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A
To
the
interim
joint
committee
hearing
on
health
and
family
services,
we,
as
always
have
a
very
full
agenda.
A
few
reminders
before
the
roll
call
members
that
are
participating
remotely.
Everyone
should
be
muted
unless
you
are
actively
speaking
in
the
meeting
and
please
use
the
chat
feature
to
notify
staff.
If
you
want
to
be
recognized
for
a
question
or
a
comment
when
you
are
answering
the
attendance
role,
please
indicate
if
you
are
in
your
lrc
office
or
if
you
are
participating
remotely.
A
Okay
secretary,
if
you
could
please
take
the
role.
B
A
A
Unfortunately,
senator
alvarado
is
not
able
to
be
with
us
and
and
actually
representative
dotson
as
well
and
several
of
our
presenters.
We
would
just
like
to
send
out
our
thoughts
and
prayers
to
judge
chris
pace's
family.
A
I
know
that
his
funeral
is
is
happening
now,
so
a
tremendous
loss
I
know
to
clark
county
and
certainly
to
his
family
and
all
who
knew
and
loved
him.
So
we
just
send
out
our
regards
to
to
everyone
involved.
We
will
need
to
approve
our
minutes
from
september.
Thank
you.
We.
A
In
a
second
all
in
favor,
thank
you
so
moving
into
our
agenda,
we
are
pleased
to
have
some
folks
with
us
today
to
discuss
assisted
living
and
actually,
I
think
what
I'll
do.
First,
I
think
I'd
like
to
go
ahead
and
approve
the
regulations
review
the
regulations.
A
First,
since
we
have
a
number
of
people
here
in
person
with
us
and
online
who
are
available
to
to
discuss
and
answer
questions,
should
we
have
any.
We
have
a
long
list
of
regs
which
have
been
referred
to
us
to
consider.
Today
all
members
were
sent
out
the
regs
and
hyperlinks.
Are
there
any
questions
or
any
concerns
about
any
of
the
regs.
A
A
Thank
you.
Oh
okay,
we're
just
we're
just
going
to
review
these.
We
actually
don't
need
to
vote
on
this,
but
thank
you
very
much.
We
will
consider
all
of
the
administrative
regs
reviewed
and
we
will
move
on
so
first,
we
have
with
us
the
assisted
living
and
long-term
care,
update
and
priorities.
A
We
have
I'll
just
read
off
the
folks
that
I
have
here
on
the
list.
Some
are
remote
and
some
are
here
in
person,
mary
lynn,
spaulding,
president
and
chief
executive
officer
for
christian
care
communities.
I
guess
is
remote
and
we
have
tim
vino
just
come
on
up
to
the
table
if
you're
here
in
person,
betsy,
johnson,
bob
white
and
mark
lee.
H
Okay,
well,
my
colleagues
in
long-term
care
voted
me
first
to
go,
so
I'm
going
to
start
off
with
just
first
of
all
good
afternoon,
and
thank
you,
madam
chairwoman,
for
inviting
us
today,
members
of
the
committee,
our
association,
represents
the
entire
continuum
of
care,
assisted
living,
personal
care
and
skilled
nursing
facilities.
We
represent
over
270
long-term
care
providers
across
the
commonwealth.
H
H
You
will
see
the
skilled
nursing
facility
level
of
care
is
the
highest
level
of
care.
Personal
care
is
the
second
highest
level
of
care
and
assisted
living
is
currently
the
lowest
level
of
care
on
the
sheet.
You
also
see
that
these
levels
of
care
how
they
are
reimbursed
and
in
kentucky
only
skilled
nursing
facilities,
are
reimbursable.
H
Under
the
medicaid
program
today,
you'll
hear
a
discussion
on
the
proposed
changes
to
the
long-term
care
continuum,
thanks
mostly
to
mark
lee
here,
who
is
a
consultant
on
this
project.
You'll
see
that
in
bill
request.
137
does
not
address
reimbursements
for
these
services,
so
that
will
not
change.
Medicaid
will
continue
to
be
only
only
reimbursed
for
skilled
nursing
facility
care.
What
it
does
address
will
it
is
the
modernizing
the
service
delivery
to
make
long-term
care
services
more
consumer-friendly.
H
What
you
will
also
hear
today
will
be
recommendations
to
change
the
levels
of
care,
and
so
what
is
outlined
on
the
sheet
in
your
packet
today
will
hopefully
not
be
the
reality
next
year.
The
nursing
facility
column
will
remain
the
same.
The
personal
care
column
will
change,
and
what
will
only
be
left
is
what
we
often
refer
to
as
state
supplementation,
personal
care
and
I'll
get
to
that
at
the
at
the
end
of
my
presentation
and
all
private
pay,
personal
care
services
will
move
to
the
assisted
living
category.
H
And
finally,
I
want
to
end
because
I
know
this
is
very
important
to
represent
moser,
but
what
will
remain
in
the
personal
care
category?
Are
our
state
supplementation,
personal
care
homes
and
specialized
personal
care
homes,
typically
caring
for
a
younger
population
and
those
with
a
severe
mental
illness.
H
These
individuals
are
also
typically
living
below
the
poverty
level
and
although
we
believe
this
bill-
and
we
thank
again
mark
lee
and
bob
white
for
listening
to
our
association-
because
we
do
represent
a
lot-
a
large
population
of
state
supplementation,
personal
care
homes-
they
did
listen
to
us
and
you'll-
see
in
section
37
of
the
bill,
requests
that
it
does
address
state
supplementation,
personal
care
homes.
However,
it's
it's
a
good
start.
H
We
will
continue
to
advocate
for
these
personal
care
homes,
and
we
appreciate
the
general
assembly,
including
funding
increases
in
the
last
two
budgets.
So
that's
just
an
overview,
and
hopefully,
if
you
have
any
questions
about
that,
one
pager
in
your
packet
I'll
be
more
than
happy
to
answer
that,
if
not
I'll
turn
over
to
tim,
vino.
F
F
My
name
is
tim
vino
and
I'm
the
president
of
leading
age
kentucky
we
are
based
in
in
louisville.
We
are
affiliated
with
leading
age
national
washington,
d.c,
leading
age.
Kentucky
also
represents
the
full
continuum
of
care
of
service
providers
to
the
elderly
and
disabled,
including
assisted
living,
personal
care,
skilled,
nursing
and
other
long-term
care
health
categories.
F
F
F
J
That
correct
again,
my
name
is
mary
lynn,
spaulding
and
I'm
president
and
ceo
of
christian
care
communities.
We
are
the
largest
faith,
inspired
provider
in
the
state
of
kentucky
and
I'm
actually
in
bowling
green
today.
So
I
appreciate
the
opportunity
to
come
in
and
speak
and
the
opportunity
for
zoom,
and
I
really
am
grateful
and
thank
you
for
that.
We
too
are
in
support,
I'm
very
grateful
to
mark
lee
because
we
have
worked
alongside
mark
in
crafting
this
piece
of
legislation
to
tim's
point.
J
There
is
never
a
perfect
piece
of
legislation
and
I
would
tend
to
agree
with
that,
but
from
our
perspective,
when
you
look
at
the
day-to-day
the
workforce,
our
residents,
their
families
and
particularly
people
with
alzheimer's
and
dementia,
this
goes
a
long
way.
I've
been
working
with
christian
care
for
about
12
years,
not
quite
13.
Actually
and
christian
care
has
been
around
for
137
years
and
we
have
all
levels
of
care.
J
So
it's
very
helpful
to
families.
It
will
also
be
very,
very
helpful
to
residents.
We
talked
about
the
fact
that
people
want
to
be
in
the
least
restrictive
level
of
care.
I've
seen
time
and
time
again
and
many
of
my
colleagues
and
other
providers
see
that
when
folks
get
to
a
certain
level
of
care,
they
can
no
longer
stay
in
what
they
consider
their
home
in
assisted
living,
because
we're
not
able
to
provide
those
services
transition
is
difficult
when
you're
young,
it's
even
more
difficult.
J
When
you
get
older,
it
exacerbates
their
medical
conditions,
it
exacerbates
their
emotional
conditions,
and
this
particular
piece
of
legislation
begins
to
address
that.
So
I
think
it's
a
really
good
thing
for
the
residents
themselves
and
something
that
we've
all
been
talking
a
lot
about.
Lately
is
workforce.
J
Many
times
we
will
recruit
individuals
into
assisted
living
to
work
in
assisted
living,
and
they
may
have
worked
in
different
levels
of
care.
They
may
have
worked
in
skilled
care,
but
the
one
common
theme
that
we
try
to
find
in
them
is
that
they
all
love,
grandmas
and
grandpas,
and
the
reality
is
is
that
when
they
come
into
the
assisted
living
setting,
it
is
quite
confusing
for
them
to
know
what
they
can
and
can't
do
because
of
the
current
differences
between
the
social
and
medical
models.
J
But
then
it
quickly
turns
to
medication
administration
that
ends
up,
posing
as
a
problem
currently
and
again
results
in
a
transition
we're
one
of
the
providers
of
the
best
friends
approach.
Best
friends
was
birthed
in
kentucky.
It's
been
around
for
nearly
40
years
and
it's
predicated
on
giving
people
a
quality
of
life
with
their
life
story.
J
I
Y'all
are
being
too
kind,
I'm
mark
lee,
I'm
privileged
to
be
here
and
thank
you
for
the
opportunity
to
share
just
a
few
thoughts
with
you,
I'm
not
known
for
my
brevity,
but
we're
going
to
break
the
mold.
Today
we
put
together
coalition
partners
and
it's
comprised
of
all
three
of
these
associations
that
you
see
represented
before
you
today,
and
we
knew
that
no
one
association
should
bring
all
the
views
or
would
necessarily
bring
all
the
views.
I
Over
the
last
two
years
we
and,
and
it's
been
a
lot
of
people
involved-
we've
studied
the
assisted
living
statutes
and
regulations
really
from
across
the
country
most
of
the
states
in
the
union.
I
I
My
companies
involved
in
independent
living
memory
care,
licensed
personal
care
and
assisted
living
by
way
of
example,
in
talking
about
listening
to
that
input,
after
seeking
it,
the
alzheimer's
association
and
we're
very
grateful
for
it
recommended
during
one
of
our,
I
guess
during
our
first
meeting,
recommended
that
we
carefully
review
the
new
minnesota
assisted
living
statute
and
they
characterized
it
as
being
comprehensive
and
a
great
example.
I
Additionally,
nine
of
the
11
entirely
new
sections
of
the
kentucky
bill
were
again
strongly
influenced
by
that
minnesota
statute.
This
bill
and
a
run
through
very
quickly.
This
bill,
modernizes
kentucky's,
assisted
living
social
model
to
more
closely
align
with
the
vast
majority
of
states,
we're
almost
on
a
limb
by
ourselves
when
it
comes
to
that
pure
social
model
that
prohibits
direct
delivery
of
any
health
services
to
our
residents
and
our
residents
are
a
lot
older
and
a
lot
less
well
as
they
come
in
today
than
they
were
20
years
ago
even
10
years
ago.
I
It
reduces
consumer
confusion,
as
you've
heard
from
the
others,
by
merging
private
pay,
personal
care
with
private
pay,
assisted
living.
It
promotes
true
aging
in
place
allowing
care
provided
in
resident
apartments
to
change
to
flex
to
meet
those
changing
resident
needs
without
necessitating
a
move
to
a
different
licensed
area
of
the
building.
I
People
in
assisted
living
already
have
that
in
the
statute,
it's
not
there
for
apartment-style
personal
care
residents.
The
bill
would
allow
providers
to
choose
how
much
care
to
offer
within
this
somewhat
broader
definition
of
assisted
living.
Should
a
provider
wish
to
offer
basic
health
services,
it
may
should
a
provider
choose
to
stay,
just
give
it
providing
that
social
model
it
may.
The
one
exception
to
that
is
that
the
bill
requires
basic
health
services,
be
provided
to
residents
residing
in
a
secured
dementia
unit,
as
these
are
our
most
vulnerable
residents.
I
The
bill
is
a
vast
improvement
over
the
current
statutes,
both
assisted
living
and
personal
care,
especially
as
they
relate
to
memory
care
units.
An
assisted
living
community
with
a
memory
care
unit
would
have
a
slightly
different
license.
It
would
be
called
that
the
license
would
read
assisted
living
community
with
a
dementia
care
and
there's
lots
of
higher
standards
that
are
built
into
that
specific
to
that
dementia
care
unit.
Delivery
of
basic
health
services
within
a
memory
care
unit
will
be
required,
as
I
indicated,
which
will
increase
quality
of
care.
I
They
they
address
concerns
about
the
social
model,
memory
care
units
under
assisted
living
that
are
currently
across
the
commonwealth
across
the
commonwealth
and
and
those
concerns
have
been
raised
by
the
cabinet
for
health
and
family
services
by
the
alzheimer's
association
and
frankly,
this
bill
aligns
with
recommendations
of
the
general
assembly's
alzheimer's
and
dementia
workforce
assessment
task
force.
That
was
the
first
thing
we
looked
at
as
we
began
to
delve
into
the
memory
care
portion
of
this
bill.
I
E
I'm
bob
white,
I'm
the
executive
director
of
the
bob
white
executive
director
of
kentucky
senior
living
association.
We
are
the
state
partner
in
kentucky
for
argentum
in
washington.
I
believe
in
your
packet.
You
have
a
letter
there
from
the
president
of
argentium
supporting
this
bill.
It's
also
signed
by
pat
maloy,
who
is
a
kentuckian
and
is
chairman
of
the
argentine
board.
This
year,
pat
malloy.
K
E
E
A
This
is
certainly
an
area
where,
as
was
said,
there's
a
great
deal
of
confusion
about
the
care
of
the
levels
of
care
that
are
currently
allowable,
and
I
agree
that
we,
it
is
time
that
we
modernize
and
clarify
some
of
those
services,
and
you
know
also
allow
a
more
a
smoother
transition
to
higher
levels
of
care,
and
you
know
it's.
It's
no
surprise
that
you
know.
As
we
age,
we
will
require
higher
levels
of
care
and
it
makes
sense
to
allow
individuals
to
age
in
place.
A
It
is
stressful
to
move
it's
stressful
for
the
individuals,
it's
stressful
for
their
families,
and
I
just
really
applaud
you
for
the
work
that
you've
done.
I
think
that
this
makes
a
great
deal
of
sense,
and
you
know
I
I
think
that
it'll
just
provide
better
care
for
our
residents.
A
So
the
the
one
question
that
we
have
gotten
over
the
past
few
days
and
and
it's
not
a
new
question,
but
it
has
to
do
with
dementia
training-
and
I
see
that
we
are
in
this
bill-
are
delineating
the
training
happening
in
the
memory
care
units,
but
not
outside
of
those
units.
So
is
there
any
training
that'll
be
happening
for
staff
on
dementia
in
assisted
living.
I
mean
we
all
know
that
as
patients
age
dementia
progresses.
So
it
has
consideration
been
given
to
that
that
portion
of
this
this
training
and
this
bill.
I
A
L
Thank
you,
chairwoman
and
thank
you
guys
very
much.
I
think
I
have
some
confusion,
so
I
just
want
to
make
sure
I'm
straight
because,
unfortunately,
you
know
I've
been
through
this
with
my
father,
who
died
of
end-stage
parkinson's
and
my
mother,
who
died
of
end-stage
alzheimer's,
and
I
have
had
family
members
on
both
my
husband's
side
and
my
side
in
long-term
facilities
for
for
years
and
years,
and
this
idea
of
being
able
to
stay
in
place
is
wonderful.
L
Neither
of
my
parents
had
that
opportunity,
but
but
I'm
concerned
about
for
me
it's
it's
a
matter.
I
think
of
definition,
because
I
think,
if
the
continuum
of
care
as
being
independent
living,
which
is
basically
like
the
model,
I
think
of,
is
where
my
mother-in-law
was.
Where
you
have
your
own
independent
units,
then
you
go
to
assisted
living,
which
is
where
you're
helped
with
medication
and
some
activities
of
daily
living,
like
you're,
making,
sure
you're
showered
making
sure
you've
got
clean
clothes.
L
Then
you
go
to
personal
care,
which
means
honestly.
You
know
you
can't
clean
yourself.
You
need
somebody
to
help
you
with
basic
toiletries
and
then
skilled
nursing,
which
is
when
you
really
need
actual
medical
care
with
rns.
Do
I
have
that
wrong,
or
is
that
about
right?
That's
about
right!
Okay!
So
when
you
say
that
assisted
living
is
a
social
model
with
no
health
services,
but
then
I
think
so
it
was
you
that
said
basic
health
care
assisted
living
model.
So
I
got
confused
in
the
assisted
living.
I
That's
that's
correct.
Senator
the
the
law,
the
current
assisted
living
statute,
which
was
enacted
in
2000,
says,
there's
a
there's:
a
prohibition
on
delivering
anything
that
is
considered
under
kentucky
law,
a
a
health
service
and
matter
of
fact.
There
would
be
the
duty
to
report
that
to
the
cabinet
and
and
bad
things
happen,
and
so
it's
a
it's
a
hard
red
line,
and
again
even
back
in
2000,
there
was
the
need
to
deliver
more
than
a
true
social
model
approach
in
assisted
living,
but
it
was
the
fir.
I
We
have
seen
over
these
years
a
real
need
for
these
people
that
are
in
assisted
living,
who
are
entering
at
an
older
age
and
less
well
to
have
basic,
not
skilled
basic
health
services,
and
so
what
we've
done
in
this
bill?
What
it
would
do
is
to
merge
personal
care,
the
basic
health
services
model,
the
ability
of
staff
to
the
ability
of
that
provider
to
have
nurses
on
staff,
the
ability
of
them
to
use
clinical
judgment.
I
So
I
I
hope
that
answers
your
question.
This
does
not
put
assisted
living
into
skilled
nursing
territory
or
I'm
pretty
sure,
both
betsy
and
tim
wouldn't
be
up
here,
testifying
for
this.
Since
most
of
their
members,
more
of
their
members
are
skilled,
nursing
facilities
than
than
assisted
living.
L
I
L
Okay,
so
we're
basically
under
this
new
the
thought
concept
of
independent
living
like
an
independent
living
facility,
where
you
know
that
basically
has
nothing
to
do
with
this.
It
does
not,
so
we
start
at
assisted
living
and
we
start
with
basically
a
model.
In
your
opinion,
the
vast
majority
of
providers
will
be
delivering
some
basic
health
care
services.
I
I
Obviously,
if
I'm
going
to
hire
credentialed
staff
licensed
staff,
if
I'm
going
to
obviously
have
you
know,
be
training
more
etc.
I'm
I'm,
I
would
have
to
raise
my
rates
or
my
you
know.
L
I
do
have
another
question,
but
it's
left
my
mind.
So
thank
you.
I
think.
Oh
no,
I
know
what
I
was
going
to
say
if
I'm
terrible
again
and
my
mother
died
of
end
stage,
alzheimer's,
she
was
in
quote
unquote,
assisted
living
for
almost
10
years
and
in
a
building
that
had
personal
care
and
had
memory
care.
L
So
as
soon
as
they
felt
like
the
need
was
there
for
her
to
have
a
higher
level
of
service
she
could
without
moving,
but
I
would
have
deemed
it
essential
that
all
of
her
health
care
providers
had
some
training
in
dementia
and
how
you
interact
and
respond
to
a
demented
patient,
because
I
mean
that
was
integral
to
her.
Day-To-Day
care
was
that
she
had
advanced
alzheimer's.
She
was
mobile.
She
knew
how
to
brush
her
teeth.
She
knew
how
to
brush
her
hair.
L
I
I
We,
as
providers
need
to
focus
on
that
even
more
and
and
you're
right.
It
is
critical.
I
know
we
give
a
great
deal
of
attention
to
that
in
my
own
operations
and-
and
I
believe
the
vast
majority
of
assisted
living
communities
already
do
that.
I
The
requirements
do
not
change
under
this
bill
as
it's
currently
written
senator
for
the
for
rank
and
file.
Employees
who
do
not
work
on
or
if
there's
not
a
memory
care
unit
in
the
building.
The
training
requirements.
Don't
change
from
what
the
current
law
is
in
some
discussions
that
we
have
had
and
and
with
a
a
key
advocacy
group
for
these
very
issues.
We're
talking
about.
I
We've
indicated
a
willingness
to
engage
in
looking
at
the
possibility
of
of
making
in
this
bill
the
a
requirement
that,
from
the
menu
of
things
that
can
be
trained
on
that
dementia
for
rank
and
file.
Employees
separate
apart
from
whether
they
work
specifically
on
a
secured
unit
or
not
be
a
required
topic
rather
than
just
on
the
menu
to
be
taught
from.
M
Thank
you,
madam
chair,
and
appreciate
y'all's
testimony.
You
know
I'm
big
supporters
of
the
work
you
folks
do
and
I
commend
you.
You
do
a
great
job
and
my
comments
in
question.
I
don't
want
to
suggest
that
I
don't
favor
this
legislation
because
I
do.
I
think
it
really
is
desperately
needed,
but
I
think
it's
interesting
we're
talking
about
a
continuum
of
care
and
that's
like
in
theory,
practical
education.
I
don't
think
it's
there.
I
don't
think
it's
ever
been
there.
M
It's
too
fragmented,
it
always
has
been,
and
I
thought
this
took
a
great
leap
towards
it
until
you
said,
but
there's
still
going
to
be
some
assisted
living
facilities.
That
would
be
just
a
social
model.
So
just
from
a
consumer
advocate
standpoint
is:
if
I'm
looking
to
place
a
family
member
in
assisted
living.
M
How
will
I
know
that
the
difference
in
in
will
we
set
up
a
set
of
expectations
that
are
here
that
can't
be
met
because
you
got
a
social
model
that
people
just
don't
understand.
You
know
aunt
thelma
is
in
this
assisted
living
and
she
gets
these
services,
but
this
one
over
here
she
doesn't
get
it.
So
doesn't
that
add
to
the
confusion.
I
I'm
happy
to
let
anybody
else
handle
this
or
I'm
happy
to.
If
you
want
me
to
all
right,
senator
it's
a
good
question
and
as
as
tim
and
I
think,
betsy,
I
think
we
all
recognize
there
is
no
perfect.
I
think
it's
a
pretty
darn
good
piece
of
legislation,
but
there
is
no
perfect
piece
and
when
you're
having
to
look
at
various
issues,
it
can
impact.
As
you
know,
another
one
and
one
of
the
things
I
mean
some
of
these
associations,
own
members.
M
I
I
I
There
are
others,
because
there's
nothing
in
the
assisted
living
statute
that
prohibits
caring
for
those
folks.
There
are
others
that
take
that
much
further,
so
there
there
are
that's
just
one
example,
but
there
are
significant
differences,
even
within
the
social
model
today
and
it's
incumbent
upon
each
provider
to
fairly
disclose
where
their
limits
are,
what
services
they
offer
and
which
ones
they
don't.
M
And
when
I
started
in
the
general
assembly
in
2017,
we
had
10
billion
dollar
medicaid
budget.
Today,
it's
15
billion
and
I
think
there's
enough
money
there
to
take
everybody's
needs
if
we
spend
it
appropriately,
but
not
getting
people
at
the
appropriate
level
of
care,
and
one
of
the
concerns
I
have-
and
it
goes
to
senator
burke's
point
is:
if
you
have
the
social
model,
we
know
that
alzheimer's
dementia
is
progressive
disease,
as
someone
who's
in
a
social
model
starts
to
exhibit
these
symptoms.
M
Turnover
among
staff-
if
they
don't
have
that
training,
and
we
just
don't
want
to
exasperate
that
you
know-
we've
got
approximately
71
000
people
in
kentucky
who
suffer
from
alzheimer's
dementia.
It
projects
to
be
85
000
by
2025,
and
yes,
sir.
I
really
see
that
this
is
going
to
be
an
onslaught
of
patients
that
that
you
folks
are
going
to
have
to
deal
with,
and
I
certainly
think
this
is
a
good
way
to
do
it.
But
back
to
that
continuum
of
care,
I
think
everybody
needs
some
level
of
training
even
in
the
social
model.
M
M
You
know
that's
a
almost
40
percent
of
our
population,
the
state
right
now
it
goes
back
that
appropriate
level
of
care
if
they
don't
have
access
to
assisted
living.
Where
are
they?
Where
are
they
going?
Probably
we've
got
many
in
in
our
nursing
homes
that
don't
need
to
be
there
in
a
much
higher
cost.
So
that's
costing
us
more
shouldn't.
Somebody
be
exploring
a
model
delivery
for
the
medicaid
patients
for
assisted
living.
Are
you
folks
doing
that?
Is
there
any
conversation
about
that?
Has
a
cabinet
never
brought
that
up.
H
H
So
I
talked
about
that
about
48
of
the
states
have
assisted
living
as
a
medicaid
certified
provider
and
then
many
more
allow
for
waiver
type
services
to
come
into
the
assisted
living
community
and
you're.
Right,
I
mean
assisted
living,
is
very
expensive
in
this
state.
Personal
care
is
even
more
dr
berg,
my
mom
just
moved
to
personal
care.
The
price
went
up
three
thousand
dollars
a
month,
so
I
think
it's
something
that
we
should
discuss.
I
actually
had
a
meeting.
H
I
hope
she
had
mommy
saying,
but
I
had
a
meeting
with
commissioner
lee
this
morning
on
another
matter,
and
she
said
that
this
is
a
discussion
we
need
to
have,
but
we
wanted
to
move.
I
think
mark
will
correct
me.
If
I'm
wrong,
we
wanted
to
move
the
licensure
categories,
to
align
with
the
services
being
provided
first
and
then
start
having
these
discussions,
because
it
will
have
a
significant
impact
on
the
medicaid
budget.
M
I
support
this.
I
truly
do
again.
I
once
looked
very
closely
at
the
training
requirements
with
dementia
and
alzheimer's,
but
and
and
don't
mean
this
to
insult
anybody,
but
we're
just
kind
of
slapping
duct
tape
on
this
issue
in
terms
of
appropriateness
of
care,
particularly
medicaid
population,
and
we
seem
to
have
a
philosophy.
A
I
agree.
Thank
you.
Thank
you,
senator
representative
fleming.
Does
she
have
a
question?
Okay,
all
right
and
representative
marzian.
Do
you
have
a
question.
B
I
do
thank
you
so
much
fascinating,
it's
well.
Where
am
I
so?
I'm
gonna
relay
some
concerns
from
the
many
many
emails
I've
received
from
the
alzheimer
folks
number
one.
They
said,
there's
a
lack
of
specified
dementia,
specific
training
and
competent
staff,
training
in
the
assisted
living
and
number
two
uniformity
and
requirements
and
qualifications
for
providing
memory
care
across
the
industry.
I
20
years
ago,
a
social
model
was
all
that
was
in
the
cards
for
this
state.
Frankly,
from
a
political
issue
in
2010
we
came
back
and-
and
I
was
privileged
to
work
on
that
first
bill-
I
was
the
primary
author
of
house
bill,
444,
representative
western,
knows
a
lot
about
the
original
bill
and
and
house
will
444
as
others
of
you
do.
We
we
made
improvements
in
2010.
I
So
I
you
know,
I'm
I'm
trying
to
be
transparent
here,
representative
marzian
and
to
say
I'm,
I'm
a
big
fan
of
strong
training
programs
be
happy
to
tour
you
in
in
one
of
my
buildings
and
and
show
you
that
right,
the
the
there
is
some
value,
though
in
realizing
that
one
size
doesn't
fit
all
from
the
standpoint
of
what's
in
the
training
and
that
just
as
mary
lynn,
spaulding
from
christian
care
communities
highlighted
that
they
are
a
best
friend's
approach
provider.
I
B
I
And
and
interacting
with
your
residents
so
again,
that's
a
needle
we've
tried
to
thread
we're
still
in
conversations
with
the
alzheimer's
association,
we're
well
aware
they
have
some
that
they
would
like
to
see
us
travel
a
little
further
down
the
road
in
in
a
couple
of
areas.
They
have
also
said
man
there's
a
lot
of
good
stuff
in
this
bill.
E
Well,
it's
across
the
board,
and
it
really
depends
on
where
you
are
in
the
market,
in
a
smaller
markets,
you're
looking
at
for
assisted
living
only
around
three
thousand
to
thirty
six
hundred
a
month
when.
B
E
Into
personal
care
that
goes
up
about
a
thousand
dollars
so
you're
up
to
around
forty
five
hundred
to
five
thousand
a
month
in
personal
care
and
memory
care
is
even
higher
than
that
because
of
the
nature
of
those
units
in
skill
nursing,
the
average,
I
would
say,
is
around
six
thousand.
Would
you
say
that.
H
Well
represent
marzian.
A
skill
nursing
facility
is
typically
reimbursed
by
medicaid,
so
it's
not
private
pay
and
we
pay
on
a
per
day
basis
and
it's
based
on
acuity
of
the
patient.
So
it's
on
average
about
182
dollars
a
day
is
what
a
skilled
nursing
facility
would
receive
under
the
medicaid
program.
There's
a
limited
medicare
benefit
if
you're
gonna
be
paying
private
pay
for
for
skilled
nursing
facility
services.
You're
gonna
be
running
out
of
money
pretty
quickly
because
it's
very,
very
expensive.
B
Thank
you
so
much.
I
just
thought
it'd
be
interesting
to
see
what
the
updated
costs
are.
Thank
you
so
much.
A
Okay,
thank
you
just
to
to
tag
on
to
representative
marzian's
question,
so
we
know
that
the
cost
of
personal
care
is
somewhere
in
the
ballpark
of
4
000
to
4
600
a
month
assisted
living
currently
is
3
000
to
3
600
a
month.
What
do
you
anticipate
merging
these
models
to
cost.
I
Decides
to
embrace
the
the
opportunity
to
provide
more
care.
I
I
think
you're
probably
going
to
be
looking
at
the
range
of
what
pc
personal
care
costs
on
a
private
pay
basis,
because
the
level
of
staffing,
the
level
of
training,
the
level
of
those
costs
or
the
service
level.
What
can
be
done
is
pretty
much
what's
being
done
in
pc
today.
So
that's,
that's,
probably
the
best
barometer
I
could
give,
and
I
promise
you
in
madisonville
kentucky
where
we
live
and
have
a
have
an
assisted
living
community,
I'm
looking
real
hard.
I
A
Okay,
thank
you
yeah.
It
seems
that
you
know
perhaps
there's
a
a
prn
kind
of
as
needed.
You
know
cost
that
could
be
looked
into
well.
I
We
did
write
our
representative.
We,
we
did
write
into
the
bill
the
opportunity,
where
appropriate,
to
have
on
a
contract
basis,
some
of
the
credentialed
staff,
so
that,
if
your
need
for
that
flexes,
a
provider
can
can
deliver
what
they
must
deliver,
but
not
always
have
to
have
them.
24
7
on
on
staff,
and-
and
we
did
that
by
design.
Thinking
about
this
very
conundrum
that
I've
I've
just
spoken
to.
A
I
think
that's
a
good
idea,
you
know
looking
into
this
on
a
con
contractual
basis
and
and
as
folks
progress
in
their
levels
of
care
yeah,
making
it
making
it
available
anyway,
yeah
great
discussion.
I
know
that
we
we
have
a
lot
to
talk
about
senator
gibbons.
Do
you
have
a
question.
C
C
C
The
the
one
pager
you
gave
us
is
very
helpful
because
it
it
struck
me
listening
the
conversation
and
thinking
about
the
lexicon
slay
people
use
as
it
relates
to
these
categories
versus
the
actual
certification
and
licensure
categories.
Governmentally
used.
We
get
it
wrong
all
the
time
and
we
as
collectively
both
the
governmental
group
and
the
lay
person.
C
But,
as
you
well
know,
a
lot
of
folks
will
say
well,
my
family's
in
the
nursing
home
there's
a
big
difference,
there's
a
big
difference
and
it
struck
me
listening
the
conversation,
57
pages
lots
of
changes,
I'm
excited
about
the
conversation,
as
I
read
on
page
27,
you're,
basically
dissolving
the
personal
care
category
into
into
assisted
living
communities.
Is
that
what
I
understand.
H
Exactly,
except
for
state
supplementation,
personal
care,
which
is
they
serve
a
younger
population
and
and
people
with
serious
mental
mental
illness
typically
and
they're,
relying
on
state
supplementation,
so
they're,
very
poor
individuals.
So
this
bill
would
change
personal
care,
that's
private
pay!
So
if
you
go
to
louisville,
for
instance,
you
might
see
what
all
of
us
would
think.
Oh
that's
an
assisted
living
community,
but
it's
really
a
personal
care.
H
Private
pay
community,
so
everybody
like
that,
would
move
into
the
assisted
living
category
and
then
change
that
from
a
certification
to
a
licensure
with
the
different
levels
of
care
as
mark
described.
So
there
still
will
be
a
licensed
personal
care
category,
but
it
is
for
the
state,
supplementation
and
again
I'll
use
this
as
a
plug,
which
we
need
to
work
on
that
issue
as
well.
C
Talk
with
me
about
some
of
the
changes
further
on
in
the
legislation
as
it
relates
to
the
assisted
living
communities
now
fall
in
under
this
umbrella
of
long-term
care
facilities,
based
on
a
definitional
change
that
you
have
here,
but
they
don't
for
circumstances
of
oversight
in
the
ombudsman.
Why?
Why
would
they
want
to
be
there,
except
for
those
times
that
they
don't
want
to
be
there?
C
I
Currently
licensed
personal
care
is,
does
have
a
relationship
with
the
purview
of
the
ombudsman
office
for
21
years.
Assisted
living
has
not,
and
it's
it's
the
way
the
general
assembly
passed
it
seeing
it,
because
people
for
these
last
21
years
have
had
their
rights
protected
and
by
having
a
lease
agreement
as
opposed
to
in
a
what
I'll
call
a
nursing
home
model
there.
I
There
typically
is
no
lease
there's
an
admission
and
there's
there's
not
a
specific
legal
document,
and
so
that
is
the
way
assisted
living,
and
I
I
would
suggest
to
you
that
the
reason
assisted
living
as
a
category
as
a
a
brand,
if
you
will
enjoys
the
level
of
support
statewide
that
it
does,
is
because
assisted
living
providers
have
done
a
really
good
job
with
that
model
and
the.
I
That
lease
being
in
place
will
not
change
under
this
bill
and
so
folks
are
still
have
been
being
protected,
and
I
I
would
suggest
to
you
that
in
kentucky-
and
this
is
not
to
throw
stones
at
my
brothers
and
sisters
that
are
that
have
skilled
care,
but
I
I
think,
if
anything
we
may
have
heard
about
fewer
issues
of
a
negative
nature
in
in
assisted
living.
I
think
we
haven't
heard
a
lot
about
those.
So
that's
the
best
answer.
C
A
Okay,
thank
you
representative,
elliot
thank.
K
O
C
F
A
Thank
you,
representative,
sheldon.
G
Yes,
thank
you
very
much.
I
quick
question.
I
I,
as
I
began
to
think
about
some
of
the
consequences
of
maybe
first
of
all,
it's
a
great
deal
and
thanks
for
all
the
work,
but
let's
I've
tried
to
put
myself
in
a
position
where
you
said
you
were
from
madisonville
one
of
you
and
that
that
was
a
an
area.
G
That's
not
necessarily
a
an
urban
area
and
that
you
are
going
to
have
to
make
some
tough
decisions
and
that
led
me
down
a
a
road
of
thinking
about
healthcare
access
kentucky,
as
you
know,
we
all
know,
is
one
of
the
largest
rural
states
in
the
country,
and
we
we
have
a
lot
of
areas
that
that
are
really
concerning
when
it
comes
to
health
care
access,
and
that
would
also,
I
think,
flow
over
into
personal
care
homes
and
and
assisted
living
as
well.
G
G
We
come
along
and
say
you
know
if
you,
if
you,
if
you
want
to
offer
these
other
health
care
services,
including
dementia
server,
type
services
or
whatever
you're
gonna
have
to
you
know,
have
these
extra
expenses
of
which
you
spoke
of
eloquently
earlier,
that
you
were
going
to
have
to
even
weigh
out
for
yourself.
So
do
we
see
this
as
possibly
causing
some
homes
to
have
to
shut
down
in
rural
areas
because
they
couldn't
afford
to
upgrade
and
or
they
would
lose
some
business
to
people
that
could
upgrade?
I
If
I
heard
you
right,
you
talked
in
terms
of
a
personal
care
facility
in
a
smaller
community,
like
you
were,
describing
if
it's
a
personal
care
community,
now
apartment
style,
private
pay.
What
we're
talking
about
that
would
bridge
over
and
become
assisted
living.
They
already
are
delivering
the
level
of
care
that
we
refer
to
as
basic
health
services.
I
So
my
answer
to
that
is
no.
However,
I
think
really
probably
what
you
meant
to
be
asking
it's
a
terrible
way
to
say
that,
but
I,
but
I
think
what
you
meant
to
be
asking
is
what
about
an
assisted
living
community
yeah
yeah,
I'm
sorry,
and
that
is
part
of
the
reason
that
we
felt
it
important
to
preserve
that
provider's
right
to
stay
social
model
if
they
couldn't
up
their
game
as
it
were,
and
layer
on
those
additional
costs
and
be
able
to
charge
appropriately
in
order
to
not
go
into
the
red.
I
We
felt
that
was
critical
and-
and
I
really
should
have
woven
that
into
my
earlier
discussion.
So
I
thank
you
for
your
question.
It.
It's
not
just
about
provider
choice,
it's
about
access
and
preserving
those
small
assisted
living
communities
that
might
be
struggling,
especially
right
now
with
having
come
through
coveted
with
that
depressed
occupancy
at
virtually
everybody's
place,
preserving
their
ability
to
look
at
it
and
say
I'd
love
to
deliver
more
care,
but
in
my
market
can
I
do
that.
I
Can
my
current
residents
can
future
residents
afford
that
and
that's
the
reality
of
it
since
and
I'm
looking
at
you
senator
meredith,
since
assisted
living
doesn't
have
access
to
any
medicaid
dollars
and
again
for
those
of
you
that
are
concerned
about
that
medicaid
budget.
We're
not
coming
asking
for
that!
That's
not
what
this
bill
does.
G
Right,
thank
you
and
I'll
go
quickly,
so
you
don't
see
any
scenario
where
there
would
be
smaller
operations
that
would
simply
have
to
just
for,
for
whatever
you
know
whether
it
be
assisted
living.
As
you
corrected
me,
you
don't
see
possibilities
where
they
just
say.
You
know
I
can't
I
can't
handle
the
increased
cost
of
training
and
when
they
don't
do
it,
they
would
lose
some
of
their
residence
to
other
people.
You
don't
see
any
smaller
operations.
A
Okay,
thank
you
so
much.
We
have
a
couple
more
minutes
on
this
topic
and
then
we're
going
to
have
to
move
on
to
our
next
topics.
This
is
a
great
discussion,
though.
Thank
you
very
much
for
putting
up
with
us.
We
have
a
question
from
representative
burch.
I
The
initiative
began
frankly
after
some
conversations
with
the
immediately
preceding
that's
not
the
right
word,
but
with
steve
davis,
who
was
inspector
general
under
the
previous
administration
conversations
began,
then
there
was
a
real
interest
at
the
cabinet
and
they
saw
a
need
for
some
realignment
and
the
cabinet
has
shared
some
of
the
very
concerns
we've
had
about
that
confusion
in
the
public
between
pc
and
al,
and
they
have
had
concerns
over
there
being
assisted
living
social
model,
dementia
care
units
and
personal
care,
dementia
care
units,
some
you
can
deliver
basic
health
services,
others
not,
and
so
we
engaged
with
mr
davis.
I
What
was
that
bob?
The
first
time
18
19,
what
and
then
have
continued
in
conversations
with
adam
mather,
the
current
in
inspector
general
with
secretary
friedlander
and
and
others
at
the
cabinet,
and
so
I'm
not
going
to
say
this
is
the
cabinet's
bill,
but
there
they
they've
seen
it
before
it
was
pre-filed
by
senator
alvarado.
We've
engaged
in
conversations
with
them
and,
as
a
matter
of
fact,
we've
got
a
another
meeting
tomorrow
with
them
to
continue
those
discussions.
I
I
I
K
There's
one
other
thing:
representative
morrison
asked
what
it
cost,
but
I
can
tell
you
from
personal
experience.
My
sister
was
in
fact
she
just
died
in
february.
She
was
in
the
nursing
home
for
about
three
and
a
half
years,
and
it's
not
that
she
couldn't
get
up.
She
just
would
not
get
up.
She
was
afraid,
she'd
fall,
so
she
had
to
have
some
of
the
services
that
we'd
ordinarily
not
go
to
a
person
in
her.
K
Fortunately,
she
had
the
resources
to
take
care
of
that,
but
hers
would
not
have
lasted
another
couple
years
right
at
that
rate,
so
it,
but
I
would
hope
that
you
all
would
get
with
freelander
and
that
group
at
the
cabinet
and
try
to
bring
this
bill
as
where
you
there's
cooperation
on
all
sides.
If
not,
it
may
have
difficulty
represented.
K
A
Thank
you,
representative
westrom.
You
have
not
had
a
chance
to
chime
in
here.
D
Question
I'd
like
to
know
I,
I
know
there
is
no
shortage
of
the
senior
population
growth
and
it
seems
to
me,
as
that
population
continues
to
grow.
The
different
levels
of
care
will
be
needed,
so
what
you're
doing
is
very
progressive
and
looking
towards
the
future.
Can
you
tell
me
what
the
senior
population
growth
looks
to
be
over
the
next
20
years?
Have
that
may
be
too
exact
for
you,
but
I
haven't
seen
any
information
on
that
for
quite
some
time.
I
Interestingly
interesting,
you
should
ask
I
just
completed
and
gave
a
report
to
the
the
client
last
week
a
week
ago
today
on
a
market
study
and
that
that
addressed
some
of
those
issues,
we're
going
to
continue
to
see
a
climb,
at
least
until
2050
and
and
and
some
beyond
it.
It
looks
like-
and
I
think
I've
got
my
year
right
about
2050.
It
starts
to
level
off
a
little
bit
the
projections
that
I've
seen
the
ones
that
come
from
claritas
and
the
census,
bureau,
etc.
A
A
I
think
that
you
know,
as
we
talk
about
streamlining
some
of
these
licensure
categories,
you
know
obviously
some
of
the
questions
about
standards
of
care
and
training
to
get
there
and
and
then
you
know
once
once
we
have
this
model
in
place,
disclosure
of
of
exactly
what
the
models
of
care
are
in
certain
areas.
It's
going
to
be
important
to
families
so
yeah
well,.
A
I
K
A
Okay:
next,
we
will
hear
from
mackenzie
longoria
with
the
alzheimer
association,
and
I
don't
know
if
you
have
anyone
with
you,
but
introduce
yourself
for
the
record
and
welcome.
We
look
forward
to
to
hearing
about
your
priorities
for
a
few
minutes
here.
Thank
you.
P
All
right,
green
light
is
on.
Thank
you
all
so
much.
My
name
is
mackenzie
longoria,
I'm
the
director
of
public
policy
for
the
alzheimer's
association
association,
greater
kentucky
and
southern
indiana
chapter,
just
very
briefly,
representative
westrom.
In
response
to
your
question:
there's
about
54.1
million
adults
over
65,
65
and
older
in
the
country.
Right
now,
that's
projected
to
be
about
81
million
by
2040
and
about
95
million
by
2060..
P
So
had
that
for
you,
since
you
asked
that
question
so
most
of
you
on
the
committee,
if
you
know
me,
I'm
not
usually
one
to
read
from
my
prepared
statements,
not
usually
my
style,
but
it's
an
important
topic
today,
so
I
will
be
doing
that
to
stay
concise
and
to
the
point
as
much
as
I
am
able
to
so
chairwoman,
moser
and
members
of
the
committee.
I
want
to
thank
you
for
inviting
me
to
speak
to
all
of
you
today.
P
Our
current
system
is
not
perfect,
as
we
heard,
and
the
association
recognizes
that
it
is
past
time
to
move
away
from
a
certified
social
model,
only
system,
coupled
with
the
confusion
over
today's
versions
of
personal
care
homes,
and
that
nearly
every
facility
is
seeking
to
provide
memory
care.
We
recognize
that
it
is
a
difficult
system
for
consumers
to
navigate
when
deciding
where
to
place
a
loved
one.
P
Before
I
address
the
specific
areas
in
which
the
alzheimer's
association
has
concerns,
I
want
to
first
provide
some
brief
background
on
how
this
process
unfolded.
The
alzheimer's
association
was
consulted
regarding
this
legislation,
first
in
early
2020
and
then
during
a
coalition
group
meeting
held
at
the
alzheimer's
association's
office
in
july
of
2021.
P
P
P
P
Our
first
concern
is
regarding
dementia-specific
training
in
the
general
assisted
living
community.
I
also
want
to
point
out
that
this
is
an
element
that
was
present
in
the
minnesota
legislation
that
was
referenced.
In
fact,
there
were
21
different
areas
that
were
included
in
the
minnesota
legislation,
but,
as
you
heard,
only
14
of
those
were
selected.
P
The
alzheimer's
association
recognizes
there
are
provisions
of
this
bill
that
do
address
training
and
education
for
assisted
living
communities
with
dementia
care.
However,
people
with
dementia
reside
in
all
long-term
care
settings,
not
solely
in
memory
care
or
in
dementia
care,
assisted
living
communities.
Therefore,
it
is
imperative
that
staff
in
all
assisting
living
communities
receive
dementia,
specific
training.
There's
been
a
lot
of
conversation
about
what
current
statute
said,
and
I
was
just
going
to
summarize
it,
but
I
believe
it
has
been
vastly
misinterpreted.
So
I
am
briefly
going
to
read
this
word
for
word.
P
The
current
applicable
statute
is
krs.
194A.719
in-service
education
for
staff
and
management,
assisted
living
community
staff
and
management
shall
receive
orientation.
Education
on
the
following
topics
as
applicable
to
an
employee's,
assigned
duties,
client
rights,
community
policies,
adult
first
aid,
cardiopulmonary,
resuscitation,
abuse
and
neglect
alzheimer's
disease
and
other
dementia
emergency
procedures,
aging
process
assistance
with
activities
daily
living
and
id
iadl's
particular
needs
or
conditions
assistance
with
self-administration
of
medication.
P
That's
11
topics
with
language
that
is
very
broad
and
leaves
it
up
to
the
discretion
of
the
employer
to
interpret
whether
or
not
they
need
to
cover
certain
topics
for
certain
staff
that
is
not
required,
dementia,
specific
training.
In
addition,
the
statute
also
describes
the
in-service
education
that
someone
has
to
receive
assisted
living.
Community
staff
and
management
shall
receive
annual
in-service
education
applicable
to
their
assigned
duties
that
addresses
no
fewer
than
four
of
the
topics
listed
in
subsection
one
again.
P
This
only
requires
that
four
of
the
11
areas
be
covered
and
discretion
is
left
up
to
the
employer
as
to
what
topics
to
cover
and
in
both
of
these
sections
there
are
no
hourly
requirements
with
over
40
percent
of
residents
in
regular
assisted
living
communities
struggling
with
alzheimer's
or
another
dementia.
It
is
critical
that
staff
serving
them
have
the
basic
dementia
training.
They
need
to
provide
quality
care.
P
P
The
coalition
acknowledged
the
importance
of
dementia
training
by
providing
updated
statutory
language
to
krs
194a
in
a
previous
draft
of
the
bill
that
they
sent
to
me
that
language,
including
the
following
editions
as
the
statute
reads
prior
to
independently
working
with
residents,
assisted
living,
community
staff
and
management
shall
receive
orientation.
Education,
addressing
quote
all
end
quote
of
the
following
topics,
quote
with
emphasis
on
those
most
applicable
to
the
employee's
assigned
duties.
P
There
is
a
great
deal
of
conversation
around
the
issue
of
health
care,
workforce
shortages,
staff,
burnout
and
staff
turnover.
Members
of
this
committee
asked
me
what
the
alzheimer's
association
recommends
to
address
some
of
these
issues
in
long-term
care,
and
the
answer
is
simple:
a
dementia
trained
workforce
in
all
long-term
care
settings.
P
The
second
area
of
concern
for
the
alzheimer's
association
and
something
that
representative
margin
brought
up
but
was
not
addressed,
is
the
creation
of
a
new
assisted
living
community
with
dementia
care
license.
The
bill
lays
out
several
requirements
that
a
facility
must
meet
before
being
issued
a
license,
including
addressing
education
and
experience
in
managing
residents
living
with
dementia.
P
This
section
represents
some
of
the
best
practices
from
the
association.
However,
these
critical
sections
only
apply
to
quote
initial
licensure
of
assisted
living
communities
with
dementia
care
and
do
not
apply
to
existing
dementia
units
in
operation.
As
of
the
effective
date
of
this
act,
end
quote:
the
same.
Provision
applies
to
personal
care
homes
that
have
existing
dementia
units
in
operation,
while
the
cabinet
is
required
to
conduct
an
on-site
inspection
prior
to
issuance.
P
I
want
to
pause
here
and
acknowledge
that
I
know
there
are
fantastic
providers
in
our
state
who
have
the
education
and
experience
to
provide
exceptional
dementia
care,
but
there
are
providers
who
do
not
facilities
providing
dementia
care
and
with
dementia
care
units,
whether
they
are
personal
care
homes
or
assisted
living
communities,
should
have
a
uniform
standard
across
the
industry
when
it
comes
to
qualifying
for
licensure
under
the
dementia
care.
License.
P
Throughout
my
statement
today,
I
have
said
repeatedly
that
it
is
my
hope
for
this
hearing
to
be
another
step
in
the
good
faith
negotiation
process
that
this
hearing
is
used
as
an
opportunity
to
get
this
legislation
into
the
hands
of
all
stakeholders
and
together
we
can
pass
meaningful
legislation
that
will
improve
the
lives
of
all
of
seniors
of
all
seniors
in
assisted
living
communities.
I
must
also
pause
here
and
note
that
the
question
of
the
long-term
care
ombudsman
was
brought
up.
P
P
A
Okay,
thank
you
so
much
you
were
fast,
so
that
was
that
was
good.
I
can.
A
You
know
I,
I
appreciate
your
input
into
this.
Of
course,
I
I
think
it's
critical.
I
I'm
glad
that
you
have
a
meeting
with
the
cabinet
tomorrow.
You
know
just
to
remind
everyone
when
a
bill
is
pre-filed,
it's
the
beginning
of
a
conversation,
and
so
you
know
it's
october,
there's
time,
and
so
you
know,
I
think
that
these
conversations
are
necessary
and
and
I'm
sure
that
your
input
will
be
greatly
considered.
A
My
question
is:
do
you
have
you
know?
I
know
that
you
are
talking
about
dementia,
specific
training,
not
necessarily
a
broader
category
of
training
that
you
know
we
all
know
is
necessary
when
folks
are
folks
enter
an
assisted
living
facility.
But
do
you
have
a
general
idea
of
what
the
cost
of
training
would
be
and
and
do
you
have
a
model
of
payment
that
other
states
have
used?
That
is
working
successfully.
P
So
it
really
varies
representative
mosher.
It
varies
based
on
the
size
of
the
facility,
and
then
you
know
how
many
units
of
training
you
need.
It
varies
on
whether
it's
in
person,
if
it's
online,
for
example,
when
senator
meredith
and
I
were
working
on
the
home
health
training
bill
last
year,
we
I
provided
to
the
cabinet
some
examples
that
range
from
sort
of
the
cream
of
the
crop
all
the
way
at
the
top.
You
know
a
model
that
florida
has
invented,
for
example,
that
costs
about
five
thousand
dollars
for
training.
P
P
So
all
our
biggest
concern
is
not
so
much
that
assisted
living
staff-
you
know
in
the
general
assisted
living
setting
as
this
bill
would
create,
aren't
having
necessarily
that
level
of
dementia
competency,
but
we
really
want
to
make
sure
that
there's
an
emphasis
on
communication,
behaviors
crisis,
de-escalation,
the
importance
of
verbal
cueing,
so
that
these
individuals
can
still
accomplish
tasks
on
their
own,
but
they
may
just
need
some
of
that
verbal
assistance
and
also
some
training
that
focuses
on
egress
prevention,
because
even
if
you
do
have
a
secure
dementia
unit,
you
know
alarms
fail
or
you
know
something
doesn't
work
during
a
power
outage.
P
We
have
to
make
sure
that
staff
are
still
capable
of
recognizing
that
exit
seeking,
behavior
and
know
how
to
appropriately
deal
with
it
before
it
could
turn
into
a
worse
situation.
So,
as
far
as
a
specific
model,
we
are
just
the
association
prefers
that
training
is
representative
of
our
dementia
care
practice
recommendations,
because
we
believe
that
that
gives
the
most
flexibility
to
providers
to
choose
a
model
of
training
that
works
for
them
and
their
employees,
but
include
sort
of
our
best
practices.
P
A
Okay,
yeah,
I
I
mean
there's
a
lot
to
talk
about.
You
know
I
think,
when
we're
talking
about
creating
standards
of
care,
the
determination
as
to
who
pays
for
that
is
important.
You
know,
does
that
follow
on
the
private
pay
facilities
which
will
trickle
down
to
the
families
and
the
residents,
or
does
this
become
part
of
training
in
a
in
a
nursing
school
or
in
in
an
actual
curriculum
for
cnas?
A
So
I
I
think
that
you
know
that
there
are
probably
some
some
different
ways
to
look
at
this
and
still
create
some
sort
of
standards.
So
thanks
very
much,
we
have
one
question
from
representative
prunty.
B
Thank
you
miss
madam
chair,
and
thank
you
for
your
presentation,
mckenzie
you,
you
mentioned
other
than
that
all
the
stakeholders
need
to
be
at
the
table,
who
else
besides
the
ombudsman
that
you
mentioned,
who
out?
What
are
the
other
stakeholders
that
need
to
be
at
the
table?.
P
I
would
also
like
to
see,
for
example,
aarp
included.
It
is
my
understanding
that
aarp
did
receive
a
copy
of
the
bill,
but
their
input
was
not
requested,
and
I
also
believe
it's
important
to
involve
individuals
like
the
area
agencies
on
aging,
while
those
individuals
do
not
necessarily
operate
or
run
any
long-term
care
facilities,
they
are
an
integral
part
of
the
care
placement
process
often,
and
I
think
it's
important
that
they
are
understanding
what
changes
may
be
being
made
to
the
long-term
care
system.
P
I'm
sure
there
are
many
others,
you
know,
I'm
sure
disabled
veterans
veterans
of
america
would
like
to
you
know,
have
some
input
in
this,
or
at
least
take
a
look,
and
you
know
many
of
our
veterans,
you
know,
are
going
to
end
up
in
these
facilities
or
you
know
on
their
way
to
perhaps
a
veterans
nursing
facility,
but
you
know
they
may
pass
through
an
assisted
living
setting
during
that
time.
So
you
know
I'm
sure
there
are
other
groups
as
well,
but
some
of
those
very
senior
focused
organizations
come
to
mind
first.
B
Thank
you,
and
I
just
I'm
sorry
I
couldn't
be
there.
I
was
going
to
encourage
the
other
group.
I
was
trying
to
get
on
that
list,
but
it
was
too
too
long,
but
I
was
I
knew
you
were
on
the
agenda
and
I
was
going
to
encourage
them
to
include
you,
since
many
of
the
topics
that
were
discussed
were
about
dementia
and
alzheimer's,
but
I
want
to
echo
what
senator
meredith
said
about
you
know
when
I
first
saw
that
sheet
of
levels
of
care.
B
The
one
thing
that
caught
my
eye
was
that
that
there
weren't
medicaid
payment
for
the
different
levels
of
service,
and
I
think
we
could
look
at
saving
a
lot
of
money
there
and
to
chair
moser's
question
about
who
pays
for
that.
So
I
think
there's.
A
lot
of
conversation
need
to
be
had,
but
I
think
I
appreciate
you
bringing
your
voice
to
the
table
and
hopefully
we
can
move
forward
on
this.
So
thank
you.
A
Okay,
thank
you
very
much.
I
appreciate
your
being
here
and
look
forward
to
hearing
from
you
once
once
you
hammer
out
some
of
these
details.
P
A
A
Okay,
I'd
like
to
just
recognize
recognize
that
representative
bentley
is
on
with
us
on
on
his
phone.
I
believe
so
that's
why
we're
not
able
to
see
him
online
today.
So
thanks
for
being
with
us
next,
we
have
a
presentation
from
lifeworks
program
transition
to
work
and
independent
living.
So
thanks
very
much
for
being
here
with
us.
A
D
It's
our
extreme
pleasure
to
be
here
with
you
today
and
it's
more
of
a
privilege
as
well.
So
thank
you,
madam
chairwoman,
moser
for
and
members
of
the
committee
for
the
opportunity
to
be
here
and
speak
with
you
today.
D
We
are
here
to
talk
about
the
lifeworks
program,
as
well
as
to
sound
an
alarm
about
an
unaddressed
problem
for
the
commonwealth
of
kentucky.
D
Sally
and
tom
hundley
had
their
third
child
jason
in
october
of
2002,
he
was
a
beautiful
well-behaved,
easy
baby
life
progressed
well
in
their
home,
full
of
the
business
and
demands
of
three
children
with
two
working
parents.
Life
was
good
by
the
time
jason
was
15
months
of
age.
His
parents
had
become
aware
that
he
was
not
talking
was
not
interested
in
playing
with
his
siblings
or
other
children
would
not
point
to
objects
to
get
his
parents.
D
D
The
purpose
of
the
suzanne
battalion
clinical
education,
complex
or
cec,
as
we
call
it
in
bowling
green,
is
straightforward
to
provide
a
seamless
curriculum
of
education
and
support
across
the
lifespan
for
individuals
and
families
with
autism,
while
providing
exceptional,
evidence-based
best
practice.
Training
for
our
students.
D
We
begin
our
programming
at
15
months
of
age
in
the
rental
early
childhood
center,
otherwise
known
as
big
red
school.
Moving
to
the
prime
time
program
of
the
kelly
autism
program,
where
we
serve
elementary
middle
and
high
school
students
and
then
when
our
students
are
ready
for
college,
we
have
a
circle
of
support
program
that
supports
60
wku
students
with
autism,
as
they
progress
through
wku,
go
through
college.
D
The
cec
has
more
than
15
years
of
experience
and
positive
outcomes
for
individuals
and
families
served
as
jason
strives
to
be
a
productive
and
independent
citizen
of
the
commonwealth.
He
will
have
the
opportunity
to
attend
our
newest
addition
to
the
concept
of
a
seamless
curriculum
across
the
life
span.
The
life
works
at
wku
program,
which
is
a
separate
501
c
3,
that
is
an
outgrowth
and
continuation
of
the
cec.
D
D
O
Thank
you
again
for
allowing
us
to
be
here
today.
The
lifeworks
transition
academy
is
kentucky's,
only
living
learning
community
for
adults
with
autism
focusing
on
transition.
This
is
a
24-month
program
that
allows
young
adults
with
autism
to
develop
and
strengthen
the
necessary
skills
to
live
on
their
own
and
to
obtain
and
maintain
employment.
B
B
The
lifeworks
campus
is
situated
on
half
a
city
block
at
the
foothill
of
western
kentucky
university
and
is
within
walking
distance
of
beautiful,
downtown
bowling
green.
The
complex
consists
of
a
centralized
community
building
and
three
newly
renovated
apartment
buildings,
known
as
the
julie
and
gary
ransdell
living
and
learning
community
participants
of
the
two-year
lifeworks
transition
academy
reside
in
modern
townhouse
style
apartments
that
are
comfortably
furnished
and
feature
a
fully
equipped
kitchen
and
laundry
facilities.
Our
participants
live
independently
or
with
a
roommate
and
are
supported
by
24-hour
access
to
the
lifeworks
staff.
B
The
multifunctional
community
building
is
where
participants
gather
to
take
classes
and
enjoy
hanging
out
with
friends.
The
common
areas
include
a
comfortable
sitting
area
and
a
spacious
communal
kitchen,
perfect
for
preparing
and
enjoying
group
meals
together.
The
large
multi-purpose
rooms
are
where
friends
gather
for
game
nights
and
other
fun
activities
in
our
state-of-the-art
classroom.
Participants
gather
daily
to
receive
instruction
in
the
areas
of
career
readiness,
independent
living
skills
and
social
engagement.
The
community
building
also
houses,
multiple
meeting
room
spaces,
private
study
areas
and
our
staff's
administrative
offices.
B
Life
works
at
wku
is
a
supportive
living
and
learning
community
where
individuals
are
empowered
to
realize
their
full
potential
and
successfully
transition
to
living
lives
of
independence.
Self-Direction
and
employment
come
discover
what
life
has
to
offer
at
lifeworks
at
wku,
your
bridge
to
independence.
O
I
just
want
to
cover
briefly
what
a
typical
participant
looks
like
a
typical
participant
at
life
works
is
someone
like
jason,
a
young
man
or
woman
aged
21
to
30,
with
autism
intelligence
levels
range
from
low
average
to
well
above
average,
and
their
socioeconomic
and
educational
educational
backgrounds
are
varied.
Our
program
is
not
a
group
home
or
24
24-hour
staff
residential
program
participants
begin
living
in
an
apartment
on
their
own
upon
enrollment.
O
We
currently
have
eight
participants
enrolled
four
males
and
four
females
from
across
the
state,
including
adair
jefferson,
nelson
webster
and
warren
counties.
They
each
have
varying
backgrounds
and
education
levels,
but
something
they
all
have
in
common
as
referenced
on
the
slide
is
a
failure
to
launch
they've
completed
high
school.
Some
have
attended
college,
but
all
have
remained
at
home
unemployed
with
little
or
no
relationships.
Their
skills
have
regressed
self-confidence
and
sense
of
direction
is
non-existent.
O
Another
shared
commonality
is
that
they
have
aging
parents
who
have
voiced
deep
concerns
about
their
son
or
daughter's
future,
stating
I'm
concerned
about.
What's
going
to
happen
to
them
when
I'm
no
longer
capable
or
present
to
help
them
in
our
program,
outcomes
focus
on
10
critical
areas,
perhaps
the
most
important
are
employability
and
life
skills.
However,
we
are
also,
we
also
target
a
variety
of
other
crucial
life
areas,
including
finance
and
relationships
and
personal
safety.
The
individualized
learning
plan
for
each
participant
is
tied
directly
to
these
10
program
outcomes.
O
This
is
how
we
do
it
for
someone
like
jason
and
others.
We
provide
instruction
in
the
classroom
and
hands-on
training
and
support
outside
the
classroom
in
their
apartment
in
the
community
and
on
the
job
site.
We
require
and
support
individuals
to
participate
in
community
service
learning,
volunteerism
and
employment.
O
We
have
partnered
with
area
businesses
and
industries
to
help
boost
ongoing
workforce
development
initiatives
across
the
state.
We
facilitate
growth
in
the
areas
of
confidence,
building,
social
and
interpersonal
skills
and
relationship
building.
Our
approach
is
comprehensive,
intensive
and
individualized,
and
then
lastly,
we
offer
an
option
for
individuals
in
our
region
who
would
like
to
commute
and
participate
in
classroom
instructions
only,
and
we
call
this
our
bridge
program.
D
D
There
are
fifty
thousand
three
hundred
and
three
individuals
in
kentucky
with
autism
between
the
ages
of
18
and
64.,
which
is
the
population
the
age
population
that
we
serve
at
lifeworks,
that
is
ten
thousand
more
people
than
in
the
entire
city
of
covington
kentucky
and
ten
thousand
less
than
in
the
city
of
owensboro.
So
that's
a
pretty
good
description
of
how
many
folks
we're
we're
talking
about
families.
D
It
costs
fifty
thousand
dollars
a
year
for
individual
therapies
for
children
with
autism,
who
are
under
eight
years
of
age.
The
majority
of
costs
for
autism
supports
in
the
united
states
are
for
adult
services,
which
is
an
estimated
cost
of
175
to
196
billion
dollars
for
adults
compared
to
61
to
66
billion
dollars
a
year
for
children.
D
There
will
be
500
000,
autistic
individuals
aging
into
adulthood
in
the
next
10
years.
Yet
85
percent
of
college
college
graduates
with
autism
are
unemployed,
underemployed
or
unemployed
compared
to
the
national
employment
unemployment
rate
of
4.5
percent,
and
a
contributing
factor
to
this
statistic
is
the
lack
of
training
in
job
readiness
and
training
in
life
skills
for
adult
life.
D
Interestingly,
the
the
average
cost
of
home
and
community
based
waiver
services
in
2019
it's
more
now,
but
in
2019
it
was
48
831.
D
So
we
are
in
a
state
of
crisis
in
terms
of
support
for
autistic
adults
and-
and
I'm
here
to
say,
we
are
here
to
sound
an
alarm
by
age.
22,
publicly
funded
education
and
services
ceased
to
be
available,
as
families
reach.
What
has
been
called
the
great
service
cliff
the
lack
of
support
services
available
for
adult
individuals
with
autism.
D
We
have
a
unique
need
for
a
unique
population
that
has
really
not
been
addressed
in
our
commonwealth.
We
get
calls
from
all
over
the
state
inquiring
about
the
program.
These
these
families
are
starved
for
our
services
and
then,
when
they
learn
about
the
program
specifics,
they
say
to
us.
This
is
too
good
to
be
true
and
exactly
what
we've
been
looking
for.
D
We
are
indeed
in
a
state
of
crisis,
but
we
have
a
solution,
a
solution
that
is
cost
effective
for
the
commonwealth,
the
tuition
of
life.
Thank
you.
The
tuition
of
the
lifeworks
program
is
50
000
per
year.
These
costs
are
for
operational
expenses.
Only
the
facility
has
been
paid
for
by
the
most
generous
support
from
mr
bill
gatton
and
mr
gary
watkins
personnel
expenses
are
985
752
dollars
per
year.
D
Non-Personnel
non-personnel
expenses
are
four
hundred
and
one
thousand
seven
hundred
and
eighty
eight
dollars
for
a
total
of
one
million
three
hundred
and
eighty
seven
thousand
five
hundred
and
forty
dollars.
Our
capacity
is
28
participants
with
the
actual
cost
per
participant
being
forty
nine
thousand
five
hundred
and
fifty
five
dollars.
D
D
There
are
very
few
programs
of
this
nature
in
the
united
states
and
there
are
no
absolutely
no
other
programs
in
kentucky
or
surrounding
states.
So,
as
you
can
see
in
the
slide,
our
tuition
of
fifty
thousand
dollars
per
year
is
the
lowest
available
of
of
programs.
That
we've
been
that
we've
researched
across
the
country
with
a
range
of
ninety
three
thousand
five
hundred
dollars
per
year
in
chapel
haven,
west
in
tucson,
arizona,
two,
fifty
seven
thousand
three
hundred
and
thirty
six
dollars
at
29
acres
in
dallas.
D
D
D
D
Would
you
please
help
us
to
offer
them
a
chance
at
a
more
independent,
productive
life
at
the
same
time
for
not
providing
a
cost
savings
for
the
commonwealth
of
kentucky
in
the
long
run,
jason
and
his
family,
along
with
50
000
plus
other
families
in
kentucky
need
your
help,
and
we
certainly
invite
you
to
to
come
and
see
us
at
the
lifeworks
at
wku
program
and
and
visit
with
us
in
bowling
green.
We
would
love
to
host
you
at
lifeworks
if
you
would
come
to
bowling
green
to
see
what
we
have.
D
Thank
you
so
much
for
the
opportunity
to
be
here
with
you
to
describe
a
program
that
we
think
is
a
solution
to
a
mounting
problem
and
to
to
hear.
I
know
you've
heard
the
alarm
before,
but
to
hear
another
voice
sounding
the
alarm
about
this
situation
that
that
we
all
find
ourselves
in.
Thank
you
thank.
A
D
A
N
With
the
for
the
sake
of
brevity
and
allowing
as
many
questions
as
possible,
more
than
happy
to
get
into
it,
it's
a
a
terrible
need
that
we
have,
but
I
would
want
to
reinforce
from
mary
lloyd's
comments,
the
ability
to
duplicate
the
technology
and
the
functioning
of
this
program
in
communities
across
the
state.
While
it's
unique
in
bowling
green
today,
there's
no
reason
that
it
needs
to
be
unique
in
bowling
green
within
the
within
the
state
of
kentucky.
N
What
you
need
are
the
kinds
of
services
and
the
kind
of
community
and
and
local
support
that
we've
been
able
to
put
together
over
the
years
to
be
able
to
create
these
programs.
We
have
those
kinds
of
opportunities
right
across
the
state
to
be
able
to
deal
with
this.
So
while
we
are
a
pilot
and
why
we
are
to
many
right
now,
a
beacon
to
be
able
to
address
this
program
in
a
very
productive
cost
efficient
way.
We
think
that
it's
it's
something
that
the
state
needs
to
look
at
in
a
broader
sense.
N
As
far
as
addressing
this
issue
in
the
in
the
future,
it's
one
of
those
classic
issues
of
support
up
front
for
a
long-term
gain.
That's
what
I
think
we're
dealing
with
here
to
address
the
problem
over
the
years.
A
Okay,
all
right,
thank
you,
yeah.
Your
program
is
certainly
impressive
and
I
I
know
that
we
have
a
few
questions
here.
Yeah
I
I
am
looking
at
the
the
three.
You
said
that
you
have
three
apartments
and
you
serve
28
individuals.
D
A
N
That
is
for
the
two-year
program
that
we're
talking
about
as
far
as
the
transition
housing
the
bridge
program,
that
david
mentioned,
which
is
basically
the
day
program
addressing
many
of
the
job
function,
support
functions
to
integrate
these
young
people
into
the
business
community
is
a
day
program
and
that's
not
included
in
the
20
a
growing
number
based
on
our
ability
and
capability
of
addressing.
A
Clarification
that
helps
yeah
senator
nemas.
E
K
E
Just
see
you
know
in
an
interview,
you
can't
see
what
that
young
man
can
do
absolutely,
but
also
he's
probably
not
capable
of
doing
as
much
as
what
people
that
have
that
degree
without
autism
could
do
so.
How
would
you?
How
do
you
equate
that?
I
think
it
would
be
impossible
to
equate
underemployment
the
actual
amount
of
that,
and
do
you
all
help
with
getting
them
proper
employment
instead
of
just
any
employment
with
like
at
kroger
or.
D
Absolutely
what
we
do
and
I'll
let
david
talk
in
just
a
minute,
but
we
provide
a
person-centered
plan
for
everyone
who
comes
in
and
so
based
upon
what
they
want
to
do
and
where
they
see
their
their
future.
Taking
them.
We
we
work
with
them
and
as
well
as
the
businesses
in
bowling
green,
to
provide
the
match,
the
appropriate
match
for
job
skills,
and
then
we
support
the
the
businesses
once
they
they
hire
the
the
folks
in
in
our
program.
So
so
yes,
david,
do
you
want
to
add
to
that.
O
In
my
experience
they
don't
do
a
lot
of
gossiping
around
the
water,
cooler,
loafing
and
sew
them.
It's
a
real
plus
and
so
they'll
say:
hey
could?
Could
your
team
come
in
and
work
with
us
on
how
we
can
you
know
best,
communicate
or
work
with
them
or
make
them
feel
more
comfortable?
And
it's
been
a
real
positive
experience
so
far
with
the
with
the
folks
in
our
in
our
area.
Thank
you.
Yeah.
N
A
great
deal
of
attention
put
into
the
process
at
the
front
end
to
determine
capabilities,
wants
desires
on
their
part,
their
family,
their
expectations,
their
ability
to
translate
that
job
into
a
career
and
for
it
to
be
a
self-sustaining
career.
Again,
it's
not
just
find
a
job
for
them
and
feel
the
job
is
complete.
N
That's
how
we
feel
we
can
take
them
from
a
situation
of,
perhaps
today
being
a
a
bag
boy
at
a
kroger
into
somebody,
who's
working
in
an
accounting,
firm
or
working
with
a
contractor,
or
they
happen
to
be
good
numbers
number
of
issues
to
get
back
to
really
focus
in
on
the
individual.
As
mary
said,
mary
lloyd
said
that
person-centered
planning
is
the
whole
essence
of
what
this
program
is
about.
E
Of
course,
do
you
all,
or
can
you
all
help
ones
that
don't
need
an
apartment
that
maybe
are
already
out
of
college
that
are
looking
to
do
better
with
their
life
than
what
they
have.
O
L
I
do
thank
you
for
a
wonderful
presentation
and
I'm
sorry.
I've
got
a
three
o'clock
meeting,
so
I'm
going
to
be
leaving.
I
don't
need
to
have
these
answers
now,
but
I
I
do
have
basically
four
very
quick
questions
that
if
you
could
answer
for
me
in
the
future,
it'd
be
very
helpful.
You
say
there's
about
50
000
people
in
the
state
of
kentucky
between
the
age
of
18
and
64
that
sort
of
meet
the.
But
you
know
we
know
autism
is
a
spectrum.
L
75
second
question
out
of
your
students,
I
guess
is,
is
because
it
seems
more
like
a
sort
of
a
college
program
to
me
what
percent
are
employed,
what
percent
are
able
to
maintain
their
employment
and
what
is
the
average
salary
that
they're
able
to
that?
Your
graduates
historically
have
been
able
to
achieve.
Those
are
my
questions.
D
L
M
Madam
chair
for
the
committee's
information,
these
folks
will
be
presenting
our
next
medicaid
oversight
committee
meeting
as
well.
So
senator
berg
we'll
have
another
opportunity
to
talk
about
this
now.
I
believe
you're
also
presenting
to
our
budget
review
for
human
services.
A
Thank
you.
Thank
you.
Okay.
Thank
you
very
much,
senator
meredith,
representative
sheldon.
Do
you
have
a
comment.
G
Yes,
thank
you,
chairwoman,
moser,
just
very
quickly.
I
I'd
be
remiss
sitting
about
two
blocks
away
from
the
suzanne
vitale
education-
complex,
not
to
mention
what
these
people
have
done
and
and
what
they've
done
for
the
not
only
this
community
in
bowling
green.
But
what
they're
speaking
of
now
is
something
that
I've
been
been
very
fortunate
to
be
close
with
the
vitality
family
for
30
35
years,
and
I
have
watched
this
thing
evolve
into
what
it
is
doing
today
and
and
where
dr
moore
is
taking.
G
This
is
absolutely
unbelievable
and
I
would
encourage
everybody
to
come
to
bowling
green
and
take
a
look
at
this
facility.
I've
had
that
opportunity
and
I
can
tell
you
they're
changing
the
world
they're
changing
lives
right
here
in
kentucky.
So
thank
you
all
for
what
you
all
do,
and
I
appreciate
the
presentation.
K
This
is
an
issue,
that's
not
new
to
me.
I
helped
set
up
the
program
for
autistic
children
at
university
of
louisville
several
years
ago,
and
what
at
what
stage
or
what
functioning
is
jason?
D
Joseon
is
jason
is
a
low
support
need,
which
means
he
he
he's
got
the
capacity
his
his
iq
is
is
above
85
and
he
is
able
to
attend
the
college
program
at
wku,
and
so
he
is
a
low
support
need
he.
He
is
not
one
of
the
individuals
on
the
spectrum,
who
has
a
high
support,
need.
K
K
Mark
right,
that's
what
I
say
what
you
see
physically
of
these
people
is
not
really
what's
going
on
with
them
until
you
understand
how
we
have
to
do
it.
I
worked
for
general
electric
for
39
years
and
we
did
hire
handicapped,
but
you
had
to
be
very
careful
of
where
you
put
them,
because
almost
every
job
in
an
assembly
operation
is
high
risk,
of
course,
and
some
companies
just
don't
want
to
take
the
responsibility
and
liability
of
putting
a
person
in
a
position
where
their
level
be
hurt.
The
first
day
they
even
start.
J
K
To
have
sympathetic
employees
who
are
willing
to
pitch
in
and
and
help
that,
individual
and-
and
I
don't
think
we're
that
far
along
yet
with
educating
employers
and
employees
well,.
D
I
think
you're
exactly,
I
think,
you're
exactly
right
and
I
think
that's
one
of
the
things
and
I'm
sorry
I
didn't
mean
to
interrupt,
but
I
get
excited
about
the
program.
Please
forgive
me.
That's
one
of
the
things
that
we
do
at
the
lifeworks
at
wku
program
is
work
with
the
businesses
in
the
industries
to
to
to
help
them
understand
how
to
respond
and
react
to
our
our
loved
ones.
D
On
the
spectrum
and-
and
I
mentioned
the
person-centered
plan,
we
would
we
would
work
with
the
individual
to
to
see
what
what
was
their
goal-
employment
and
and
hopefully
not
get
them
into
a
situation
that
was
not
appropriate
for
them
to
be
in,
but
but
I
think,
you're
so
right.
Education
is
key
and
and-
and
we
recognize
that
we
need
to
be
better
educators
and
that's
what
we
seek
to
do.
A
Okay,
thank
you
so
much
and
senator
meredith.
You
have
a
question.
M
Yes,
ma'am
again
a
great
program
very,
very
beautiful.
I
think
it's
a
invaluable
to
a
sigma
population
that
we've
largely
ignored
and
that's
very
tragic.
So
I
think
it's
wonderful,
but
I
think
anticipation
the
next
two
committee
meetings.
I
think
we
really
need
to
focus
on
its
impact
upon
the
medicaid
program
and
I'd
be
curious.
M
Do
you
all
have
any
any
thought
about
a
long-term
funding
model
beyond
an
appropriation
from
the
state,
because
I
think
you
know,
we've
got
a
lot
of
fiscal
demands,
they're
going
to
be
hitting
this
this
next
budget
session,
and
I
think
this
is
an
investment
in
our
program
that
we'll
see
some
savings
long
term.
But
I
think
we
have
to
document
that,
but
I
think
committee
members
are
going
to
know
it's
just
going
to
be
an
ongoing
appropriation
that
we
that
we
need
to
consider.
D
Thank
you
for
the
guidance
and
I
think
that
we
see
this
funding,
for
this
is
a
multi-prong
approach
and
we
will
define
that.
Thank
you.
Thank
you
great
program.
Congratulations!
Thank
you.
Thank
you.
A
Thank
you,
and-
and
I
had
a
question
really
about
the
the
funding
and
creating
partnerships,
much
in
line
with
what
senator
meredith,
just
briefly
discussed,
but
really
looking
at
how
scalable
your
program
is.
You
know
if
this
is
something
that
you
really
would
like
to
see
across
the
state?
Is
there
an
opportunity
to
partner
a
year
you're
with
wku?
Is
there
an
opportunity
to
partner
with
other
state
universities
who
receive
state
funding?
Do
you
do
you
receive
any
support
at
all
from
weed.
D
University,
we
do
not
receive
any
support
from
the
university,
but
but
we
would
be.
We
would
certainly
welcome
partnerships
across
the
commonwealth
because
I
you
know,
I
think
that
as
you've
heard
before
many
times,
we're
certainly
better
together
and
and
we
have
a
model
and
we
have
there-
there's
no
need
to
reinvent
the
wheel
and
we
have
a
wheel.
So
we
can,
we
can
put
it
across
the
commonwealth
and
we.
D
A
A
lot
of
sense-
and
you
know
the
universities
do
receive
some
say
just
a
little
bit
of
state
funding,
so
I
mean
maybe.
D
N
A
A
You
for
your
work,
you're
doing
great
things.
A
K
A
minute:
okay,
last
tuesday,
I
attended
a
meeting
down
in
lebanon,
kentucky
with
social
workers.
Senator
hargett
and
hargan
actually
chaired
the
meeting
down
there,
but
I
heard
the
complaints
of
social
workers
they're
supposed
to
have
25
cases.
Some
have
as
many
as
80
and
90
cases
they
get
disciplined
because
they
do
not
clear
these
cases.
K
They
can't
hire
people
to
even
fill
the
jobs
that
they
they're
quitting
faster
than
they
can
hire
people.
In
fact,
they're
quitting
faster
than
we
can
graduate
people
in
louisville.
We
have
over
a
hundred
workers
short,
and
you
can
multiply
that
across
every
place
in
this
state,
depending
on
the
size
of
the
state
of
the
the
complex
there.
But
I
would
hope
that
and
request
that
you
might
put
that
on
the
agenda
before
we
go
into
the
regular
session,
because
this
is
going
to
become
an
issue
and
just
to
decide
this.
K
So
we've
got
a
serious
problem
there
and
believe
me
for
a
guy
that
went
out.
I
shadowed
social
workers
for
three
or
four
weeks
these
people
in
harm's
way
every
day
I
wouldn't
go
in
them
homes
with
an
ak-47
and
they
go
in
there
with
a
pencil
and
a
piece
of
paper,
and
I
think
it's
serious
enough,
madam
chair,
that
you
might
want
to
consider
having
some
social
workers
come
here
and
testify
and
also
have
the
cabinet
come
and
testify
how
they're
going
to
deal
with
that
issue.
Thank
you.
A
Okay,
thank
you,
representative,
birch,
okay,
so
our
next
meeting
will
be
november
23rd
at
1
pm
here
in
the
annex
and
seeing
no
further
business.
We
are
adjourned.