MINUTES OF THE meeting

of the

ASSEMBLY Subcommittee on Ways and Means

and

the senate committee on finance

joint subcommittee on k-12/human resources

 

Seventy-First Session

March 15, 2001

 

 

The Joint Subcommittee on K-12/Human Resources was called to order at 8:09 a.m. on Thursday, March 15, 2001.  Chairwoman Chris Giunchigliani presided in Room 3137 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.

 

 

ASSEMBLY SUBCOMMITTEE MEMBERS PRESENT:

 

Ms.                     Chris Giunchigliani, Chairwoman

Mrs.                     Barbara Cegavske

Mrs.                     Vonne Chowning

Mr.                     Joseph Dini, Jr.

Ms.                     Sheila Leslie

Ms.                     Sandra Tiffany

 

SENATE SUBCOMMITTEE MEMBERS PRESENT:

 

Senator Bob Coffin

Senator Bernice Mathews

Senator William J. Raggio

Senator Raymond D. Rawson

 

SUBCOMMITTEE MEMBERS EXCUSED:

 

Mr.                     David Goldwater

 

STAFF MEMBERS PRESENT:

 

Mark Stevens, Fiscal Analyst

Robert Guernsey, Principal Deputy Fiscal Analyst

Georgia Rohrs, Program Analyst

Russell Guindon, Deputy Fiscal Analyst

Connie Davis, Committee Secretary

 

DEPARTMENT OF HUMAN RESOURCES, AGING OLDER AMERICANS ACT – BUDGET ACCOUNT 101-3151 – BUDGET PAGE AGING-4

 

Chairwoman Giunchigliani recognized Mary Liveratti, Administrator, Aging Services Division.  Ms. Liveratti identified herself for the record, and reported that Budget Account 3151 included general administration of the division, grants management, resource development, elder rights, and fiscal services.  Ms. Liveratti stated that funding was a combination of federal funds, state General Funds, Taxicab Authority funds, oil overcharge funds, and senior rights coupon sales. 

 

Ms. Liveratti referred to a document distributed to the subcommittee (Exhibit C) and indicated performance indicators for Budget Account 3151 could be found on the blue pages.  Ms. Liveratti reported the number of investigations completed by the division's Long-term Care Ombudsman increased 46 percent from FY1997 to FY2000, and in the last year, the number of complaints investigated increased by 24 percent.  During FY1999, the division investigated 9,631 complaints and in FY2000, the number of complaints investigated increased to 11,927.  Ms. Liveratti reported that decision unit M-200 recommended funding for a new ombudsman position that addressed caseload growth, ensured the protection of residents' rights, and resolved concerns in a timely manner.  Currently, the division had nine ombudsmen positions statewide.

 

Chairwoman Giunchigliani noted that the division appeared to have met or exceeded their work performance standards in most areas for Budget Account 3151; however, she questioned why the performance indicators for the number of retired and senior program volunteer participants and the number of foster grandparent volunteer participants were below the number of volunteers funded by the 1999 legislature.  Ms. Liveratti discussed problems the division had encountered with a reporting system that had been developed for the volunteer program.  Previously, reported performance indicators showed that the number of volunteers was cumulative.  However, Ms. Liveratti pointed out that the figures, as outlined in the handout (Exhibit C), were the actual number of volunteers.  Chairwoman Giunchigliani addressed the $361,151 approved by the 1999 legislature for foster grandparent volunteers in FY2000 and noted the number of volunteers was lower than the number that was funded.  Ms. Liveratti responded that the division projected 44 volunteers and were 4 short of the projected number.

 

Chairwoman Giunchigliani questioned whether the work performance standards for the Community Ombudsman Program for FY2001-03 were reasonable and attainable.  Ms. Liveratti attributed the slightly decreased numbers in the work performance standards to only having three community ombudsmen employed statewide, one in Las Vegas, one in Reno, which had been vacant for three months, and one in Elko.  Ms. Liveratti further explained other staff members had "fielded" calls.

 

Chairwoman Giunchigliani moved to rural senior programs and addressed decision unit M-200.  Chairwoman Giunchigliani requested clarification concerning the duties and responsibilities of the Compliance/Audit Investigator position.  Ms. Liveratti explained that the Compliance Investigator title was misleading and was actually the Long-term Care Ombudsman.  Chairwoman Giunchigliani questioned whether the Long-term Care Ombudsman investigated assisted-living facilities.  Ms. Liveratti indicated the number of assisted-living facilities had increased, especially in southern Nevada, and further advised that the division's Long-term Care Ombudsman investigated complaints in nursing homes and group‑care homes, sometimes called residential group facilities. 

 

Chairwoman Giunchigliani questioned the number of assisted-living facilities that the division projected would be built.  Bruce McAnnany, Deputy Administrator for the Aging Services Division, advised that the division had worked for the past five years to try to improve the reporting of complaints by self-reporting long-term-care facilities, and he attributed the increased number of complaints to Nevada's being one of the highest self-reporting states in the nation.  Mr. McAnnany indicated that complaints were being reported from within the facilities by staff and indicated there appeared to be greater self-reporting in the north.  It was anticipated that the new Long-term Care Ombudsman position, if approved, would be moved to the north to cover the Reno-Sparks and outlying areas.  Mr. McAnnany reported that at least ten nursing homes had been built in the last two years in Nevada, and it was expected that the increased growth would generate an additional 2,000 complaints during the next two years, which it was anticipated could be handled by the new position.  In response to a question from Chairwoman Giunchigliani concerning the number of nursing homes projected to be built, Mr. McAnnany discussed concerns about one of the major corporations that had 16 facilities throughout the state and was in bankruptcy.  Two facilities had closed in the last two months, and Mr. McAnnany advised there were no new facilities forecast to be built. 

 

Chairwoman Giunchigliani questioned how the closures affected patients.  Mr. McAnnany reported a 79 percent occupancy with the possibility of some shifting, however, he explained that many of the extra beds were in the south and closed facilities in the north meant the possibility of patients being relocated to the south at great disruption to their lives.  Chairwoman Giunchigliani inquired why 75 percent of the costs of the compliance investigator or ombudsman position was recommended to be funded by the General Fund.  Mr. McAnnany reported the division only had 25 percent federal funding for the position under the Older Americans Act.  Chairwoman Giunchigliani asked if there had been a decrease in the funding under the Older Americans Act.  Mr. McAnnany advised that the funding had been stable and had been increased only slightly.  Ms. Liveratti reminded the members of the subcommittee that during the 1999 session the division requested an additional ombudsman position that was not approved. 

 

Chairwoman Giunchigliani moved to decision unit E-275 that recommended four new positions and inquired why a Computer Systems Technician was needed for the Las Vegas office since the Las Vegas office already employed an Information Systems Specialist.  Ms. Liveratti advised that the Information Systems Specialist, at a grade 37, was a professional level position that oversaw the office databases as well as the purchase of hardware and software.  The Computer Systems Technician position, at a grade 29, was being requested to support the computer unit and would be involved in more "nuts and bolts" type of activities such as installing and repairing hardware and network maintenance.

 

Chairwoman Giunchigliani also noted that a Computer Systems Technician was recommended in the Senior Services Program for the Carson City office. Ms. Liveratti explained that two positions were requested for Budget Accounts 3151 and 3146; one position would be stationed in the south and one in the north.  Ms. Liveratti further explained that the division had 132 computers they tried to maintain, and the Information Systems Specialist did not have the time to maintain the computers and assist users with hardware, software, and network problems.  The two recommended positions would provide the technical support required.  Chairwoman Giunchigliani inquired whether there had been any problems that justified the need for two technical support positions.  Ms. Liveratti advised that the Information Systems Specialist, employed in Las Vegas, had been flying to Reno on a weekly basis to support the Reno and Carson City offices.  Chairwoman Giunchigliani indicated that the Department of Personnel was working on a report that would define the number of employees "transporting" between areas rather than being located at their home station.  Ms. Liveratti further advised that the employee also traveled to Elko to support the office there.  The members of the subcommittee were told that the division had recently experienced a major problem with their computer backup systems and lost an entire day's worth of work for their fiscal unit.  While the Las Vegas employee corrected the problem, Ms. Liveratti indicated that someone stationed in the north could have responded more quickly.  Chairwoman Giunchigliani noted the positions were recommended to be funded 50 percent out of the General Fund and inquired how the positions would have been funded in the past.  Ms. Liveratti responded that the positions were new and had not been funded in the past.  Chairwoman Giunchigliani inquired as to the source of the other 50 percent of the funding if half was being recommended from the General Fund.  Ms. Liveratti responded that Medicaid would be charged for 50 percent of the funding recommended in Budget Account 3146 because the position would support the Medicaid billing and tracking systems.  Chairwoman Giunchigliani inquired as to whether the position could be fully funded from Medicaid rather than 50 percent out of the General Fund.  After some discussion it was determined the position was fully funded under Medicaid.

 

Chairwoman Giunchigliani moved to decision unit E-300 and Ms. Liveratti reported that a wide area network (WAN) was recommended to improve communications within the division.  Ms. Liveratti explained that each of the division's four offices had local area networks (LAN).  A WAN would allow statewide access to the databases in the regional offices and would provide the division the ability to access information on a "real-time basis."  The division's current client tracking combined information from the four regional offices after the information was sent to Carson City.  Ms. Liveratti explained, for example, that a WAN could be queried if the division wanted to know how many Community Home-Based Initiatives Program (CHIP) clients were in the Senior Services Program.  In summary, Ms. Liveratti said that the WAN would allow the agency better management of their documents and better access to statewide planning in the four regional offices as well as an enhanced e-mail system.  Chairwoman Giunchigliani inquired as to the availability of additional federal funds or whether the recommendation could be funded out of a budget that could access federal funds.  Ms. Liveratti advised that a portion of the cost for the WAN was contained in Budget Accounts, 3151, 3146, and 3252.  Chairwoman Giunchigliani noted the General Fund share of the WAN had been funded twice in The Executive Budget, once in the budget and once in a one‑shot appropriation and questioned why the funding had been split in that manner.  Ms. Liveratti advised that a one-shot expense applied insofar as tying into T-1 lines (4 individual channels, each of which supported 64Kbits per second).  Georgia Rohrs, Program Analyst, Fiscal Analysis Division, clarified that the one‑shot appropriation was the General Fund portion of the cost.

 

Chairwoman Giunchigliani noted that the issue concerning the recommendation for increasing revenues in decision unit E- 451 to pay taxicab companies for one-half of the cost of rides provided to program participants had been resolved. 

 

Chairwoman Giunchigliani requested discussion on why the Chief Of Elder Rights position had been vacant since July 4, 2000, and indicated that state agencies would be advised that positions held vacant longer than a year would be abolished.  Ms. Liveratti indicated that the division's Chief Of Elder Rights position was technically addressed in Nevada Revised Statutes (NRS) as a specialist for the rights of the elderly and a licensed attorney within the state of Nevada.  Ms. Liveratti advised the members of the subcommittee that she had four applications for the position and would be interviewing two applicants in Las Vegas during the following week and two in northern Nevada.  Ms. Liveratti indicated that while the division had received a number of applications, the attorneys who had applied for the position were of the opinion that the salary was not sufficient.  Chairwoman Giunchigliani inquired as to the rationale for using an attorney.  Ms. Liveratti reiterated that NRS required that a licensed attorney fill the position.  Additionally, Ms. Liveratti said the position interfaced with the court system and district attorneys.  In discussions with other attorneys, Ms. Liveratti indicated it was believed that judges and other attorneys gave more credibility to issues when they knew they were working with another attorney.  In response to a question from Chairwoman Giunchigliani, Ms. Liveratti advised that the salary was about $55,000 and would increase by 4 percent with the Governor's proposed salary increase; however, it was difficult to compete with the Office of the Attorney General where the salaries were higher.

 

Chairwoman Giunchigliani noted that all of the M-300 decision units for salary increases were funded by the General Fund rather than by federal dollars.  Chairwoman Giunchigliani inquired if there was any opportunity to having any portion of the salary dollars offset by federal funding.  Ms. Liveratti responded that all of the federal dollars received by the division were already being spent; however, if there were any increases the division would look at applying that funding to the salary increases in the M-300 decision units.  In response to a question from Chairwoman Giunchigliani, Ms. Liveratti explained that new monies had been received from a national caregiver initiative under the Older Americans Act but that most of those funds were allocated to direct services to provide assistance to family caregivers. 

 

Chairwoman Giunchigliani inquired as to whether there were savings or recommendations from the Governor's Steering Committee to Conduct a Fundamental Review of State Government that applied to the division's budgets.  Ms. Liveratti responded that Senior Citizens' Property Tax, Budget Account 2363, was affected as a result of the Governor's review.  Chairwoman Giunchigliani advised that the subcommittee would address the recommendation during the budget hearing for Budget Account 2363.

 

DEPARTMENT OF HUMAN RESOURCES, AGING SERVICES GRANTS

BUDGET ACCOUNT 262-3140– BUDGET PAGE AGING-1

 

Chairwoman Giunchigliani addressed the fact that no performance indicators had been established for Budget Account 3140, and suggested that the division develop indicators that dealt with the efficiency of the staff.  Chairwoman Giunchigliani noted that the division's expanded program narrative stated that performance indicators were negotiated for each grant award and that perhaps the division could look at staffing goals.  Ms. Liveratti referred to the "pink sheet" in the division's handout (Exhibit C).  The document listed grants awarded under "independent living grants" as well as the "unduplicated clients" that the programs proposed to serve and the "units of service" for the funds that were being received.  Ms. Liveratti advised the listing provided an indication of how the funds were used and included a variety of programs such as home delivered meals, respite services, transportation, escorted transportation, and in‑home services.  Chairwoman Giunchigliani inquired as to the difference between home modifications and home repairs.  Ms. Liveratti explained that while Medicaid would buy hardware, services provided under the independent living grants included installing hardware such as shower grab bars or ramps so that seniors could become more accessible in their homes.  Home repairs included services such as seeing that air conditioning units were working properly in Las Vegas or that there was enough heat for seniors in Reno.

 

Chairwoman Giunchigliani requested that the agency provide an explanation of the process that determined which grant proposals would be funded.  Ms. Liveratti testified that under NRS 439.630 the agency was required to:

 

·        Prioritize and quantify the needs of seniors for programs;

 

·        Develop, solicit and accept grant applications for allocations;

 

·        Expand or augment existing state programs upon approval of the Interim Finance Committee (IFC);

 

·        Award grants and other allocations;

 

·        Conduct annual evaluations of programs to which grants or other allocations had been awarded; and

 

·         Submit annual reports to the Governor and to the IFC.

 

Ms. Liveratti indicated that the division negotiated a contract with the University of Nevada, Las Vegas, and the Cannon Center for Survey Research, to conduct the needs assessment.  The assessment included a survey of almost 500 caregivers throughout the state, demographic trend analysis, and focus groups of service providers and community organizations.  Ms. Liveratti reported that a request for proposals was advertised in July 2000; orientations in the north and the south were held to answer questions about the grant.  Applications were submitted in August and reviewed in August and September.  An independent review panel scored the grant applications and made funding recommendations.  Members of the panel included Commission on Aging members, former commission members, and representatives from senior and community organizations.  Ms. Liveratti indicated that there were no conflicts of interest by any members of the panel.  Funding recommendations were based on the following factors:

 

 

 

 

 

Ms. Liveratti reiterated earlier testimony that a variety of services were funded by independent living grants which included homebound meals, personal care, homemaker, home repair and modification, adult day care, respite care, care coordination, transportation and escorted transportation.  Ms. Liveratti referenced the "yellow" fact sheet in the division's handout (Exhibit C) and advised that the independent living grant funds were also used to match the Nevada Alzheimer's Disease Demonstration grant.  The Alzheimer's Disease Demonstration grant allowed the division to:

 

 

 

Chairwoman Giunchigliani requested clarification on whether the auditor position audited exclusively for the Independent Living Grants Program or for the entire division.  Ms. Liveratti advised that two positions conducted fiscal monitoring for the grants and that the auditor position audited the Independent Living Grants; however, it was preferred that one person not travel the entire state.  Ms. Liveratti indicated that most likely all three of the audit positions would be auditing independent living grants as well as the other grants administered by the division.  Chairwoman Giunchigliani inquired as to whether the grants analyst position or the auditor position would be responsible for assisting the division and conducting annual program evaluations.  Ms. Liveratti advised that a grants analyst position had been approved through the IFC, and an auditor position was requested.

 

Ms. Leslie questioned whether the auditor would also track the cost saved by implementing the independent living program and whether a report could be provided to the subcommittee.  Ms. Liveratti advised that one of the auditor's duties would be to prepare the annual report to the legislature and to the Governor.  Ms. Leslie requested a copy of the report and said she would like to see the costs saved by implementation of the independent living program.  Ms. Liveratti advised the division was also looking at how hospitalizations and trips to the emergency room could be avoided.

 

Chairwoman Giunchigliani recalled a policy question that arose at the February 8, 2001, Interim Finance Committee hearing that addressed a transfer of money from the Tobacco Settlement Fund in Budget Account 3140 to Budget Account 3252 (EPS/Homemaker) to fund an additional social worker position.  Chairwoman Giunchigliani advised that while staff had recognized the transfer of funds as being legal, it had been determined that an amended budget would be provided.  Ms. Liveratti advised that division staff would be preparing and submitting the amended budget.

 

Senator Rawson indicated the Carlin Community Health Center was in jeopardy of closing.  Senator Rawson asked if seniors were seen through the Carlin Community Health Center and further questioned the availability of sources that might keep the center open.  After some discussion among staff, Ms. Liveratti responded that while the division was not aware of any available funding, she would look into the issue and provide the information to the members of the subcommittee.

 

In response to a question from Chairwoman Giunchigliani on whether the social worker position was intended to be permanent, Ms. Liveratti advised that the position would be considered permanent.  Chairwoman Giunchigliani expressed concern regarding the heavy reliance on Tobacco Settlement money throughout the division's budget and indicated that funding for ongoing programs and staff would have to be closely studied.  Chairwoman Giunchigliani reiterated a request for an amended budget.

 

DEPARTMENT OF HUMAN RESOURCES, AGING, SENIOR SERVICES PROGRAM

BUDGET ACCOUNT 101-3146 – BUDGET PAGE AGING-13

 

Ms. Liveratti reported that the Senior Services Program, Budget Account 101‑3146 contained the Community-Based Care Program, Community Home-Base Initiatives Program (CHIP), and the Group-Care Waiver Program.  Ms. Liveratti reported that Medicaid, state funds, client co-payments, and Tobacco Settlement funds, under the Independent Living Grants, funded the programs.  Ms. Liveratti indicated the division wanted to use the Tobacco Settlement funds to expand the CHIP services. 

 

Ms. Liveratti referred to the second yellow sheet in the division's handout (Exhibit C), from which the following performance indicators for the Senior Services Program were cited:

 

 

 

 

 

In the M-200 decision unit, Ms. Liveratti said the division requested that the CHIP Medicaid program be expanded because the number of Medicaid CHIP clients was increased based on demographic growth of the population 75 years and older.  In the last fiscal year, 75 percent of the program's clients were over the age of 75.  The number of clients to be served was projected to increase by 6 percent in FY2002 and 5 percent in FY2003.  As a result of the expansion, an additional 171 clients would receive CHIP services.  Tobacco Settlement funds, through the Independent Living Grants, would be used to match the Medicaid federal funds.  The request included funds for contracted services such as personal care, homemaker, respite, and adult day care; two Social Workers, a Program Assistant III and a Computer Systems Technician.

 

Chairwoman Giunchigliani inquired as to the current cost of nursing home care.  Ms. Liveratti responded that nursing home care, based on the level of care, averaged in the range of $2,500 to $7,700.  In response to a question from Chairwoman Giunchigliani on the average cost per client for CHIP services, Ms. Liveratti indicated that the monthly cost projected for FY2002 was approximately $650 per client per month, and in FY2003, $678 per client per month.  In response to an additional question from Chairwoman Giunchigliani concerning the cost for CHIP services, Ms. Liveratti explained the numbers provided included case management cost. 

 

Chairwoman Giunchigliani requested an explanation for the differences in eligibility criteria for the federal and the state CHIP services.  Ms. Liveratti explained that to be eligible for CHIP, a person had to be 65 years or older and had to meet a nursing home level of care.  Ms. Liveratti explained that the income level for the Medicaid program was $1,590, and that a sliding fee scale was used for the state program that went up to $2,490, but those individuals with higher incomes had to pay a greater percentage of the cost of services.  Ms. Liveratti further explained that under the Medicaid program, the asset limit was $2,000 and excluded the person's home, a car, and a burial policy up to a certain amount.  Additionally, she said there were no asset limits under the state program.  Chairwoman Giunchigliani questioned whether a value was set on a client's car under the Medicaid program.  Ms. Liveratti explained that automobiles were excluded because transportation was needed for clients to keep medical appointments.

 

Senator Rawson questioned how the waiting lists for adult group care would be affected by the changes.  Ms. Liveratti responded that currently there were only about five individuals on the waiting list for the adult group-care waiver.  Senator Rawson addressed the average federal and state CHIP waiting lists and the adult group-care waiting lists which showed 566 Medicaid CHIP clients on a waiting list in Las Vegas and 133 in Carson City.  Ms. Liveratti advised that 566 was the number waiting in Las Vegas for the Medicaid program, and 85 individuals in Las Vegas were waiting for the state program.  Ms. Liveratti pointed out that the next enhancement unit addressed the waiting list.

 

Ms. Liveratti moved to decision unit E-429 (expansion in the Medicaid CHIP services) and advised that the recommendation expanded the number of Medicaid CHIP slots, which addressed the waiting list.  Ms. Liveratti said that an additional 160 Medicaid CHIP clients would be served by the enhancement and the recommendation included funds for contracted services for social workers, a social work supervisor, an accounting clerk, and a program assistant.  An additional 331 seniors would be served over the biennium, as recommended in decision unit M-200 (growth in the Medicaid CHIP service) and E-429 (expansion in the Medicaid CHIP service).  Ms. Liveratti referred to the second yellow sheet in the division's handout (Exhibit C) and pointed out that the projected client numbers under the M-200 decision units both for FY2002 and FY2003 were projected based on approval of the recommendation.  Ms. Liveratti further advised that the FY2000 figures that combined E-429 (expansion in the Medicaid CHIP service) and E‑430 (expansion in the adult group-care waiver programs) projected the total number of clients based on approval of funding for both M-200 and the enhancement unit.  Ms. Liveratti explained that decision unit E-430 recommended increased federal Medicaid funding for the adult group-care waiver program and that the division had not submitted an M-200 unit to increase the group-care waiver.  However, the enhancement unit E-430 that would allow the division to increase the group‑care waiver to the 300 percent Supplemental Security Income (SSI) level was submitted so that it was equitable with the eligibility requirements for CHIP and nursing homes.

 

Chairwoman Giunchigliani questioned how the ratio of social workers to caseload was computed.  Ms. Liveratti responded that a formula was used, and social workers carried a caseload of 50 people, which included about 45 who were actually approved and on the program, and another 5 in-process. 

 

Chairwoman Giunchigliani questioned how many social workers were in Elko and Las Vegas.  Ms. Liveratti responded that there were 14 social worker "slots" in Las Vegas with some vacancies; 3 in Elko, 6 in Reno and 4 in Carson City.

 

Chairwoman Giunchigliani questioned whether salary was an issue in the recruitment of social workers.  Ms. Liveratti indicated that salary was a factor.  In response to additional questions from Ms. Giunchigliani, Ms. Liveratti pointed out that many social workers employed by the division stayed because they preferred working with the senior population; however, county and city governments, in Las Vegas and Washoe County, paid a higher salary. 

 

Under E-430 (expansion in the adult group‑care waiver program) Chairwoman Giunchigliani requested that if the division had not already done so, they should provide staff with the formula for the ratio of social workers to caseload.  Additionally, Chairwoman Giunchigliani questioned whether the computer technical position was also driven by caseload.  Ms. Liveratti responded that the computer technical position was based on the workload of the computers that supported the CHIP service.  In response to a question concerning the number of computers related to the CHIP service, Ms. Liveratti indicated that while she did not have the breakout with her, she would provide the information to staff.

 

Chairwoman Giunchigliani addressed decision unit E-450 which recommended funding to increase rates paid to community services providers and requested an explanation on why an increase was necessary and how it was determined that a 3 percent increase was appropriate.  Ms. Liveratti responded that she believed the increase in funding would assist in recruiting providers and that the 3 percent increase was an inflationary factor.  The division had looked at "rates across the board" so that they were consistent between divisions and had proposed the 3 percent increase at the time the budget was submitted in August 2000.  Ms. Liveratti said the division would continue to ensure there was equitable distribution of rates within the Department of Human Resources and while they wanted to be reasonable, an incentive was required to ensure that workers continued their contracts.  Additionally, Ms. Liveratti explained that the division contracted out for services, as there were no direct service providers under the Community Home-Base Initiatives Program, and problems were encountered in the rural areas because the number of agencies that provided services was limited. 

 

DEPARTMENT OF HUMAN RESOURCES, AGING, EPS/HOMEMAKER PROGRAMS, BUDGET ACCOUNT 101-3252– BUDGET PAGE AGING-19

 

Ms. Liveratti advised that Budget Account 101‑3252 contained the Homemaker and Elder Protective Services programs funded primarily through federal Title XX funds.  Ms. Liveratti referred to the performance indicators on the green sheet in the division's handout (Exhibit C).  Performance indicators cited were:

 

 

 

 

 

 

 

Chairwoman Giunchigliani commended the division's work for FY2000 in having exceeded all elder protection projections; however, she noted that homemaker services did not meet projections and questioned the reason for the lower level of performance.  Ms. Liveratti explained that in FY2000 the number of clients on the program was reduced because of an anticipated cut in Title XX funding and when it was determined the funds would not be cut, the number of clients was increased. 

 

In response to a question from Chairwoman Giunchigliani concerning the FY2002 and FY2003 elder protective complaint investigation projections, Ms. Liveratti indicated the division was "comfortable" with the projections.  Chairwoman Giunchigliani questioned whether increases were being seen in any particular area.  Mr. McAnnany responded that an increase in the complexity of cases was being seen and referred specifically to news accounts of exploitation of some elders by caregivers.  Mr. McAnnany advised that as the division increased their "educational effort" to provide information concerning the program, they had received more contacts concerning problems.  It was Mr. McAnnany's opinion that the program's strength and accountability had increased, and he further advised that the budget's transfer to the Division of Aging Services was working well. 

 

Ms. Leslie discussed the February 2, 2001, minutes for the Washoe County Elder Protective Services' Roundtable and requested an update on what had transpired since the February meeting.  Ms. Liveratti explained that the Roundtable met on a monthly basis and would be meeting again in March.  Ms. Liveratti further explained that the division had close collaboration with Washoe County's service workers, and they were looking at ways to focus the division's attention on investigations while county support services conducted the ongoing case management to ensure seniors were stabilized, safe, and secure.  Ms. Leslie indicated that it appeared, in reading the minutes, a conflict remained concerning who would conduct the initial investigation and whether the response had been provided in a timely manner.  Ms. Leslie inquired as to whether a need for additional division staff was anticipated in order to provide a more timely response.  Ms. Liveratti advised that currently the division met the three-day response to reports on elder abuse as required by statute.  Ms. Liveratti explained the main problem was related to division investigators also being involved in the ongoing case management and indicated the division was working with Washoe County Social Services and Washoe County Senior Services to provide case management.  Ms. Leslie advised the division representatives that if additional resources were required to "reach out to seniors," they needed to provide testimony to that effect.  Ms. Leslie indicated that she did not want to read another newspaper account of elder abuse that could have been prevented had the response been timely.  Chairwoman Giunchigliani discussed Las Vegas Metro's successful effort to dedicate an individual, trained in working with the elderly, who focused on elder abuse complaints and encouraged other regions to do the same. 

 

Chairwoman Giunchigliani asked how many of the current 13 social workers in the EPS/Homemaker Program were dedicated to Homemaker Services and how many were dedicated to Elder Protection Services.  Ms. Liveratti advised that 8 social workers were dedicated to Elder Protective Services and 5 to Homemaker Services.  Chairwoman Giunchigliani inquired as to how it was determined that an additional social worker would add 100 clients to the number of clients served.  Ms. Liveratti explained that the social worker was being requested for the Homemaker Services Program, and in response to Chairwoman Giunchigliani's question, advised that the division did not have a standard for Homemaker Services, which had been transferred into the division in FY2000.  Ms. Liveratti explained the standard had been developed during the time the Community Home-Based Initiatives Program was built, and the division was currently looking at setting a standard for the Homemaker Services Program.  Additionally, Ms. Liveratti advised that the division did not have a standard for either the Long-term Care Ombudsman or EPS workers because they responded to any complaint.  Chairwoman Giunchigliani encouraged development of a formula that demonstrated the justification for additional workers since budgets were "lean" and a huge increase in growth was being seen.  Chairwoman Giunchigliani also reiterated concern that the Tobacco Settlement monies being used to fund many of the programs could disappear which would create a funding deficit.

 

DEPARTMENT OF HUMAN RESOURCES, AGING, SENIOR CITIZENS' PROPERTY TAX ASSISTANCE, BUDGET ACCOUNT 101-2363 –  BUDGET PAGE AGING-23

 

Ms. Liveratti stated that the Governor's Steering Committee to Conduct a Fundamental Review of State Government, recommended a transfer of the Senior Citizens' Property Tax Assistance budget from the Department of Taxation to the Aging Services Division.  Ms. Liveratti advised that the program provided tax relief to eligible senior citizens who carried an excessive property tax burden relative to their income and introduced David Pursell, Executive Director of the Department of Taxation, who presented the proposal to transfer the budget to the Division of Aging Services. 

 

Senator Rawson questioned why seniors who knew they would be eligible for the program could not apply before having paid their property tax and then had to wait for a refund.  Mr. Pursell explained that final assessed property value information, collected by the Department of Taxation, was required in order to determine a rebate for seniors and was not available at the time seniors were required to pay their property tax.  Senator Rawson strongly recommended that the process be streamlined so that eligibility information could be determined before seniors had to come up with "out‑of‑pocket cash."  Mr. Pursell advised that the timing between how the assessed values were established and reimbursement disbursed would be reviewed.  Senator Rawson encouraged a review of the procedure in order to alleviate the burden of eligible seniors having to pay the property tax and then receive a reimbursement.  Senator Rawson also recommended that renters' eligibility be reviewed. 

 

Additionally, Senator Rawson asked whether the recommendation to move the Senior Citizens' Property Tax Assistance Program was a good move.  Mr. Pursell advised that while he would personally take "any and all calls" from seniors who wanted to talk to him about property tax assistance, he had little knowledge concerning what else was available for seniors.  From his perspective, Mr. Pursell indicated it was more advantageous for seniors to be in an agency that dealt with the senior population base. 

 

Chairwoman Giunchigliani asked whether any savings were identified in moving the program to the Division of Aging Services.  Mr. Pursell responded that the program was a one-person operation with assistance from a part-time position to enter data as received from Assessors' offices.  Mr. Pursell indicated that currently the department was working with the Clark County Assessor's office, to streamline moving information on assessed valuation from the Assessor's office into the Department of Taxation's database.  In response to a question from the Chairwoman, Mr. Pursell explained that the application for assistance included sections on assessed value and the property tax rate and after the information from the Assessor's office was entered into the database, the reimbursement check would be issued from the Department of Taxation.  Mr. Pursell noted that Mark Schofield, the Clark County Assessor, and his information services' staff worked with the Department of Taxation to electronically transmit information between offices.  Mr. Pursell also indicated that the Department of Taxation would assist the Division of Aging Services through the transition period. 

 

Mr. Pursell agreed with the Chairwoman's assessment that there was no real cost savings involved with moving the program to the Division of Aging Services.  However, Ms. Liveratti indicated there were some benefits such as the division already had income information on the clients they were serving, that could perhaps expedite faster refunds, and it was anticipated that seniors could be tied into other services in the senior service network.  As an example, Ms. Liveratti indicated case managers were currently referring clients to the tax assistance program when it was determined they qualified.

 

Chairwoman Giunchigliani asked whether the October 1, 2001, transfer date was reasonable, given that refunds had to be paid by August 15, 2001.  Mr. Pursell responded that the transfer date was reasonable and would provide the Department of Taxation the opportunity to assist in phasing the program into the Division of Aging Services.  Mr. Pursell also noted that "the enabling legislation" recommended an extension of the application period.  In response to a question from Chairwoman Giunchigliani on the status of the Bill Draft Request, Mr. Pursell advised that the request had been submitted to the Department of Administration but had not yet been introduced.  Chairwoman Giunchigliani expressed concern that the details of the proposed changes to the program were not yet currently available.  Her concern addressed whether refunds would be provided to those most in need of receiving assistance or would be provided to individuals in the upper-income brackets of the program. 

 

Chairwoman Giunchigliani questioned how the determination was made to increase the maximum amount of the allowable refund to $1,500.  Mr. Pursell advised that his presentation would address the maximum allowable benefit.  The Chairwoman requested that Mr. Pursell proceed with his presentation.

 

Mr. Pursell stated that the Senior Citizens' Property Tax Assistance Program provided relief to eligible seniors who carried an excess residential property tax burden relative to their income and to those senior citizens who, through rent payments, paid a disproportionate amount of their income for property taxes.  Mr. Pursell informed the members of the subcommittee that much of the material being presented to them had been gathered from a 1998 public policy institute study done through the American Association of Retired Persons (AARP).

 

Mr. Pursell advised that it was the AARP's opinion that property taxes were the most regressive type of tax for elders in certain income categories.  The current structure of the program allowed for the rebate of a percentage of the claimant's accrued property tax with household income ranges established by statute for homeowners and renters.  Rent accrued to property taxes was determined at 8.5 percent of the total annual rent paid by the claimant.  At the time the pre-session report was provided to the joint committees in January, some thought had been given for an increase to 10 percent.  However, a Department of Taxation survey determined the 8.5 percent rate was reasonable, and, based on that study, the portion of the rent that accrued to property taxes was not increased.

 

Senator Rawson indicated that a senior citizen, through inflation and increases in property values could be placed in a situation of having a $1,500 tax bill and recalled his own experience in purchasing a home for $24,000 which sold 35 years later for $130,000.  Senator Rawson indicated it was conceivable that in a period of 35 years an individual who had done well and had a reasonable job could be on social security through either illness or loss of job.  It was Senator Rawson's opinion that such a fate had occurred for many people and they were not in $300,000 homes but in $140,000 homes that they may have purchased for $20,000 or $25,000.  Mr. Pursell agreed with Senator Rawson's assessment and indicated he had seen similar situations in Douglas County and Lake Tahoe where individuals had been in their homes for many years and the appreciation on their property was greater than the Consumer Price Index (CPI) increase to their income levels.  It was Senator Rawson's opinion that the last thing an elderly person needed to do was sell their home and take on a new house payment.

 

Mr. Pursell explained how the department determined the increase for the allowable refund from $500 to $1,500.  The average assessed value by county was examined in the department's current database, and it was determined that ten claimants would qualify for a refund of over $1,000 and one qualified for a refund of over $1,500.  Income category information, submitted to legislative staff, was at the same level currently outlined in statute with CPI increases; the lowest income level was $0 to $13,200 and the highest $19,900 to $22,400.  In response to a question from the Chairwoman, Mr. Pursell advised that the statute was specific in what could be included as income and a question to that effect was on the application form. 

 

Mr. Pursell indicated that statistically the most difficulty encountered was in determining whether seniors age 65 and over were in a home they owned, assisted care, or renting, and was the one variable for which there appeared to be no sources of reliable information.  While the AARP nationwide had a database and had the information for some states, they did not have the information for Nevada.  Another variable discussed by Mr. Pursell was the difficulty in keeping track of seniors who had passed away or moved in with children.  Because of the difficulty encountered in gathering some statistics, Mr. Pursell advised that the department's projections were based on historical data they had accumulated over the years as well as some of the conclusions based on the AARP study.  It was pointed out that the AARP study indicated that 41 percent of seniors said they did not require assistance, 25 percent indicated they were not aware of the program and 14 percent indicated they did not believe they qualified.  Mr. Pursell reported that the growth, indicated by the study, had been built into the projections and met the Governor's mandate to increase the benefit to seniors and ensured that anyone else who might now qualify would be covered. 

 

Additionally, Mr. Pursell said the proposed legislation contained a provision that in the event not everyone received 100 percent of the reimbursement to which they were entitled, the refund could be prorated.  Mr. Pursell advised that the provision would, for example, ensure the availability of funding, if the number of seniors had been underestimated.

 

Assemblywoman Leslie questioned Mr. Pursell's earlier testimony that indicated 41 percent of the seniors in the AARP study responded they did not need the property tax assistance and whether that percentage had been factored into the projections.  Mr. Pursell advised Assemblywoman Leslie that the 41 percent had been factored into the department's projections.  It was Assemblywoman Leslie's observation that if 41 percent of the seniors decided to take advantage of the assistance after all, there would be no problems encountered in providing that assistance because of the provision placed in the pending legislation.  Mr. Pursell agreed that Ms. Leslie's observation was correct.  Based on the income levels illustrated on the chart provided to the subcommittee, Ms. Leslie indicated the highest income level shown was $22,425 and questioned whether that income level was per household or per person.  Mr. Pursell responded that the $22,425 income level was per household.

 

Chairwoman Giunchigliani addressed the observation that 25 percent of the population who responded to the AARP study were not aware of those tax assistance programs.  The Chairwoman indicated she hoped to see more targeting toward that 25 percent and believed it to be the more needy population that had been underestimated.  Additionally, Chairwoman Giunchigliani advised that to better understand the proposed changes, provisions should be made for providing different scenarios, i.e., an increase in the allowable refund from $500 to $750 so that the subcommittee could see some incremental adjustments.  Chairwoman Giunchigliani recalled that after approval of the department's previous budget for this program, additional revenue had to be requested from the Interim Finance Committee to offset under-projected estimates.  Chairwoman Giunchigliani indicated an expectation should not be created that could not be funded.  The Chairwoman reiterated her request to target as many of the needy as possible while staggering the potential increase so that perhaps the increases could be moved incrementally toward higher refund levels rather than moving directly to the maximum $1,500 refund level. 

 

Mr. Pursell advised that the department's database changed as more applications were received, however, the department used the established database of approximately 12,585 eligible claimants for FY2001.  The income ranges, as indicated in earlier testimony, remained the same but allowed for increases in the CPI as currently specified in statute with a sliding refund scale applied to those income ranges for each of the five categories.  Under current statute, the property tax bill was rebated at the following percentage for each income range:

 

 

Mr. Pursell advised that it was proposed to change the property tax bill rebate for both property owners and renters to:

 

 

Using the new criteria, Mr. Pursell indicated the department's programmer was requested to query information from the current database, and, under the current statute and the current refund levels, the department had distributed about $3.4 million to the 12,585 eligible individuals.  The property tax rebate based on the $1,500 cap was projected at $5,824,000.  Using that benchmark and the fact that 25 percent of the population indicated on the AARP study they were unaware of the program, Mr. Pursell advised it was estimated that in FY2002, there could be as many as 15,731 eligible seniors and cost approximately $7.2 million to meet the rebate requirements under the new established parameters.  The cost for growth built into FY2003 to meet the needs of an estimated 16,565 eligible claimants was projected at $7.6 million.  Mr. Pursell advised that, based on the Governor's recommended appropriation, some funding would be left over in each year and in FY2002, there would be approximately $256,000 remaining which would support an additional 25 percent increase from FY2001-2002 and another 534 claimants; in FY2003, another 993 additional claimants would be eligible.  Mr. Pursell advised that the figures had been provided to the subcommittee's staff and would be updated when the final numbers were run on the current database. 

 

Mr. Pursell explained that while the new parameters increased the average refund to about $462, a summary by county and by income category would also be available.  Mr. Pursell provided several statistics to put the refunds into perspective and indicated that under the new parameters 66 percent of the claims would go to Clark County; 22 percent to Washoe County and approximately 12 percent to rural Nevada.  Mr. Pursell indicated that in several days the department could provide a side-by-side comparison to the parameters outlined in current law.  At that point, Mr. Pursell indicated he had concluded his presentation. 

 

Chairwoman Giunchigliani reiterated that the issue was to rebate the population with the most need.  In a review of the department's chart that illustrated income levels used to determine eligibility for refund, the Chairwoman indicated that in the $0 to $13,246 income-level range, 32.2 percent of the population were actual homeowners while 72 percent were renters, and it was that population who required the most assistance.  Chairwoman Giunchigliani suggested that, for comparison purposes, the department rerun the rebate program using the new parameters for the first three income levels but the current percentages for the last two income levels to determine the potential budget impact.  The Chairwoman requested the comparison be provided to staff for the subcommittee's information.

 

Ms. Leslie indicated that according to information presented to the subcommittee, it appeared that currently the percentage of renters served in the first income level category was 72.4 percent and in the recommended program, the percentage of renters dropped to 65.8 percent.  Ms. Leslie questioned whether it was anticipated that there would be fewer renters in the new program.  Mr. Pursell did not have access to the same material as the subcommittee; however, advised that depending on how the percentages were reviewed, there did not appear to be a logical change as to how individuals were placed in the categories.  Mr. Pursell reminded the members of the subcommittee that the department was looking at averages.  Ms. Leslie expressed concern that it appeared that the number of renters in the most needy category was being reduced and indicated an interest in seeing that particular number.  Mr. Pursell advised that he would review that particular category.  Additionally, Ms. Leslie requested clarification on the rationale used to make "such a drastic change" in the recommended program percentages.  Mr. Pursell responded that the department had responded to the Governor's directive based on his recommended appropriation to provide as much assistance as possible to seniors in the outlined income levels.  Ms. Leslie agreed with the Chairwoman's assertion that there was room to see if the fiscal needs of the state could be balanced and at the same time meet the needs of needy seniors with perhaps a different formula and not the 100 to 80 percent recommended in the budget.  Mr. Pursell agreed to look at the other sliding scales recommended by members of the subcommittee. 

 

Chairwoman Giunchigliani further advised that no matter what level of funding was finally agreed on, the need was recognized and inquired as to whether there was any public relations plan to provide information to the 25 percent of the population who indicated they were not aware of property tax assistance.  Mr. Pursell advised that the Governor had promoted property tax assistance on his statewide travels.  Additionally, Mr. Pursell said that information on the program was available on the Department of Taxation's Web site, although the recommended changes had not yet been included.  Mr. Pursell advised that the county assessors also promoted the program, and he indicated several of the rural county assessors had requested additional applications after a news story about the program had been written.  In response to a question from Chairwoman Giunchigliani concerning the availability of printed information, Mr. Pursell indicated that the county assessors had a pamphlet that contained some of the same information as seen on the department's Web site.

 

Assemblywoman Tiffany inquired as to whether Census Bureau data could be accessed and combined with the Department of Taxation's data.  While Mr. Pursell indicated he had not seen the latest census information, he advised that the department had used 1990 Census information concerning age and income group data, but information on where seniors actually lived was not available.  Chairwoman Giunchigliani advised that the information was provided on the latest census data; however, the information for the current census would not be available for at least six more months to a year.

 

Ms. Tiffany suggested that whenever it was available, it would be worth taking a look at it for the future.  Chairwoman Giunchigliani agreed it would be helpful to have that information for the future.

 

Chairwoman Giunchigliani commended the department's work and moved to public testimony.

 

PUBLIC TESTIMONY

 

Jon L. Sasser, Lobbyist, representing Washoe County Senior Law Project, identified himself for the record, and addressed issues concerning community based services and the need for affordable assisted living for Nevada seniors.  Mr. Sasser commended Ms. Liveratti, Ms. Sala, Unit Manager, Community Based Care, and the Aging Services Division' staff for their "hard work" on behalf of Nevada seniors. 

 

Mr. Sasser indicated meetings had been held with Ms. Liveratti and her staff concerning the implications of the Olmstead decision, a 1999 U.S. Supreme Court decision that said, under the Americans with Disabilities Act (ADA), it was discriminatory to serve disabled individuals in an institution, if they could be served in the community.  Mr. Sasser advised that the decision also applied to those individuals over the age of 60, if they could meet the definition of disabled under the ADA.  Mr. Sasser extended his appreciation to the Governor and to Ms. Liveratti for the recommended increase in the budget for the number of waiver slots in the CHIP program and also that the slots for the group‑care waiver were recommended to double.  While Mr. Sasser was uncertain that the recommendations, if approved, would take care of the total need, he indicated additional meetings would take place concerning a survey the division was conducting for all individuals currently in nursing homes to determine whether they could be placed in the community if adequate services were available to them.  Mr. Sasser named Carla Sloan, Nevada State Director, AARP, Virginia Cain, with the Commission on Aging, Ernie Nielsen, Lobbyist, Washoe County Senior Law Project, and Ruth Mills from Las Vegas as individuals who were involved with the affordable assisted living project for Nevada seniors.

 

Mr. Sasser discussed the gap between those individuals who could survive in the community on the CHIP program and those individuals in nursing homes.  Mr. Sasser explained that the CHIP program only provided a few hours a week of home assistance and there were a group of seniors who, while they needed to have someone available 24 hours a day, did not necessarily need 24‑hour‑a‑day nursing care.  Mr. Sasser explained that in the private sector, the gap had been filled by assisted living units that permitted individuals to live in their own apartment in a complex with on-site services that assisted in the activities of daily living.  In Nevada, assisted living services required an annual income of about $35,000.

 

Mr. Sasser referenced the interim study on "Long-Term Care in Nevada," chaired by Senator Mike McGinness, and an excerpt from the study (Exhibit D) was distributed to the members of the subcommittee.  The study recommended that Nevada explore development of assisted living for the lower‑income population.  Mr. Sasser explained that Nevada had a Medicaid eligibility system that provided services for the aged or disabled receiving Supplemental Security Income (SSI) of approximately $500 a month or less.  Individuals whose incomes ranged from $500 up to $1,500 a month could be provided with services if they were in a nursing home or in one of the limited CHIP waiver slots.  Individuals with Social Security checks in the amount of $1,200 a month would not qualify for Medicaid.  It was Mr. Sasser's opinion that Nevada needed an expansion of the current waiver to cover not only CHIP services but also assisted-living services.

 

Mr. Sasser pointed out that the difference between assisted living and Medicaid was that Medicaid paid only for medical services and not for room and board and that a number of individuals went into nursing homes because they had nowhere else to go.  The proposal by the Washoe County Senior Law Project presented to the interim study committee recommended matching two streams of funding through funding from the federal government and through federal tax credit programs, many of which were administered by the Housing Division in the Department of Business and Industry.  Mr. Sasser advised that the proposal recommended matching federal funding with service dollars flowing through Medicaid so that an affordable option for seniors in the $500 to $1,500 a month range could be created.  Mr. Sasser said that while the interim committee thought the idea was worth exploring, they recognized it would take coordination from Housing Division and Human Services' technical staff to develop the concept and amendments to Nevada's current CHIP waiver, and to provide guarantees to developers and banks who wanted to put up the money to build the projects. 

 

Mr. Sasser discussed the Robert Wood Johnson Foundation grant for $100,000 a year for three years to develop such a program and to do the staff work required to build the infrastructure.  Nevada applied, but unfortunately was not one of the eight states awarded the grant.  Mr. Sasser pointed out that the interim committee had recommended that money be placed in the budget to develop the project if Nevada was not awarded the grant.  Funding in the amount of $500,000 for a long-term strategic plan for the needs of the elderly was placed in the budget.  However, Mr. Sasser indicated, the work in the more technical field needed to go forward now and the division testified they needed approximately the same amount of money that was in the Robert Wood Johnson grant in order to carry forward the staff work.  Mr. Sasser made the subcommittee aware that the funding, to his knowledge, was not in the budget. 

 

In response to a question from Chairwoman Giunchigliani, Mr. Sasser advised that the Robert Wood Johnson Foundation grant totaled $100,000 a year for three years and that the proposal recommended funding for a staff member at $32,000 per year, $12,000 in fringe benefits, $8,000 for consulting fees and the balance for other expenses such as copying and travel.  Mr. Sasser indicated that the Bill Draft Request (BDR) was being processed and was called to the attention of the joint subcommittee since it was a budget item.

 

In response to a question from Chairwoman Giunchigliani, Mr. Sasser advised that the interim committee studying long-term-care in Nevada had proposed the BDR.

 

Ms. Leslie extended her appreciation to Mr. Sasser for making the subcommittee aware of the BDR and questioned whether the $100,000 was in The Executive Budget.  It was Mr. Sasser's understanding that the $100,000 had not been included in The Executive Budget.

 

Ms. Liveratti said that an assisted living provision for seniors was an area that the long-term strategic plan would look at and which included "the whole spectrum of services."  In response to a question from Ms. Leslie, Ms. Liveratti indicated that the strategic plan definitely looked at the waiver issue.  Ms. Leslie asked to be made aware of any specific elements in the strategic plan proposal, and Ms. Liveratti agreed.

 

Mr. Sasser referenced the excerpt from the "Long-Term Care in Nevada" study (Exhibit C) and indicated there were some specific tasks that would be accomplished with the money that were not related to strategic planning tasks.  Those tasks included building the infrastructure; drafting the change waiver and putting the change waiver forward; negotiating with the Division of Housing, and meeting with developers.  Mr. Sasser indicated that moving those specific tasks forward was necessary, and that unless staff was designated to do the very specific detail work, accomplishing the tasks in the context of the larger study appeared uncertain. 

 

Carla A. Sloan, Nevada State Director, AARP, identified herself for the record and advised the members of the subcommittee that she had been very involved with the "Long-Term Care in Nevada" study committee having attended all of the hearings and provided testimony.  Ms. Sloan discussed "institutional bias" as an area of great concern and indicated that individuals with incomes between $500 and $1,500 a month could be placed in a nursing home under one of the group‑care waiver slots, or the CHIP program.  Ms. Sloan pointed out that some individuals, who could not afford the cost of assisted living for which there was no federal or state support, other than under the waivers, were sometimes placed in nursing homes inappropriately because of the income discrepancy.  Ms. Sloan indicated that the AARP wanted to prevent institutional bias for that segment of the population with moderate incomes who did not have access to the full continuum of health care services.  Ms. Sloan expressed concern that the important dialogue that had begun and the groundwork that had been laid in applying for the Robert Wood Johnson grant would be lost if the project was included as part of a total strategic plan.  Without the specifics that were detailed by Mr. Sasser, Ms. Sloan indicated there would be a two‑year delay.  Ms. Sloan concluded her remarks and encouraged the subcommittee to support the project for affordable assisted living for Nevada seniors.

 

Renny Ashleman, Lobbyist, representing Nevada Health Care Association, concurred with the remarks of the two previous speakers.  Mr. Ashleman added that the project for affordable assisted living for Nevada seniors had a lot of potential and pointed out that there were a number of people in the low‑to‑moderate income level who were being more expensively and intensively cared for than needed.  Mr. Ashleman addressed the fact that it was not cost effective for nursing homes to house low-to-moderate income seniors, nor was it cost effective to use state or federal monies to house them there and it was not the most satisfactory living environment.  Mr. Ashleman concluded his comments and reiterated his concurrence with the remarks of the two previous speakers.

 

Chairwoman Giunchigliani questioned whether assisted-living facilities were in competition with nursing homes.  Mr. Ashleman responded that assisted-living facilities were not in competition and that some institutions owned assisted‑living facilities. 

 

With no further business before the subcommittee, the meeting was adjourned at 9:49 a.m.

 

 

 

 

RESPECTFULLY SUBMITTED

 

 

Connie Davis

Committee Secretary

 

 

APPROVED BY:

 

 

 

                       

Assemblywoman Giunchigliani, Chairman

 

 

DATE: