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A Failure in Public Policy Joint Hearing S. HRG. 101-93 BOARD AND CARE: A FAILURE IN PUBLIC POLICY JOINT HEARING BEFORE THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE AND THE SUBCOMMITTEE ON HEALTH AND LONG-TERM CARE AND THE SUBCOMMITTEE ON HOUSING AND CONSUMER INTERESTS OF THE SELECT COMMITTEE ON AGING HOUSE OF REPRESENTATIVES ONE HUNDRED FIRST CONGRESS FIRST SESSION MARCH 9, 1989 Printed for the use of the Senate Special Committee on Aging and the House Select Committee on Aging Senate Special Committee on Aging Serial No. 101-1 House Select Committee on Aging Pub. No. 101-714 U.S. GOVERNMENT PRINTING OFFICE 97-857 WASHINGTON: 1989 For sale by the Superintendent of Documents, Congressional Sales Office U.S. Government Printing Office, Washington, DC 20402 SPECIAL COMMITIEE ON AGING DAVID PRYOR, Arkansas, Chairman JOHN GLENN, Ohio JOHN HEINZ, Pennsylvania BILL BRADLEY, New Jersey WILLIAM S. COHEN, Maine QUENTIN N. BURDICK, North Dakota LARRY PRESSLER, South Dakota J. BENNETT JOHNSTON, Louisiana CHARLES E. GRASSLEY, Iowa JOHN B. BREAUX, Louisiana PETE WILSON, California RICHARD SHELBY, Alabama PETE V. DOMENICI, New Mexico HARRY REID, Nevada ALAN K. SIMPSON, Wyoming BOB GRAHAM, Florida JOHN WARNER, Virginia HERBERT KOHL, Wisconsin NANCY LANDON KASSEBAUM, Kansas PORTIA PORTER MITTELMAN, Staff Director CHRISTOPHER C. JENNINGS, Deputy Staff Director JOSEPH A. LIEBERMAN III, M.D., Acting Minority Staff Director SELECT COMMITTEE ON AGING EDWARD R. ROYBAL, California, Chairman CLAUDE PEPPER, Florida MATTHEW J. RINALDO, New Jersey, THOMAS J. DOWNEY, New York Ranking Minority Member JAMES J. FLORIO, New Jersey JOHN PAUL HAMMERSCHMIDT, Arkansas HAROLD E. FORD, Tennessee RALPH REGULA, Ohio WILLIAM J. HUGHES, New Jersey NORMAN D. SHUMWAY, California MARILYN LLOYD, Tennessee OLYMPIA J. SNOWE, Maine MARY ROSE OAKAR, Ohio THOMAS J. TAUKE, Iowa THOMAS A. LUKEN, Ohio JIM COURTER, New Jersey BEVERLY B. BYRON, Maryland CLAUDINE SCHNEIDER, Rhode Island HENRY A. WAXMAN, California THOMAS J. RIDGE, Pennsylvania MIKE SYNAR, Oklahoma CHRISTOPHER H. SMITH, New Jersey BUTLER DERRICK, South Carolina SHERWOOD L. BOEHLERT, New York BRUCE F. VENTO, Minnesota JIM SAXTON, New Jersey BARNEY FRANK, Massachusetts HELEN DELICH BENTLEY, Maryland TOM LANTOS, California JIM LIGHTFOOT, Iowa RON WYDEN, Oregon HARRIS W. FAWELL, Illinois GEO W. CROCKETT, JR., Michigan JAN MEYERS, Kansas IKE SKELTON, Missouri BEN BLAZ, Guam DENNIS M. HERTEL, Michigan PAUL B. HENRY, Michigan ROBERT A. BORSKI, Pennsylvania BILL SCHUETTE, Michigan BEN ERDREICH, Alabama FLOYD SPENCE, South Carolina NORMAN SISISKY, Virginia WILLIAM F. CLINGER, JR., Pennsylvania ROBERT E. WISE, JR., West Virginia CONSTANCE A. MORELLA, Maryland BILL RICHARDSON, New Mexico PATRICIA F. SAIKI, Hawaii HAROLD L. VOLKMER, Missouri JOHN EDWARD PORTER, Illinois BART GORDON, Tennessee JOHN J. DUNCAN, JR., Tennessee THOMAS J. MANTON, New York CLIFF STEARNS, Florida TOMMY F. ROBINSON, Arkansas CRAIG T. JAMES, Florida RICHARD H. STALLINGS, Idaho JAMES McCLURE CLARKE, North Carolina JOSEPH P. KENNEDY II, Massachusetts LOUISE M. SLAUGHTER, New York JAMES H. BILBRAY, Nevada JIM JONTZ, Indiana JERRY F. COSTELLO, Illinois HARLEY 0. STAGGERS, JR., West Virginia FRANK PALLONE, JR., New Jersey JOLENE UNSOELD, Washington MANUEL R. MIRANDA, PH.D., Staff Director PAUL SCHLEGEL, Minority Staff Director (QD) SUBCOMMITTEE ON HEALTH AND LONG-TERM CARE CLAUDE PEPPER, Florida, Chairman JAMES J. FLORIO, New Jersey RALPH REGULA, Ohio, HAROLD E. FORD, Tennessee Ranking Minority Member MARY ROSE OAKAR, Ohio MATTHEW J. RINALDO, New Jersey THOMAS A. LUKEN, Ohio CLAUDINE SCHNEIDER, Rhode Island HENRY A. WAXMAN, California THOMAS J. RIDGE, Pennsylvania MIKE SYNAR, Oklahoma CHRISTOPHER H. SMITH, New Jersey BUTLER DERRICK, South Carolina SHERWOOD L. BOEHLERT, New York BRUCE F. VENTO, Minnesota JIM SAXTON, New Jersey BARNEY FRANK, Massachusetts HELEN DELICH BENTLEY, Maryland RON WYDEN, Oregon JIM LIGHTFOOT, Iowa IKE SKELTON, Missouri HARRIS W. FAWELL, Illinois DENNIS M. HERTEL, Michigan PAUL B. HENRY, Michigan ROBERT A. BORSKI, Pennsylvania WILLIAM F. CLINGER, JR., Pennsylvania BEN ERDREICH, Alabama NORMAN SISISKY, Virginia ROBERT E. WISE, JR., West Virginia BILL RICHARDSON, New Mexico EDWARD R. ROYBAL, California (Ex Officio) KATHLEEN GARDNER CRAVEDI, Staff Director MARK BENEDICT, J.D., Minority Staff Director SUBCOMMITTEE ON HOUSING AND CONSUMER INTERESTS JAMES J. FLORIO, New Jersey, Chairman MARILYN LLOYD, Tennessee JOHN PAUL HAMMERSCHMIDT, Arkansas, BEVERLY B. BYRON, Maryland Ranking Minority Member TOM LANTOS, California JIM COURTER, New Jersey BILL RICHARDSON, New Mexico THOMAS J. RIDGE, Pennsylvania HAROLD L. VOLKMER, Missouri HARRIS W. FAWELL, Illinois BART GORDON, Tennessee BILL SCHUETTE, Michigan THOMAS J. MANTON, New York PATRICIA F. SAIKI, Hawaii JAMES H. BILBRAY, Nevada JOHN J. DUNCAN, JR., Tennessee FRANK PALLONE, JR., New Jersey CRAIG T. JAMES, Florida JOLENE UNSOELD, Washington MATTHEW J. RINALDO, New Jersey EDWARD R. ROYBAL, California (Ex Officio) (Ex Officio) WILLIAM F. BENSON, Staff Director PATRICIA LAWRENCE, Minority Staff Director (III) CONTENTS Members' opening statements: Page Senator David Pryor, presiding............................................................................. 1 Senator John Heinz ............................................................ 6 Representative Jim Florio ................. ........................................... 18 Senator Bill Bradley ............................................................ 36 Representative Claude Pepper ........................................................... 37 Senator Richard Shelby ........................................................... 69 Representative Ben Erdreich ........................................................... 76 Senator Bob Graham ........................................................... 132 Members' prepared statements: Senator John Glenn ............................................................ 9 Senator John Breaux ........................................................... 11 Senator Herbert Kohl ........................................................... 14 Senator Charles Grassley ............................................................ 15 Senator John Warner ........................................................... 16 Representative Mary Rose Oakar ........................................................... 30 Representative Helen Delich Bentley ........................................................... 33 Representative Ralph Regula ........................................................... 34 Representative Robert Borski ........................................................... 35 Representative Edward Roybal .......................... ................................. 154 CHRONOLOGICAL LIST OF WITNESSES Representative Claude Pepper, chairman, Subcommittee on Health and Long- Term Care ............................................................. 37 David Lazarus, director of litigation, community health law project, East Orange, NJ ........................................................... 62 Alice Lippold, resident, board and care home, Washington, DC . 67 John Sharp, resident, board and care home, Sacramento, CA . 68 Julie Oetting, long-term care ombudsman, Jefferson County, AL . 73 Ima Ring, sister of board and care resident, Indianapolis, IN . 77 Anne Hart, long-term care ombudsman, Washington, DC . 78 Melva Colegrove, investigator/consultant, Ohio Department of Health, Colum- bus, OH ........................................................... 87 Pam Hinckley, owner/operator, board and care home, Cleveland, OH . 96 Mary Beth Africa, long-term care ombudsman, Altoona, PA . ..................... 101 Patricia H. Murphy, director, New York City long term care ombudsprogram, New York, NY ........................................................... 125 Michael Coonan, long-term care ombudsman, Sacramento, CA . ................... 143 Janet L. Shikles, director, National and Public Health Issues, Human Re- sources Division, General Accounting Office, accompanied by Alfred Schnupp, assignment manager and Chris Rice, evaluator-in-charge . ............. 156 APPENDIX Item 1. Staff briefing paper of the Senate Special Committee on Aging ............ 165 Item 2. Introduction and proposed model standards from report of the Sub- committee on Housing and Consumer Interests, House Select Committee on Aging.............................................................................................................................. 171 Item 3. Chronology of significant Federal activities related to board and care homes, prepared by the Congressional Research Service . ....................... 211 Item 4. Testimony of the National Association of Residential Care Facilities, submitted by Barbara B. Jameson, Ph.D ...................................... 216 (v) VI Page Item 5. Testimony of the Arkansas Department of Human Services, Division of Economic and Medical Services, submitted by Jerry N. Rayburn, admin- istrator, residential and adult day care, office of long term care ....................... 221 Item 6. Testimony from the community residential facility operators in the District of Columbia, submitted by Mary T. Scott, past president ..................... 223 BOARD AND CARE: A FAILURE IN PUBLIC POLICY THURSDAY, MARCH 9, 1989 U.S. SENATE, SPECIAL COMMITTEE ON AGING, JOINT WITH SUBCOMMITTEE ON HEALTH AND LONG-TERM CARE AND THE SUBCOMMITTEE ON HOUSING AND CONSUMER INTER- ESTS, SELECT COMMITTEE ON AGING, U.S. HOUSE OF REPRESENTATIVES, Washington, DC. The
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