
department for their support of the concept and their help in
coming forward with different numbers.
MS. KAY BURROWS, Director of the Division of Senior Services,
stated SB 73 would help Alaskans assist vulnerable adults in having
a place to live with dignity, hope and care. The Alaskans who care
for other Alaskans need this living wage. The rate study was
funded by the Mental Health Trust Authority and conducted by the
Assisted Living Training Institute out of Connecticut. She cited
statistics for the FY 98 caseload on which the rate study was
based, noting 68% fell under the Mental Health Trust beneficiary,
and an additional 32% were either physically disabled or
vulnerable adults. Most of the caseload receive general relief
funding for one year or less in assisted living. The rate study
asked 33 homes to provide detailed private financial information,
and resulting data showed that if the rate were adjusted just for
inflation over the 15 years it has not been adjusted, it would be
$68. The study looked at the actual financial costs to a home for
15 people or less, which came to about $73 per day. More severely
ill people are in the homes and may need an augmented rate of
between $3 and $22, mostly for added staffing. MS. BURROWS
concluded the rate study showed a rate of $70 per day is
appropriate for the kind of care being offered.
The department will be looking at the assisted living home
regulations through the Long-Term Care Task Force, and a number of
the task force recommendations. The recommendations include
increased training and education requirements for assisted living
administration and staff, and separate standards for homes caring
for fifteen people and less, and homes caring for sixteen people
and more.
MS. BURROWS said she and Dwight Becker, Supervisor for Adult
Protective Services, would stay on-line to answer questions.
Number 426
CHAIRMAN MILLER remarked that Mr. Becker did the fiscal note and
could explain the numbers. Mr. Becker responded that he didn't
have anything to add to the discussion at this point.
CHAIRMAN MILLER said he would begin with the Fairbanks providers
waiting on-line to testify, and requested that people limit their
remarks to 5 minutes. He publicly thanked Ms. Montafaye Lane for
the care she provided for his father in North Pole when he had
Alzheimers. Chairman Miller said he is acutely aware of the
current situation with assisted living homes because of Ms. Lane.
Number 438
MS. MONTAFAYE LANE, Assisted Living Home provider, thanked the
division and the committee, and stated the private assisted living
home administrators work very hard at their own expense to provide
a high standard of care for vulnerable people at a very reasonable
cost to the public. The homes are the grass-roots place that
families, agencies and guardians bring people in emergency need for
nurturing and basic care. The providers welcome people, often with
no guarantee of pay, and share their home with no idea of the
impact the resident will have on it and the people in it. The
provider accepts people when they arrive, and worries about the pay
later. MS. LANE admitted that from a practical standpoint, adopting
that philosophy is probably a mistake but it is the nature of their
business to care for the vulnerable ones.
She said that the current stipend is not only unrealistically low,
it often takes three months to receive the reimbursement covering
someone who couldn't make it through the door of a larger, more
profitable facility. The homes cannot continue to adequately care
for these people at $1.44 an hour with the minimum wage at $5.62.
Qualified helpers demand at least $10 per hour, a wage they can get
at a facility taking in the $3000 per month resident.
If the bill does not pass, MS. LANE said the providers have no hope
of financial relief and many will have to look to their own
survival at a great emotional cost to their residents, and a great
financial cost to the state. She urged doing away with the co-pay
for elders, and raising the personal needs spending of the
residents to $100-150 per month because many of them smoke
cigarettes.
Number 510
MS. LYNN BRANSON, Consumer and Assisted Living Home professional,
Mat-Su, asked for provisions to monitor the assisted living homes
and stricter hiring practices for employees working in the homes.
She was concerned that the system is set up for abuse with little
monitoring of some of the homes.
MS. LESLEE OREBAUGH, assistant at Parkside in Anchorage, discussed
the added expenses the assisted living homes have incurred since
the new licensing regulations went into effect. Now there is a
per-bed fee for licensing, new insurance policies required for
professional liability, and new fire and safety equipment expenses.
She asked members to take these added expenses into consideration
when raising the rate to $70 per day.
MS. HELEN POWELL, owner of an assisted living home in Fairbanks and
treasurer of Alaska Care Givers Association, said she agreed with
Montafaye Lane's comments. She suggested taking $10 from the
Permanent Fund Dividend. She said if the homes don't get a higher
rate, she could no longer accept general relief clients in her
home. "At $70 dollars a day, we're still the best quality of care
and the cheapest rent you'll ever get."
MS. DEBBIE CASH, Fairbanks provider, discussed fuel cost increases
over 3 years, and costs for insurance. She received $99 per day
for one client who was paralyzed and totally bedridden, while the
same person at Denali Center would have cost $320 per day. MS. CASH
said she could no longer keep her doors open at the $34.50 per day
rate. She discussed the wear and tear on the home, with nurses,
caseworkers, family and friends coming in and out.
MS. FRANCES PURDY, Long-Term Care Ombudsman, supported the comments
of the Division of Senior Services, and the providers. The
potential rate increase would provide clients with the services
they need when they first enter an assisted living home, or while
waiting for Medicaid waiver programs to be approved. She echoed
the fear that many good providers will leave the business because
they are constantly overextending themselves to provide services
they're not being paid for. The funds are desperately needed to
keep the continuum of care for all residents in long-term care
services.
TAPE 99-12, SIDE B
Number 595
MR. LES WESTLING, Assisted Living Home provider in Fairbanks,
thanked Ms. Purdy for her testimony and urged passage of the rate
increase this session. He recommended building teams of community
agencies and assisted living homes around each elder to solve the
difficulties in each town. He said training is very necessary to
raise the standards of administrators, and workers like CNAs
because assisted living homes are a more homelike environment than
nursing homes or hospitals. A worker may know how to change a
bedpan but that doesn't mean he will know how to sit down and
communicate, play a game of cards, or work on memory skills and
other ways to increase awareness.
On the issue of monitoring abuse, MR. WESTLING said he can't afford
a secretary and his paperwork for 10 staff "runs him over"
sometimes because he's keeping on top of his staff to ensure there
is no abuse. He monitors if workers are not dealing with someone
properly due to lack of training, and he urged funding for
training.
When he started the home, Mr. Westling would take in clients on no
notice and without funding and he almost put himself into
bankruptcy doing that. Problem clients need placement in the
assisted living homes until their funding sources come together.
Increasing the daily rate should provide the leeway to make that
possible again. He also urged increasing the personal spending of
the clients to more than $75 per month, which provides only about
two cartons of cigarettes to smokers.
Number 545
CHAIRMAN MILLER said there still wasn't a quorum but he intends to
work on SB 73 and bring it back before the committee next week.
There is a lot of support in the Legislature for this measure but
he questioned how to fund it.
SENATOR WILKEN questioned if one approach might be to "take this a
bite at a time."
CHAIRMAN MILLER said that's essentially what he's been looking at,
but he hasn't run it by the service providers. The concept would
be to "ratchet it up to $50 the first year, to $75 the second year,
and up to $100 the third and final year." It would be smaller
"bites," but in the long run the providers would actually be
ahead. Mr. Becker in Anchorage would do the number crunching for
the committee. It would start the rate increase in the right
direction.
SENATOR WILKEN said he agreed, and he hoped to get it started this
year.
CHAIRMAN MILLER concurred that it must get started this year. With
no further business before the committee, it adjourned at 2:30 p.m.
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