Legislature(2011 - 2012)BUTROVICH 205
02/23/2011 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Health Workforce Planning Coalition | |
| Presentation: Long Term Care Ombudsman | |
| Presentation: Alaska Commission on Aging | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 23, 2011
1:33 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Dennis Egan
Senator Johnny Ellis
Senator Kevin Meyer
Senator Fred Dyson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HEALTH WORKFORCE PLANNING COALITION PRESENTATION
- HEARD
OFFICE OF THE LONG TERM CARE OMBUDSMAN PRESENTATION
- HEARD
ALASKA COMMISSION ON AGING PRESENTATION
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
JIM LYNCH, Chief Finance Officer
Fairbanks Memorial Hospital
Fairbanks, AK
POSITION STATEMENT: Presented report for Health Workforce
Planning Coalition.
DELISA CULPEPPER, Chief Operating Officer
Alaska Mental Health Trust Authority
Alaska Department of Revenue
Anchorage, AK
POSITION STATEMENT: Presented report for Health Workforce
Planning Coalition.
JAN HARRIS, Vice-Provost for Health Programs
University of Alaska Anchorage
Anchorage, AK
POSITION STATEMENT: Presented report for Health Workforce
Planning Coalition
DIANA WEBER, Long Term Care Ombudsman
Alaska Mental Health Trust Authority
Department of Revenue
Anchorage, AK
POSITION STATEMENT: Presented report for Office of the Long Term
Care Ombudsman.
DENISE DANIELLO, Executive Director
Alaska Commission on Aging
Division of Senior and Disability Services
Department of Health and Social Services
Anchorage, AK
POSITION STATEMENT: Presented report for Alaska Commission on
Aging.
ACTION NARRATIVE
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:33 p.m. Present at the
call to order were Senators Dyson, Meyer, Egan, Ellis and Chair
Davis.
^Presentation: Health Workforce Planning Coalition
HEALTH WORKFORCE PLANNING COALITION
1:33:19 PM
CHAIR DAVIS announced the first order of business would be a
presentation by the Alaska Health Workforce Planning Coalition.
JIM LYNCH, Chief Finance Officer, Fairbanks Memorial Hospital,
said he was representing the delivery part of the health care
industry. The information to be presented pertains to the health
care workforce coalition, which is a volunteer coalition of
different aspects of the health care industry that have come
together to work on a strategic plan for the health care
workforce.
CHAIR DAVIS asked if there was a list of the coalition members.
MR. LYNCH responded it was included in the plan document. He
said he would speak to the industry part of the plan. The health
care industry is a big part of the economy, representing about
10 percent of the workforce in Alaska, with a payroll of more
than $1.4 billion annually. The health care workforce will not
be reduced by the application of technology; instead it will be
increased.
Health care is predicted to show significant growth in the next
decade. This trend is driven by the aging population, which has
a dual impact. Workers retire, and at the same time an aging
population requires more health care services. This is not
unique to Alaska but we do need to address the problem.
He said that health care is a complex industry. One challenge in
training the workforce is all the individual licensure rules.
Every profession that requires an educational background in
health has its own licensure body, with its own credentials.
This is a factor they have to work within as they build training
models. Shortages in the health care field are also connected to
economics. In Fairbanks Memorial Hospital alone, they are
spending on average $3 million a year on short term, temporary
employees. The Department of Labor (DOL) numbers show $2.5
million in 1995, but he thinks that is understated. This
critical shortage in distribution is a reminder of the diverse
careers available in the field.
There are about 150 occupations in health industries, ranging
from housekeepers to physicians. Most will be in demand, but
each demand curve is different. The coalition has a
prioritization process, and has selected a most urgent group.
They have developed a very extensive partnership which is
industry driven and they hope to make a real difference for
these careers.
1:44:13 PM
MR. LYNCH explained there are four broad strategic categories:
Engagement, train, recruit and retain. Retaining is extremely
important. Recruitment from the outside to Alaska will be an
equal part of the puzzle. They have to pursue both strategies.
SENATOR DYSON noted that many medical professionals are not in
private practice, but rather in institutional settings which
protects them from liability issues. In Texas they have passed
tort reform to deal with the high cost of liability insurance.
Doctors are moving to Texas because of this. He asked if there
is anything more the state needs to do on the liability issue.
1:47:37 PM
MR. LYNCH said yes, there is always more to do. The state has
made positive steps forward in the last 5 or 6 years by putting
some limitations on frivolous lawsuits. There are other policy
issues that can be influenced, such as the practice environment.
DSHS policy may make Alaska favorable or unfavorable as a
practice environment.
1:50:48 PM
DELISA CULPEPPER, Chief Operating Officer, Alaska Mental Health
Trust Authority, Department of Revenue, said the coalition has
been working on this plan for about a year. They started
developing the plan in the summer of 2009 through health forums,
and they also did surveys of groups that did not have forums
available. In May of 2010 the plan was presented to the
workforce investment board and approved. Initial priority
occupations were identified and data was compiled about health
care occupations in the state to make sure that they are aware
of the numbers of people needed, percentages of vacancy, and the
critical nature of those occupations to ongoing health care.
1:54:31 PM
JAN HARRIS, Vice-Provost for Health Programs, University of
Alaska Anchorage, said there needs to be a shared vision in
order to arrive at strategies. This is a public/private industry
problem to solve. Current investments in the short term are loan
repayment for the health care workforce. In trying to recruit
people such as doctors, Alaska is competing with states that do
have loan repayment programs and are offering incentives. If you
have lived in a state for 3-4 years you are much more likely to
stay. The trust puts money into the loan repayment program, and
the state has applied for a national health services corps loan
repayment program. The trust matches federal funds, and they
would like the state to match also. They also have money in the
budget for a psychiatric residency program.
CHAIR DAVIS asked for dollar figures.
MS. CULPEPPER said that $202 thousand was in the governor's
budget.
CHAIR DAVIS asked if it that money had been pulled.
MS. HARRIS confirmed that it had. She noted the psychiatric
residency is a program they have been studying for a few years.
Private industry and others are putting money into the program,
and the University of Alaska has area health education centers.
MR. LYNCH said that from the industry perspective these centers
are incredibly valuable. Area health education centers are
headquartered in regional hubs, and they have a three-fold
mission. The most critical mission is outreach, getting young
people interested in health careers. The centers manage job
shadowing, internships, and try to connect with students in as
many ways as possible. Industry is putting up half the money to
match federal dollars, but those dollars are going to sunset.
CHAIR DAVIS asked when the federal dollars will expire.
2:02:40 PM
MS. HARRIS said two centers will get a smaller amount starting
next year. There is a six year time frame for full funding, and
then it slides off.
MS. CULPEPPER said she hopes the committee members get a chance
to look at the plan.
CHAIR DAVIS asked if the Mental Health Board had approved the
plan.
MR. LYNCH said the Alaska Workforce Investment Board, under the
Department of Labor, had approved the plan. This is actually the
governor's board. He noted the plan has also been endorsed by
the State Hospital and Nursing Home Board of Directors, as well
as the mental health trust board.
At-ease from 2:04 until 2:09
^Presentation: Long Term Care Ombudsman
LONG TERM CARE OMBUDSMAN REPORT
2:09:09 PM
CHAIR DAVIS announced the next order of business would be a
presentation by the Long Term Care Ombudsman.
DIANA WEBER, Long Term Care Ombudsman, Alaska Mental Health
Trust Authority, Department of Revenue (DOR), said her goal was
to help the committee become aware of the long term care
ombudsman program. A lot of Alaska's aging population will need
this type of care. The mission of the Office of the Long Term
Care Ombudsman (OLTCO) is to preserve and protect the dignity of
seniors age 60 and above in long term care. First, the authority
of the OLTCO is to oversee, investigate, and resolve complaints
in long term care for seniors. The federal Older Americans Act
of 1965 established a pilot program for a long term care
ombudsman. Every state now has a long term care ombudsman. It
was originally conceived as a consumer protection program to
provide paid staff, but also trained and certified volunteers,
to keep an eye on what was happening with seniors in long term
care facilities.
MS. WEBER said that AS 47.62 sets out the specific duties of the
position, which is consistent with the federal Older Americans
Act. The OLTCO is charged with investigating and resolving
complaints made by or on behalf of older Alaskans in long term
care, if the complaint relates to a decision, action, or failure
to act by a provider or by a public agency or social service
agency. The resolution of complaints can involve many
strategies. The OLTCO can mediate disputes and provide better
strategies. Sometimes they cannot resolve an issue, and have to
ask another agency to take over.
2:14:03 PM
MS. WEBER emphasized that the OLTCO's enforcement authority is
very limited. They can pursue legal or administrative remedies,
but they don't have the authority to take any licensing actions
or remove seniors from homes.
SENATOR DYSON asked if OLTCO should have that authority.
MS. WEBER responded the state has the right people in the right
places already with enforcement authority, but it could probably
use more of them because the number of complaints is rising.
OLTCO's role is resolution of complaints and monitoring of the
system, as opposed to enforcement.
SENATOR DYSON asked if OLTCO is not able to resolve a situation
and you report this to an agency, do you get a rapid response.
MS. WEBER said yes, the response time has actually improved
recently.
SENATOR DYSON asked about fraud by providers.
MS. WEBER said she did have information on fraud. The Medicaid
fraud control unit has powers to prosecute fraud offenders; in
fact, it is currently is prosecuting a provider on three counts
of neglect of a vulnerable adult.
CHAIR DAVIS asked how many people are employed in the OLTCO
office.
MS. WEBER said they have a staff of five, including herself, to
serve 312 facilities. They also have 12 volunteers working in 23
facilities. Staff is stretched.
CHAIR DAVIS asked if they are able to cover all areas with the
existing staff.
MS. WEBER said the staff is able do investigations and resolve
complaints, but they have trouble monitoring facilities. They
are supposed to monitor each facility quarterly, and they aren't
able to do that.
CHAIR DAVIS asked if they were able to make one visit a year
MS. WEBER responded they have difficulty doing that, as their
travel budget is minimal.
CHAIR DAVIS asked if they had requested a budget increase.
MS. WEBER responded that in the FY12 budget they asked for
continuation of a onetime increment they were given last year,
to fully fund two investigator positions.
2:19:55 PM
MS. WEBER explained the Older Americans Act has a broader
mandate beyond investigating and resolving complaints. They are
supposed to monitor facilities, advocate for vulnerable elders,
and to raise public awareness of elder justice issues. The OLTCO
is administratively housed in the Mental Health Trust Authority.
They are advised and represented by the state Attorney General,
who also ensures they are operating within the mandates of law.
Their funding is a combination of federal Office of Older
Americans (OAA) grants and some matching state general funds.
In FY2009 they opened 14 cases a month. In the first seven
months of this fiscal year they opened 30 cases a month. The
division of adult protective services is also experiencing
increased case loads.
SENATOR MEYER asked why the OLTCO case load has almost doubled
since last year.
MS. WEBER responded she was not sure, but these are not spurious
complaints. Possibly the public is more aware and knows where to
report because reports are coming in.
2:22:52 PM
She noted that 90 percent of the complaints are about assisted
living homes, and the top three complaints are poor medication
management, falls or improper handling, and shortage of staff.
SENATOR DYSON asked if she meant a shortage of trained and
competent staff.
MS. WEBER answered yes, noting that requirements for these jobs
are very minimal. They have to speak enough English to reach 911
and be understood, and they have to be supervised for about
three days. The only education requirements are for
administrators, not care-givers. As far as the resolution of
complaints, 67 percent were resolved and 23 percent had to be
referred to another agency. Only one percent was not resolved to
the satisfaction of the resident or complainant. She pointed out
that other agencies are extremely important.
She feels that the OLTCO needs to contribute to improving the
system of care by collaborating with providers. They have
increased their volunteer ombudsman corps, and place them in
homes where they visit once or twice a month. They have worked
with providers to get them used to the idea of volunteer visits.
Volunteers are trained to be courteous and respectful. They are
able to identify problems and help resolve them before someone
is hurt. They see a lot of improvements in homes where
volunteers are placed.
2:26:41 PM
MS. WEBER said she is hoping to have as many as 50 volunteers by
the end of this year, because they do lead to improvements in
the homes. She noted the OLTCO has been working with DSHS to
collaborate better. They are participating in DSHS licensing
orientations for new administrators, so they can talk about the
problems they are seeing and how to prevent them. Also, the
Division of Senior and Disability Services has included them in
its mortality review team, which gives them the opportunity to
review deaths and investigate if something doesn't look right.
They are in the governor's operating budget for FY12.
SENATOR DYSON asked if payment for assisted living home
providers is too high, because it seems like a fairly
comfortable home business, but the homes look more like
warehouses for seniors.
MS. WEBER replied there are many things we could do, such as
revising our assisted living licensing laws, which are too lax.
We could also do more to provide training for caregivers and
possibly incentivize so that providers get the caregivers
trained.
SENATOR DYSON stated Commissioner Streur is aware and concerned.
The committee can affect the budget, but it is difficult to
change regulations; the committee needs direction.
MS. WEBER answered this is an opportune time to have a long-term
care plan. We have lots of studies but not a real plan that
looks at all aspects.
^Presentation: Alaska Commission on Aging
ALASKA COMMISSION ON AGING
2:32:29 PM
CHAIR DAVIS announced the next order of business would be a
presentation by the Alaska Commission on Aging.
DENISE DANIELLO, Executive Director, Alaska Commission on Aging,
Division of Senior and Disability Services, Department of Health
and Social Services, said she would do an overview of the
demographics of Alaska's senior population, the purpose of the
needs assessments, describe findings of the senior survey and
present a list of priorities for seniors' future.
The mission of the Commission is to advocate, plan, and educate
on behalf of all older Alaskans, and to ensure the dignity and
independence of all older Alaskans. The commission has 11
members, with seven members appointed by the governor, including
six seniors. The remaining seats are designated for the DSHS,
the Department of Community and Economic Development, the chair
of the Pioneer Home Advisory Board, and a senior care provider.
Alaska's senior population is growing rapidly; Alaska is the
state with the fastest growing senior population. People who
came to the state in 1970s and 1980s are still here and planning
to retire.
2:36:28 PM
The population of people 85 and over is projected to grow by 500
percent between 2000 and 2034. This growth varies by region,
with the fastest growing regions being South Central, Fairbanks,
and Anchorage. Over 6,000 Alaskans suffer from Alzheimer's
disease and related dementias. In the next 20 years there could
be as many as 17,000. Health care costs are much higher for this
population.
MS. DANIELLO said the Alaska Commission on Aging is developing
the next state plan for senior services. The current plan
expires on June 30, 2011 of this year. The plan meets federal
requirements for the state to get funds. These funds are matched
with state general funds and mental health trust funds to
provide services such as the senior meal program,
transportation, chore respite, information referral, and more.
These funds are provided through Title 3 of the Older Americans
Act (OAA). They also have funds to provide vocational training
for low income seniors through Title 5 of the OAA, and funding
to provide elder meals and transportation services through title
6, as well as funds for elder protection.
2:39:35 PM
MS. DANIELLO explained that a main component of the state plan
is a needs assessment, which is why they conducted their efforts
this year. These efforts included six community forums, a senior
survey, and a provider survey. The senior survey was available
in both paper and electronic formats. It was published in the
Senior Voice. The Commission received 3,222 total responses from
people age 50 and older, of which 2,836 came from people age 60
and over. This was not a random, statistically valid sample, but
rather a sample of convenience. However, responses represented
all regions of the state and all ethnicities.
By gender, more of the respondents were female. Ethnicity
percentages tracked with population percentages. Fifty-six
percent of respondents had lived in Alaska for more than 40
years, with 16 percent being born here.
2:43:01 PM
She also said the survey found that more than half of the
seniors are happy with their community, and 59 percent said they
visit their senior center at least once a month. For those who
do not use the centers, 12 percent would like to but have no
transportation. Twenty percent of Alaska's seniors said their
monthly income is not enough to meet their needs. More than half
of the respondents have household incomes of $2,000 a month or
less
2:45:45 PM
SENATOR DYSON noted that social security for a couple is usually
more than $2,000.
MS. DANIELLO replied that many of the respondents might be
single, so they receive less money. Also, in rural Alaska many
seniors have lived subsistence lifestyles and don't qualify for
social security. Seniors were also asked if they had an illness
or disability that limited their activities and 60 percent said
they did. A concern of many seniors was not having a primary
care doctor, with 31 percent reporting having a problem finding
a doctor.
2:49:20 PM
The survey provided a list of concerns, and found that health
care and financial security were at the top of the list. Seniors
were satisfied with services that they used, such as adult day
care and home delivered meals. They also said the state needs
more senior housing and senior transportation services. The
findings from the Elder/Senior Community Forums were basically
the same as those of the survey. People attending the forums
emphasized their appreciation for home and community-based
services. These services enabled them to maintain their
independence and health. Services were not always available in
the rural areas, which was a concern for people in those areas.
Rural forums reported an emerging problem of senior
homelessness. Seniors would also like to have a one stop shop
for information referral services. Many stakeholders mentioned
the need for a statewide long term care plan.
2:56:17 PM
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 2:56 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Alaska's Health Workforce - Legislative Presentation (AK Mental Health) 2-23-11.pptx |
SHSS 2/23/2011 1:30:00 PM |
|
| Long Term Care Ombudsman.pptx |
SHSS 2/23/2011 1:30:00 PM |
|
| ACoA Senate HSS Presentation 2011.ppt |
SHSS 2/23/2011 1:30:00 PM |