SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

 

January 23, 2001                                                                                                   Hearing Room 50

1:00 PM                                                                                                                         Tapes  8 - 10

 

MEMBERS PRESENT:         Sen. Bill Fisher, Chair

Sen. Margaret Carter, Vice-Chair

Sen. Gary George

Sen. Ken Messerle

Sen. Frank Shields

 

MEMBER EXCUSED:

 

STAFF PRESENT:                 Rick Berkobien, Committee Administrator

Andrew Morris, Committee Assistant

 

 

MEASURE/ISSUES HEARD:           Long Term Care Issues

 

 

 

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

TAPE 8, A

(The committee met jointly with the House Health and Public Advocacy Committee)

006

Chair Fisher

Calls the meeting to order at 1:11p.m.

LONG TERM CARE ISSUES

018

Roger Auerbach

Administrator of the Senior and Disabled Services Division (SDSD).  Details handout (EXHIBIT A).

041

Auerbach

Discusses SDSD programs:

§         Long-term care

§         Eligibility

§         Licensing

§         Protective Services/Risk Intervention

§         Cash Assistance

§         Older American Act

§         Employment Initiative

Mentions services that assist people with disabilities to enable them to work and keep their state benefits. Indicates that these services assist people with disabilities to achieve their maximum level of independence.

082

Auerbach

Explains that the most important focus of SDSD is that of the clients.  Provides anecdote of elderly client.  Advocates for the help of the client’s family and loved ones.

114

Sen. Shields

Asks about the cost of a transfer from home to a health care facility.

117

Auerbach

Responds that the cost per month of housing an elderly person in a facility is around $3,000. Provides anecdote of a disabled patient. Discusses importance of SDSD care in relation to this patient.

134

Rep. Morrisette

Asks for the estimated cost of the actual transfer of people from an in-home living situation to a health care facility.

143

Auerbach

Responds that the cost would be around $3,000.

146

Rep. Morrisette

Requests more detailed information on each of the separate cases to be provided.

151

Auerbach

Responds that he will provide the information. Introduces anecdote of arthritic woman needing treatment. Mentions costs of SDSD’s services per month. Discusses how clients enter the system and begin to require services. Continues testimony by detailing the breakdown of family support of their elderly relatives.

204

Auerbach

Points out another reason for seniors receiving services:

§         Post hospitalization

§         Breakdown of family support

§         Depleted resources (spend down)

§         Discovered through abuse investigation

Maintains that seniors may be able to receive SDSD services and stay in their home at the same time. Refers to the remainder of the handout.

245

Sen. Shields

Asks for clarification of page 10 of the handout.

254

Auerbach

Responds to the question.

263

Sen. Shields

Asks that if in rural Oregon fewer people have access to SDSD’s services.

274

Auerbach

Answers that SDSD provides people with access to their services throughout the state of Oregon.  States that the percentage of people receiving the services is not an exact figure.

301

Dan Kaplan

Deputy Administrator, Senior and Disabled Services Division.  Calls attention to page 12 of the handout. Discusses the rapid growth rate of the senior population as well as the rate of growth of disabled persons receiving Medicaid.

330

Sen. Messerle

Asks about the growth rate of the senior population and if it will reach a foreseeable plateau.

338

Kaplan

Answers that the population of elderly will continue to grow. Refers to page 13 of the handout. Notes that SDSD serves slightly more than 1 out of every 10 Oregonians over the age of 85. Details income levels throughout people’s lives.

380

Kaplan

Makes note of graph on page 14 in handout. Remarks that community-based care facilities are more prevalent today than ever before which has caused a drop in numbers of those served through SDSD. Discusses those that are in need of the greatest amount of care; those termed most medically fragile. Provides that assisted living facilities are growing. Underlines the changing market which is reducing the demand for nursing homes.

TAPE 9, A

027

Kaplan

Discusses changes in the market such as the building of more assisted living and residential care facilities that have had a destabilizing affect on SDSD. Points out information on the chart on page 15 of the handout. Discusses the decline in demand for those needing long-term care and says that 19 nursing facilities around the state have closed.  Indicates that the reason for this occurrence is that there is a decline in demand because people have more options today than in the past. Points out that occupancy of nursing facility care has dropped from a relatively high number to one that is quite low.

069

Kaplan

Discusses facility level and says that many facilities have low occupancy rates which makes for low revenues and therefore there is not enough money to, much of the time, give the patients the care they need.

087

Rep. Monnes-Anderson

Asks what assisted living is in comparison to adult foster care/residential care and questions the numbers of people SDSD employs.

093

Kaplan

Responds that SDSD employs roughly 835 people.  Comments that foster homes are the smallest facilities that serve the elderly and that when it comes to what residential care facilities look like, there is a great variety of models.

122

Sen. Messerle

Asks for clarification of page 13 of handout.

135

Kaplan

Responds.

140

Sen. Messerle

Asks for more information.

145

Kaplan

Discusses the way in which a program is run.

153

Sen. Carter

Asks about the probability of SDSD maintaining its services in lieu of budget cuts.

165

Auerbach

Responds by discussing service priority levels.  Requests more time to specifically detail the repercussions of budget cuts.

177

Chair Fisher

Asks that Mr. Auerbach be available for questions after the committee meeting.

180

Sen. Carter

Wishes to spend more time on issues that impact seniors.

192

Chair Fisher

Agrees that these issues are important.

196

Meredith Cote

State Long-Term Care Ombudsman.  Discusses mission statement of the Office of the Long-Term Care Ombudsman.  Details work of the office:

§         Enhance the quality of life

§         Improve the level of care

§         Protect individual rights

Explains that the work is done by investigating and resolving residents’ complaints and concerns in nursing facilities, assisted living facilities, residential care facilities, and adult foster homes.  Provides that another mandate is for monitoring the long-term care system and to give input of the implementation of policy, rules and laws that affect long-term care facility residents.  Mentions that 80% of the complaints taken by the office are resolved at the actual facility from which the complaint originated. Details the uniqueness of the program saying that it is the primary advocate for long-term care facility residents. Points out that it is the responsibility of the office to bring forward complaints and concerns from the residents to legislators and those who can most efficiently address the problem.

245

Cote

Stresses the importance of quality of care within the agency.  Adds that the Office of the Long-Term Care Ombudsman advocates for seniors and those with disabilities. Submits written material (EXHIBIT B) and reports on issues discussed during the interim. Stresses seriousness of workforce issues. Indicates that the key component of quality long-term care is appropriately trained staff. Notes that a high turnover rate costs the agency a lot of money. Mentions that staff ‘burnout’ due to staffing shortages is a great problem that affects the workers’ morale and causes a cycle of absenteeism which further exacerbates the staffing problem.

296

Cote

Alludes to objective data that details staffing shortages and needs of residents not being met at their long-term care sites. 

313

Rep. Carter

Asks why facilities are shorted-staffed. 

317

Cote

Responds that wages and benefits or lack thereof makes it difficult to recruit new staff. Details better working conditions for staff. Wishes to develop answers to these problems in relation to the future demands of an aging population.

360

Cote

Asks members to consider what the role of nursing home care is in the system.  Discusses the fact that people are being taken out of nursing homes and put into community-based care facilities. Details the financial collapse of many nursing homes around the state and wonders about the capacity of community-based care facilities. Believes that nursing home care has a legitimate role in Oregon but that the issue will be discussed as a public policy.

TAPE 8, B

005

Cote

Questions the role of the state in addressing declining occupancy issues in regards to the quality of long-term care. Informs committee of issues to be aware of and says that it is important to address monitoring of facilities that are in a licensing capacity. Believes that long-range planning in long-term care must examine the role of public and private sector in making sound policy decisions and financing the delivery of services.

060

David Fuks

Executive Officer, Cedar Sinai Park.  Offers an anecdote from his family.  Discusses the history of Cedar Sinai Park. Details policy surrounding the long-term care plan. Makes note that the plan in the 1980s was to diversify the system for the elderly by providing them with more long-term care options. Believes that long-term care today is at the cusp of change and that now is the time for planning.

102

Fuks

Discusses the long-term care environment that he says is changing rapidly.  Explains that there is a growing population of elderly over the age of 85.  Brings to light the medical hardships of the elderly and the necessity for nursing home care at some point in their lives. Establishes that those that are most medically fragile are the people in nursing homes because the elderly that can care for themselves to a degree choose to go elsewhere. Details crisis stabilization care in nursing homes. Makes distinction that nursing home care is usually that of end of life care. Provides that if nursing homes are doing a good job, they care for the families of the dying as well as the dying themselves.

167

Fuks

Discusses the lack of resources among the elderly in nursing homes.  Notes that a higher number of elderly these days need Medicaid than in past years.

208

Fuks

Details the loss of a million and a half dollars this last year at Cedar Sinai Park. Talks about the shrinking workforce in nursing homes. States that the challenge of long-term care providers is to increase staff wages by 10-15% in order to keep from losing employees. 

246

Fuks

Expresses concern for the health care system in Oregon that is a managed-system and not a free-market one. Concludes by saying that rural communities need more support in keeping their long-term care providers afloat. Comments on the necessity of managing and maintaining a high quality of care.

288

Phillip Fogg

President, Marquis Health Care.  Expresses pride for his job as a health care administrator.  Discusses the position of Marquis Health Care in Oregon as that of managing skilled-nursing facilities and assisted-living facilities as well as providing private home care services.  Details background information from last year. Maintains that long-term care is not a normal free-market business. Explains that providers of long-term care do not have the luxury of raising rates for services or stopping the provision of services. Believes that providers are in a precarious situation today.

343

Fogg

Reiterates the problems of long-term care facilities:

§         Inflated costs of workforce 

§         Poor quality and quantity of staff equals poor quality of service 

§         Loss of revenue due to loss of residents

§         20-40% increase in health insurance premiums

§         Declining occupancy drives up fixed costs

386

Fogg

Makes it clear that there is no money, credit options, or equity left to fund these facilities.

424

Fogg

Maintains that long-term care will no longer be available if the urgency of the issues providers face are not addressed immediately.   

TAPE 9, B

020

Fogg

Questions good policy and stresses the need for providing good service to seniors. States that he strives to assure the quality of services of care by allowing seniors choice in where they prefer to live. Praises system in Oregon in comparison to other states. Concludes testimony by saying that sound continuity of policy during the legislative session is important in regards to long-term care. Mentions a bill that is being drafted to address these issues.

051

Rep. Morrisette

Asks why Mr. Fogg acquired a new facility in Springfield in light of the budget cuts.

058

Fogg

Responds that the acquisition happened two years prior to the cost inflation difficulties he is dealing with today.  

066

Rep. Krummel

Asks about the impact of reducing the regulations long-term care providers face.

070

Fogg

Responds that the federal government creates mandates for nursing home care facilities and that SDSD provides rules to match in order to receive federal funds.  Indicates that some reduction of regulations would lower costs only slightly because 70% of costs are labor-related costs.

075

Chair Fisher

Comments that the process of converting nursing home facilities into another business is difficult because these facilities are designed to house long-term business.  Explains that nursing homes can’t compete with community-based care facilities that are springing up all over the state.

113

Fuks

Adds that needier and more fragile populations in nursing homes require routine upgrades of the facilities.

130

Jim Carlson

Executive Director, Oregon Health Care Association.  Refers to handout (EXHIBIT C) in addressing the costs of loss of patients in nursing facilities, facility closures throughout the state and the shifting trends in the long-term care market.

177

Carlson

Submits written testimony (EXHIBIT D) and points out chart in reference to Oregon’s Medicaid payment rates, which are not as high as those of other western states.  Indicates that although more people are admitted to nursing homes than ever before, their stay is generally a lot shorter than in the past. Outlines legislation to be brought forward this session that identifies long-term care needs as well as the market’s capacity for the needs in the future and creates a task force to respond to these issues. Remarks that Oregon will need to prepare itself for an elderly population to double in the next 20 years.

223

Carlson

Continues discussion of legislation that will be introduced to the committee.  Asks for active state involvement in the process of bettering the long-term care system. Details goals and objectives of this upcoming legislation (LC 2285).

269

Carlson

Expresses hope to replace old and outdated nursing-care facilities with amenities that are necessary for an older population.

296

Rep. Krummel

Asks how much money would be lost to fund these facilities with federal and matching state dollars in consideration of the Governor’s proposed budget.

312

Carlson

Responds that 50 million federal dollars would be lost to support long-term care services because of the Governor’s proposed budget.

321

Chris Otis

Executive Director, Oregon Alliance of Senior and Health Services.  Supports the draft legislation and urges the support of the committee in the future.

336

Chair Fisher

Praises SDSD’s efforts and those of relating departments.  Points out that nursing home facilities were built to fill a need but that the need was suddenly taken away.  Expresses his intent to hear the draft legislation.

380

Rep. Kruse

Stresses the importance of working together with the Senate Heath and Human Services committee.

404

Rep. Garrard

Asks Mr. Carlson how much impact project independence has had on the discharge destination data.

TAPE 10, A

003

Carlson

Responds by discussing in-home health services that help people transition back into their own homes.  

011

Rep. Barnhart

Asks how much money the state matches to federal allotted funds. 

014

Carlson

Responds that it is a $15.1 million general fund item, and $37.8 million in total funds. 

034

Rep. Kruse

Discusses the Governor’s call for the convening of a workgroup to discuss parody in mental health and notes that the loss of funds never was mentioned during this workgroup session. Wishes to commit to finding funding elsewhere for long-term care programs in light of the Governor’s proposed budget.

052

Rep. Krummel

Asks how much the state expects a family to cover of their relatives’ long-term care costs.

064

Carlson

Responds that residents in long-term care that receive Medicaid assistance are required to contribute everything but $5000 of their income and assets. Adds that federal law does not allow for family ‘supplementation’ and on the federal level, the family cannot assist with the cost of care.

077

Rep. Krummel

Asks if Medicaid supplements a resident’s income and asset contribution.

088

Carlson

Remarks that the state contributes what individual cannot.

094

Rep. Monnes-Anderson

Wishes to know more about Medicaid reimbursement and the monetary allotment discrepancy between states.

103

Chair KruseFisher

Adjourns the meeting at 3:07 p.m.

 

Submitted By,                                                                           Reviewed By,

 

 

 

Andrew Morris,                                                                        Rick Berkobien,

Committee Assistant                                                                 Committee Administrator

 

EXHIBIT SUMMARY

 

A – Long Term Care Issues, written material, Roger Auerbach, 16 pp.

 

B – Long Term Care Issues, written material, Meredith Cote, 24 pp.

C – Long Term Care Issues, written material, Jim Carlson, 2pp.

D – Long Term Care Issues, written testimony, Jim Carlson, 10 pp.