2023-06-26 00:00:00 - Joint Committee on Elder Affairs
2023-06-26 00:00:00 - Joint Committee on Elder Affairs
SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - What?
SPEAKER2 - Wait a minute wait a minute.
SPEAKER3 - Oh, it's a long list. That's why. assisted living, continuing care retirement communities, phone care, and community based services, so a very limited group of Thanks for us to talk about today. I'm Pat Jelen. I'm the Senate's Coacher of this committee. I'm gonna introduce
my colleague, friend and cochair, Tom Stanley, who is going to interest the house members.
SPEAKER2 - Thank you, Matt.
So we have a vice chair, Kate Liper Garabedian to my left. Next, we have a representative Tommy Fottola. Representative of Michelle Sicolo and representative of Cai Minh Gentai.
And online, we have a representative of barrels and representative k.
And Representative of Montana.
SPEAKER3 - It can't tell from the screen if Senator Lovely is here? Not yet.532 Okay. We're gonna As is our custom takeout of order legislators, and then we'll be going to testimony from everybody both in person and virtually.
If you have 2 bills that you wanna talk about, why don't you just take 1 opportunity to talk about that Dignity Alliance has sent us testimony in favor of about 20 bills. so we're not gonna ask them to talk about each of them. Okay.568 So I see Representative Donahue. I'd like to call you up and reminding everybody that there's a 3 minute limit we hope on testimony.
SPEAKER4 - I will be very brief.
REP DONAGHUE - HB 624 - SB 398 - Chair Jehlen, Chair Stanley, honorable members of the committee. Thank you for taking me out of turn. I'm here in support of H 624 S 398, an act relative to councils on aging. This Bill would allow directors to make staffing decisions directly if the Municipal Council on Aging is an advisory council. It's a necessary change because it gives COA directors more authority to ensure that their department is meeting the needs of the municipalities without the advice of a volunteer council. This would increase the effectiveness of the director and the ability to meet the needs of older adults. I want to thank Senator Rausch for her partnership on this Bill and ask that it be reported favorably, and I can take any questions. SHOW NON-ESSENTIAL DIALOGUE
well under my 3 minutes.
SPEAKER3 - Well, thank you very much. This is a new issue for me anyway. So -- Yeah. It's -- Are are there questions from members of the committee? Yes. I share.
REP LIPPER-GARABEDIAN - Thank you for coming, of course, that's really an interesting proposal. Did it come out of a particular issue that you became aware of?
DONAGHUE - Yes, it came out of an issue in a town that Senator Rausch represents, I think, the community of Sherburn. You might call it a technical fix but it relates a little bit more to the fact that when the authorizing law was written advisory council, the whole COA movement was much more volunteer driven and there wasn't the same level of service and professionalism. I guess they were looking to change their regulations to allow the executive director to hire and they realized that it violated state law. So that was when Senator Rausch moved forward with this, and she asked694 me as a senior citizen to file it in the House. It's a small number of communities it recommends, it's a little more than I would characterize it as a little more than just a technical fix, but updating to reflect the modern reality of what counsels on aging do. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER1 - Thank you. Thank you
SPEAKER3 - for your testimony. Are there other questions?
SPEAKER4 - If not, thank you. Thank you very much, everybody.
SPEAKER3 - So next we're hearing house 634. No 1 has signed up for that and sent 385 the same thing. Then we have if Senator Lovely is here to talk about those bills,
Not. Deuce. Is Betsy Kremin here
to talk? Let me Yes.
SPEAKER6 - I am senator.
SPEAKER3 - Oh, okay.
SPEAKER7 - Can you see me?
SPEAKER3 - Sort of.755 Yes.
SPEAKER6 - There I am. Hi. Good morning, everybody. Thank you so much for the opportunity.
I'm sorry.
SPEAKER3 - If you wanna talk about both bills, you're here for, you can.
SPEAKER6 - That would be great. Thank you so much.
BETSEY CRIMMINS - MASS HOME CARE - SB 385 - HB 634 - HB 630 - SB 370 - Good afternoon. Thank you to the members of the joint committee on elder affairs for this opportunity to testify in S 385 and H 634, an act relative to expanding the availability of personal care homes for older adults. My name is Betsey Crimmins, and I'm the executive director of Mass Home Care which is the nonprofit trade association for the Commonwealth's network of 27 aging service access points or ASAPs, and area agencies on aging or triple A's. This single statewide network of coordinated care delivers home and community based services to over 60,000 individuals per month providing over $600,000,000 a year in services. The coordinated system of home and community based services offered through the executive office of Elder affairs, in partnership with our network, provides essential caregiver resources and cost saving supports that enable individuals to successfully age in place and avoid nursing home placement. As you know, Massachusetts suffers from an acute shortage of affordable housing, especially for our rapidly growing population of older adults on fixed incomes who cannot afford market rate housing.
This legislation is designed to address our housing shortage by allowing for the creation of personal care homes which are small homes for four to six older adults who want to remain living in the community but need assistance with personal care and activities of daily living. This legislation is modeled on857 a successful pilot from 2006 when Mass Home Care received grant funding to develop a new model of affordable housing with services for small groups of older adults and people with disabilities who would otherwise be placed in nursing homes. These homes are developed so each resident has a private bedroom with shared common areas, and home care staff provide direct care services and assist residents with their daily needs. The Bill would direct EOEA to establish a process for licensing personal care homes similar to the processes utilized by other state agencies such as the Department of Developmental Services, which would allow older adults access to community living options similar to the options that DDS consumers have.
This Bill would also create a financing model for these small homes that includes two distinct funding lines to ensure the financial viability of the program, resources to provide necessary long term services and supports, and resources to cover room and board expenses. Frontline ASAP staff and other aging network providers have consistently highlighted the limited options for community based residential care settings available for older adults. Unlike consumers of other state agencies like DDS or DMH, consumers of services through EOEA only have the option of living in either costly private market housing or assisted living, scarce affordable housing, or becoming prematurely institutionalized in a nursing home due to a lack of less restrictive and less costly options in the community. At this time, we need to use every tool available to us to create and sustain housing options for older adults which allow people to remain in957 their communities of choice with the service959 and supports they need to do so. Across the country, 11 other states who are also grappling with an expanding aging population and shrinking affordable housing options have created innovative and successful personal care home models.
Given our state's current affordable housing crisis, along with the fact that 10,000 people turn 65 across this country every day, and that most older adults prefer to remain living in their communities, Massachusetts also needs to create innovative housing options to meet people's needs and preferences, this Bill is a big step in that direction. Mass Home Care is extremely grateful to Senator Joan Lovely and Representative Sally Kerans for working with our organization to file this Bill. We'll also be submitting written testimony on the Bill. Thank you. So this legislation will codify into statute a program currently being piloted through the executive office of Elder Affairs to provide intensive case management services called the advocacy and navigating care in the home with ongoing risk program, otherwise known as the anchor1048 program. Anchor allows a more time intensive and rigorous level1052 of case management for those older adults who are current or prospective participants in the state home care program who are determined to be clinically complex and who are at greater risk of institutionalization1063 in a nursing home1065 or homelessness due1067 to the inability to accept or retain1069 home care services.
The language in the Bill targets intensive case management services toward three general categories of consumers; individuals with serious mental illness or behavioral health issues, individuals with complex family dynamics that impact the acceptance of home care services and individuals with multiple medical and functional needs. Intensive case management is provided to individuals eligible for or enrolled in the state home care program or determined to be clinically complex and require sustained in-depth case management services to remain engaged and supported. Without these services, these individuals often have a hard time accepting or sustaining the services necessary to enable them to live safely in the community. Many of these individuals are subjects of reports to elder protective services and cycle in and out because their care coordination requires more time and attention than the current case management service provides.1130
The purpose of1132 Anchor is to connect, advocate, and build rapport and relationships with older adults. While assisting them to stabilize and receive home care services they need, they need to remain healthy and independent. One of the most common concerns faced by home care providers is the increased acuity of consumers and the1152 inter relationship of the multiple medical and behavioral health needs older adults struggle with on a daily basis. According to data included in EOEA's fiscal year 22 annual legislative report, 40% of the over 66,000 older adults who receive services through the state home care program have some type of behavioral health condition. The growth in the state's population of people age 65 and older is projected to increase 46% by the year 2035. People with disabilities and chronic health conditions have moved from institutional settings and are living longer in the community, adding to the demand and putting further strain on the long term services and supports delivery system. The need for use of these intensive case management services will continue to grow as our network works to help older adults navigate their growing and diverse care needs. Mass Home care would like to thank Senator Adam Gomez and Representative Daniel Gregoire for working with our organization to file this Bill. Thank you. SHOW NON-ESSENTIAL DIALOGUE
And thank you for your testimony. Other questions from members, rep Vitillo.
REP VITOLO - Good afternoon. I want to ask you a question about the first Bill, which is a really lovely idea recognizing this app in house and allowing for lower and more flexible housing for older adults who are in that sort of sweet spot in their life. My question is this; I can imagine those sort of four to six bedroom, smaller multifamily homes really elegantly in1261 places where there is great transit and great sidewalks, my concern is further away from those places, we've got a housing community which is really quite small for something like a senior bus, but maybe not so easy for the residents to get to the drug store or the grocery store or the senior center or any of these other places where they can fully participate in their community and society, I sort of feeling pulled up. in I suppose stuck in in these sort of three roommates. It makes for, you know, a great 1980s television show but how are we thinking about transportation outside of community squares or downtown areas in a housing system like this?
CRIMMINS - Thank you for that question. Because the ASAP network would be providing the support of services transportation would be one of those services for people who need it, whether it's to go to store, to go to the drug store, to go to a medical appointment. I would actually say that, I think, in rural areas, this type of housing, the ASAP network would be providing the services. So transportation would be one of the services provided for people, for medical appointments, shopping, etcetera. I actually think more rural or suburban areas are where this housing is very, very important because we have such a lack1405 of affordable housing options outside1407 of cities. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
SPEAKER3 - Thank you.
If not, thank you very much for your testimony. I'd like to recognize Senator Luke. Thank you. She's joined us, a member of the committee. and another member of the committee is going to testify. Rep errors is here. You're here to talk about how 61 4, I believe.
REP AYERS - HB 614 - Thank you, Madam Chair, Chairman Stanley, members of1453 the committee. I'd like to appreciate the opportunity to take me out1457 of order. I would like to testify this afternoon in support of House Bill 614, an act relative to early onset Alzheimer's disease. As we all may know, Mass health operates the frail elder waiver to help those who require nursing home level care enabling them to receive these services, these support services at home rather than in an assisted living facility or a nursing home. However, there is a waiver that sets an1491 age requirement of 60 years old, what this Bill would do, this legislation would remove that age provision, allowing people who suffer from early onset Alzheimer's to be able to take advantage of this type of level of service at their own home. This is a very small population but one that is desperately in need and that deserves to stay in their own homes. I filed this Bill after my longtime friend1523 constituent Jerry Ceurvels came to my office to tell me about the challenge that he was facing with his family after his wife, Jennie was diagnosed before the age of 50. So this Bill, I think, would right a wrong and allow us to be able to offer care for people throughout the Commonwealth of Massachusetts that's desperately in need. SHOW NON-ESSENTIAL DIALOGUE
And with that, I'd like to turn it over to Mister Kerbles.
SPEAKER14 - Gary Kerbles, Abington. Thank you.
JERRY CEURVELS - CONCERNED CITIZEN - HB 614 - Thank you for letting me share my experience with early onset Alzheimer's disease and how eliminating the age requirement or the fee of the waiver would help so many families suffering from this horrible and very debilitating disease. Alzheimer's never comes at a good time in someone's life, and it is always fatal but my family came much too early. At the age of 51, my wife, Jennie, was diagnosed with early onset Alzheimer's. Like my family, and for so many diagnosed with early onset, it comes at a time when your kids are still in school. I was 51, had two boys who were 16 and 17 and received Jennie's diagnosis. Prior to her diagnosis, Jennie worked on the Braintree Public School System. She was placed on leave pending an evaluation, when she received her diagnosis, she had to leave work and she was not there long enough to receive any benefits or a pension. I was a Quincy firefighter in that 27 years of service. Very quickly, things at the house changed, discussions about the future, college for the boys, retirement plans for Jennie and me, the joy of having that first grandchild all took a backseat for the reality of the situation. Jennie would need constant supervision to keep her safe as her cognitive abilities diminished, and her life would undoubtedly decline at a rapid pace.
Jennie's daily struggles with her cognitive abilities were and continue to be extremely difficult. Within six months of her diagnosis, she could no longer drive, she could no longer care for our boys, pay the bills, do the grocery shopping, and just about anything else associated with day to day living. Over time, she would need help eating, bathing, dressing herself among many other things. But I was still working, our boys are in school, we weren't done raising our children. I wouldn't manage any of this, especially now that I was Jennie's caregiver. Here are some of the choices a family faces when early onset strikes. Like me, many people at this age are still working full time. To care for Jennie, I'd have to choose between taking time off, or if I had already taken too much time off, I'd simply have to leave her alone. I have to go to work and hope for the best when I return home. Some people end up losing their jobs, putting their jobs to provide the level of care needed for their loved one then they can lose their homes1694 and face bankruptcy.
Another choice1696 is to employ caregivers so you can remain employed yourself. With this option, any money you've saved quickly goes away. We were told the only way qualify for the frail elder waiver was to get a divorce. We were married for1714 21 years at the time and no one should have to consider divorce as a way to get care for their spouse's needs. This brings us to the need for access to the frail older waiver regardless of age. As I looked1726 into available services for Mass Health,1728 I was told by so many healthcare professionals, it's too bad your wife is too young to be eligible for the frail elder waiver, it seems that more than most agree, the needs of a person at any age should be eligible for such services needed. Unlike many families, I had my employer's compassion and understanding, help me with my situation. My employer took me off shift work and gave me a day job and when it was no longer safe to leave Jennie at home for any period of time, I was able to stay at home under the family medical leave act until I could retire at the age of 56.
I was lucky, I could've lost my job as well as my pension after 32 years of being a firefighter. My wife is now in the late stage of the disease, and I'm thankful that I wasn't forced to make the difficult choice between her care or my job, and we are still married, 33 years. Other families are not as1782 fortunate. Alzheimer's is1784 a horrible disease at any age, but at early onset, and the spouse is still working, and the kids are still in high school, it becomes so difficult for everyone in the family. The day in and day out challenges, the financial worries of science seemed insurmountable. All the while, you're losing your loved ones to this very devastating disease. Alzheimer's disease has no cure, no prevention or no treatment. Since there's no way to prevent Alzheimer's, anyone in this room is at risk. As you weigh the pros and cons of eliminating the age related requirements, the frail elder waiver, I would ask that you think about the early onset families who are already losing their loved one way too soon, they shouldn't have to also lose their jobs, pensions, homes, savings account on marriage enormous for their loved ones. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Bavencio, thank you again for taking us out of
order. I'm I'm very grateful to 71 of my colleagues who co sponsored this legislation and also the Alzheimer's Association for their steadfast support. and then ask for any consideration you could give this bill.
SPEAKER3 - Thank you very much. And I
like much of the testimony we hear on this if you including from 2 of my friends,
it's compelling. Not to prejudge.
SPEAKER1 - Yes.
SPEAKER3 - Thank you for being
SPEAKER15 - Thank you.
SPEAKER3 - Are there questions or -- Thank you.
SPEAKER1 - --
SPEAKER16 - I think your
SPEAKER1 - --
SPEAKER3 - Yeah. -- remarks. Speak for yourself.
SPEAKER13 - Thank you very much.
SPEAKER3 - We have. a panel oops. Sorry.
I've got a panel from the1906 Alzheimer's Association,1908 which is next on this group from Chelsea Gordon, Rihanna Cole, and Joan on Mindy's. It looks like
SPEAKER4 - oxide in
SPEAKER3 - the seat. And then This is an issue.
And after that, you'll go back to feeling lovely. that are lovely, and then our representative asks who also has a plan. Right.
SPEAKER12 - Okay. I wasn't sure if you guys were calling us at first.
SPEAKER7 - I got no 1. Yeah.
CHELSEA GORDON - ALZHEIMER'S ASSOCIATION MASSACHUSETTS & NEW HAMPSHIRE CHAPTER - HB 614 - Good afternoon, Chairman Jehlen, Chairman Stanley, and members of the joint committee on elder affairs. Thank you1944 for having us today. My name is Chelsea Gordon, and I am the director of Public1948 Policy Agency for the Alzheimer's Association, Massachusetts, and New Hampshire chapter. I want to thank the committee for the opportunity to testify today on behalf of the Alzheimer's community, and thank the legislature for the important steps you have already taken to improve care for those living with Alzheimer's and other dementia in Massachusetts. We really appreciate the attention you give to this community and your work. I am joined today by two of our wonderful advocates who have been impacted directly, unfortunately, by younger onset Alzheimer's, and they are here today to share their stories in support of House Bill 614, an act relative to early on to Alzheimer's disease. I want to thank Representative Ayers for his leadership on this Bill and for considering an often overlooked segment of our population, those living with the under onset Alzheimer's. Before you2000 hear from our advocates, I want to to very briefly outline the issue at hand from the Alzheimer's Association's perspective today. Based on national estimates, it is likely that approximately 3500 people are living in Massachusetts age 30 to 64 with younger onset Alzheimer's or other dementia.
The stigma associated with younger onset Alzheimer's can have a significant impact on an individual's well-being and quality of life and often poses unique challenges when it comes to family work and finances. As our advocates will tell you today, and Jerry just told you as well, these challenges can be further amplified for those living with younger onset Alzheimer's due to lack of appropriate care and critical services oftentimes because their age denies them are access2044 to services that they need as we currently see through the Massachusetts frail Elder waiver. Mass Health2050 operates the frail elder waiver specifically to help residents who require nursing home level care to receive care and ongoing support services in their homes or community living residences instead of in a nursing home. These types of services can allow those living with Alzheimer's to remain in their homes for longer if they wish to do so and increase their quality of life and reduce health care costs for the state. This legislation would ensure the services provided through the waiver are made available to persons diagnosed2077 with younger onset Alzheimer's disease regardless of their age if they were otherwise eligible for such services.2083 Therefore, if this Bill is passed and you qualify for Mass Health and you are diagnosed with younger onset Alzheimer's, you would be able to access these important services. Thank you for your time today. SHOW NON-ESSENTIAL DIALOGUE
and it is now my pleasure and honor to introduce Advocate and National Board member for the associate, Shan Chiao Mahbany.
JOSEPH MONTMINY - ALZHEIMER'S ASSOCIATION - HB 614 - Good afternoon. My name is Joe Montminy and I live in Plymouth, Massachusetts, and I want to thank the community for giving us this opportunity to testify or giving me this opportunity to testify today and share with you my experience living with younger onset Alzheimer's disease. I'm 59 years old today, but I was diagnosed six years ago with the disease. My wife and I, we were shocked when I got my diagnosis because my neurologist told us, and we asked her to be totally upfront, she said, Joe,2131 you know, you very likely are gonna start to experience declines over the next five years, and she said, you may not recognize your sons and your family in five to seven years and in the tail end of that process, you may need to go into a nursing home because you have roughly a 10 year life expectancy. And that was very traumatic for us because we had no idea that somebody diagnosed with younger onset Alzheimer's could have such a shortened life expectancy, it was hard. I've been fortunate that my progression has been slower than expected, but many others have not2168 been so fortunate.
You know, you hear Jerry talk about his wife, I know many others that it's been2172 a challenge and I know for2174 us getting this diagnosis has been really difficult for my family, myself, both emotionally and financially. We had lost income, my wife and the youngest son had to go out and get their own much more expensive health insurance because I was no longer working. I needed to drop my life insurance because of the annual premiums skyrocketed to the maximum, and we just couldn't afford that and we very likely don't have adequate retirement savings because I was forced to retire 14 years early. And the disease, it it continues to change the core of who I am. I have trouble finding a conversation if somebody talks too fast or we kind of are bouncing around from topic to topic, anything that requires cognitive processing, doing chores around the house, emails, even texting is taking me two to three times longer than it did a year ago, and, unfortunately, that puts a lot more pressure my wife to pick up a lot of the chores and issues around the house. My mother and my wife have actually noticed changes in my personality, this is a little scary for me.
You know, more mood swings, my ability to reason is declining, they tell me and less impulse control and as my condition worsens, I know I'm going to need nursing home level care at some point and my family and I would really prefer to see that nursing home care and ongoing support services either in my home or in a local community living residence instead of in a nursing home. This disease steals my identity, it steals my experiences and I'm just asking that not let it take me out of my community. So please, you know, don't let my age be a reason that I or somebody else living with younger onset of Alzheimer's cannot receive the care we deserve if we were otherwise eligible for such services through this frail elder waiver. That's why I'm asking for your support of House Bill 614. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
SPEAKER3 - Thank you.
SPEAKER17 - And I'm not gonna pass it over to Regan Nicole.
BRIANNA COLE - CONCERNED CITIZEN - HB 614 - Good afternoon. My2304 name2304 is Brianna Cole and I live in Watertown. I want to thank you also for the opportunity to testify.2309 My late husband, Alfredo,2311 was only 47 when he was diagnosed with the younger onset Alzheimer's. Our daughters were 10 and 12 at the time. Despite experiencing a variety of dementia symptoms, it wasn't until this disease caused him2325 to wipe us out financially that he was finally properly diagnosed. Alzheimer's is a stigmatized disease and one that is associated with geriatrics, that is not just limited to perception, it translates to available services. Combination of us being financially devastated with him being too young to meet the age required after many of the services was horrific. I was working full time, still am, raising our daughters, managing our household,2353 and caring for Alfredo, and he was2355 too young for too many services needed by2357 Alzheimer's patience. Alfredo was 58 years old, he just passed away two months ago and he was only 58. While his decline was significant, the one area that remained strong was his social ability, I'm not even sure that's a word, but he was the friendliest guy you'll ever meet and maintained his social skills right up to the end.
In those earlier years when he was still safe to be home alone, he was so socially isolated and limited on what he could do for himself. I wished he was eligible for the companion services that would be included in the legislation that's being discussed today. Research shows the value of social content is tremendously significant for those with dementia. Needless to say, changes proposed in Bill 614 have a great impact on the quality of life with those with younger onset Alzheimer's and their loved ones. The challenges associated with Alzheimer's disease are enormous and those with younger onset as you've heard are unique. My experience was 65 was a common cutoff age for resources sometimes 62 and even less often 60. Bill 614 will extend that waiver as you've heard to include not just those 60 to 64, but almost anyone with younger onset Alzheimer's. By definition, early or younger onset Alzheimer's2438 means the person was diagnosed under the age of 65.
By passing an act relative to early onset Alzheimer's disease, the availability of community services through Mass health will be expanded and proved to make a major difference in the lives of those afflicted, their loved ones, and our communities. When my husband was diagnosed and we learned the realities of the disease, we knew so much of we were advocating for wouldn't change our situation but our hope was that we could speak out, that we could use our experience for all the future progress needed. So I speak out today on behalf of my Alfredo and our precious daughters, but especially for those whose lives we can prove now and going forward. I urge you to pass Bill 614, an act relative to early onset Alzheimer's. Thank you so much for your time and attention and consideration of this important issue, and we're open to any questions. SHOW NON-ESSENTIAL DIALOGUE
Thank you. All for your testimony. Are there questions from members?
2502 Just2502 admiration.
Screenshot.
Okay. The next person we had signed up, a legislator we had signed up was Senator Lovely, then representative f, and then I see Senator Payano and representative,
read an amendment. Thank you. Senator Lovely.
SEN LOVELY - SB 385 - HB 634 - SB 386 - Thank you, Chair Jehlen, Chairs Stanley and members of the committee, thank you for taking me out turn. I'm testifying on two Bills, I will be brief. The first Bill is Senate number 385, House number 634, an act relative to expanding the availability of personal care homes for older adults, filed with our host colleague, Representative Sally Kerans. Personal care homes for older adults would provide the option for a small group home environment of no more than six residents where older adults and individuals with disabilities can receive both housing and long term care services. Residents living in these homes do not require services of a licensed long term care facility in nursing home, but do need assistance or supervision with daily activities. For seniors who are not comfortable living in a large community setting, these personal care homes would provide a real home away from home. The smaller size gives residents a chance to get to know one another better and build important social networks, most often, right, in the same community where they lived and raised a family and worked.
11 other states, have successfully created a system of personal care homes. So what the legislation would do would enable our ASAPs network to partner with housing providers to build or convert housing into small group homes, establishes license procedures through the office of Elder Affairs and creates a spending model for these small group homes that would include two distinct funding lines to ensure the financial viability of the program. This Bill was reported out of committee positively last session, and I would ask for another positive consideration this session. The next Bill I'd like to testify on is Senate number 386, an act relative to goes in continuing care retirement community entrance fees, commute continuing care retirement communities, CCRCs. So this Bill, when a senior goes into a CCRC and the Mass dot gov website has really great information on this, including all the CCRCs across Massachusetts.
There's one in my district, Roxby Village, I want to say there's about 2500 seniors who live in this particular facility. But when you go into a CCRC, seniors must pay a pretty significant entrance fee. Usually, it's almost all the proceeds from when they have sold a home to go into this type of facility. A lot of this entrance fee is refundable when the senior passes away, and it would be given to the family or when a senior moves, and then the senior would receive that back. What this Bill does is sometimes it's a little confusing for seniors, they're not sure do they have to wait for that fee to come back when they're moving on to another location where they would need those proceeds or that entrance fee to go into the their next living situation, or is the family having to wait for an unusual amount of time to receive those funds back? So simply put, S 386 would require CCRCs to provide a separate agreement to the senior upon enrollment that would clearly state the fee and the facilities policy for returning the fee, the senior resident would acknowledge the agreement in writing before paying the full entrance fee, very simple. Again, this received a positive consideration last session, thank you, and we are looking for another positive consideration this session. Happy to answer any questions. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Are there questions about either bill for the senator?
Go ahead and say, committee. Thank you, senator. And next, we have representative, Ash. is online, I think.
SPEAKER19 - Yes.
Hello,
REP ASH - HB 612 - Madam Chair, Chair Stanley, Vice Chairs, esteemed colleagues on the joint committee on Elder Affairs, I thank you for taking me out of order and I thank you for listening to me about this Bill and the good work that you are doing today. I'm here to speak to you about Bill H 612, an act relative to social card games at Municipal Senior Centers. Just to give a brief history; a couple years ago, we had a new senior center open in my town of Longmeadow, and a senior approached me and said that they were no longer able to play card games for nickels or for any money. I didn't know much about the issue or any of the gambling issue or card games or any of the games that necessarily were played, so over the next year or so, we were approached by many seniors throughout my district, and we're asked about this.
Apparently, the state lottery has come down after gambling was made legal in the state of Massachusetts. State lottery has come down on some of the senior centers about gambling as it is illegal, and now there's some inconsistencies as some senior centers continue to allow the senior to do so where other seniors have prohibited. This Bill would simply try to put some consistency in there, giving low stakes gaming where a senior could bet a maximum of $5 per game or per session for the day, and the most anyone could win would be $50. We're certainly not trying to take any revenue from MGM, Encore, Plain Ridge, or anything like that, this is just to try to continue along with some of the fun activities that seniors have to make the excitement for their games there. I know Rep Puppolo has filed a similar Bill as he's been approached by many seniors throughout his district and I believe we had sent a letter. There's over 100 seniors from a couple of senior centers around here that have voiced their concerns and what they would like to have this go through. I'd be more than happy to answer any questions if there are any. SHOW NON-ESSENTIAL DIALOGUE
Do we have any questions for a repash? I'm seeing none. Thank you for your testimony again this year.
SPEAKER19 - Thank you so much.
SPEAKER3 - And so it's under Patiano, Representative Mendez.
Well, let me just before you, I just wanted to mentioned that in the previous fill, house 614 about early onset that representative, Bradley Booveier had sent written testimony. I'm gonna try to announce written testimony
SPEAKER10 - over
SPEAKER3 - those people who aren't here. Thank you. Senator.
SPEAKER20 - Thank you. Well,
SEN PAYANO - SB 379 - HB 640 - Thank you, Chair Jehlen, Chair Stanley, and the rest of the committee for allowing us the opportunity to speak today on Senate Bill 379 and House Bill 640, an act to improve infection control in Massachusetts home care. You know, during the pandemic, I was actually a city councilor and I was chair of the public safety committee and one of the things that I would receive almost on, like biweekly basis is the individuals that had passed away because of the pandemic and it got to the point where I stopped reading those memos and that information because it's I happen to have known a lot of individuals and a lot of my elderly that unfortunately are not here with us today. You know, the one positive thing if there was anything positive is that there was a lot of takeaways, a lot of lessons learned during the pandemic on how to do things different, and I think that this Bill goes to that. It mandates an infection control training program for all PCAs, personal care attendants, and direct care employees. The language specifies that the training is going to be developed based on the current infection control training offered to new PCAs, during the hiring orientation.
It's a one hour training that would teach home care workers proper techniques and strategies to reduce the threat of spreading viruses and pathogens. It's including how to use the proper use of gloves, how to handle dirty laundry, and the safest possible disposal of waste and other techniques that I think would end up saving lives. My grandma is 91 years young, she's a survivor of breast cancer and is currently still battling the disease for several several years and one of the things that I always keep in mind is the people that are coming into her home, those that are taking care of her, are they trained enough? Do they know everything that they need? I think that something like this is to me, initially before filing this Bill, I thought that this was mandatory. You know, I thought that after a couple of years of this, it was something that was mandated throughout, so it became a huge concern of mine, and this is why I'm here before you today hoping that this receives a favorable recommendation. Thank you so much for your time.
REP MENDES - SB 379 - HB 640 - Thank you so much, the committee, for your time. This is a very straightforward Bill and what really is proposed in it is just makes it a mandate. So the new PCAs, they're doing it, but it's not really a mandate, so it's, like, optional at this3108 point, they figured it would be included as part of the training because of what we went through with Covid, but making it a lot making it a mandate and also the plus hundreds of PCAs, licensed people that are going to people's homes every day without receiving this training because In the past, we didn't think about this because we hadn't really had the experience with Covid and how deadly that could have been. So now3135 we're thinking of these things, and we're trying to play catch up with the times that we're living right now. So we don't want to wait for another outbreak of something more and to know that we could have done something to prevent this and to make sure that the most vulnerable population, which is older adults, the disabled people, when they have others that are treating them, have been through this training, and know the proper ways.
I've looked through the training that they offer now, and it's very straightforward, but it's crucial. There are going to be members here today from SEIU that's going to be testifying on this training and the great things that it could do to really protect this vulnerable population. So I urge all of you to really recommend this favorably so they can start working with the department of health and implement this across statewide and making sure that this becomes law and goes into effect right away. Obviously, there's going to be a time frame for those who are already licensed to be able to go and take this training online, one hour translation available, and that all is going to be done after the fact, but now we need to make sure that there's a line placed and that we pass this right away. So I urge for a favorable recommendation. I thank you so much for your time. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
SPEAKER3 - Questions for members? I know we have several other panels so we can ask more questions later. Thank you.
Issue for this bill.
I'd like to welcome representative Michelle Debois from the committee who is here. But now we have a panel from 1199, James Wilmas, and members who are going to introduce there's how many?
SPEAKER1 - 1, 2, 3?
SPEAKER17 - Mhmm. Or or -- Yeah.
SPEAKER1 - --
SPEAKER3 - panelists We need more chairs. Sorry. Can you like
SPEAKER21 - We'll do switch out.
SPEAKER3 - Switch in and out.
There's 1 more chair here.
SPEAKER11 - Good enough.
SPEAKER21 - We'll figure it out.
Let's get started.
JAMES WILMAS - 1199 SEIU - SB 379 - HB 640 - Good morning, Chair Jehlen, Chair Stanley, members of the committee. I appreciate the opportunity to be here today with these 119 SEIU home care worker members, testifying in support, and on behalf of more than 75000 Massachusetts members, and strong support of an act to improve infection control in Massachusetts home care. As we begin to emerge from the worst of the Covid-19 pandemic, it's time for state government to act upon the lessons learned and to learn from the experiences of the Massachusetts home care workforce in order to improve care delivery under States many home care programs. Everyday across the Commonwealth, tens of thousands of home care workers deliver personal care and other essential long term supports and services to tens and thousands of elderly and disabled consumers, and these workers deliver intimate care, like assistance with bathing and toileting, putting themselves, those they care for in their own families and communities at high risk of spreading infectious diseases. That's why 1199 SEIU worked with the administration back in 2021 to develop and implement a new and updated one hour infection control training that's now given as part of the new hire orientation for personal care attendance.
To date, more than 6000 newly hired PCAs have successfully completed that training. Yet, there is as many as 50,000 PCAs who began working before 2021 that have not gotten this training as part of their orientation, and there are almost as many workers at private home care agencies that are ineligible altogether. To help address this across the home care industry, 1199 SEIU worked with our lead sponsors to file the Bill, a Bill that directs the executive office of Health and Human3370 Services in consultation with other appropriate state agencies, community stakeholders, and the workforce itself to develop a standard infection control training program for all Massachusetts home care workers. EOHHS would in turn contract with the state's home care agencies, the 1199 SEIU training fund and other existing training entities to conduct this training. Upon passage, though the PCA training will be a helpful model, there will need to be an updated curriculum along with new program rules and EOHHS regulations.
We expect to work3403 with EOHHS, the industry, and other stakeholders to ensure that the new infection controlling training, one, would be mandatory for all workers, two, that there would be a long perhaps multi year grace period before workers would be required to complete the one time training, we certainly don't want to lose any home3420 care workers who are already short staffing and wait list for care. Three, that the workers taking this mandatory training would be paid by state government. This very low income workforce cannot afford to take time away from their consumers and their families without being reimbursed for their work to complete this training. Thank you for your time and attention, we respectfully request a favorable committee recommendation for an act to improve infection control in Massachusetts home care, and we look forward to continued collaboration in furthering our shared vision of a robust spectrum of long term supports and services that is safely delivered to all those in need. SHOW NON-ESSENTIAL DIALOGUE
With your permission, I'd like to turn it over to William to give his testimony.
WILLIAM KYLE - PERSONAL CARE ATTENDANT - SB 379 - HB 640 - Good afternoon, members of the committee. My name is William Kyle, I currently reside in Everett, Massachusetts. I've been a personal care attendant, a PCA, going on 20 years now. I am also a proud member and delegate of 1199 SEIU. I am here in support of creating a mandatory one hour paid infection control training for all home care workers. In all my years as a PCA I have never had access to this type of training. Coming out of the Covid pandemic, it is crucially3505 important that all PCAs and home care workers in the state of Massachusetts do get this training. In our new hire orientation, there is a piece with this training, but access to that is limited to new PCAs only. I've been to PCA long before there was any orientation program or this new training, and I'm sure I'm not the only one in this position.
We need to open this training to all home care workers across the state, it should be mandatory and it should be paid. All through out Covid, there were decent restrictions, but PCAs and other home care workers like myself were unable to uphold this. Due to the nature of the care we provide, we provide close contact care, sometimes called intimate care, such as bathing, toiletry regimens, and assistance with lifting and mobility, all requiring close contact with our consumers. So this training would protect not just ourselves and our consumers, but our families and loved ones as well. If I got this training, I would definitely pass this knowledge on to my five daughters. I would like to thank thank you all for your time and support in passing this tremendously important Bill forward, and please enjoy the rest of your day. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
JANICE GUZMAN - 1199 SEIU - SB 397 - HB 640 - Good afternoon, committee. My name is Janice Guzman, I'm from Worcester Mass. I'm a proud PCA and a delegate from 1199 SEIU. I am the current executive council member in the home care for the 58,000 PCAs in Massachusetts. I have been a PCA since 2003, 20 years to be correct. I have taken multiple trainings from 1199 upgrading funds, which helped3627 me so very much on a daily basis for my job. These trainings have helped me in so many ways, like how to keep myself from injuring my back and from also injuring my consumer. Like, for example, Covid-19, I wouldn't be able to attend to my consumer if I didn't have proper PPE to stay safe, and wear our K 95 and gloves, or else I wouldn't be3655 here today. Also known that a catheter, if our consumer has catheters, we have to take care of those on a daily basis. We need to learn how to clean those catheters or else they can get a bad infection and can get to serious more complications. So this is another problem that we need infection control training because the majority of our PCAs who are new don't know how to do this.
All these training should be paid due to when a PCA has to do one of these trainings, they take a hardship losing hours for the training, and they have less money to pay bills or put food on their tables for their3695 family. This is the number one reason why PCAs3699 who are grandfathered in, like myself, do not take these trainings due to they are not paying. Homecare is growing right now,3709 there are 58,000 in our states, and we keep growing. So, therefore, the state should and that's more on us, the home care workers. Today, I testify and hoping you guys will pass and act to improve infections control in Massachusetts home care workers. Thank you for your time. SHOW NON-ESSENTIAL DIALOGUE
Just before you, Twilio, or if you leave other questions for these members and the of the panel. Otherwise, we'll bring up the other members of your panels.
Can you speak into the microphone?
SPEAKER5 - I got non
SPEAKER1 - what a manhood.
SPEAKER18 - Wow.
You saw your window chip jog.
Not
3864 SPEAKER73864 -3864 like.3864
JUDY - 1199 SEIU - SB 397 - HB 640 - Good afternoon. My name is Judy, I'm a home care worker. I have worked for Elara Home Care Agency for more than four years. I am also a member of 1199 SEIU. I immigrated to the United States from China in 2018. My sister also entered the industry as a home care worker. Not long after I start working, the pandemic happens suddenly, the impact of these events didn't stick on all walks of life were unimaginable especially for us. For the frontline workers in the industry, we have to take care of ourselves and our families, and mix and meet, we have to work from clients to clients, we have face to face contact with our clients who are all elderly. If they are infected with a virus, it4014 posses a serious threat4016 to their life. There is a lot of psychological pressure on the home care worker to keep them and ourselves safe. I wear a glove and a mask when4035 I work and I wash4037 my hands frequently. Although I'm careful,4041 I still got the coronavirus twice during the pandemic. In order to raise awareness, Elara and1199 SEIU jointly organize some infection disease training for all employees. For me, this knowledge is very useful to deepen our understanding at work, and these training classes are paid. Our industry needs to increase awareness of preventative measure to truly protect clients and ourselves. So I hope Massachusetts legislators will support the safety of home care workers and pass this Bill as soon as possible. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Are there questions for this panel? I'll just express appreciation to all 3 of the PCAs who's spoken, the work you do is so important and underappreciated and under compensated. and we are grateful for that, but
SEN JEHLEN - I did have a question; there's no mandated training for people who have long period of experience, is that right?
WILMAS - Correct. The only mandated training for PCAs is the new hire orientation and those who've been working before 2020 are not required to take that.
JEHLEN - So that's interesting also. And for people who work in the private sector, there's no requirement for training?
WILMAS - Well, like, this worker who works at Elara, they do have in service trainings.
JEHLEN - But not mandated?
WILMAS - They have to go, but there are not any particular mandated trainings, those in services are decided based on by the agencies who decide on their own training that they're going to offer. Sometimes it's about how to submit your time sheets, sometimes it's about how to deal with an angry client.
SHOW NON-ESSENTIAL DIALOGUE
I do SHOW NON-ESSENTIAL DIALOGUE
wanna talk about the in services at all, but you'd get
SPEAKER2 - It's easier.
SPEAKER1 - Actually
JUDY - Actually, I'm not a worker, I am just helping them to connect to the company what they need for the training because they have monthly labor and management meeting, the worker will suggest they need how to protect themselves for that surface.
WILMAS - So that's the situation at Elara where we have labor management meetings. Alara is one of 400 and something home care agencies that it's represented by a labor union, we only represent one in Massachusetts. So I think they have a little bit more say in sort of what kind of trainings they get, but, usually, that's decided by the home care agencies. As we've discussed before, there are absolutely no state regulations whatsoever about operating a home care agency. Nobody in state government is telling them they have to train their workers in any particular way or operate their business in any particular way. There's no license, there's no certificate, there's no regulations at all4275 about home care agencies and how they operate.4277 SHOW NON-ESSENTIAL DIALOGUE
Okay. Thank you.4279
SPEAKER3 - I think we have another We have Julie Watvicker is on
SPEAKER1 - --
SPEAKER17 - Thank you.
SPEAKER1 - --
SPEAKER3 - online for us. Are you there?
SPEAKER23 - I'm here.
SPEAKER3 - Okay.
SPEAKER23 - Hope you can see me.
JULIE WATT FAQIR - HOME CARE AIDE COUNCIL - HB 640 - SB 397 - Thank you, Senator Jehlen, Representative Stanley and members of the committee. We are grateful for this opportunity to testify on H 640 and S 397, an act to improve infection control in Massachusetts home care. I'm Julie Watt Faqir, I'm the executive director of the Home care Aide Council. We are a membership association with 100 agencies as members who directly employ and supervise and manage more than 50,000 home care aids who provide direct care services to elders and disabled individuals throughout this day in their homes. Training the home care workforce in infection control is vital to ensure the health and safety of our dedicated home care workforce and the frail elders who they take care of. The council fully supports and our member agencies currently implement infection control training for their home care workforce. Home care agencies who contract with the aging service access points, the ASAPs, are already required to provide infection control training when aids are onboarded during their orientation and on an annual basis, as part of their in service requirements.
The proposed language in this Bill requiring employees of all home care agencies to take a proposed mandatory infection control training is appropriate for employees and agencies where no current infection control training requirement or mandate exists. Home care agencies at contract with the ASAPs already adhered to an existing requirement. Therefore, this proposed mandate would be duplicative and is unnecessary. It can also cause confusion by establishing two different infection control training requirements for the same home care services delivered by the same home care workers. We respectfully propose consideration of an amendment to add home care agencies contracting with the ASAPs and home health agencies to the list of agencies and provider groups already excluded from those requirement. We suggest language that Section 1A is hereby amended by asserting in line 13 after the words ASAP entity, as defined in Section 4B Chapter 19A, the following; a home care agency who contracts with an ASAP entity and a home health agency as defined in Section 51K. Thank you for your commitment to the Commonwealth's home care program and your tremendous support of the home care workforce. We will be submitting written comments. Thank you. SHOW NON-ESSENTIAL DIALOGUE
And thank you. Let's ask Jake4447 Kirlovich to come forward also online, and then we'll have questions from members.
SPEAKER24 - Thank you. Thank you to the committee.
JAKE KRILOVICH - HOME CARE ALLIANCE OF MASSACHUSETTS - HB 640 - SB 397 - Good afternoon. My name is Jake Krilovich, I'm executive director of the Homecare Alliance of Massachusetts. On behalf of our over 200 members, we do appreciate the opportunity to provide testimony on this Bill. Today, I'll raise a few substantive concerns about4471 the legislation, but also offer a couple of perspectives on the policy and the environment on the ground. First, substantively, we would like to alert the committee just like Julie just did to the fact that home care agencies under contract with aging service access points4485 already have infection control requirements4487 as part of their contracts in the home care program Again, like Julie said, they require training during the employee onboarding and on an annual basis as part of their in service requirements. In addition, federally certified home health agencies are also required to implement infection control requirements as part of the federal conditions of participation from CMS. Therefore, it's our belief that this legislation and proposed new mandate would prove duplicative and unnecessary. Like, Julie, we propose adding an amendment that would exclude home care agencies contracting with ASAP entities, and also exclude home health agencies as defined in the Massachusetts General Laws Section 51K.
I want to be clear, the home care alliance and its membership wholeheartedly support adequate infection control measures. That's why we support an infection control requirement within Senator Jehlen's and Representative Stanley's licensure legislation currently before the body. We believe that the requirements within the ASAP home care program, CMS' conditions of participation, and the requirement in the proposed licensure legislation would subject all home care providers to infection control requirements from private pay home care agencies to state and federally funded providers. Our second drafting concern WITH the legislation pertains to section 1B, which instructs EOHHS to establish contracts with labor management, training funds, community colleges, and other entities. While home care agencies could be considered part of the other entities category, we believe the legislation should be more specific to allow home care agencies themselves to conduct any such training.
Third party training programs may benefit personal care attendants who do not have the infrastructure of a traditional employer model but it's critical that home care agencies themselves be able to develop and meet any training requirements for their own employees. Given the incredibly high turnover in this industry, we believe the Commonwealth should do everything possible to strengthen the employee, employer relationship, and training is one of the most effective ways to do that. It does not make much sense given the high turnover for a home care agency to hire a new caregiver and then require that new hire to be trained elsewhere. Strengthening the bond and trust between an employer and its employee is one of the greatest things we can do to improve retention in this industry. Lastly, I'll just offer a bit of perspective4622 on the proposed legislation as it relates to the current environment and in the past three years.
As everyone knows, when Covid gripped the health care industry in 2020, there was a rapid race to overhaul existing infection control mechanisms and care delivery. The single greatest challenge for home care agencies and its workforce at the outset was access to adequate personal protective equipment, not adequate understanding and training on infection control. Legislation should aim to solve policy issues, and by all accounts, infection control in the home care setting was extremely effective as compared to facility based settings. I should remind the committee that during this time, there was a significant effort to expand access to services in the home due to it being the safer setting. But due to lack of licensure in our state for these services, home care and home health agencies struggled to establish adequate PPE supply chains and we struggled to get priority access to state and federal PPE stockpiles because of4680 this. So one question that I think that's important to consider is, are we looking to fill an educational training gap because infection control is somehow failing in our state or should we focus our attention to licensing these services to4692 ensure that home care providers and their direct care workers are on the radar for PPE when the next pandemic hits?
I'll end with this; we're in the midst of a catastrophic workforce shortage for these services, and we need to remember that our direct care work continue to practice enhanced infection control measures in the home care setting. There's a lot of fatigue, frustration, and angst about topics like PPE, mask mandates, vaccination mandates among our workforce, and quite frankly,4718 they're exhausted and we've asked a4720 lot of them throughout the pandemic. While many of us feel that we've moved on from the pandemic, our direct care workers are still dealing with the virus on a day to day basis and that doesn't mean we shouldn't improve our understanding of infection control or ensure that we have adequate standards. But I think it's important that as we consider new mandates to keep in mind the incredible work that our home care providers and their direct care workers have done in keeping workers and their patients safe for three long years. I'm happy to answer any questions, but we do respectfully ask the committee not take action on this legislation while us and other stakeholders continue to work toward4752 a reasonable licensing structure for home care services. Thank you, Senator. SHOW NON-ESSENTIAL DIALOGUE
And thank you. Are there questions for members? If not, thank you. We will Yes. Thank you very much. Now we're taking up senate
SPEAKER1 - 365
SPEAKER3 - and house
SPEAKER1 - 636
SPEAKER3 - We have testimony from the Fenway Health, LGBTQIA
SPEAKER1 - --
SPEAKER3 - Okay. -- project. Sean Cahill and Lisa Krinsky, they are online. Okay.
SPEAKER1 - Oh, yeah.
SPEAKER3 - I think I see Lisa.
SPEAKER25 - Yes. Good afternoon.
SPEAKER26 - Okay. Hi, everyone. Lisa, you're gonna go first. Right?
SPEAKER25 - Yes. I am.
LISA KRINSKY - LGBTQIA PLUS AGING PROJECT - HB 645 - SB 376 - Good afternoon, and thank you to the committee for the opportunity to testify, I'm going to be speaking on H 645 and S 376, an Act relative to Massachusetts home care eligibility. I'm Lisa Krinsky, and I'm the director of the LGBTQI plus aging project. My colleague, Sean Cahill of Fenway Health and I are submitting written testimony for both this Bill and H 636. I will speak on this Bill, and Sean will testify in H 636. The aging project work starts equity, inclusion and community for lesbian gay bisexual transgender, queer questioning intersects an asexual, older adult to ensure that they can age with the dignity and respect they deserve. We are proud of the Commonwealth's leadership on LGBTQIA plus aging issues with first in the nation legislation establishing the Massachusetts LGBTQ Aging Commission and legislation requiring LGBTQ cultural competency training for the executive office of Elder Affairs Statewide Network of Elder Care Providers. Today, we have another opportunity for leadership, I ask your support for individuals who are living and aging with HIV/AIDS, who are experiencing health and functional complications that meet the state's home care program eligibility, but do not yet meet the age requirement of 60 years of age. In4876 the world of HIV/AIDS, age 50 has been considered old, many didn't live to see that age.
Today, we talk about long term survivors those living with HIV/AIDS for 20 plus years. They were pioneers having lived through this epidemic, and the early4891 years of treatments and never imagine themselves reaching an old age, and still, they continue to be pioneers as they live at the Intersection of the illness, the long term impact of their treatments and the inevitable experience of aging. The irony is that for some functional clinical elements of old age such as cardiovascular disease, cognitive disorders, liver and kidney diseases to name a few have arrived before the state's definition of old age 60 has arrived. Imagine having lived with HIV/AIDS for more than 20 years, lost scores of friends and loved ones and now surprisingly find yourself at 57 and needing assistance with bathing and dressing, groceries, transportation, laundry and facing potential nursing home placement because you are three calendar years younger than the age eligibility criteria despite functioning at the level of someone 10 or 20 years older.
Massachusetts is fortunate to have a robust community based option in the state home4950 care program for older adults that successfully provides home based services as those I just referenced. Services that support independence, physical, and mental health, and it costs far reduced from those of residential long term care. Previous testimony addressed those living with early onset Alzheimer's, understanding the need to support those who are not yet 60 but facing the functional impact of an older person's disease. We think the same is true for some of those who are aging with HIV and AIDS. On behalf of those who are aging with HIV/AIDs, I ask that you provide them with access to the state home care program and remind you that our LGBTQ aging commission has identified access to home care for those with HIV and under the age of 60 as one of our priorities. This access will not open the floodgates nor will it incur significant costs for the Commonwealth, but it will recognize these long term survivors and pioneers and afford them the opportunity to benefit from the services and supports that will enable them to live independently in their community with the dignity and respect they deserve. Thank you for your time and consideration. SHOW NON-ESSENTIAL DIALOGUE
And thank you, and gonna take Sean Cahill, and then we'll have questions.
SEAN CAHILL - FENWAY HEALTH - HB 636 - SB 365 - Thank you, Chair Jehlen, Chair Stanley, and members of the committee. Fenway Health and AIDS action would like to go on record in support of H 636 and S 365, an act relative to LGBT and HIV positive seniors in the Commonwealth, we urge you to report this Bill favorably This bill would designate older LGBT people and older people living with HIV as populations have greatest social need under the older Americans Act. I'm Sean Cahill, director of Health Policy Research at Family Health, a federally qualified health center and HIV Clinic serving about 35,000 patients, about5065 half5065 of our patients are LGBTQ plus and about 22100 are living5069 with HIV. Older people living with HIV experience higher prevalence of comorbidity conditions such as kidney disease, geriatric conditions like frailty, behavioral health burden, psychosocial needs, and disability. People with HIV in the US are almost twice as likely5086 as the general population to have a disability and older people with HIV are 2.5 times more likely to experience cognitive decline than their age peers who are HIV negative.
Older people with HIV in the US are more likely to live alone, have higher rates of loneliness, social isolation, and lack of social support, and older gay and bisexual men living with HIV are twice as likely to experience depression compared to their age peers who are HIV negative and heterosexual. I'd also like5118 to present some research on older LGBT people in Massachusetts, this is based on a study we did in collaboration with the Massachusetts LGBTQ Commission, which is led by Senator Jehlen and Representative Stanley. We conducted nine in person and virtual listening sessions with older adults across Massachusetts, in 2019 and 2020 and found a number of important findings, including high rates of anti LGBT prejudice and discrimination, particularly in rural parts of5149 the state, social isolation5151 and lack of connection, the need for ongoing services and mental health care for widows and widowers in our community, the need for social activities that create a sense of community and belonging, and the need for targeted support groups and services.
We also work with colleagues at Mass Department of Public Health and analyze behavioral risk factor survey data and compared older LGBT people to older straight cisgender people and found a number of important findings, including twice the rate of depression, three times the rate of reporting difficulty paying for housing or food in the past year, twice the rate of falling in the past year and being injured in a fall in the past year, and four times the rate of suicidal thoughts in the past year. This report is available on our website and cited in my comment. So we know that older LGBT people and older people with HIV have unique needs and experiences and may be in greater need of formal elder services But at the same time, they may be less likely to access these services due to fear of experiencing discrimination and stigma in elder services. So designating these populations as populations of greatest social need would encourage elder service providers to think more explicitly about how they're meeting the5232 needs of these populations and how they're5234 ensuring that they can access affirming culturally responsive services. I'll just mention that six other states have done this for older LGBT adults, four states have done it for older people with HIV plus the5247 District of Columbia. So thank5249 you very much for considering this5251 testimony and considering favorably reporting the act relative to LGBTQ and HIV positive seniors in the Commonwealth. SHOW NON-ESSENTIAL DIALOGUE
Do that. So thank you for your testimony and especially for calling our attention to the listening tour of which the commission is going to do another series this year. and welcoming vice chair, Liberty River Caribbean as taking leadership in that commission. Thank you all. Are there members that have questions?
Okay. Hey. Thank you. Susan.
I talked
SPEAKER7 - about.
SPEAKER3 - We're moving on to house 624 and senate
SPEAKER1 - 398.
SPEAKER3 - think we have a panel from the mass councils on Aging. Do you have Betsy Connell and Susan Keller?
SPEAKER27 - Yes. You do.
Thank you so much.
ELIZABETH CONNELL - MASS COUNCIL ON AGING - SB 398 - HB 624 - Thank you, Chairs, Jehlen, Chair Stanley, and all the members of the joint committee on Elder Affairs. I appreciate the opportunity to testify today in support of S 398 and H 624, an act relative to counsels on aging. I also want to thank Senator Rausch and Representative Donaghue for their leadership on this legislation, which will certainly provide a much needed update to the council on aging statute. I'm Betsy Connell, the executive director of the Mass Councils on Aging. We are the nonprofit membership association of the 350 Massachusetts municipal councils on Aging and Senior Centers in5362 the Commonwealth serving all your districts who support the 1,700,000 older adults in Massachusetts in5368 leading healthy and purposeful lives. The purpose of this Bill to amend Section 8P of Chapter 40 of the General Laws is twofold. First, to amend outdated and aging terminology, and two, update language which does not reflect the current construct of the majority of council on aging boards. Since the statute establishing councils on aging was passed in 1956, the councils have fallen into two categories; supervisory and advisory. The current statute states the council may appoint which only reflects the constructs where the council on aging, an appointed board has supervisory or hiring capacity.
Whereas over the last 60 years, the majority of councils on aging and their boards shifted to become advisory as municipalities built senior centers and created senior center and council on aging director positions and created other support staff positions for their council on aging departments. As you can see in the Bill, the proposed language change reflects both constructs,5443 thus allowing both the capacity to hire staff whereas without the additional language only the council is allowed to hire. Issues with the outdated statute were brought to our attention last year when the town of Sherborn having submitted and received approval through town meeting of a warrant article to change their council on aging bylaws was notified by the Attorney General's office that the warrant article was disapproved. The Attorney General stated, they disapproved the warrant article text that authorized the director rather than the council on aging, to hire all other staff positions for the council on aging because it was in conflict with Chapter 40 Section 8B. So I want to urge the committee to support this Bill and give it a favorable report so that the council on aging and their directors can continue to run their centers without being at risk for being in conflict with the state statute. Thank you. SHOW NON-ESSENTIAL DIALOGUE
And thank you. Sue Kellogg, you're here also?
SPEAKER28 - Yep. I'm here. Thank you.
SUE KELLIHER - SHERBORN COUNCIL ON AGING - SB 398 - HB 624 - Thank you, Chairs, Jehlen, Stanley, and the members of the joint committee on Elder Affairs. I appreciate the time and opportunity to testify today in support of S 398 and H 624, an act relative to councils on aging. I'd also like to thank Senator Rausch and Representative Donaghue for their leadership on this legislation. So as you heard, my name is Sue Kelliher, and I'm currently the director at the Sherborn Council on Aging. When I was hired three years ago, I was supervised by the COA board, they were a supervisory board in which leadership changed every year. As the director, I was responsible for supervising my staff. Due to the evolution of how the structure and operation of how towns currently work, we found that the supervisory board model was not consistent with town personnel policies. For example, the board wasn't always knowledgeable on appropriate hiring practices, personnel issues, and there was the potential that they could also make changes that could be costly and or legally challenged. We went5582 to town meeting to obtain approval to change from a supervisory to an advisory board, this was approved by our Council on Aging Board and was voted on and5591 approved by the town to change the original town by law, which was written 50 years ago upon the establishment of the COA.
When the by law change was submitted to the Attorney General's office, they approved only a portion of the by law allowing the director to report to the town administrator, but they disapprove the director hiring staff as the state statute states that only the board can hire what they call clerks or staff. This is counterintuitive since the staff works and reports to the director and is the director's responsibility. This5627 is the model that has evolved through the years as towns become more complicated and sophisticated in the way they are structured. This is the reason we are asking for the original bylaws to be changed and made current and relevant to how advisory boards are currently structured. Where the director would report to the town administrator, the town administrator would conduct their personal performance evaluations, and then the director would be responsible for all their direct reports. Your approval to support this Bill would be very much appreciated and relevant for today's COA structure. Thank you. SHOW NON-ESSENTIAL DIALOGUE
SPEAKER3 - Thank you for your testimony. There's a question for members. If not, I'd like to thank you and representative, Donna, and set it around for bringing this to our attention, which we did not know about. Thank you for your testimony. Next, we have Thank you. I sent 367 in house
SPEAKER1 - 639
SPEAKER3 - about public awareness of community based PACE programs. We have a panel. Is that online? I believe it's Candy Koopa.
Casey, Gerald Casey and Tracy Leberg.
Welcome.
I can't hear you though.
Are you muted?
SPEAKER9 - Hello?
SPEAKER3 - There you go. Okay. Good.
SPEAKER29 - I apologize,
CANDACE KUEBEL - MASS PACE ASSOCIATION - SB 367 - HB 639 - Senator Jehlen, Representative Stanley, distinguished chairs and members of the committee. Thank you so much for this opportunity to speak in support of this Bill, S 367 and H 639, an act increasing awareness of community based PACE programs for older adults. So I'm Candace Kuebel, I'm the5758 executive director of the Association of all eight Pace organizations in the state of Massachusetts, an alternative to nursing facility placement. Pace is a federally and state funded provider of medical care, which also serves as a health insurer. This unique arrangement ensures that decisions about medical coverage are in the hands of the member and their healthcare team. So in a few minutes, Tracy, who is a caregiver, and Gerald5791 are going to give you a little bit of information personally about Pace, so I'm not going to go on and on about it here but let me tell you what the Bill does. The Bill promotes awareness about Pace by inserting a little clause to existing statute two times in Chapter 19A, once in Chapter 1118E to include information about Pace when5820 presenting options, to individuals who come through the state seeking alternatives to nursing facility placement. So a lot of people have talked about the crisis that you are all very familiar with, back to New York Times, February of 2019, one of many headlines, a growing American crisis who will care for the baby boomers? Well, something that I5847 don't think anybody has spoken of today yet is the fact that caring, this is a quote from this article, but it's in all of the literature, caring for America's elders is the single most expensive, it's also the single most important if you ask me, domestic priority on the horizon.
Breaking the projected budgets of both Medicare and Medicaid, all 50 states, most of the middle class, and the truth is no one is truly prepared for what is to come. In the year 2002, the National Institutes of Health put a study out on this 30 years ago and they said that the title was called the 2030 problem. Well here we are, seven years away from the 2030 problem. You know in Massachusetts, we've worked pretty hard to develop and promote some of those very solutions that were outlined in that article and now this committee has the opportunity to promote one of those solutions, and that is to promote awareness about pace, which is simply what this Bill will do. So one last point, I just want to say a lot of times I have been asked, why don't you just advertise this program more? All of our programs are non profits, they don't have the budget to do a broad scale advertising campaign and we have the infrastructure to promote awareness of this program in place, we just need to give it a little nudge. With that, I thank you so much for the opportunity to testify. I would like to thank5959 Representative Madaro and Senator Eldridge for their leadership on this. SHOW NON-ESSENTIAL DIALOGUE
And now I couldn't be more pleased to introduce5967 Tracy Leibberg, who will then introduce Gerald Casey to share some of their personal stories about PACE.
SPEAKER30 - Okay. I hope everyone can hear me.
SPEAKER12 - Yes.
SPEAKER30 - Okay.
TRACY LEEDBERG - CONCERNED CITIZEN - HB 639 - SB 367 - Thank you, chairs, and members of the committee. My name is Tracy Leedberg, and I'm testifying in support of S 367 and H 639, an act increasing awareness of community based Pace programs for older adults. In 2019, my partner, Jimmy, suffered a spinal cord injury. On the way to the med evac helicopter, the paramedic braced my shoulders and said, listen to me, this is a life altering event, I had no idea what that would really mean. Jimmy survived with a C5 level spinal cord injury, leaving him with quadriplegia. After months in an acute rehab, we were sent home where we would receive the supports needed in the community. What we actually got were weekly or monthly check ins, despite him having a PCP, a dozen specialists, social workers, VNA, who was assigned to elder services and to a community partnership program, all incredibly expensive providers and programs, we had very little of what we actually needed, and none of them talked to each other. No continuity of care, no coordination, no reliable transportation, no caregiver support, countless ambulance trips to the ER for non urgent care, countless hospital admissions with core of any discharge planning, which then often resulted in needless and repeated readmissions, no meaningful help at home, no respite, and no quality of life.
Alone, I was trying to do the work of an entire 24/7 facility staff doing everything from PT to OT, skilled nursing, housekeeping, scheduling, medication and case management, wound prevention, bowel and bladder care. I didn't have the physical, emotional, or financial reserves to do it all, just like too many family caregivers, I was just existing like Sisyphus. I called these doctors and the social workers, the hospitals, and the agencies sobbing, begging for help only to be told there was nothing else available to us other than a nursing home. We both suffered6128 the consequences of my burnout and exhaustion. After almost three years, I found some of the elder care pace on my own quite by accident. I contacted every provider, they knew about it but I heard some version of, yes, that's a great program, I didn't even think of that, what? Honestly, I didn't think pace could be real, and I was very skeptical but it is real and really life changing. Summit's pace needs all of the health and support needs that I had been searching and begging for. We are equal members of a comprehensive proactive whole health care team with Jimmy's well-being always a focus. It's not just sickness management or observation. Pace is the standard for what wraparound care should look like, it's medically, socially, culturally, and fiscally responsible for all stakeholders. Family caregivers deserve the support we need to keep our family members out of hospitals and nursing homes.
We deserve information about this high quality community based life changing model of care. For me, it's frustrating to see somebody reports confirming what we need, everything from Medicare And Medicaid Universities, the Commonwealth Fund, NIH HHS.6207 So much money is spent just confirming barriers and solutions for improving outcomes in health care for high need, high cost populations. Expensive initiatives for providers and communities to become6222 age friendly and inclusive, improve overall health care, reduce secondary illnesses and complications. True interdisciplinary community health6228 care teams like Pace are a solution. I'm here to tell you that Pace has already proven that they know how to deliver, they've been doing this well for decades, but families depend on our health care providers to tell us about these resources. Pace interdisciplinary care teams are not an idea on a bulletin board, it's how they start the day every day. Walk into a summit day room, you'll see engaged people with smiling faces, participants and staff, it's very different than walking through a nursing home. I'm just one family care, there are thousands of women like me caring for a spinal cord injury partner and thousands of family caregivers to seniors with complex needs struggling every day. There isn't enough time for me to tell you all of the examples of how Pace has provided exceptional whole person care for Jimmy, but I will tell you this; I would choose summit pace for my own care, for my own mother, it's all inclusive, cost effective, personalized, and sustainable. I know without summit pace, Jimmy would have ended up a 55 year old man permanently placed in a nursing home waiting and wanting to die, no caregiver or receiver should be faced with that. I can't put a dollar amount on the benefits of Jimmy being enrolled in Pace but for us, the hope and help that we have now is priceless. Thank you. SHOW NON-ESSENTIAL DIALOGUE
And now it's my pleasure to introduce Daryl Casey.
SPEAKER2 - Can you hear me?
SPEAKER3 - Mhmm. Yes.
SPEAKER2 - Oh,
GERALD CASEY - CONCERNED CITIZEN - HB 639 - SB 367 - Thank you very much. My name is Gerald Casey, I'm 75 years of age and I'm a Vietnam veteran. The first thing I want to do really is to really afford the East Boston Neighborhood Health Center and its leadership for bringing the pace program into their facility. I think the leadership has been outstanding in the administration of this program. I moved away from Boston about 13 years ago, and upon returning to Massachusetts of Virginia, I was looking for a health care, that is when I ended up joining the East Boston Neighborhood Health Center where a lot of my health care concerns were addressed. After having about with blood clots and the East Boston Health Center immediately sent me over to Boston Medical to deal with that issue, and I'm thankful for the partnerships that the pace program has with all these institutions. I took a real personal interest in my health care because of this near death experience. During my health care visits, to the East Boston House, and I was introduced to the Pace program via a brochure. I was intrigued about the services they offered a person my so I made an appointment that was accepted to the program. The assignment to a neighborhood center where I could go and participate in around variety activities. I also started to tell you the wellness center where they offered programs and exercise, yoga, meditation, nutrition, classes and so much more. The center allowed me to teach others about computers, to allow me to help solve a book club in a class on bomber operation. I felt that I was contributing to the overall program and services they were offering us at the wellness center.
During this time, I was assigned to my team of healthcare professionals led by my primary care physician to address all of my health care needs6466 from physical to mental by offering massage therapy acupuncture to chiropractic service and specialized services6472 where needed such as eye and dental. What I liked about the pace program was a professional attention, this health care team stabilized my high blood pressure. I was able to lose over £100 to address my issues with my blood clots. They provided me with daily home delivered meals and transportation to and from my many health care appointments. I6499 can honestly say that the East Boston Neighborhood Center and its pace program6503 save my life and continue to help me maintain a6508 good quality of life and own. However, health care is a two way street; individuals must take a personal interest in their health care and to be encouraged to do so by their health care professionals. The pace professionals encouraged me to do so and I've been a member of the pace program now for over eight years, and it truly and I say this on the bottom of my heart, it has really improved my quality of life, saved my life, and currently, I'm recuperating from hip surgery, and I received6543 daily care at the wellness center6545 in Winthrop with my physical therapist. It's been a blessing. So I support any awareness, especially in the African American community where health care services might not be as good in other communities but I really want to get the word out about the pace program. Thank you for your attention to this.
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Thank you for helping spread the word. Are there questions for members of the committee? Yes.
Representative. John Tao.
SPEAKER2 - Yeah. Accurate.
SPEAKER9 - And
REP GENTILE - Thank you for your testimony today. Could you tell me about how many hours a week that you have services in your home and6590 if you know of others in the Pace program, you know, if they have similar or other numbers of hours of services provided for them at home through the Pace program?
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SPEAKER2 - Oh, yeah. That's because
SPEAKER9 - he's -- -- visiting6604 the house or physical therapists or PCAs.
CASEY - Well, for me, when I6608 joined the Pace program, I was going to the Pace program every day, they would pick me up 10 o'clock in the morning, I would come back home at 2:00, and6622 as the year's gone by, you know, I kind of curtailed that. But I get services at my home in terms of meal delivery, they come out and they check my home to make sure that it's safe, that I have all on the certain things in my own to keep me safe. What I like about the program, any service that I need, I'm able to get in contact with the pace program through the MyChart program they have. I tell you the response is tremendous, automatic, I could wake up late at night, and I could email them and in the morning, I get a response. So it's been a blessing to me.
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Thank you very much.
SPEAKER30 - Thank you. Did I answer that question also or where was that just directed to Gerald?
SPEAKER9 - No. It answered also. Thank you very much. Yes. Go ahead.
SPEAKER30 - I can't hear.
LEEDBERG - So the way that it works6683 for us because Jimmy and6685 I live together, so he is picked up every morning, they provide transportation, he goes to the pace center, he sees his nurses, his primary care physician is there. If he has a specialist appointment, they coordinate that now, and they'll arrange his transportation. We have PCA hours that are approved as some of the people talked about earlier, PCAs are in big demand right now. I can call them at any time, we meet regularly. There was an example, Jimmy had a pick line because one of the common challenges for people with spinal cord injury is chronic UTIs, so his infectious disease doctor had a pick line installed, and something was going on with it. So I called the on call number because there's always somebody on the6743 other end of the line, I was talking to them, and they were saying, you know, kind of beginning to develop a plan. Before we had even, like, hung up the phone, there was a knock at the door, and it was one of the nurses from his center that knows him personally that showed up here to check it. It's amazing the way that they support the health of the person and the caregivers. Prior to Jimmy enrolling, he was in and out of the hospital couple times a month, minimally. When he enrolled in the program for a full year, not one trip or things that are are easily preventable and managed, it's a remarkable program, and everybody deserves6812 to know about6814 it.6814
6814 SHOW NON-ESSENTIAL DIALOGUE
Thank you.
SPEAKER3 - Thank you very6816 much, Senator Marin.
SPEAKER15 - I hope I'm doing this. I haven't been in 1 of these hearings in a while.
SEN MIRANDA - Thank you to both of you for sharing your thoughts, particularly, Mr. Gerald. I just had a6830 comment about how great the6832 Pace program is, I represent the second Suffolk6834 which are the neighborhoods of Hyde Park all the way to the South end here in the city of Boston and worked very closely with Upland's Corner Health Center with their Pace program in Roxbury. Actually, being a support to many Black and Brown families that are living in Roxbury and Dorchester. One of the things that I wanted to highlight was that there were nurses and cared directly on-site, and for many of the members of the disabled community and the elders, even though we're very close to Boston Medical Center, most of the people get their care from a community health center. So they were not getting the type of care that they just heard, but they got their care, culturally competent care, linguistically available and connected to the language of their choice or that they could speak and then they provided that. So thank you for sharing.
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Thank you for all for testimony.
We also have written communication from senator Eldridge in favor of this bill. We have6902 no6902 16902 signed6902 up to speak on senate 382 or senate
SPEAKER1 - 400.
SPEAKER3 - On senate 404,6911 we have written6913 testimony from senator Timothy. and from the food system caucus, particularly by representative Cona Kane, who is also a member of the committee and cochair of the caucus
on senate 386 and house 635. We've heard from Senator Lovely, and We have signed up at Clarence Richardson and Dave Finn6946 Arsdale.6946 Clarence6946 Richardson6946 is online. I'll take Dave Bernard's sale, and then Clarence Richardson, please.
DAVE - MASSACHUSETTS LIFE CARE RESIDENTS ASSOCIATION - SB 386 - HB 635 - Thank you, Madam Chairwoman Jehlen, and Chairman Stanley for your time today as well as the others on this joint commission on Elder Affairs. I'm Dave [inaudible 01:55:58], and I'm a seven year resident of the Edgewood retirement community in North Andover. It is a CCRC and I come representing the Massachusetts Life Care Residents Association, which some of you've come to know as MALCRA. MALCRA is a volunteer group of 17 different CCRCs across the Commonwealth, and these communities are often referred to as life care or life plan communities. CCRCs as Representative Lovely, as already described, provide continuum of care for seniors over age 62 and they may start with independent living, they may include assisted living, as well as caregiving during skilled nursing care needs when that comes. Although there are several financial models available for this care, all involve an interest fee that is substantial, comparable to the purchase of a single family home or a condominium. Literally, it may be $200,000, but it may be $600,000 and all CCRCs at that point provide a return of that fee to the resident, should they leave that facility or to their relatives and the estate that is left.
So the return of that portion of the fee is refunded to the estate when that person dies, but it also may be refunded if that person chooses to go to another facility and there's not always transparency about how that's to happen. So currently, many residents and family members who are residents of Massachusetts, they don't understand the process for their7081 community to return7083 that refund should they need it when they move on to another facility, or their families when they should die. So in accordance with the CCRC's establishment in 2013, 2014 by the Commonwealth, it was not required that the management rather be nonprofit or for profit provide a document that actually spells out how that refund would be given. This proposed Bill would not be any cost to the CCRC, it would not be any cost for the Commonwealth but it would clarify and bring peace of mind to a number of seniors today who don't understand how that process works for their facility, and they've never received the document describing it. S 386, H 635, would remedy that, would provide transparency as well as protection for seniors. So we urge the committee to report this Bill out favorably so that it can be voted out in the general session, and if you have any questions for a real live resident of a CCRC, you now have an opportunity.
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But we're gonna give Mister Richard sent a chance to talk to, and then we'll have questions for both of
SPEAKER13 - you
SPEAKER3 - if he's here.
Think I see him.
SPEAKER22 - Welcome.
SPEAKER3 - We can't hear you.
SPEAKER16 - Can you hear me now?
SPEAKER3 - We can hear you now.
7184 SHOW NON-ESSENTIAL DIALOGUE
SPEAKER167184 -7184 Okay.7184 Wonderful. I apologize for that technical difficulty. Teams does not like me for some reason.
CLARENCE RICHARDSON - NATIONAL ACADEMY OF ELDER LAW ATTORNEY - SB 386 - HB 635 - Thank you, Chairs Jehlen, and Stanley and members of the committee for allowing me this opportunity to testify in support of H 635 and S 386, an act relative to disclosing community care continuing care retirement, community entrance fees. My name is Clarence Richardson, and I'm the executive director of the Massachusetts Chapter of the National Academy of Elder Law Attorneys or Mass NAELA. I will keep my remarks brief, but would like to echo the testimony already provided. The purpose of this legislation is to empower the residents of the Commonwealth to make more informed decisions when determining where to live when they need increased health care support. As committee members, I'm sure that you are all well versed in the differences between independent living, assisted living, nursing homes, and continuing care, retirement communities, or CCRCs but unfortunately, most people are not.
In addition to a lack of information, many times these decisions are made on a very short timeline or in an emergency These short timelines may prevent many residents from being able to make the best decision possible about their care. As you know, and was just mentioned, CCRCs often require a large upfront deposit usually between $500,000 and $1,000,000. If a resident of a CCRC would like to move to a facility that is more appropriate for their needs, they are entitled to receive this deposit back after certain deductions and expenses. Unfortunately, many times, the requirements and circumstances to receive this refund is buried in complicated legal contracts. This legislation would require these requirements and circumstances to be explained to potential residents and their families through a separate document allowing individuals to make more informed living decisions when navigating the aging process. I ask the committee to report this legislation out favorably, and thank you again, and I'm happy to answer any questions. SHOW NON-ESSENTIAL DIALOGUE
Are there questions for members of the committee? I will just affirm that when you're entering
another living situation and your estapal sign lots of documents.
SPEAKER17 - Well, thank you.
SPEAKER3 - It's daunting. So thank you for bringing this to our attention.7327
Next we have set
SPEAKER1 - 372.
SPEAKER3 - We have a panel. for Mass A LA, Brian Dorothy, and Mark Hendricksley.
BRIAN DOHERTY - MASSACHUSETTS ASSISTED LIVING ASSOCIATION - SB 372 - Good afternoon, Chairwoman Jehlen, Chairman Stanley and distinguished committee members. I'm Brian Doherty, President and CEO of the Massachusetts Assisted Living Association. We're the voice of assisted living in Massachusetts, providing information and education and advocating on behalf of our members and the older adults they serve. We promote a model of care that treats all residents with dignity, provides privacy and encourages independence and freedom of choice. We have many Bills impacting assisted living being heard today, but I'll focus my verbal testimony on one of those and then submit written testimony on others. We strongly support Chair Jehlen's Bill Senate Bill 372, an act directing the administration to amend the frail elder home and community based waiver to7400 permit eligible older adults to choose to reside in certified assisted living residences. We encourage efforts to allow Massachusetts residents to choose assisted living under the provisions of the home and community based waiver.
I'll provide some detail here in my remarks, but the bottom line in one sentence is while income eligible older adults in more than 40 other states can choose to live in assisted living under the waiver, the Commonwealth residents cannot and must instead choose between home care and skilled nursing, leaving out an important part of the elder care continuum. The cornerstone of assisted living in our state is the residential model where residents live in their own home in a vibrant community and receive the support services they need at the same time. Currently, our waiver only allows older adults to live alone without these supportive services often leading to loneliness or depression and the need to bring in home care or move to skilled nursing. In the last three years, we've seen examples of closures of affordable assisted living residences including last year in Boston and Beverly, and those communities were dedicated to serving residents on the public reimbursement programs that we do have in place now, group adult foster care known as GAFC program for all inclusive care for the elderly that you just heard7481 about Pace and senior care options, SCO.
None of those programs was designed to reflect the cost of providing care and a private residence specifically in assisted living. So we were actively engaged in the GAFC rate setting review in 2020 and we came away from that process realizing that because the cost reports that the state gets are sometimes from other settings and not assisted living that can provide that at a much lower cost, GAFC did not have a rate adjustment and that was the first rate adjustment in 2007 that accurately reflected what the cost is of providing care in assisted living. Neighboring state like Maine have opened their waiver to assisted living, offering reimbursement for both traditional and memory care. So we urge the committee to give this Bill a favorable report and take a step towards allowing more older adults in Massachusetts to access assisted living. SHOW NON-ESSENTIAL DIALOGUE
And now I'll hand it over to my colleague who can give the direct provider experience on this
MARK HINDERLIE - HEARTH - SB 372 - Thank you for the opportunity. I do really appreciate this chance to sort of give a little local color to it. My name's Mark Hinderlie, I'm the president and CEO of Hearth. Hearth is one of, I was told by the chair of the national alliance and homelessness, I got the job, she called me to congratulate me and I said, how on earth did you know that I got this job at a tiny little agency in Boston? She said, because you're the7587 only organization that exclusively focused on elder homes that we know of. I went to our board to say, is our mission to end elder homelessness or to end elder homelessness inside Route 128? Because the issues are so large that are creating homelessness, the national crisis in affordable housing, there are so many issues. But in particular, we need to be able to articulate what it is that we need to really take care of this really incredible vulnerable population. So what does Hearth do? We develop and operate permanent, supportive housing for normally homeless or at risk seniors.
We use a lower age for our outreach, we do outreach in the shelters, which was extremely impaired by the pandemic but used 55 instead of 62 because of the acceleration of aging that happens, so that people have a clinical age that's 15 or even 20 years older than7667 their chronological age. So there's a range of service intensity in our programs, and we have one certified assisted living facility that's located in Roxbury and the challenges that we face because of the lack of a7688 reasonable rate of reimbursement for the services that are required has credibly has put the whole operation at risk. This program never in the 17 years, I've been there, we had two years where it didn't lose money, most years lose significant money. We made it up7712 from philanthropy or borrowing from other sources, but in order to work, if the salaries have increased over the last 17 years significantly, we've committed to a living wage to our PCA's and other workers even though that we didn't have revenue stream to do it, but that deficits that become very challenging, it remains sustainable.
So like Donald Lacey House in Charlestown, were at risk, serious risk of losing the only affordable assisted living program in Roxbury. There's many problems, but one of the issues that we emphasize is that everyone has voted is the fact that the lack of eligibility, when someone shows up in our wait list, interview them, and they think that they're as hell as they were, for example, a VAT. The average VA payment, the stipend is about $1500 flips your $400 over a Mass health level. So we also have vacancy rates that are too high because the referrals we're getting, people don't know, understand the nature of those challenges There's a huge number of people who absolutely should be eligible, absolutely, you know, the alternative is almost always skilled nursing, which costs the Commonwealth roughly 2.5 times what we can deliver our assisted living services. The other part of it is our ability to attract nursing staff at some points, and it's really nursing everywhere is pressure, but if we are so limited in our revenue, we can't do what others did and say, okay, we'll pay $150, when you get the the daily rate raised from $40.27 to $41.39 and then you complain and say that's not really much of a raise, and they say, we'll double the raise, it's kind of frustrating, you know, because it's still only $43. You go hire a nurse for $43 a day.
So I don't want to take more of your time, and I really appreciate your listening, but please really think through continuum of permanent support of housing, everybody knows it starts with accessibility but a lot of it, the HUD standard is a 100 residents for one resident service coordinator whose job is to help people where they can get services, refer them to pace, refer them to the Community Center. We have the next level, which is service enriched housing where we have personal care, nursing, and other administrative staff on-site, so we're able to do almost as assisted living, but we don't have in the other sites, we have a meal comes in from Kit Clark, one of the other communities eating agencies. So there's some base level of nutrition that we're responsible for, but people are really independent, they live in their own place and they get the care they need. Because we're on-site our contracts with the Department of Health, and so that gives us social workers on-site. And the social workers will work on DMH client having a DMH type. 5% of our budget is which is up and down and faithful and requires a lot of attention. So there's a gap in funding affordable assisted living.
So if you look at the continuum, there's all of a sudden, there's this cliff, and then down here is at the end of the continuum is skilled nursing, not independent living. I think the reason is historical and not to hear about it, but it's because assisted living was started on opportunity and as people got old, we didn't have huge 75 and now we do and it's getting bigger. So, when government decided to think about assisted living, it said, we need to regulate because people are taking advantage of vulnerable seniors. So as a result, its attitude towards assisted living is regulatory, the others came from we need to take care of our elders, we have a national commitment to take care of our seniors, this came from something else. Assisted living started brilliantly, not corrupted because it wasn't regulated and now I think it's back in a really good place, except for the fact here in Massachusetts can't afford it. So we have a gap in the continuum, and this would essentially help as one of a piece of of changes that you can make and would create a truly working, affordable assisted living. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you for your testimony. explaining that. Are there other people? Are there questions for members of the committee?
Not I appreciate your testimony on your work. Thank you.
We have no 1 signed up to test if I hadn't sent at
SPEAKER1 - 3 73.
SPEAKER3 - We have a panel for house 617 and how sent at
SPEAKER1 - 387.
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SPEAKER3 - We have a mass nailer panel with Kathleen Lynch Moncada. Leon Zites. and John Ford. Are you all here?
Gonna get Britain. written testimony from Christine Barber representative.
Is anyone here from that panel? Yes. We can't see them.
SPEAKER30 - We're here.
SPEAKER3 - Oh, We're here.
SPEAKER8 - Cathy, are you going
SPEAKER3 - first? I
we have different things on different screens. I'm sorry.
KATHLEEN LYNCH MONCATA - MASS NAELA - SB 387 - HB 617 - Good afternoon, Chairs Jehlen and Stanley, and members of the Elder Affairs committee. Thank you for the opportunity to appear today to speak in favor House 617, Senate 387, an act protecting the rights of assisted living residents. My name is Kathleen Lynch Moncata, I'm an elder law Attorney speaking on behalf of the Massachusetts chapter of the National Academy of elder law attorneys known as Mass NAELA, which is an organization of approximately 500 Massachusetts Attorneys who advocate on behalf of older adults and disabled persons in the Commonwealth. I will address the legal framework of assisted living residences known as ALRs and how this Bill would address the concerns of the older adults we serve. You'll also hear from two of my colleagues, and you've received written support of Dignity Alliance and others. I recently attended one of your hearings regarding the Omnibus Nursing Home Bill, and the focus was concerns about transparency and accountability.
We share those same concerns for those living in assisted living residences. Massachusetts enacted assisted living legislation nearly 30 years ago in 1994, the legislative intent clearly define the new law's purpose8260 of providing a residential8262 environment and not a medical one. ALRs were not intended for those with serious medical needs, and until the Covid state of emergency were not permitted to provide medical or nursing services. There was a bright line separating a residential environment and a medical one, that line has eroded. The changes over the past 30 years have resulted in ALRs looking more like nursing homes for people who can afford to pay privately but without the corresponding oversight. ALRs include many individuals with serious cognitive impairment. According to the executive office of Elder Affairs' most recent data released last month, a typical a ALR resident is a female 85 to 89 years old, and there are many, many residents who are diagnosed with Alzheimer's or related dementia.
Today's ALR residents mirror those in nursing home. As nursing homes close, the number of ALRs increases, in the past two years have been at least eight new ALRs opening. Certain parts of the metro west area are set rated with ALRs while other areas in the Commonwealth have very few options. The EOEA is not empowered to conduct a determination of need, they cannot license ALLRs, they merely certify them. Consumers lack8363 adequate access to ALR information to make informed decision. For example, there's no way a family to compare one facility with another, EOEA provides aggregate reports for all of the 267 ALRs. Incident reports that are filed,8383 there were over 16,000 filed over a 13 month period from 2020 to 2021, families don't have access to that information. And, yes, a place for mom, a website that I've mentioned before continues to rank Massachusetts as a state providing consumers the least access and transparency to information.
In 2019, Massachusetts ranked 36 out of 50 states and as of last night, checking the website, a place for mom ranks Massachusetts even worse, in the bottom nine states, or 41st place alongside Mississippi, Kentucky, and Louisiana. The EOEA report also mentions that there is no requirement for ALRs in Massachusetts to have a8440 backup generator in the event of a power outage. The majority of ALRs do have a generator even though they're not required to do so but EOEA reports that 24 Massachusetts ALRs still do not have backup8457 generators. Throughout the Covid emergency, assisted living residences enjoyed blanket immunity, access to government financial assistance, waiver of minimum staffing requirements to the extent such existed and expanded services to include medical services. When required to provide8481 the level of transparency and accountability as out of nursing homes,8485 the industry is quick to point out that ALR were not nursing homes. ALRs look more like nursing homes, act more like nursing homes, but are not held to similar standards and accountability as nursing homes. The Bills that we are supporting intend to rectify this because the older adults in Massachusetts deserve at least as much. Thank you for your time. SHOW NON-ESSENTIAL DIALOGUE
Is Zikes are you there?
SPEAKER8 - Yes. I'm here.
SPEAKER3 - There we go.
SPEAKER8 - Okay.
LIANE ZEITZ - MASS NAELA - SB 387 - HB 617 - Senator Jehlen, Representative Stanley and members of the community, I appreciate this opportunity to present testimony, I will be brief. I believe that Kathleen has explained many of the concerns that we as elder law Attorneys see representing elder clients. I've been practicing law for 38 years. When I first got out of law school, there was no nursing home reform law and I had several cases in which I had very8563 few remedies to represent elder clients. One of my cases right out of law school, I ended up having to go into Superior Court to defend the rights of the nursing home resident because there were just no mechanisms or laws in place that gave me any other alternatives. With the nursing home reform law that was passed as part of over 87, Congress gave nursing home residents rights set forth many protections and provisions regarding nursing home care. As you know, there are still many issues regarding nursing home cares and the care, and there are proposals to reinforce the rights of residents and to create more regulatory oversight. I have seen the problems that used to exist for nursing home residents, I have seen them now exist for assisted living residents. The nursing home residents after over was passed, I along with John Ford who I believe may not be available to testify, but is supposed to testify, we were on a task force with the Attorney General's office, and the attorney general promulgated 93A consumer protection regulations to protect nursing home residents.
This was a mechanism that enabled family members in nursing home residents to come to the table to actually avoid what I had to do going to Superior Court to avoid litigation, to give some force to have another way to resolve8663 disputes with a8665 facility. Nursing home residents8667 are vulnerable assisted living residents now look a lot like what nursing residents look like. People in memory care and assisted living facilities are virtually indistinguishable from nursing home residents except that they tend to be wealthy people who can afford the price of an assisted living facility. The Continuum of care is changing, we certainly support increased funding mechanisms to provide for care in assisted living. Congress has acted to protect nursing home residents rights because they were able to act because they fund the Medicare and Medicaid programs that fund nursing homes. Congress can't act8714 in terms of regulating assisted living facilities, they exist in different forms and different states, so it's up to the state to act. So we want to the state to act to provide greater protections for residents and assisted living facilities as they now look like the nursing residents I saw in 1985 when I first graduated from law school. Thank you for your support. SHOW NON-ESSENTIAL DIALOGUE
And is John Fortier?
SPEAKER8 - I think
SPEAKER3 - he said he's not.
SPEAKER8 - I know that he had a potential conflict of them hearing Ram late. Okay. I believe he will submit written testimony.
SPEAKER3 - Excellent. Okay. So are there questions? Members
And if not, we thank you very much for your testimony. And I know that the next bill
House
SPEAKER1 - 3927
SPEAKER3 - is sponsored by the vice chair. I don't know if you're going to present written any testimony today. Okay? I don't see anyone else signed up to testify today. And so in that case, I will entertain a8795 motion to adjourn. I heard this motion.
I'm here a second8802 on favor. I'll pose8804 thanks to everybody for their attendance and testimony today. and attention on liquidity.
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