Call to Order and Roll Call
TheInterim Joint Committee on Health and Welfare was held on Wednesday, November 16, 2016, at 10:00 a.m., in Room 129 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order at 10:01 a.m., and the secretary called the roll.meeting of the
Members:Senator Julie Raque Adams, Co-Chair; Representative Tom Burch, Co-Chair; Senators Ralph Alvarado, Tom Buford, Danny Carroll, Julian M. Carroll, David P. Givens, Denise Harper Angel, Jimmy Higdon, Alice Forgy Kerr, Reginald Thomas, and Max Wise; Representatives Robert Benvenuti III, George Brown Jr., Bob M. DeWeese, Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Phil Moffett, Tim Moore, Darryl T. Owens, Ruth Ann Palumbo, David Watkins, Russell Webber, Susan Westrom, and Addia Wuchner.
Guests: Jim Kimbrough, State President, AARP; Eric Evans, Associate Director, AARP; Jessie Meiser, DNP, APRN, CPEN, Senior Vice President and Director of Nursing, The Lily Pad at Easter Seals West Kentucky; Jody Rogers, MSN, RN, NEA-BC, Vice President of Nursing, The Kidz Club, KYPPEC, Inc.; Shannon McCracken, Executive Director, Kentucky Association of Private Providers; Betsy Byrnes, Direct Support Professional, Kaleidoscope; Abigail Ball, adoptive parent; Rachel Blanford; KimberlyHinkel, Kentuckiana Regional Planning; Kelli Williams, Accenture; Scott Wegenast, AARP; J. Scott Judy and Julie Mulligan, Masonic Homes of Kentucky; Laurie Jones, Child Protective Services, Department for Community Based Services, Cabinet for Health and Family Services; Andrea Flichum and Robert Brawley, Department for Public Health, Cabinet for Health and Family Services; Katy Coleman, Social Worker, Department for Community Based Services, Cabinet for Health and Family Services; Charles Williams, AARP; Harold Brown, Sterling Health Solutions, Inc.; Marylee Underwood, Commonwealth Council on Developmental Disabilities; Tim Feeley, Deputy Secretary, Cabinet for Health and Family Services; and Adria Johnson, Commissioner, Department for Community Based Services, Cabinet for Health and Family Services.
Family Caregiver’s Act
Jim Kimbrough, State President, AARP, and Eric Evans, Associate Director, AARP, stated that there are four parts to family caregivers: 1) individuals who already receive services; 2) individuals who are currently caregivers; 3) someone who will receive services in the future; and 4) someone who will be a caregiver in the future. Approximately 648,000 family caregivers in Kentucky help loved ones to live independently keeping them out of more costly nursing homes saving taxpayer dollars. In Kentucky, family caregivers of adults provide $6.9 billion annually worth of unpaid care. Most individuals who receive assistance at home rely mainly on unpaid family caregivers for help.
The AARP recommends the General Assembly enact the Family Caregiver Act to support family caregivers to safely help Kentucky seniors stay at home. The bill features three important provisions: 1) name of the family caregiver is recorded when a loved one is admitted into a hospital; 2) family caregiver is notified if the loved one is to be discharged to another family or back home; and 3) facility must provide an explanation and give instruction of the medical tasks that the family caregiver will perform at home. Almost 46 percent of family caregivers perform medical or nursing tasks for loved ones with multiple chronic physical and cognitive conditions with little or no training. Kentucky spends a huge amount of money on Medicare because of readmission rates.
In response to questions by Senator Givens, Mr. Evans stated that each time someone is admitted to the hospital, a caregiver is designated.
In response to a question by Senator Danny Carroll, Mr. Evans stated that the language in the Family Caregiver Act prevents liability against lay caregivers.
In response to a question by Representative Benvenuti, Mr. Evans stated that 98 percent of individuals want to stay in their home after release from a hospital. Family caregivers save taxpayers money by helping provide care in the home.
Approval of the Minutes
A motion to approve the minutes of the November 2, 2016 meeting was made by Representative Jenkins, seconded by Representative Watkins, and approved by voice vote.
Consideration of Referred Administrative Regulations
The following administrative regulations were referred for consideration: 201 KAR 20:411 – establishes the requirements relating to a sexual assault nurse examiner course and the credentials of a sexual assault nurse examiner; 902 KAR 2:020 & E – establishes notification standards and specifies the diseases requiring immediate, urgent, priority, routine, or general notification, in order to facilitate rapid public health action to control diseases, and to permit an accurate assessment of the health status of the Commonwealth; 902 KAR 20:058 – establishes licensure requirements for the operation of and services provided by primary care centers; 921 KAR 1:380 – specifies the process by which an individual may apply for child support services, the scope of services available, and the process for an intergovernmental case; 922 KAR 1:151 – repeals 922 KAR 1:150, 1:170, 1:210, and 1:230 which are obsolete and have been superseded; and 922 KAR 1:500 – establishes eligibility and an application process, specifies allowable uses, and provides a procedure for administrative hearings pertaining to the educational and training vouchers to youths who have aged out of foster care or were adopted from foster care at age sixteen (16) or older. A motion to accept the referred administrative regulations was made by Senator Julian Carroll, seconded by Representative Jenkins, and approved by voice vote.
State Social Service Workers
Rachel Blanford, former Child Protective Service (CPS) worker, stated that she was in foster care for eight years and is thankful for CPS getting her out of a bad situation. She wanted to give back to the agency and eventually became a CPS worker herself. Everyone is overworked and underpaid with no change in the foreseeable future. Because CPS workers are involved in horrible circumstances every day, there is a high turnover rate. The children and families of Kentucky deserve the best.
Katy Coleman, Social Worker, Department for Community Based Services, Cabinet for Health and Family Services, stated that the state cannot protect vulnerable children without social workers. While social workers are appreciative for the current raise, salaries need to be competitive in order to retain workers. The Kinship Care program needs to be reinstated. A child receives $300 a month for Kinship Care services compared to $77.14 per day for foster care. As of November 6, 2016, there were 8,093 children in state custody, because there are not enough homes for placement. Some family members cannot afford to take in children, and the Kinship Care program would help with costs. Children of all ages are affected.
In response to a question by Representative Burch, Ms. Coleman stated that two days after testifying at the September meeting, an email was sent to all working saying not to speak to the media without prior approval. One worker’s unit was the only unit placed on a Performance Improvement Plan (PIP) after his testimony before the committee.
Senator Julian Carroll stated that the raise that social workers received caused problems with other employees because they did not receive a raise. Legislators need to do something to help social workers.
Representative Burch stated that social workers need protection and tools to perform their job. Children in state custody need to be adopted.
Senator Danny Carroll stated that changes are coming in the 2017 Regular Session to help social workers.
Tim Feeley, Deputy Secretary, Cabinet for Health and Family Services, stated that the email about needing prior approval to speak to the media was sent to the entire cabinet reemphasizing policy already in place and was not meant as a threat. There has not been any retribution of any social worker who testified at the September meeting. The cabinet is taking steps to improve situations for workers. Recruiting for new social workers has increased with some former workers coming back due to the changes the cabinet has implemented. The cabinet has reached out to retired law enforcement officers to help with investigations. In 2013, the Kinship Care program was put on hold because the number of children coming into state custody continued to grow. Children who were placed with relatives received 6 to 12 months of child care assistance and a one-time $350 payment was given per child to help offset the cost of needed supplies.
Representative Benvenuti stated that in today’s society, the needs of parents are put over the needs of the children. Families need to take care of their own families. The current cabinet staff is being more transparent.
Pediatric Extended Care
Jessie Meiser, DNP, APRN, CPEN, Senior Vice President and Director of Nursing, The Lily Pad at Easter Seals West Kentucky, and Jody Rogers, MSN, RN, NEA-BC, Vice President of Nursing, The Kidz Club, KYPPEC, Inc., stated that the statutory authority for Prescribed Pediatric Extended Care (PPEC) is found in KRS 216.875 to 216.890 and the standards for PPECs are covered in 902 KAR 20:280. A PPEC is a nonresidential health care service which provides an important link in the continuum of care for medically or technologically dependent children and their families. The children that are served receive ongoing medical treatment, constant assessment and supervision while being in a stimulating social and education program. The holistic approach to care enables children who are medically fragile to excel in a structured fun environment with other children. It also strengthens family unity by allowing the parent to return to work or school. The PPEC center provides day health care, developmental interventions, and parental training. All PPEC facilities shall have two full-time registered nurses and one nursing assistant and are reimbursed for skilled nursing services. In 2011, the Department for Medicaid Services developed an objective framework to evaluate the medical needs of the child so appropriate payments could be determined. The Leveling Evaluation Tool (LET) not only measures the medical and nursing need, but also social, developmental, educational, and therapeutic needs. The LET determines benefits and outcomes outside of skilled nursing interventions and helps to encompass the holistic and community care provided by PPEC.
Representative Wuchner stated that the administrative regulation should be changed to cover licensed practical nurse services.
Senator Danny Carroll stated that PPEC facilities allow children with special needs and their families the ability to lead a normal life.
Home and Community Based Waivers: The Invaluable Role of the Direct Support Professional
Shannon McCracken, Executive Director, Kentucky Association of Private Providers (KAPP), stated that KAPP has 110 member agencies, 12,000 waiver participants, and 7,000 full-time direct support professionals. The Medicaid Program was established in 1965 and the home and community based waiver (HCBS) program in 1981. Home and community based waivers are a small but critical component of Medicaid and need to be protected. KAPP is working with the Department for Community Based Services (DCBS) to reduce unnecessary administrative regulations. The aging disabled population has grown due advanced medical interventions. HCBW rates have not changed in twelve years causing facilities to not be able to give raises to staff. There is a 50 percent turnover rate of staff and costs a facility approximately $5,000 per staff. Workforce labor is 80 percent of a provider’s budget. Solutions to help PPEC facilities would be to streamline and standardized billing and documentation of services, establish realistic baselines for reimbursement rates, revise service models that require fewer direct support professionals, expand technology use, and explore innovative care approaches.
Senator Thomas asked for a breakdown of the the demographics of the workforce be given to committee members.
Betsy Byrnes, Direct Support Professional (DSP), Kaleidoscope, stated that she has worked at Kaleidoscope for 17 years and averages 40 to 52 clients. Having the same DSP allows clients to feel safe and with someone they can trust. Everyone deserves to be valued and heard.
Abigail Ball, adoptive parent, stated that one of the three main purposes of our Constitution is to protect citizens from intrusion in their personal lives by the government. A parent has a fundamental right to raise a child, but this right is not equally protected under the law as is our right to free speech. Intrusion by government in the parent/child relationship is a clear violation of the rights not specifically listed but still protected by the Constitution. The clearest example of this in Kentucky is KRS 405.021 concerning grandparent visitation. The courts have interpreted this law to mean that it can grant any amount of visitation to any grandparent at any time for any reason, and parents and children across the Commonwealth have suffered. The judge that granted the petition for her to adopt her husband’s three children a year later granted the biological maternal grandmother visitation with the children. Granting visitation to grandparents after an adoption should not be legal, because they are no longer a part of the child’s family. There is no one better equipped to make choices about a child than the person with the responsibility to raise the child. Since the court ruling in 2014, two different psychologists have written letters stating that the visitation with the maternal grandmother is not in the children’s best interest and both letters were ignored by the court.
Representative Burch stated that the courts have struck down most of KRS 405.021. Parents are primarily responsible for decisions pertaining to their children.
In response to a comment by Senator Thomas, Ms. Ball stated that not all grandparents follow a parent’s wishes and do not deserve visitation rights.
Representative Benvenuti stated that it is harmful for a grandparent to usurp a parent’s authority.
Representative Wuchner stated that parents and grandparents need to be able to work out problems in the best interest of the children.
There being no further business, the meeting was adjourned at 11:35 a.m.