ARIZONA STATE LEGISLATURE

Forty-fourth Legislature – First Regular Session

INFORMAL TASK FORCE ON LONG TERM CARE

Minutes of Meeting

Wednesday, June 30, 1999

Governor’s Reception Room, 2^nd Floor Capitol Tower – 1:00 p.m.

(Tape 1, Side A)

The meeting was called to order at 1:05 p.m. by Chairman Gerard and attendance was noted by the secretary.

Members Present

Senator Freestone Mrs. Allen

Senator Hartley Mrs. Foster

Mrs. Knaperek

Mrs. Leff

Ms. Voss

Mrs. Gerard, Chairman

Members Absent

Senator Day Mrs. Blewster

Senator Grace Mrs. Johnson

Senator Guenther Mr. Loredo

Senator Lopez Mr. Nichols

Senator Petersen Mr. Verkamp

Speakers Present

Mary Wiley, Assistant Director, Assurance and Licensure Services, Arizona Department of Health Services (ADHS)

Judy Sgrillo, Program Manager, Long Term Care Licensure, Arizona Department of Health Services (ADHS)

Laura Hartgroves, Program and Project Specialist, Assurance and Licensure Services, Arizona Department of Health Services (ADHS)

Malena Albo, Assistant Director, Division of Aging and Community Services, Arizona Department of Economic Security (DES)

Jason Bezozo, Senate Research Analyst, Health Committee

Lynn Dunton, Assistant Director, Office of Policy Analysis and Coordination, Arizona Health Care Cost Containment System (AHCCCS)

Alan Schafer, Arizona Long Term Care System (ALTCS) Administrator, Arizona Health Care Cost Containment System (AHCCCS)

Karen Baerst, Attorney, Office of the Attorney General

Guests Present (Attachment 1)

WELCOME

Chairman Gerard introduced herself and welcomed everyone. She mentioned that a recent newspaper article resulted in many letters and phone calls detailing problems with long term care (LTC), some containing suggestions for solutions. Recent incidents of neglect or abuse in skilled nursing facilities indicate a need to review regulations and protections; however, a whole range of issues relating to LTC should be examined since people can now live 20 to 30 years with a chronic illness, requiring all kinds of help. She indicated that after areas of concern are identified, Subcommittees will be formed. She added that Senator Sue Grace is out of town, but plans to participate as her counterpart in the Senate.

INTRODUCTIONS

Everyone present introduced himself or herself, related a personal or professional interest in LTC, and identified an item to be reviewed. Issues suggested include:

· How to keep people independent enough to avoid going into a skilled nursing facility.

· Develop a larger cadre of caregivers.

· Provide more accessibility and input by the public, and accessibility to Legislators.

· Prevent use of the spend down theory to eliminate all assets in order to obtain coverage.

· Identify areas where minimum standards for health, safety, and welfare of Arizona citizens are needed or should be increased.

· Provide adequate resources for the Arizona Department of Health Services (ADHS) to conduct inspections and complaint investigations of nursing homes.

· Maximize available community services to keep elderly at home and independent.

· Provide education on all aspects of LTC.

· Arrange an adequate reimbursement system for care of residents at all facilities.

· Streamline redundant regulatory agencies and put money into reimbursement issues.

· Move the program from the welfare ranks to the health care ranks.

· Review the service process and identify incentives to improve performance of substandard facilities.

· Develop options to support more pipelines for LTC staffing.

· Prepare for growth but preserve and maximize choice for people.

· Provide funding without overburdening taxpayers.

· Review staff /client ratio in nursing homes.

· Develop a higher level of integration between services provided through the Arizona Long Term Care System (ALTCS).

· Provide resources for proper regulation by the Nursing Board.

· Provide adequate staffing or adequate regulators to measure outcomes.

· Help people become aware of LTC insurance.

· Develop medication management programs in Assisted Living Facilities (ALF).

· Increase independence through wellness programs.

· Have more supervision from primary care providers (PCPs), possibly by introducing Nurse Practitioners into facilities to provide a more daily hands-on type approach to PCPs, and more advanced practiced nurses to prescribe medications.

· Discuss eroding federal reimbursement and ability of providers to continue services.

· Provide more education on what constitutes elder abuse.

· Review safety issues.

· Make the system more consumer-friendly and protect elderly at the same time.

· Review current regulations to make sure they are adequate and enforced.

· Review the regulatory system to make sure it is working properly and integrate wherever possible.

· Provide adequate protection and care for people relegated to skilled nursing.

Mrs. Gerard thanked Debi Wells from the Governor’s Office for obtaining the room for such a large group. Introductions and suggestions for review continued:

· Increase amounts of funding to providers to be utilized across the board.

· Create a state plan or vision for LTC and continuing care for the growing population.

· Understand and resolve professional medical issues.

· Develop alternative settings to provide services under ALTCS.

· Streamline the enforcement mechanism for investigating and dealing with complaints so all go to one central investigative unit.

· Review model service delivery programs so people can learn best practices.

· Reduce and remove barriers that limit patients’ access to receiving home care services.

· Maintain functional ability and independence in elderly wherever they live.

· Make sure services recognize the needs of separate populations, i.e., frail elderly, developmentally disabled, persons with physical disabilities, and persons with serious mental illness.

Mrs. Gerard indicated that St. Luke’s Charitable Trust published a booklet entitled, “LTC Care Services in Arizona,” which will be valuable to the Task Force Members. She added that additional copies can be obtained. Introductions and items to be studied continued:

· Develop a health policy that supports all levels of care needed as Arizonan’s age.

Mrs. Gerard advised that an Attorney General Task Force is meeting about different subissues of LTC and asked to be informed about other groups, to avoid duplication.

Anne Lindeman commented that the Arizona Hospital and Healthcare Association formed a group to review labor force issues. The Department of Economic Security (DES), ALTCS, and a variety of persons formed another group regarding labor force issues.

PRESENTATIONS

Arizona Department of Health Services

Mary Wiley, Assistant Director, Assurance and Licensure Services, Arizona Department of Health Services (ADHS), stated that Assurance and Licensure Services is responsible for regulating all health care and child care facilities. A nursing home survey takes four to five days and involves the State and Health Care Finance Administration (HCFA); whereas, an ALF survey, depending on the size of the facility, takes one-half to a full day, with only State involvement. She added that there are 165 nursing homes and 1,265 ALF in Arizona.

Judy Sgrillo, Program Manager, Long Term Care Licensure, Arizona Department of Health Services (ADHS), reviewed a handout relating to State authority and responsibility for nursing home facilities (Attachment 2).

(Tape 1, Side B)

Ms. Sgrillo agreed to find out for Mrs. Knaperek how many of the 590 complaints were substantiated.

Laura Hartgroves, Program and Project Specialist, Assurance and Licensure Services, Arizona Department of Health Services (ADHS), reviewed a handout relating to State authority and responsibility for ALF (Attachment 3).

Mrs. Foster commented that she was a member of the Task Force on assisted living care and commended everyone involved, particularly Joan Johnson and Ms. Hartgroves.

Ms. Sgrillo advised Mr. Hatch-Miller that nursing home surveys take much longer than ALF surveys due to numerous federal regulations requiring review of medical records, observation of resident care, and interviews of staff, family, and residents.

Ms. Wiley related that ADHS will be requesting additional resources, noting that a legislative appropriation was made to LTC, which funds eight new LTC surveyors and may be federally matched.

Anne Lindeman pointed out that the assisted living rules and regulations are still being implemented, so facilities must catch up with the changes and surveyors need to be trained. In time, the program should do very well; however, she is concerned about obtaining help at skilled nursing facilities because the federal government plans to reduce funding, which will ultimately result in cuts in staff since the only staffing requirements are “appropriate to the level of care necessary.”

Mary Murphy expressed a concern about noncertified caregivers taking care of people after surveys are completed, noting that unannounced surveys are conducted in Ohio, not to review records, but the environment. Ms. Wiley acknowledged that the problem exists, but submitted that ADHS barely has adequate resources to maintain current responsibilities, and authority is needed to conduct unannounced inspections.

Ms. Wiley advised Mr. Carpenter that surveys are conducted at facilities and information is entered into computers at the office. Some laptops are available and more would be useful, but the issue of less paperwork is under review. Ms. Sgrillo commented that very few forms must be filled out for State requirements of nursing home surveys, but many federal forms have to be completed.

Mrs. Foster stated that some people in facilities or at home have no visitors, and therefore, no one to advocate on their behalf. She said she believes Legislators should require unannounced spot-checking or more inspections of facilities with patterns of complaints or problems.

Anne Lindeman indicated that a DES Ombudsman Program utilizes volunteers to visit nursing homes. The service is expanding to the group home industry, but there are not enough people. It is a cost-effective program, but money is needed for training.

Mrs. Gerard noted that health professionals and educators are required to report suspected abuse and neglect of children and asked if the same is true in adult care. Cindy Woodruff, a home health care nurse, stated that she has been instructed by the company she works for to report any incidents, which is part of the vulnerable adult law. Ms. Hartgroves said reporting is required under Adult Protective Services (APS) statutes, but prior to changes in assisted living rules, those statutes did not apply to ALF so many providers were unaware and, therefore, not held accountable to that standard by surveyors.

Ms. Wiley advised that information about quality of care in nursing homes is not yet posted on the Internet, but hard copies are available at ADHS. A team is reviewing the complaint process, including the fact that reports are incomplete. Ms. Sgrillo pointed out that obtaining information about quality of care in nursing homes involves linkage with the federal government computer system, which is slow, and the amount of time depends on the number of requests made.
Anne Lindeman endorsed the idea of providing such information on the Internet.

Arizona Department of Economic Security

Malena Albo, Assistant Director, Division of Aging and Community Services, Arizona Department of Economic Security (DES), stated that last session, as a result of a Task Force, the Legislature appropriated money for centralized intake for APS, which is now operating (Attachment 4). DES has 63 investigators statewide who investigate all types of adult abuse and neglect through APS, Monday through Friday, 8:00 a.m. to 5.:00 p.m., and the hotline to report abuses is open 24 hours per day, seven days a week. She related that 18 percent of calls received involve residents in LTC facilities.

She remarked that DES also has a LTC Ombudsman Program. The State provided $359,000, which goes to nine Area Agencies on Aging, including the Intertribal Council of Arizona. The agencies have coordinators who are trained on what to look for in homes, legal rights, and how to resolve issues with residents. Many times ADHS is involved, so the coordinators bring the right people together.

Ms. Albo advised Mrs. Gerard that if a complaint is made about a licensed facility, DES notifies ADHS. ADHS oversees facilities and DES oversees individuals. DES provides the name of a substantiated abuser to the Attorney General’s Office so anyone who calls can obtain information about prior complaints. She clarified that ADHS notifies licensing boards if a licensed health professional is involved.

Ms. Hays pointed out that in the case of a professional working in someone’s home, the proper board might not find out, which probably should be addressed. Ms. Albo said DES does not have authority to notify a licensing board, but could probably do so for a substantiated report.

Mrs. Gerard related that lists of unsubstantiated complaints usually contain a few that are not resolved, probably because the people involved could not relate what happened. Ms. Wiley acknowledged that sometimes ADHS visits a facility to substantiate a complaint, but the person cannot remember the incident. Other residents are questioned, but may also be unable to recall the situation due to Alzheimer’s, etc. Ms. Sgrillo stated that the survey process includes group interviews with alert and oriented residents about staff treatment.

Martin Solomon commented that the federal government encourages family groups to organize and advocate on behalf of family members in a facility and asked how many were interviewed by ADHS in the last few years. Ms. Sgrillo responded that she does not know about groups, but families of residents that are not interviewable are interviewed in the sample. Any relevant deficiencies are stated in the deficiency statement, or otherwise noted in the interview sheet.

Kenneth Murphy commented that if an aide is suspected of wrongdoing, it must be reported to the DES Ombudsman, ADHS, local law enforcement, APS, State Board of Nursing, and the Arizona Health Care Cost Containment System (AHCCCS), who do not communicate with each other. Sometimes every other agency has cleared a case, but two months later, two people show up from the Attorney General’s Office because of a report to AHCCCS. He added that another problem is obtaining money owed to facilities, i.e., a son controlling his mother’s money sells her house, so AHCCCS says she is not qualified because her money is gone, then the family may not pay the cost for the mother’s care.

Ms. Albo related that a Statewide Elder Abuse Financial Exploitation Task Force, composed of people from different local areas, meets on a quarterly basis. She suggested contacting the group because financial exploitation is a problem.

Genny Rose pointed out that there are 165 licensed nursing homes in Arizona, but only 94 annual surveys were conducted during FY 1998-99, along with complaint investigations. She expressed a concern that 71 facilities did not receive an annual survey, which means there is a large number of people who are very vulnerable, perhaps with dementia or without an advocate. Ms. Sgrillo said that is due to lack of resources.

Cindy Woodruff asked if anyone is ever arrested for abuse, etc., and Kenneth Murphy indicated that people are arrested in his area. Ms. Albo stated that DES works with some county attorneys, but there is no formal mechanism for obtaining information on status of criminal charges.
Karen Baerst remarked that people who commit these crimes are prosecuted. Suggestions were provided relating to staffing facilities:

· People providing care are paid minimally and may or may not have adequate backup or proper supervision. Development of a caring and trained staff in facilities is needed, which may be done in conjunction with economic development through the Office of Senior Industries cluster in the Arizona Department of Commerce.

· Self-reporting should be done when somebody commits an offense in a facility. Another state has a health practitioner database to which any problems with staff are reported, and when someone is hired, a form is filled out verifying that the database was contacted regarding the applicant.

· Valuable resources should be spent where there may be some problems.

Ms. Albo clarified that funding is provided to Senior Employment Works, which places seniors in employment, the LTC Ombudsman Program, and the remainder goes to nine Area Agencies on Aging for home and community-based services, visiting nurses, home health aides, etc. Local areas decide where resources are most needed. She added that a funding formula is involved, which should probably be reviewed.

(Tape 2, Side A)

Ms. Albo advised that it is DES’ responsibility to remove an individual from a facility if a complaint is substantiated. DES does not file legal forms, etc., but tracks the person until he/she is out of danger. Ms. Lindeman indicated that APS cannot relate results of a complaint because the information is confidential. Ms. Albo added that a family member cannot be advised either, but can be interviewed for further information.

Ms. Sgrillo informed the Members that surveyors receive 12 weeks of orientation training at ADHS and travel to Baltimore, Maryland where a test is taken to become qualified to conduct federal investigations. Taining includes some investigative processes, but improvements could be made. Surveyors are sent to various programs offering investigative techniques, etc., but not on a regular basis.

Ms. Wiley indicated that ADHS is working with the Attorney General’s Office to provide training. Surveyors of nursing homes receive more training because of federal participation. She anticipated that training for assisted living will occur in the next few months. Paul Blunt remarked that he never sees compliance officers at seminars for law enforcement on dealing with adult abuse situations. Ms. Wiley responded that a seminar was attended in Yuma and added that the Governor’s Office is holding one on July 17 and 18, 1999, which will be attended.

Mr. Solomon asked if ADHS is able to discriminate between facilities with substantial complaints and those that are not as significant or life threatening. Ms. Wiley replied that it can be done through the facility database as part of ADHS’ work with the Attorney General’s Office. Ms. Sgrillo stated that ADHS has a list of focused facilities that are visited every six months and complaints are prioritized according to need and seriousness. Focused facilities are mandated by HCFA, with the State’s choice, from the President’s Nursing Home Initiative. She said perhaps information can be obtained from HCFA, but the State must keep the information confidential according to the federal government.

Vulnerable Adult Legislation 1998

Jason Bezozo, Senate Research Analyst, Health Committee, reviewed a handout concerning Vulnerable Adult Legislation (Attachment 5).

Mrs. Gerard pointed out that fingerprinting will not begin until November 1999. Mr. Murphy submitted that health care institutions are being singled out since the legislation does not apply to hospitals and indicated that he would like to see a level playing field at some point. Mrs. Gerard replied that another Committee can address the issue in the future.

Mr. Bezozo clarified that 1998 legislation required fingerprinting to begin on the 1998 general effective date for residential care institutions and home health agency personnel. There was a delay in the effective date for nursing care institution personnel because of the transfer of responsibility from ADHS to the Arizona Department of Public Safety (DPS). DPS has fingerprinting and background check requirements dealing with other agencies and employees, which become effective this year, so a policy decision was made to delay requirements for all three types of providers to begin on the same date through one agency.

Linda Palmer pointed out that some personnel already received a card through ADHS and Ms. Wiley responded that it is okay. Mrs. Gerard explained that there would be three months of startup of the program at ADHS, before moving it to DPS. In addition, ADHS never received funding to begin the program. Ms. Wiley remarked that there is currently a 3.5 month interim and ADHS is awaiting an Attorney General’s opinion about how to proceed.

Arizona Health Care Cost Containment System

Lynn Dunton, Assistant Director, Office of Policy Analysis and Coordination, Arizona Health Care Cost Containment System (AHCCCS), related that AHCCCS is the single Medicaid agency in the State. From a $2.2 billion budget, $824 million is used to operate a LTC program for 27,000 people, so LTC is expensive. AHCCCS is responsible for the following items in the LTC program:

· Determining eligibility by reviewing an individual’s finances, resources, and medical impairment, which must be serious enough to require institutional care.

· Setting up the network to operate the program. Contracts are issued to seven program contractors in the state, as well as DES for persons with developmental disabilities. A major change in the contracting process will occur next year when it is opened up statewide to full competition. Anyone eligible for LTC receives medical services, home and community-based services, institutional services, and behavioral health services (via case managers), through the program contractors.

· Insuring that quality services are provided by:

¨ Working in conjunction with the program contractors and ADHS on allegations of abuse.

¨ Working with DES and the Attorney General’s Office (an allegation is followed until final disposition).

¨ AHCCCS personnel check on program contractors once a year, review finances, and operations.

¨ Case managers are required to visit homes or institutions on a regular basis, which is monitored by AHCCCS.

¨ Program contractors are required to provide a quality management plan, and AHCCCS checks to make sure the plans are filed.

Ms. Dunton stated that AHCCCS plans to conduct a member and provider survey regarding the LTC system. She added that there is a grievance and appeals process. If a case is not resolved, it goes to the grievance process to determine if some type of remedial action is needed. She clarified that the $824 million includes total expenditures for the LTC program, including administrative costs, home and community-based services, etc., and 65 percent is funded by the federal government. On overhead costs, capitation rates for program contractors are about six percent, and for AHCCCS administration, about three percent.

Ms. Dunton related to Martin Solomon that AHCCCS contracts with program contractors who, in turn, contract with a facility; therefore, the program contractors are authorized to suspend payment to a particular facility based upon quality of care, as well as impose sanctions, terminate a facility, or place a facility under temporary management.

Alan Schafer, Arizona Long Term Care System (ALTCS) Administrator, Arizona Health Care Cost Containment System (AHCCCS), related that if a program contractor places bed holds or emergency restrictions on a facility, there is a grievance and appeal process through Medicaid, but the process will not temporarily suspend that action because it is based on the contract. He indicated that a unique characteristic of AHCCCS is that if a program contractor, as a managed care organization, believes a member is not receiving proper care, the program contractor can divert the member to a better facility in a timely manner.

Ms. Dunton advised that several years ago Congress passed legislation stating that disabled individuals and elderly persons can be eligible for Medicaid by sheltering their income, i.e., setting up an income trust. AHCCCS knows exactly how many do so because the agency ultimately approves the applicants as part of the eligibility process, and the practice is becoming much more widespread. She clarified that AHCCCS looks back for a certain period of time to determine if an applicant diverted assets, for example, by selling their home to a son or daughter in order to become eligible, but if a trust is set up that meets all federal requirements, the applicant is eligible.

She advised Mrs. Knaperek that AHCCCS sets clinical trials and works in conjunction with program contractors on quality indicators, which are used to review health care access. AHCCCS approves quality management plans, so all are mentioned in the contract.

Mr. Schafer acknowledged that AHCCCS approves quality management plans, but looks at how the process is implemented when annual operational reviews are conducted. For instance, a certain number of credentialing files are pulled and perused to make sure the facility considered everything relating to that standard and contacted the right boards about complaints or malpractice suits against the facility. AHCCCS collects a number of quality of care complaints and makes sure the whole process is followed, including plans of correction, intervention, teaching, eliminating providers, etc. He acknowledged that the eight entities that contract with service providers include indicators in contracts at various levels with certain providers, but he does not know if outcome measures are included.

Kathy Eskra said there are no clinical outcomes in their contracts, but facilities are monitored. Experimentation is underway as far as indicators and outcome measures, which were included as an amendment to contracts this year.

Mr. Schafer related that AHCCCS and program contractors establish some indicators, but the program contractors expand beyond that in other areas. Every program contract is somewhat different and every county where services are provided is a little different, so everyone should not be the same across the state. There is some uniformity, but contractors need to focus on indicators or trends that show problem areas.

Dick Peitzmeier asked if there are two sets of criteria if a facility is located near the county line. Mr. Schafer responded that there may be, but generally, criteria will default to the program contractor with the most residents in the facility.

Ed Hannen questioned the amount of funding spent on overhead, etc., and Ms. Dunton recommended that he meet with AHCCCS financial personnel on the subject.

Matt Luger pointed out that there is currently no mechanism to recognize and reward quality care in facilities, which should be pursued. Mrs. Gerard indicated that it is an issue the Task Force will have an opportunity to review.

Kenneth Murphy stressed the fact that reimbursement is an issue with AHCCCS clients and recent Medicare cuts. Mrs. Gerard agreed, noting that AHCCCS personnel can explain Medicare changes and the overall impact to the LTC system.

Anne Lindeman noted that Maricopa County is currently participating in a pricing demonstration project imposed by HCFA that will change the way Health Maintenance Organizations (HMOs) are funded and options seniors have in HMOs. The whole funding situation will change drastically.

Attorney General’s Office

Karen Baerst, Attorney, Office of the Attorney General, related that the Office represents all of the state agencies that work with the elderly and a number of licensing boards. Internal responsibilities include prosecuting AHCCS fraud cases and abuse and neglect cases from AHCCCS facilities, as well as prosecuting and taking civil action against other kinds of fraud, including consumer fraud. The Office maintains the Elder Abuse Central Registry, which requires filing of civil lawsuits relating to elderly abuse and neglect, any number of administrative decisions, criminal indictments, etc.

She noted that Elvera Anselmo is the Elder Abuse Manager. Her department includes a specialized staff of volunteers trained to work with elderly people and provide close communication and attention. Reporting is done to public and private agencies on various items, including LTC. Investigators are experienced in working with elderly victims and investigating cases.

Ms. Baerst stated that when the new Attorney General entered office, she identified the elderly as a major concern and created an Elder Issues Task Force. The Task Force wishes to be involved in this group as much as possible to provide assistance and resources. She showed a pamphlet entitled, “Abuse, Neglect and Exploitation of the Elderly”, a training guide for staff, and indicated that she can bring more copies to the next meeting.

She clarified that the Task Force is not an investigative body, although there are many people with investigative responsibilities at the table. She submitted that if communication and education about danger signs are improved, and patterns in facilities experiencing troubles identified, whatever body has jurisdiction can provide extra training, education, or whatever, to reduce complaints. Kenneth Murphy commented that representatives of nursing home facilities should be involved in the Task Force. Ms. Baerst replied that she recognizes the expertise and knowledge in the room, which is why she is present.

Ms. Hartgroves indicated that the pamphlet displayed by Ms. Baerst is an excellent document and training aide provided by the Attorney General’s Office at no charge.

Mrs. Gerard questioned if materials are given to people about their rights when entering a nursing home. Many Members acknowledged that such information is provided.

DISCUSSION

Other Presentations/Information

Discussion followed concerning future presentations.

(Tape 2, Side B)

Mrs. Gerard asked Liana Martin, House Majority Research Analyst, to contact Jane Pearson about obtaining the booklet she referred to earlier for the Members. She added that everyone would probably like a copy of the booklet from the Attorney General’s Office. Ms. Dunton remarked that if the mailing list is provided, she will make arrangements to send the booklets to everyone present.

Mrs. Gerard indicated that future presentations will address the following issues:

· Labor Force.

· Area Agencies on Aging.

· Funding and Reimbursement.

Subcommittees

The following topics were chosen for Subcommittees:

· Quality/Best Practices

· Regulation/Enforcement

· Public Accessibility to Information

· LTC Insurance

· Funding and Reimbursement

· Agency Coordination

· Initiatives/Incentives

· Home and Community-Based Care

· Facilities Care

Mrs. Gerard recommended focusing on LTC for elderly and vulnerable adults, but not addressing behavioral health, disabled, etc., which involve different funding and regulatory streams, eligibility standards, etc. She encouraged Members to volunteer to Chair a Subcommittee and stated that her office can be contacted for information (542-5766). Liana Martin (542-1989) or
Jason Bezozo (542-3171) can also be contacted.

Next Meeting

Mrs. Gerard commented that it is difficult to meet during the summer; therefore, Subcommittee work can be done, and the whole group will meet in early September 1999.

Ms. Albo agreed to have someone from DES give a demographic presentation about LTC populations.

Mrs. Gerard indicated that she will compile a list of Subcommittees and contact people, noting that participation is voluntary. She referred to a report by the Alliance for Aging Research entitled, “Independence for Old America.” She noted that it includes demographic information and she will attempt to obtain additional copies.

She added that insurance people will be invited to the next meeting and the Department of Commerce will be contacted about the Office of Senior Industries cluster. She related that she recently learned about prescriptions not being sufficient, overprescribed, or causing complications due to errors or wrong combinations, and for every $1 spent on pharmaceuticals, it costs $1 for errors. This is probably a great concern to facilities and should be considered when quality of care is reviewed.

Anne Lindeman expressed pleasure at the interest shown by attendance and the fact that Mrs. Gerard is taking the time and effort to hold the meeting, which has been needed for quite a while.

Gil Gonzales asked if the minutes will be distributed to everyone in attendance. Mrs. Gerard replied that they can be, but it will probably take a week to 10 days.