HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE February 1, 2000 3:44 p.m. MEMBERS PRESENT Representative Fred Dyson, Chairman Representative Jim Whitaker Representative Joe Green Representative Tom Brice Representative Allen Kemplen Representative John Coghill MEMBERS ABSENT Representative Carl Morgan OTHER HOUSE MEMBERS PRESENT Representative Lisa Murkowski Representative Pete Kott COMMITTEE CALENDAR HOUSE BILL NO. 268 "An Act relating to the Alaska Higher Education Savings Trust; and providing for an effective date." - MOVED CSHB 268(HES) OUT OF COMMITTEE HOUSE BILL NO. 288 "An Act relating to the creation of an aggravating factor for the commission of domestic violence in the physical presence of a child." - MOVED HB 288 OUT OF COMMITTEE HOUSE BILL NO. 258 "An Act relating to assisted living homes; and providing for an effective date." - MOVED CSHB 258(HES) OUT OF COMMITTEE PREVIOUS ACTION BILL: HB 268 SHORT TITLE: COLLEGE TUITION SAVINGS PLAN Jrn-Date Jrn-Page Action 1/10/00 1889 (H) PREFILE RELEASED 12/30/99 1/10/00 1889 (H) READ THE FIRST TIME - REFERRALS 1/10/00 1889 (H) HES, FIN 1/10/00 1889 (H) REFERRED TO HES 1/27/00 (H) HES AT 3:00 PM CAPITOL 106 1/27/00 (H) Heard & Held 1/27/00 (H) MINUTE(HES) 1/28/00 2035 (H) COSPONSOR(S): KEMPLEN, MORGAN, DYSON 2/01/00 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 288 SHORT TITLE: CHILDREN WITNESSING DOMESTIC VIOLENCE Jrn-Date Jrn-Page Action 1/14/00 1923 (H) READ THE FIRST TIME - REFERRALS 1/14/00 1923 (H) HES, JUD 1/14/00 1923 (H) REFERRED TO HES 2/01/00 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 258 SHORT TITLE: ASSISTED LIVING HOMES Jrn-Date Jrn-Page Action 1/10/00 1887 (H) PREFILE RELEASED 12/30/99 1/10/00 1887 (H) READ THE FIRST TIME - REFERRALS 1/10/00 1887 (H) HES, FIN 1/10/00 1887 (H) REFERRED TO HES 2/01/00 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER CASEY SULLIVAN, Legislative Administrative Assistant to Representative Lisa Murkowski Alaska State Legislature Capitol Building, Room 406 Juneau, Alaska 99801 POSITION STATEMENT: Presented amendment for CSHB 268. DENISE HENDERSON, Legislative Secretary for Representative Pete Kott Alaska State Legislature Capitol Building, Room 118 Juneau, Alaska 99801 POSITION STATEMENT: Presented sponsor statement for HB 288. ANNE CARPENETI, Assistant Attorney General Legal Services Section-Juneau Criminal Division Department of Law P.O. Box 110300 Juneau, Alaska 99811 POSITION STATEMENT: Answered legal questions on HB 288. MR. GEORGE HANSEN, Dentist Alaska Dental Society 4860 Folker Street Anchorage, Alaska 99507 POSITION STATEMENT: Testified in support of HB 288. MONTA FAYE LANE, President Alaska Caregivers Association Owner, Assisted Living Home 109 East Fifth Avenue North Pole, Alaska 99705 POSITION STATEMENT: Testified in support of HB 258. LESLEE OREBAUGH, Owner Parkside and Rosewood Assisted Living Homes Executive Secretary Alaska Caregivers Association 309 East 24th Avenue Anchorage, Alaska 99503 POSITION STATEMENT: Testified in support of HB 258. ALISON ELGEE, Deputy Commissioner Department of Administration P.O. Box 110200 Juneau, Alaska 99811 POSITION STATEMENT: Testified in support of HB 258. ELMER LINDSTROM, Special Assistant Office of the Commissioner Department of Health & Social Services P.O. Box 110601 Juneau, Alaska 99811 POSITION STATEMENT: Testified in support of HB 258. JANE DEMMERT, Executive Director Alaska Commission on Aging Division of Senior Services Department of Administration P.O. Box 110209 Juneau, Alaska 99811 POSITION STATEMENT: Testified in support of HB 258. ACTION NARRATIVE TAPE 00-7, SIDE A Number 0001 [The minutes for the State Independent Living Council are found in the 3:00 p.m. cover sheet for the same date.] CHAIRMAN FRED DYSON reconvened the House Health, Education and Social Services Standing Committee meeting at 3:44 p.m. Members present were Representatives Dyson, Whitaker, Green, Brice, Kemplen and Coghill. HB 268 - COLLEGE TUITION SAVINGS PLAN Number 0051 CHAIRMAN DYSON announced the next order of business as House Bill No. 268, "An Act relating to the Alaska Higher Education Savings Trust; and providing for an effective date." [Before the committee was version 1-LS1235\H, Ford, 1/24/00, which was adopted as a work draft on 1/27/00.] Number 0075 CASEY SULLIVAN, Legislative Administrative Assistant to Representative Lisa Murkowski, Alaska State Legislature, came forward to present an amendment. REPRESENTATIVE COGHILL made a motion to adopt Amendment 1, 1- LS1235\H.1, Ford, 1/31/00, which read: Page 4, line 16: Delete "An" Insert "Except as provided under AS 34.40.110, an" CHAIRMAN DYSON asked whether there was any objection. There being none, Amendment 1 was adopted. Number 0240 REPRESENTATIVE COGHILL made a motion that CSHB 268, version 1- LS1235\H, Ford, 1/24/00, as amended, move out of committee with individual recommendations. There being no objection, CSHB 268(HES) moved from the House Health, Education and Social Services Standing Committee. HB 288 - CHILDREN WITNESSING DOMESTIC VIOLENCE CHAIRMAN DYSON announced the next order of business as House Bill No. 288, "An Act relating to the creation of an aggravating factor for the commission of domestic violence in the physical presence of a child." Number 0295 DENISE HENDERSON, Legislative Secretary for Representative Pete Kott, Alaska State Legislature, came forward to testify. She explained this bill would add a new section to Statute 12.33.144(c)(18). At the present time, committing domestic violence in the presence of a child is not included as a determining factor in the sentencing of the perpetrator. Currently there is nothing in the Alaska Statutes that would allow judges to factor the egregiousness of the crime into the sentencing. This should be an aggravating factor in determining sentence for the crime of domestic violence. This bill would expand the list to include the special vulnerability to children. It would become a major factor in determining the severity of the crime and the resulting sentence thereof. House Bill 288 would allow the courts to consider these factors to mitigate or aggravate the severity of domestic violence when committed in the presence of children. It is Representative Kott's belief and her own that this is valid criteria for the court in rendering sentence. MS. HENDERSON went on to say the public policy that the committee is being asked to consider today is that the commission of the crime of domestic violence be included on this list of factors. She shares an interest in the welfare of children. She has seen the devastating and long-term effects that domestic violence can have on the children. She worked for the Juvenile Division of the District Attorney's Office in Albuquerque, New Mexico and unfortunately the one underlying factor that seemed to play a role in the lives of the kids that came through the system was domestic violence. Since moving to Anchorage, she had the opportunity to work with Abused Women's Aid in Crisis where she witnessed once again the devastation that domestic violence can play on children. She is also a Court Appointed Special Advocate (CASA) with the Office of Public Advocacy in Anchorage. This bill would give the court system a new tool to further the fight against domestic violence and child abuse. This bill would not only bring awareness to the trauma that children bear in witnessing domestic violence in the home, but it would be instrumental in breaking the cycle of domestic violence. REPRESENTATIVE GREEN asked if what the children are witnessing would be a felony if charged under AS 11.41. Number 0587 ANNE CARPENETI, Assistant Attorney General, Legal Services Section-Juneau, Criminal Division, Department of Law, came forward to answer questions. She explained that AS 11.41 addresses person crimes. The fact that this is an aggravating factor means it gives the court the discretion to raise the sentence in a particular case. It only applies to felonies to which presumptive sentencing applies, which isn't even all felonies. REPRESENTATIVE COGHILL asked if there is some significance to the age 16 and not age 18. Number 0629 MS. CARPENETI answered that age 16 is the age of consent. Many statutes dealing with children draw a line at the age of 16. The statutes address different ages for different statutory purposes. REPRESENTATIVE COGHILL asked if this proposed statute would apply if children who are 17 or 18 years old witness domestic violence. MS. CARPENETI answered the way it is written now would only apply to domestic violence in front of a child under 16. REPRESENTATIVE COGHILL asked if this could be used to put a block between parents if a youngster witnessed something and gets caught between two parents in an argument. The charge of felony is there but he wondered if the youngster could find himself in a very hard position of tipping this into a definite felony conviction. MS. CARPENETI answered that wouldn't happen because this only applies to felony offenses to which presumptive sentencing applies. It is an aggravating factor for sentencing after a person has been convicted of a crime. Number 0743 MR. GEORGE HANSEN, Dentist, Alaska Dental Society, testified via teleconference from Anchorage in favor of HB 288. The organized dentists in Alaska are interested in this bill because they are often called upon to treat the injuries to the face and/or mouth which have been caused by physical abuse. For this reason the American Dental Association (ADA) has a policy and commitment to recognize and prevent domestic abuse. It has been postulated that children witnessing abuse are prone to commit that same abuse when they are adults. It is desirable that the cycle be stopped. This bill is intended to assist only in the sentencing phase following a conviction for domestic abuse by adding to the list of aggravating factors. He knows of no opposition to this bill. He referred to the age issue and mentioned he has read material which says by the time a child is ten or twelve, his/her adult habits and thoughts are reasonably formed. He would not encourage lowering the age but would not oppose it if the age were raised to 18. CHAIRMAN DYSON told Mr. Hansen that he was impressed that the dentists' organization takes a stand on this issue. The committee took an at-ease from 3:55 p.m. to 3:56 p.m. REPRESENTATIVE COGHILL wondered if the age were not changed to 18 would the judge not have a legal precedent to put that in as an aggravator. MS. CARPENETI agreed if the child witnessing the crime is 17 or 18, the judge won't be able to apply this specific aggravating factor. A judge usually does have other aggravating factors to consider in domestic violence cases. REPRESENTATIVE KEMPLEN asked if this factor would still be applied if the child were too young to experience the impact of domestic violence. MS. HENDERSON stated the age of the child should not matter nor play a factor because the child is in danger anytime violence is present in the home. REPRESENTATIVE KEMPLEN asked if during an argument someone throws a skillet across the room would that be considered domestic violence. Number 1095 MS. CARPENETI replied it always depends on the circumstances. An aggravating factor at sentencing is something the judge can consider. It doesn't necessarily mean that the sentence will be raised because he/she finds that aggravating factor. There may be other aggravating factors; there may be mitigating factors. This legislation just gives the court more leeway in terms of fashioning a sentence appropriate to the case, and it only applies to felonies. CHAIRMAN DYSON explained when there is physical violence, not only is there danger to the child of getting hit, there is tremendous emotional impact on the child. Newborns can tell if there is anger and tension in the home, and they can tell things aren't right between their parents. There is evidence that prenatally, children are affected by the tension and/or insecurities of what goes on around them. Aside from the physical danger, there is emotional danger. That damage occurring to an infant perseveres for a significant part of his/her life. REPRESENTATIVE BRICE also commented that the level of research and understanding of emotional impact on children, newborns, infants and the unborn is becoming more and more documented, and the environment in which a child is brought up does impact the way that child acts and reacts throughout life. He would be concerned about trying to establish a minimum age. They may want to increase the age from 16 to 18. REPRESENTATIVE COGHILL indicated since most children can be emancipated at 16, he is willing to let this bill pass without amending the age. Number 1286 REPRESENTATIVE COGHILL made a motion to move HB 288 from the committee with individual recommendations. There being no objection, HB 288 moved from the House Health, Education and Social Services Committee. HB 258 - ASSISTED LIVING HOMES Number 1348 CHAIRMAN DYSON announced the next order of business as House Bill No. 258, "An Act relating to assisted living homes; and providing for an effective date." Number 1374 REPRESENTATIVE COGHILL, co-sponsor with Representative Jeannette James, presented HB 258. He noted he has dealt with this subject on the Long-Term Care Task Force. Assisted living homes have been well defended today, and the cost of institutional care is way beyond the state's ability to handle. The average age is growing rapidly, and the need for assisted care, long-term care, respite care and institutional care is rising. To plan for this, they have to figure out how to take care of people in the best, most dignified and least expensive way possible. A community- based effort is the best way to do that. The proposed CS deals with indigent people who are not able to take care of themselves and are under general relief and the caregivers who are being reimbursed only $35 per day. Since this bill has a Finance committee referral, he suggested this committee focus on the policy itself. Representative James and he feel strongly that this issue is a priority for this legislature because the alternative is costly institutional care. Number 1500 REPRESENTATIVE COGHILL made a motion to adopt the proposed committee substitute (CS) for HB 258, version 1-LS1076\D, Lauterbach, 1/29/00, as a work draft. There being no objection, proposed CSHB 258 was before the committee. REPRESENTATIVE COGHILL explained the difference in the bill versions was on page 2, Sec. 5 where there was a tiered approach in three different years. Representative James and he felt they should start at this basic level. REPRESENTATIVE KEMPLEN asked Representative Coghill why he is interested in raising the rate for assisted living services and facilities when there are other alternatives that have been suggested, in particular with faith organizations assisting with these people. It seems that expanding the size of the budget goes contrary to that way of thinking, and he wondered how that is reconciled. REPRESENTATIVE COGHILL indicated this is not to diminish faith- based work. Most of the people working in assisted living homes do not do it for the money. This bill would take care of an indigent population that the State of Alaska has agreed to care for. It should be done with dignity or not done at all. This is a statement saying let's do it so that there is a real reimbursement rate for this. He is a fan of getting faith-based organizations involved so that these costs do not have to be there. They need to work hand in hand. The cost of the rate in the proposed CS was brought from the Mental Health Trust Authority. The Department of Administration has suggested another model that brings the rate up to $100, but he did not suggest that rate but agreed the Finance Committee should discuss it. This bill goes to the $75 limit. The cost definitely needs to be shifted; there is a need here. Number 1712 MONTA FAYE LANE, President, Alaska Caregivers Association, Owner, Assisted Living Home, testified via teleconference from Fairbanks. She represents about 45 assisted living homes in that association which provide indigent care. She described a situation where she was asked by Denali Center to take a 525 pound man who needed three showers a day and wound care on his stomach three times a day for $34.50 per day. She felt she had to turn this down because of the potential damage this man could cause on the pipes in her home and on her bathroom. Because the state has no reimbursement rates for damage control, it would be impossible for her to take this man in. It would be a poor business judgment on her part to have done so; therefore, she had to refuse this person. One year later Denali Center called her again and said the same man now only weighs 425 pounds. He lost 100 pounds, but that is still not enough to walk on her floors with pipes to her furnace. MS. LANE said there has been a long battle with the state for general relief rates in Alaska. She came into this business ten years ago, and the state told her at that time that she should have another job in order to pay the mortgage and pay for food and utilities for her home. Now Alaska's population is getting older and living longer and getting sicker. Back then the state said the care providers could not take anyone in their homes who was in a wheelchair who could not transfer himself/herself to the bathroom or to and from the bed or chair. Now she gets calls from Denali Center saying a patient is out of money now and on Medicaid, and Denali Center can no longer keep him/her in their facility, but they could move the patient to her facility for $34.50 a day. She noted that Denali Center gets $345 a day and she gives personal one-on-one attention for $34.50 a day. The difference is she gets 10 percent of what Denali Center makes. MS. LANE pointed out that the legislature supports the pioneer homes for between $30-38 million a year. The public doesn't understand that the person going into the pioneer home pays $2000 a month to be there. With 600 people in the pioneer homes, that equals $12 million a year which can put back into the general fund. MS. LANE wanted the committee to know that the caregivers are there for the people and will remain for the people, but they cannot do it at $34.50 a day. Last year the caregivers said they would not take any new people at $34.50 a day and then reneged on that because they didn't have the heart to put the patients out. This year will be a whole different story. She urged the committee to find a solution for this. Number 1977 REPRESENTATIVE KEMPLEN asked Ms. Lane if money was the only thing she would be satisfied with or would other means of compensation be appropriate. He suggested education credit at the university or a housing voucher or a percentage rate reduction for a loan or other in-kind benefits. MS. LANE replied she has some education which has trained her for this and is game for education. As to other subsidies, she is a for-profit entity, and the legislature does not provide money for that. She is a business but does not get paid for any of the administrative costs. Number 2136 LESLEE OREBAUGH, Owner, Parkside and Rosewood Assisted Living Homes, Executive Secretary, Alaska Caregivers Association, testified via teleconference from Anchorage. She has 32 beds in her homes. She is also representing approximately 45 homes across the state. She reminded the committee the state reimbursement rate is 17.5 years old and economically, no one is living with a 17.5 year old budget right now. In 1995 the state made them a business, with business licenses and business insurances. She emphasized that they can't take anything but money. Her staff does not and will not take education units or anything else as a form of compensation for their work. There is a problem in Anchorage right now because the owners get paid so little that they cannot pass on good wages to their staff. They have to have this raise. There is a staffing crisis now. MS. OREBAUGH has received numerous calls in the past two or three weeks asking her if she had people or knew of people available for staffing. Owners and administrators have told her they can no longer afford to take a straight indigent person without a Medicaid waiver or CHOICE [the Community and Home Options to Institutional Care for the Elderly and Disabled] waiver. The state is the largest consumer even though there are private clients. The number of state beds and homes that will take indigents are decreasing. The daily rate increase is desperately needed. The care givers can't do without it and continue in their business. The state will be looking at culpable liability at having indigent clients placed in inappropriate housing, on the street or other places; they are looking at illnesses and death that they don't want to face. She urged the committee to take a hard look at this issue. ALISON ELGEE, Deputy Commissioner, Department of Administration, came forward to testify. Through the Division of Senior Services the department deals with the assisted living industry in the state for services provided to seniors. It is a foundation of their home and community-based care delivery system. She referred to the testimony from two assisted living providers and the economic straits they find themselves as a result of the current general relief rates. A study was done about 18 months ago under the auspices of the Mental Health Trust Authority to look at the economics of the assisted living industry in Alaska, and that study supports the $75 rate that is suggested in CSHB 258. In the provision of home and community-based care services, and in the assisted living environment in particular, they are often dealing with the most vulnerable adults who, as a result of some crisis, need protective housing arrangements. Assisted living is a very appropriate environment for them, and there needs to be the economic resources to supplement the income of these individuals when they don't have the resources themselves. She offered support for the bill on behalf of the seniors. Number 2324 ELMER LINDSTROM, Special Assistant, Office of the Commissioner, Department of Health & Social Services (DHSS), came forward to testify. He noted that his department and the Department of Administration (DOA) are companion agencies. The DOA tends to fund the senior population through the Division of Senior Services and DHSS funds persons with developmental disabilities or mental health consumers through the Division of Mental Health and Developmental Disabilities. He mentioned there are fiscal notes from both departments. REPRESENTATIVE KEMPLEN asked Ms. Elgee about the study she mentioned. He mentioned another option in Scandinavia called "co-housing" which is a living arrangement where individuals come together in a mutually supportive arrangement. It is small groups that live together. TAPE 00-7, SIDE B Number 2385 REPRESENTATIVE KEMPLEN noted that option is not a for-profit business, however the needs of the participants are met. He wonders if the study done by the department considered the option of that alternative support system, and if they evaluated co- housing as a viable alternative to the system currently in place. MS. ELGEE answered they did not evaluate that option. The study was specifically to look at the economics of the assisted living industry here in the state of Alaska to determine what was necessary as an underlying rate to make it a viable industry. The environment he described is not one in most of the examples she is familiar with that incorporates the actual services that are available in an assisted living environment. In an assisted living environment those services are provided to individuals who are no longer capable of performing those functions without assistance which includes bathing, dressing, eating, transferring, and others. REPRESENTATIVE KEMPLEN clarified that the person running an assisted living home or their staff are tasked with the responsibility of providing the physical assistance to the elder in terms of physically carrying them to the bathroom or physically washing them or whatever type of service or activity that needs to be provided. MS. ELGEE explained there are individual care plans developed for each person in an assisted living home on a CHOICE waiver or Medicaid waiver. The services are tailored to the individual's needs. Not every individual needs assistance with all services. There will be quite a spectrum. CHAIRMAN DYSON asked if the $2.4 million fiscal note was in the Governor's budget this year. MR. LINDSTROM said it is not currently in the Governor's budget which is why it is seen as a fiscal note. MS. ELGEE referred to a spread sheet for both Senior Services and Health and Social Services so that the committee can see the total cost anticipated of $4,738.3 million. MR. LINDSTROM pointed out the funding source is split between general funds and the Mental Health Trust Authority which has been supportive of the program. There is $850,000 from the Mental Health Trust Authority. CHAIRMAN DYSON asked if the administration supports the bill and this fiscal note. MS. ELGEE answered yes. She said the department sees assisted living as an alternative to nursing home care. The cost for this program is considerably less than the cost would be if many of these individuals were admitted to a nursing home which would be the only alternative available to them for long-term care. REPRESENTATIVE BRICE asked how the original $30 a day standard set. MS. ELGEE answered the rate is set in regulations. REPRESENTATIVE BRICE asked why they couldn't just do it through the regulatory process. MS. ELGEE answered that certainly could be done, but it wouldn't work without funding to cover the rate. MR. LINDSTROM noted this was one of the recommendations from the Long-Term Care Task Force last year, and Senator Miller did introduce legislation that was supported by the task force and by the administration. It is keeping faith with that approach from last year. REPRESENTATIVE COGHILL agreed with Ms. Elgee that the trouble with these figures is the real costs are not seen. In the day of missions and measures, the cost of institutional care is going to drive the state into the ground. Those are costs that are not only are formula-driven but are needs-driven. He anticipates solving a problem before a real serious problem exists. A $4 million problem is nothing compared to what is going to be happening over the next eight years.   REPRESENTATIVE COGHILL mentioned a fiscal note put together by Community Mental Health and said it was different from what came from the Department of Administration and DHSS. Because there are some differences and Representative James was working on getting some agreements, he would like to see this go to the Finance Committee for that kind of work. Since there are some wide differences in the fiscal notes, those things should be discussed at the Finance Committee. REPRESENTATIVE KEMPLEN asked if all assisted living homes are operated as businesses. MS. ELGEE answered that assisted living homes are licensed where they have occupancy of three or more residents. To that degree, anybody interested in public funding has to be licensed even if they are only taking one person. REPRESENTATIVE KEMPLEN asked if a license turns them into a business. MS. ELGEE answered there are very specific requirements set out in statute and expanded upon in regulation that look very business like. One of the providers told the committee that they are required to have insurance. There are financial accounting responsibilities as well as the responsibilities of an employer, there is staff in the larger homes hired to help provide services. People are not providing assisted living for a little extra pocket change. They do it as a livelihood. REPRESENTATIVE KEMPLEN asked about nonprofit organizations. MR. LINDSTROM agreed there are a number of nonprofit organizations that are in this business, particularly for the developmentally disabled (DD) population. He guessed that most, if not all, of the assisted living homes for the DD population are under the umbrella of a nonprofit organization. Assisted living used to be called adult foster care. He guessed that some caregivers come to the business with the basic outlook of someone who has a foster care sort of mentality. Assisted living covers the spectrum from someone at home with one to three persons all the way to the larger facilities which house 30-50 people. Motivation, expectations and business ability are going to cover a wide spectrum of assisted living. REPRESENTATIVE KEMPLEN asked how many of the provider organizations are faith organizations. MS. ELGEE said she doesn't have an answer to that but could develop that information. REPRESENTATIVE KEMPLEN said he would be interested in that information. JANE DEMMERT, Executive Director, Alaska Commission on Aging, Division of Senior Services, Department of Administration, came forward to testify. She referred to previous discussion and added the need for an increase in the rate is something that will affect and does affect Alaskans of all ages. She emphasized that the commission focuses on responding to critical issues as they affect everyone as they age as well as the effect on children and grandchildren. Assisted living is a form of small business for the most part. It is a young industry around the country and even younger in Alaska. "There are businessmen amongst us and you cannot go into a business and expect to survive if you don't have a way to at least begin to meet your expenses." The situation heard about this afternoon is one in which people who are in a business are being asked to provide a service that they are taking a very real loss in. For those people who intend to spend their lives in Alaska, assisted living is one of the very critical pieces. If they can't see that these businesses are able to make a go of it by providing a service that the state is asking them to provide, then that is a disservice to the business community as well as to all those involved from a perspective of public policy. MS. DEMMERT referred to Ms. Lane's testimony. There are people who have difficult circumstances, so this is not the kind of work that can be done casually; it requires professionalism. She pointed out again that these rates have been in place since 1983, so there has not been any ability to keep up with inflation. Because assisted living is a new concept and questions have been asked about it, she invited the committee to visit a small assisted living home in Juneau. Number 1788 REPRESENTATIVE KEMPLEN asked Ms. Demmert what exactly the expenses are in assisted living homes. MS. DEMMERT answered there are basic expenses for operating and maintaining these businesses which include the facility, staffing, pieces of equipment needed for particular individuals and the on-going operating support in terms of providing meals, transportation and any other particular services needed and insurance, which a very significant item. REPRESENTATIVE KEMPLEN asked how much of the rate increase will go to personnel. MS. DEMMERT answered that should be asked of the providers because the pay ranges do vary slightly across businesses. There would be an individual answer for each facility. There is great difficulty in this area now in being able to offer any kind of a wage that recognizes the quality of work provided by the employee. It is work that is physically and mentally challenging. REPRESENTATIVE KEMPLEN said he is trying to figure out whether the business model is the best model to implement in the state to provide assistance to the elders. It seems to him there are other viable models to consider. He could envision nonprofit organizations like AmeriCorps or faith organizations providing these professional services, but other personnel could participate as a part of community service. He sees two competing models available to them: profit-motivated and community-service-motivated. He would be interested in hearing about the community service model. CHAIRMAN DYSON stated that what Representative Kemplen is bringing up is valid, but he is not sure this is the best forum for that discussion. He suggested that the Long-Term Care Task Force would be interested in a presentation on some other models that have worked, or this committee could have a discussion on some of the other models. He chose not to pursue that issue further at this time. REPRESENTATIVE COGHILL added that faith-based modeling is part of the mix. It does not compete with this; it works hand in hand with it, but it is sporadic. The rate is undergirding a cost for service. REPRESENTATIVE COGHILL made a motion to move CSHB 258, version 1- LS1076\D, Lauterbach, 1/29/00, as amended, from committee with individual recommendations and attached fiscal notes. There being no objection, CSHB 258(HES) moved from the House Health, Education and Social Services Committee. ADJOURNMENT Number 1500 There being no further business before the committee, the House Health, Education and Social Services Committee meeting was adjourned at 4:47 p.m.