MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-First Session
April 23, 2001
The Committee on Health and Human Serviceswas called to order at 1:30 p.m., on Monday, April 23, 2001. Chairman Ellen Koivisto presided in Room 3138 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Mrs. Ellen Koivisto, Chairman
Ms. Kathy McClain, Vice Chairman
Mrs. Sharron Angle
Ms. Merle Berman
Mrs. Dawn Gibbons
Ms. Sheila Leslie
Mr. Mark Manendo
Ms. Bonnie Parnell
Mrs. Debbie Smith
COMMITTEE MEMBERS ABSENT:
Mrs. Vivian Freeman
Ms. Sandra Tiffany
Mr. Wendell Williams
GUEST LEGISLATORS PRESENT:
Senator Valerie Wiener, District 3
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Darlene Rubin, Committee Secretary
OTHERS PRESENT:
Mary Liveratti, Administrator, Division of Aging, Department of Human Resources
Janelle Mulvenon, Family Resource Center, Department of Human Resources
Marty Bibb, Retired Public Employees of Nevada
Anne Keast, Team Leader, Department of Education
Julie Whitehead, University of Nevada, Reno, Athlete
Dr. Joe Crowley, University and Community College System of Nevada
Chairman Koivisto announced a quorum was present. She then opened the hearing on A.J.R. 13.
Assembly Joint Resolution 13: Urges Congress to eliminate inequities in payment of social security benefits to certain persons. (BDR R-1215)
Assemblyman Mark Manendo, District 18, introduced his resolution and explained it dealt with Social Security “notch babies,” people born between 1917 and 1926. In past sessions the committee had supported resolutions encouraging Congress and the President and Vice President to pass such legislation. Unfortunately, they had not listened to the Nevada delegation. However, because there was a new Congress and new administration, Mr. Manendo said his constituents had asked him to reintroduce the resolution. He felt it was important to keep trying for the thousands of retired Nevada seniors.
Mr. Manendo noted that for many “notch babies” the money they would derive from Congress taking action on the resolution would mean survival. The $5,000 lump sum discussed at the national level would significantly help those seniors who were barely getting by on their small fixed incomes from Social Security, particularly where a spouse had died and they had to live on one income. Mention had been made about those seniors who did not really need that lump sum benefit. It would be up to those individuals, he said, to save it, or spend it, putting it back into the economy and creating jobs for people who would then be putting money back into Social Security.
It was an issue worth pursuing, Mr. Manendo said, and he commented that Assemblywoman Gibbons might want to invite Congressman Gibbons out to lunch to discuss the matter with him. However, he also acknowledged that the Congressional delegation had supported the resolution in the past, and in fact listened to the voice of the population on other issues as well. He wished other states supported the issue like Nevada had.
Chairman Koivisto asked for the committee’s wishes.
ASSEMBLYWOMAN GIBBONS MOVED TO DO PASS A.J.R. 13.
ASSEMBLYWOMAN PARNELL SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY BY THOSE PRESENT.
Accordingly, Mrs. Koivisto asked Mr. Manendo to discuss the resolution on the floor.
Senate Concurrent Resolution 7: Encourages Family Resource Centers to work closely with Aging Services Division of Department of Human Resources to provide information to public regarding services available for senior citizens. (BDR R-503)
Senator Valerie Wiener, District 3, urged the committee’s support for S.C.R. 7, which encouraged Family Resource Centers to work closely with Nevada’s Aging Services Division to provide information to the public regarding the services that were available to seniors at locations throughout Nevada. Prior to session, Ms. Wiener said she met with Mary Liveratti, Administrator, Aging Services Division, as she customarily had each session in the past, to determine what seniors needed. Ms. Wiener explained she had been a member of the Commission on Aging since first elected to the legislature and enjoyed it more than anticipated. The result of her conversation with Ms. Liveratti was S.C.R. 7.
Senator Wiener provided background on the Family Resource Centers. There were 38 in the state that provided information and referrals to social service agencies and organizations. They provided assistance to community members of all ages and also those who requested services. In addition they provided on-site responses to local needs, including everything from problem facilitation, job readiness training, and crisis intervention for families. She added that the wonderful thing about Family Resource Centers was that they served the people closest to home in those neighborhoods.
In developing the resolution, Senator Wiener said she had asked early on if Ms. Liveratti wanted her to bring the measure forward as a bill to create some mandates, but Ms. Liveratti said the important thing was to develop the relationship between the division and the resource centers. The centers had provided wonderful contributions, just as the Aging Services Division had, and together they would be a wonderful team.
In terms of community, whether large or small, they could work together to help seniors learn what was available to live more enriched lives. For those reasons, Senator Wiener encouraged the committee’s support for the resolution. The Senator provided her written testimony (Exhibit C).
Assemblywoman Parnell noted that when her own mother became ill and she tried to analyze her options she had been frustrated, even knowing as she did a little about where to go to get answers. She was concerned about others who had parents who were becoming fragile and who might not know about federal or state programs, assisted living, or any other options that might be available. In fact, she had even thought of working on a pamphlet for the caregiver son or daughter that could provide some information. She hoped that type of literature would be a byproduct of the resolution. Senator Wiener said she also felt that same concern and, after the last session, had developed a handbook and distributed 5,500 copies in southern Nevada. The handbook contained the resources available and the contact information, and it was printed in 14-point type so it could be easily read. She planned to print 10,000 to 15,000 more handbooks when she returned to Las Vegas. Senator Wiener added that Ms. Liveratti had helped with the project.
Mary Liveratti reported that the Commission on Aging had a subcommittee working on access to services. Hearings would be held May 1, 7, and 11, in Reno, Carson City, and Las Vegas, which would also be videoconferenced to rural areas. They wanted to make sure information about services would be available, as well as help families access those services. A caregivers’ survey had been conducted last year by the Cannon Research Center, in association with the University of Nevada, Las Vegas, in which the 500 caregivers surveyed knew about the services but had difficulty in knowing how to access those services when needed. She hoped that an RFP (request for proposal) would be issued in the summer for a single point of entry-type system so that family members would not have to struggle through multiple agencies, but instead go one place or have one phone number to call to access a needs assessment, information, and services.
Assemblywoman Parnell volunteered her services to assist in an advisory capacity based on her own experiences and knowledge. Ms. Liveratti thanked her and also encouraged family members to participate either at the public hearing or by written statements.
Vice Chairman McClain recalled one of the topics discussed at the interim Committee on Health Care was the single point of service and access to different services. She felt the Family Resource Center was the place for those services, which currently were scattered. Ms. McClain mentioned, too, that in her other job she worked on Senior Forums, which were a great avenue for getting service providers together. There were many good things going on in Nevada, she added, and people needed to know about them.
Ms. Liveratti said she was pleased to support S.C.R. 7. The Aging Services Division had been working with the Family Resource Centers to increase the availability of information for senior citizens and their families. Last year her division developed the State Plan for Services for Nevada’s Elders, which covered the period of October 2000 through September 2004. One of its objectives was to strengthen the collaboration between the statewide senior services network with the Family Resource Center network. One thing being seen more and more was a grandparent raising grandchildren, thus an intergenerational issue not only for the care of elders but the care of children.
Ms. Liveratti thanked Senator Wiener who was a member of the Commission on Aging, for bringing the resolution forward.
Janelle Mulvenon, Administrator of Community Connections, an organizational structure in the director’s office of the Nevada Department of Human Resources (DHR). The DHR supported S.C.R. 7 and Ms. Mulvenon said the 38 Family Resource Centers (FRC) throughout the state offered citizens and their communities information, referrals to social services, and programs to improve their quality of life. FRC provided services to anyone in their community who needed assistance. Partnerships between FRC and the Aging Services Division had existed for some time. In June 1999, the Laughlin FRC assumed financial and program responsibilities for the senior center in that community. In 2000, the Aging Services Division accepted proposals from FRCs to install Web television units to aid senior citizens in accessing Medicaid and other pertinent information from the Internet. Eight FRCs submitted proposals and three FRCs were chosen; they were Lyon County, Community Chest in Virginia City, and McGill Reberra FRC in Reno. In fiscal year 2000, FRCs referred 750 senior citizens to services in their communities.
In conclusion, Ms. Mulvenon said that S.C.R. 7 was consistent with the mission and goals of FRCs. The FRCs supported the partnerships with other community organizations and state agencies. The two local governing boards of FRCs were aware of S.C.R. 7 and fully supported the resolution. Ms. Mulvenon provided her written testimony (Exhibit D).
Assemblywoman Leslie said she supported the resolution and knew many if not most of the FRCs were working with seniors at one level or another. She was concerned, however, that the legislature was not giving any money to add more FRCs to reach more seniors. Ms. Mulvenon said the DHR recommendation was to maintain the same level of state funding that the FRCs had received in the past two years. In addition, Community Connections and the statewide coordinator, working with the local governing boards and the 30 FRCs, saw a need to provide technical assistance, and those local FRCs were applying for additional funds, such as children’s trust funds, Title 20, IVB, and so on. Ms. Leslie asked if there were plans to add any additional FRCs for communities that did not have them. Ms. Mulvenon said that current funding would maintain the existing FRCs.
Ms. Liveratti stated the Division of Aging Services, through the federal Older Americans Act funds, had received $600,000 under the federal Family Caregiver Initiative, which they were going to use for the demonstrations with the single point of entry, and the FRCs would be able to apply for that money. She said she had also talked with the FRCs about doing some joint training so they could access the training they were putting on for the senior network. There was also some opportunity through the tobacco settlement money, the Independent Living Grants, if they wanted to put forth grant proposals.
Next to speak was Marty Bibb, representing the Retired Public Employees of Nevada in support of S.C.R. 7, particularly the single point of entry, which he felt was critical. He noted there were so many retirees, both in and out of groups; his group alone consisted of 8,770 members, and he thought that trying to coordinate the efforts of the Division of Aging Services and FRCs was a good move. His group received a great many calls for assistance and whatever could be done to streamline the referral process would be welcomed.
Chairman Koivisto asked the committee’s wishes.
VICE CHAIRMAN MCCLAIN MOVED TO DO ADOPT S.C.R. 7.
ASSEMBLYWOMAN SMITH SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY BY THOSE PRESENT.
Chairman Koivisto then opened the hearing on S.C.R. 17.
Senate Concurrent Resolution 17: Urges Commission on Mental Health and Developmental Services in cooperation with Department of Education, University and Community College System of Nevada and local school districts to take steps necessary to increase public awareness of certain eating disorders. (BDR R-25)
Senator Valerie Wiener introduced S.C.R. 17, which she stated would create a greater public awareness about eating disorders. She provided some background to illustrate how profound the problem had become. Researchers estimated that between 55 to 90 percent of women experienced some level of discomfort for how they see themselves in a mirror, even though objectively there was no problem. They focused entirely on their physical appearance to determine who they were. The primary reasons for the distortion was the media, because they portrayed the ideal woman as probably much thinner than healthy. But the media often helped women to develop expectations about who they were that were unrealistic, whether or not those portrayals were standards of beauty they should live by. Often that was called “body hatred” and it went deeper than appearance because it often served as a manifestation for other more profound issues. Nevertheless, body hatred could also cause severe self-defeating behavior such as those described in S.C.R. 17.
Senator Wiener shared her own experience with the committee: She said that while attending McGeorge School of Law in 1978, she struggled with her grades. Up to that point she had been an exceptional student in her undergraduate program; in the top 10 percent of her class at the University of Missouri School of Journalism, the first ever to be dually enrolled as an undergraduate-graduate student in that journalism school and still maintained that top 10 percent status, as well as being in the top 2 percent of her contemporary literature masters program at the University of Illinois. She had done well, and then went to law school, where she had not done well. During her second year at law school she decided to do something innovative to take control of her life, since her grades were about C-plus. Her frustration prompted her to join a Slimnastics class, where she hoped to wear off the stress, and she designed a personal diet, which she thought would help improve her mental and physical health. Ten days later she was in the throes of what would become one of the toughest challenges she would ever face and still faced every day: anorexia nervosa. She cut her caloric intake to 240 a day, she had 5 grams of carbohydrates, and exercised no less than two hours every day. Within months she had slimmed down to 85 pounds and dropped eight clothing sizes, and she was under five feet tall. She also expanded her daily regimen to include diet pills, water pills, up to five-hundred 1000-milligram wafers of vitamin C and 60 laxative tablets every day. She had become an addict with all the fears and isolation that could be imposed on a person. During her early months as an anorexic at age 29, she still maintained her commitment to studies, never missing a class, even though she was in pain the entire time. Part of her third year she had suffered an upper body paralysis that incapacitated her entire right side from the waist up. She spent her third year in law school in a sling and could only take notes from the wrist down. That also required her to schedule each time she would have to enter a door, because of the pain she incurred each time she had to hold a pencil and for how long in each class she attended. She experienced severe panic when anyone she knew approached her because touching was so painful that she had to avoid contact. She did not know then that it was more than physical pain she would experience until her mother came to visit her from Arizona and took care of her. Each night her mother gave her a massage to help with the pain, and one night with tears streaming down her face she said she could no longer do it, because all she could feel were her bones; she said she had no body anymore, she was nothing more than a living corpse, and she could not stand to touch her. Senator Wiener said nothing hurt as much as those words.
She then realized she was not the only victim of that disorder. The endless pain did continue and her injury increasingly prevented her from finishing her exams, therefore she withdrew from law school before being sent away for bad grades. She took a leave of absence five weeks before the end of the third year. She did not return to law school and continued to struggle with the disorder and had two brief but substantial bouts with anorexia. It had been 15 years since her last slip, but she was still in recovery one day at a time. She noted it was like any other addiction; she faced it one day at a time, and could attest to the fact that she was surviving self-destruction. She often thought that one reason for her survival had been to help others, it had been a mission, and even when she left Senator Reid’s staff in the late 1980s she vowed to one day do something in the state of Nevada to help others. She felt that S.C.R. 17 helped satisfy part of that mission.
Senator Wiener stated that for people to make healthy decisions they must use strong values in thinking about themselves. People must recognize they had self-worth and needed to accept that one’s own needs to feel good about who they were needed to be paramount to those of others who consciously or not sabotaged with words or actions. That was the message that legislators could share with those who felt alone and alienated by eating disorders that had captured their lives and taken hold of their psyches. She emphasized that S.C.R. 17 would help accomplish that and shed light on the issue to help provide hope for many victims that still hid from the disorder because of fear and shame. For those and many other reasons, Senator Wiener urged support of S.C.R. 17. Senator Wiener provided her written testimony (Exhibit E).
Assemblywoman Leslie thanked the senator for her courageous and compelling testimony. She noted on page 2 of the resolution it mentioned what was going to happen. It appeared there were two major parts beside the transmission of the resolution; one was working with the University System and the Department of Education to direct the development of educational programs and materials, and the second was asking the Commission on Mental Health and Development to do the same, as well as to support legislation to include eating disorders as part of the insurance benefits mandated for mental health coverage.
Senator Wiener said there had been support from the university system for the resolution. The numbers were conservative at 1 percent of adolescents and 4 percent of those in college who were afflicted with the disorder. The resolution was to make the public aware of the problem, and the hope was that if ever the money was available consideration could be given to expanding mental health concerns to include eating disorders.
Next to speak was Anne Keast, Team Leader, School Health, Safety, and Nutrition, Department of Education. Ms. Keast provided her written testimony (Exhibit F). She commended Senator Wiener for sharing her personal experience. Ms. Keast voiced support for S.C.R. 17; however, she wanted to bring several concerns to the committee’s attention. Some were personal concerns separate from her role at the department.
In closing, Ms. Keast stated there was a need to address the healthy nutritional needs of students through the enhancement of educational and academic programs; the improvement of school lunch programs; and the increase of information and training for teachers to address eating disorders.
Assemblywoman Parnell noted that currently students were required to take a health class in the ninth grade; yet, Ms. Keast’s testimony was that education on eating disorders would not be part of the curriculum. Ms. Keast said that was correct. According to the health specialist on the staff, a teacher could say such disorders existed and could be identified, but nothing more as far as the mental health aspect of the disorder. Ms. Parnell asked where one would find the parameters of how to teach that. Ms. Keast said it was the Standards Committee who had denied that component in terms of academic standards. Ms. Parnell said the health classes could be a vehicle for disbursing information, with no additional funding needed.
Assemblywoman Smith noted that the Standards Council established the standards and the curriculum and how those standards were taught was identified by the different school districts. She asked to speak to Ms. Keast following the meeting to see if they could make sure that issue was resolved.
Senator Wiener noted that it was a coordinated effort between mental health and education, and she appreciated the willingness of the parties to develop some ideas. She related an anecdote that occurred when she spoke at an eating disorder clinic in North Las Vegas. She shared her story with an anorexic who was working on her Ph.D. in California about taking the 60 laxative pills a day. The woman was elated to hear that because she had been taking only ten a day. In two months that woman was in kidney failure.
Senator Wiener said she hoped to be able to work on the issue of self-esteem, on seeing one’s self differently than the mirror defined one to be, rather than some of the more specific mental health issues It was important to understand that eating disorders were often the manifestation of deeper problems that found their source in the victim’s psyche. They reflected issues with self-esteem, personal achievement, relationships with others, especially parents, and many other psychological issues. She did not underestimate the importance of mental health working in collaboration with education, to provide information and instruction about these destructive disorders. However, she appreciated that certain rules or regulations might impose some restrictions on teaching mental health to students. It was Senator Wiener’s hope that educators at all levels would be able to teach as much as the law allowed about eating disorders, their affects, prevention, and intervention to help educate children, adolescents, and young people about healthy living, physically and mentally.
Assemblywoman Parnell noted there were UNR students present and asked them if they recalled from their high school health class if they had covered such things as self-esteem and eating disorders.
Julie Whitehead, an athlete at the University of Nevada, Reno, responded that those subjects were not covered in depth. Until she had a recent interaction with anorexia she had not known much about it. Basically, she said, the high school teacher identified anorexia and said not to let it happen. However, many girls would not heed that advice; they wanted to look like the girl on television. Ms. Whitehead felt guidance from parents, teachers, and coaches was very important. Athletes were more susceptible to eating disorders, because of the belief that one had to be the thinnest, the strongest, and so on to be good. It came back, she felt, to the parents and teachers getting the message across.
Dr. Joe Crowley, representing the University and Community College System of Nevada (UCCSN), expressed support for S.C.R. 17. He said he had heard the problem discussed in the past during his time with the National Collegiate Athletic Association (NCAA), and there were probably many resources available at the University and Community College System that could help implement in a significant way the intent of the resolution. He believed the university’s athletic program should be giving the issue considerable attention. There were nutrition programs where the information could be disseminated, as well as child and family development programs, teacher education, educational leadership, and student health services, which he knew focused on eating disorders. Also the campus wellness centers would also be appropriate, if they were not already providing that information. Further, the Board of Regents had a Campus Environment Committee that covered many areas, one part of which could be the eating disorders issue. Accordingly, if S.C.R. 17 passed, Dr. Crowley said he would be pleased to suggest to the chancellor that she take the matter to the board, possibly conduct an inventory around the system to see the extent to which the problem was discussed by campus programs and develop a strategy for doing it better.
Chairman Koivisto asked the committee’s wishes.
ASSEMBLYWOMAN LESLIE MOVED TO DO ADOPT S.C.R. 17.
ASSEMBLYWOMAN PARNELL SECONDED THE MOTION.
THE MOTION PASSED UNANIMOUSLY BY THOSE PRESENT.
With nothing further before the committee, the Chairman adjourned the meeting at 2:34 p.m.
RESPECTFULLY SUBMITTED:
Darlene Rubin
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairman
DATE: