The Senate Committee on Human Resources and Facilities was called to order by Vice Chairman Maurice Washington, at 11:50 a.m. on Friday, February 26, 1999, in Room 2135 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.

COMMITTEE MEMBERS PRESENT:

Senator Maurice Washington, Vice Chairman

Senator Mark Amodei

Senator Bernice Mathews

Senator Valerie Wiener

COMMITTEE MEMBERS ABSENT:

Senator Raymond D. Rawson, Chairman (Excused)

Senator Randolph J. Townsend (Excused)

Senator Michael Schneider (Excused)

STAFF MEMBERS PRESENT:

Cynthia Cook, Committee Secretary

OTHERS PRESENT:

Robert U. Johnston, Lobbyist, Retired Public Employees of Nevada

Vice Chairman Washington opened hearings on Senate Concurrent Resolution (S.C.R.) 6 and Senate Concurrent Resolution (S.C.R.) 9.

Pepper Sturm, Committee Policy Analyst, Research Division, Legislative Counsel Bureau, read introductory remarks on behalf of Chairman Raymond D. Rawson of the Legislative Committee on Health Care (Exhibit C).

Robert U. Johnston, Lobbyist, Retired Public Employees of Nevada, testified in support of S.C.R. 6 on behalf of his organization, and urged all committee members to adopt the resolution.

Edward R. Guthrie, Executive Director, Opportunity Village Association for Retarded Citizens, reported Opportunity Village was established in 1954. The association has a 45-year history of advocating for persons with mental retardation and related conditions. In 1998 the association paid over $1.1 million in wages to people considered unemployable, and found 120 jobs for people with severe disabilities. The state is currently spending approximately $32 million annually for 310 people residing in intermediate care facilities for the mentally retarded (ICFMR). Access to ICFMR is mandated when it is a part of the Medicaid state plan. Unless the applicant accepts a less costly alternative, such as the Home and Community Based Services Waiver, the state is obliged to provide ICFMR care within a reasonable length of time. Federal court cases have defined a reasonable length of time to be 90 days. The association proposes alternate solutions, as described in Exhibit D. The articles emphasize the theory of self-determination, a system built on freedom of choice, control of resources, support, and responsibility. There is no self-determination in an ICFMR. Mr. Guthrie read from Exhibit D a full description of self-determination pointing out there are efforts in 29 states to pioneer self-determination. The association proposes Nevada look at these services as an alternative to ICFMR. A suggestion is the state use the equivalent funding for two or three ICFMR beds and put it into a pilot project focused on self-determination.

Jon L. Sasser, Lobbyist, Washoe Legal Services, emphasized his support for the bill.

Winthrop S. Cashdollar, Lobbyist, Nevada Health Care Association, spoke in support of S.C.R. 9. The current survey of nursing facilities by the Bureau of Licensure and Certification, Health Division, Department of Human Resources, (Exhibit E) shows the best grade a facility can receive is an "S" for satisfactory. He pointed out there are facilities that receive a grade of "NI" (needs improvement). The association and the bureau are working together in order to develop a new approach to consumer information for nursing facilities. A Massachusetts’ model is being reviewed.

Richard J. Panelli, Chief, Bureau of Licensure and Certification, Health Division, Department of Human Resources, read prepared text (Exhibit F).

Senator Washington inquired if group homes were also surveyed. Mr. Panelli answered not at this time. The bureau is in the process of developing a survey for group homes. Senator Matthews made note of how many facilities received an "NI" grade. Mr. Panelli said the survey is based on complex federal regulations, and a minor infraction of a regulation could put the facility into an "NI" position. Senator Washington asked if the assessments that are being graded included quality of life, physical environment, dietary, etc. Mr. Panelli said the key is quality of care. Facility administrators are aware of requirements, which are published in federal regulations, prior to the survey. Mr. Cashdollar added the regulations for nursing facilities are very elaborate. A problem being addressed is trying to translate regulations into something that consumers can understand. For example, Exhibit E reflects Fallon Convalescent Center received 19 complaints in 1998. The facility did face very real problems during 1998, and has now turned around. It is risky to look at the number of complaints, as they could be trivial. Senator Mathews asked if there are models from other states Nevada could use. Mr. Cashdollar responded Massachusetts has done some good work in the quality-of-life area, and might serve as a model for Nevada.

Edwin Murray, Lobbyist, American Association of Retired Persons, Western Regional Office, voiced the support of the association for S.C.R. 6 and S.C.R. 9. Mr. Murray stated he had conducted a survey in Montana, which has used the Medicaid waiver program since 1983. The nursing home population has been reduced each year since then. The average cost of nursing home care in that state is $20,000 per year, while the cost of people receiving care at home is $9,000 per year.

Vice Chairman Washington adjourned the meeting at 12:20 p.m.

RESPECTFULLY SUBMITTED:

Cynthia Cook,

Committee Secretary

APPROVED BY:

Senator Maurice Washington, Vice Chairman

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