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From YouTube: House Standing Committee on Health and Family Services
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D
A
A
C
A
C
Thank
you,
madam
chairwoman
and
members
of
the
committee.
I
appreciate
the
opportunity
to
present
house
resolution
59
and,
as
representative
moser
stated,
there's
I
have
a
guest.
So
if
you
would
like
to
introduce
yourself
yes
hi
good
morning,
my
name
is
layla
kashan,
I'm
an
attorney
with
the
kentucky
association
of
sexual
assault
programs.
That's
the
coalition
that
the
members
are
your
great
crisis,
centers
serving
constituents
in
your
districts,
ms
laila,
for
the
sake
of
the
time.
If
you
would
like
to
just
go
ahead
and
present
on
this
resolution,
I
would
appreciate
it
absolutely.
C
Thank
you,
so
I'm
here
to
speak
on
behalf
of
this
resolution
and
asking
for
everyone's
support
today.
While
the
resolution
covers
programs
outside
of
rape,
crisis
centers,
including
domestic
violence,
shelters
and
children's
advocacy
centers
for
time
purposes,
we
only
had
one
of
us
come
to
represent
all
three
of
the
coalitions
and
the
other
two
coalitions
are
the
kentucky
coalition
against
violence
and
the
children's
advocacy
centers
of
kentucky.
C
So
please
know
that
our
coalitions
are
a
resource
for
you
all
on
any
bills
relating
to
these
issues.
So
representative,
tate
is
taking
an
important
step
with
this
resolution
and
we
greatly
appreciate
her
for
sponsoring
house
resolution
59.
We
also
want
to
thank
the
two
current
co-sponsors
representative,
king
and
representative
banta
domestic
violence,
sexual
violence
and
child
abuse
are
all
public
health
crises.
C
All
of
us
want
to
live
safe
and
healthy
lives
in
safe
and
healthy
homes,
including
children,
and
no
one
deserves
to
be
abused
or
violated.
Domestic
violence,
shelters,
rape,
crisis,
centers
and
children's
advocacy
centers
have
continued
to
provide
services
throughout
this
pandemic
and
when
we
have
one
in
10
children
who
are
sexually
abused
before
their
18th
birthday,
when
we
have
26
percent
of
10th
graders
who
reported
sexual
victimization
have
attempted
suicide.
C
We
need
to
take
a
hard
look
at
and
really
own,
what's
happening.
We
must
center
these
public
health
crises
with
policies
that
are
evidence-based,
so
we
can
prevent
these
harms
from
ever
happening.
We
can't
stop
until
the
violence
stops
together.
We
can
make
great
progress
for
our
commonwealth,
and
I
thank
you
all
for
your
time
and
we
look
forward
to
seeing
this
list
of
co-sponsors
crow.
Thank
you.
C
Thank
you
very
much,
and
you
know
just
as
our
resolution
states.
We
know
that
violence,
domestic
violence,
sexual
violence
and
child
abuse
each
one
of
us,
none
of
us
are
limited
from
that.
Every
one
of
us
knows
someone:
either
we've
been
a
victim
of
this
ourselves
or
our
children
or
have
been
or
our
brothers
or
sisters,
or
our
parents
or
our
neighbors,
and
so
I
think
that
it's
very
important
for
us
to
call
attention
to
this,
not
only
the
impact
to
the
individual
but
the
impact
to
our
society
and
to
our
communities
at
large.
C
So
I
certainly
appreciate
you
coming
and
testifying
for
me
and
at
this
time,
if
there's
any
questions,
we'll
open
for
questions.
A
D
D
G
D
E
Explanation,
if
I
may,
I
just
would
like
to
vote
yes
first
of
all
and
to
thank
representative
tate
for
this
really
important
resolution.
I
think
we
spend
so
much
time
and
legislative
power
focused
on
punishment
and
not
nearly
enough
on
prevention
and
I'm
really
eager
to
work
together
on
evidence-based
programming
and
initiatives
to
prevent
violence.
So,
thank
you
very
much.
Thank
you.
Yes
enthusiastically.
A
A
A
D
A
Okay,
thank
you
very
much.
Do
we
have
any
questions
from
the
committee
and
I
know
that
we
have
one
more
guest
online
evan
reinhart,
so
I
don't
know
if
you
want
to
introduce
yourself
for
the
record
and
if
you
have
anything
to
add.
D
G
D
D
D
F
D
D
A
C
A
Good
senate
bill
154
passes
with
favorable
expression.
The
same
should
pass
on
the
house.
Thank
you
very
much.
Thank
you
so
much.
Thank
you,
chairwoman
and
members
of
the
committee.
Thank
you
okay.
Next,
I
see
senator
meredith
is
here
with
us.
So
if
you
would
like
to
approach
the
table-
and
you
can
let
us
know
which
bill
you'd
like
to
present
first
and
I
don't
know
if
you
have
any
guests
but
feel
free
to
introduce
anyone
you
have
with
you.
Thank
you.
I
Thank
you,
madam
chair,
appreciate
your
indulgence,
appreciate
the
that's
having
a
friday
afternoon
meeting.
I
know,
what's
how
challenging
it
is
for
everyone,
but
if
you
don't
mind,
then,
let's
start
with
senate
bill
55.
First.
I
All
right,
thank
you.
This
deals
with
medicaid
co-pays
or
is
known
in
the
health
care
industry
is
medicaid
and
no
pays,
and
I
hope
the
starting
point
for
this
is.
We
all
understand
appreciate
that
health
care
is
too
expensive
way
too
expensive.
You
know
we
spend
two
to
three
times
more
than
other
industrialized
nations
on
health
care,
and
one
of
the
primary
causes
of
that
is
the
administrative
costs.
I
The
building
cost
is
30
cents
of
every
dollar,
which
again
is
double
what
other
industrialized
nations
paid,
and
I've
had
the
pleasure
of
serving
many
of
you
on
the
committee
over
the
last
three
four
years,
and
it
certainly
has
been
a
learning
experience.
But
when
I
presented
this
bill
before
the
senate,
I
mentioned
that.
I
think
every
bill
that
we
pass
in
in
our
committees
should
have
a
three-pronged
test:
that
the
bill
should
make
sure
that
health
care
is
accessible
that
is
affordable
and
improves
the
quality
of
care.
I
I
I
had
a
primary
care
physician
in
my
home
community
of
grayson
county.
Tell
me
so
I
really
like
cinema55.
So
I
appreciate
that
I
like
it
too,
but
why
do
you
like
it?
He
said
I
had
a
patient
last
a
couple
of
three
weeks
ago
that
was
a
copd
patient
and
making
the
appointment
and
my
office
clerk
told
the
patient.
There
would
be
a
coinsurance
and
he
stopped
and
thought
he
said.
I
Well,
maybe
oh
wait
a
week
now
to
us,
a
dollar
seems
rather
insignificant,
but
to
our
medicaid
recipients,
it's
not
so
insignificant,
and
this
doctor
told
me
that
the
patient
waited
the
following
week
and
forced,
unfortunately,
their
condition
had
worsened.
They
had
to
be
hospitalized,
so
additional
expense
right
there
and
that's
just
not
an
isolated
incident.
It
happens
each
and
every
day.
I
You
know
this
is
a
policy
that
truly
is
pennywise
and
dollar
foolish,
because
think
about
that
you
can
go
to
a
physician,
be
treated
versus
being
treated
in
the
hospital,
and
we
know
we
don't
have
so
much
money
within
the
medicaid
program
and
when
we
start
to
run
short
of
those
funds,
what
happens?
Usually
the
providers
pay
an
additional
price
by
reduced
reimbursement.
I
I
You
know
you
can
force
these
patients
and
to
pay
these
kobe's
try
to,
but
the
end
cost
to
the
provider
into
society
in
total
is
much
greater
again.
11
million
dollars
to
the
medicaid
program
they
can
absorb,
but
I
can
show
you
the
actual
cost
of
this
is
in
multiples
of
that
by
continuing
this,
this
policy.
A
Thank
you
very
much
senator
meredith.
I
know
that
we've
had
several
discussions
about
this
and
I've
talked
to
to
some
of
my
colleagues
and
your
colleagues
and
the
cabinet.
The
cabinet
is
fine
with
this.
Yes,
as
I
understand
it,
and
this
will
actually
increase
federal
drawdown
dollars
for
medicaid,
yes,.
I
A
It's
probably,
I
think,
on
paper,
it
looks
like
11.7
million
dollars
for
a
fiscal
note,
but
there's
a
state
share
and
a
federal
share,
and
it's
you
know
with
that
mixture
of
dollar
and
the
increase
in
federal
drawdown
dollars.
This
is
not
going
to
be
an
11.7
million
dollar
fiscal
hit
to
the
to
the
cabinet.
As
I
understand
it,.
I
I
In
the
total
cost
of
the
of
the
program,
there's
a
savings
here
by
eliminating
this
right.
A
Well-
and
I
think
this
makes
sense
as
well
to
the
providers
who
have
to
chase
these
very
small
co-pays-
it's
it's
really
cost
prohibitive
to
continue
spending
overhead
and
administrative
dollars
trying
to
track
down
one
or
two
dollars
and
to
your
point
earlier,
this
really
is
one
of
the
drivers
of
increasing
healthcare
costs.
Well,.
I
A
I
Options
to
the
provider
is
say,
no
you've
got
to
pay
the
bill
and
then
probably
medicaid
recipients
can
say
well
bill
me.
Well,
you
know
the
cost
to
generate
a
bill
for
a
patient
real
in
excess
of
15
20
dollars
you,
you
may
not
think
so,
but
all
the
people
that
are
involved.
It
is
actually
that
much
so
again
it
costs
to
the
system
which
again
has
to
be
absorbed
by
everyone
else.
That's
not
within
the
medicaid
program.
So
it's
a
major
driver
of
cost
to
the
healthcare.
A
You're
exactly
right,
and
as
far
as
folks
having
skin
in
the
game,
there
are
more
creative
ways
to
incentivize
folks
to
participate
in
their
preventative
and
and
and
otherwise,
health
care.
D
A
Yeah,
I
I
agree
with
this
concept
and
invite
any
of
our
committee
members
who
have
questions
or
comments.
A
G
F
B
D
A
I
Madam
chair
senator
bill
61.,
I
do
have
a
a
guest
with
me
that
many
of
you
know
she's
testified
many
times
before.
As
we
come
to
the
table.
J
I
Madam
chair,
the
genesis
of
this
bill
is
a
senate
concurrent
resolution
46
was
passed
during
the
2019
session,
with
center
from
henderson
senator
robbie
mills
being
his
primary
sponsor,
and
it
called
for
establishing
alzheimer's
dimension,
workforce
assessment
task
force
and,
tragically
many
of
you
recall,
senator
mills
lost
his
father
months
before
to
illustrated
illness
and
is
unfortunate.
Firsthand
experience
has
been
the
guiding
force
for
the
work
of
our
task
force,
and
I
know
several
of
you
participate
in
that
task
force
as
well.
I
I
certainly
had
the
honor
and
privilege
of
serving
this
task
force,
as
did
my
guest
here,
and
we
gathered
data
and
came
to
the
stark
realization
very
quickly
that
we
were
ill
prepared
to
handle
this
disease
and
which
is
growing
an
alarming
rate
and
the
lack
of
preparation
preparation
is
not
meant
as
criticism,
healthcare
providers.
We
know
everyone's
doing
the
very
best
they
can
to
try
to
deal
with
this,
but
it
it
certainly
is
a
new
territory
for
us
and
president
with
no
cure.
I
You
know
this.
Last
year
the
coven
19
virus
certainly
has
got
everyone's
attention
and
we're
losing
over.
I
think
4
500
people.
This
last
year,
but
at
the
same
time
we've
lost
close
to
2
000
people
to
alzheimer's
in
dimension
the
last
year,
and,
what's
really
alarming
is
because
of
the
isolation
that
figures
I
have
seen
said
that
that
number
number's
increased
almost
16
percent
during
this
this
this
period
you
know
and
nationally.
I
I
And
you
know
it's
projected
that
this
is
going
to
increase
even
more
in
the
future,
as
we
have
an
aging
population,
the
baby
boomers,
which
obviously
I
fall
in
that
category
today,
so
it's
going
to
grow
and
grow
and
grow
until
we
can
find
a
cure,
and
we
all
hope
and
pray
for
that,
and
you
know
this
number
is
expected
to
grow
significantly
for
kentucky
right
now
we
have
around
71
000
people
who
have
disease,
but
by
2025
it's
projected
to
be
85
000
and
in
solution.
I
I
You
know
with
accomplishes:
we've
got
272
000
family
care,
caregivers
in
kentucky,
and
they
provide
over
300
million
hours
of
unpaid
care
and
family
caregivers
are
supplementing
assist
about
home
health
and
personal
care
agencies.
They
certainly
provide
an
invaluable
service
to
it,
but
you
know
the
united
states
bureau
of
labor
statistics
estimates
that
1.1
million
new
direct
care
workers
will
be
needed
by
2024
and
that's
a
26
increase
from
2014
and
with
the
shortage
of
personnel.
I
To
begin
with,
you
know
adding
to
this
problem
and
one
of
the
things
this
bill
tries
to
address
it
for
home
health.
Personal
care
attendance
turnover
in
2020
was
22
percent,
so
not
as
this
is
the
shortage
of
personnel,
but
the
massive
turnover
in
these
folks
as
well
in
2019,
that's
the
last
day
that
is
available,
personal
caregiver,
the
turnovers
exceeded
60
percent,
instead
of
showing
that
one
of
the
major
causes
of
this
is
lack
of
preparation
of
those
personnel.
I
You
know
a
lot
of
people
have
the
false
impression
that
when
you're
providing
services
to
all
hundred
patient
you're,
just
providing
adult
babysitting-
and
we
know
it's
much
more
than
that-
and
to
be
effective
in
what
they
do-
they
need
training
and
presently
that's
not
mandated
again
a
lot
of
good
folks.
Take
this
seriously.
The
home
health
agencies
do
have
a
requirement
for
this,
but
we
think
there
needs
to
be
some
standardization
this
across
the
board,
particularly
for
personal
care
attendance.
I
So
that's
why
we're
asking
that
we
adopt
some
standardization
of
the
training
for
this
personnel,
but
there's
a
second
component
of
this
as
this
grows.
Demand
for
services
are
going
to
grow
and
we
want
to
make
sure
that
our
patients
and
their
family
members
are
protected.
I
call
this.
The
consumer
protection
portion
of
it
that
if
a
provider
holds
themselves
out
as
being
an
alzheimer's
dementia
caregiver,
they
need
to
assure
the
public
that
their
personnel
had
been
trained
in
this
area.
I
So
it
simply
says
if
you're
going
to
advertise
yourself
for
this
you're
going
to
hold
yourself
out
as
this,
then
you
need
the
training,
if
not
there's
a
fine,
that's
associated
with
it
and
appropriately.
So
so
that's
the
two
major
components
of
the
bill,
but
I'll
turn
this
over
to
ms
longoria
and
I'm
sure
that
she
can
give
you
more
information-
and
probably
you
ever
want
to
know
in
your
lifetime.
J
Thank
you,
senator
meredith,
I
think
that's
a
compliment.
Senator
meredith
does
a
really
great
job
kind
of
explaining
the
genesis
of
the
bill
and
sort
of
the
need
for
it.
He
really,
you
know,
talked
about
some
of
the
numbers
not
just
of
the
individuals
with
this
disease
and
how
that
is
increasing
both
in
kentucky
and
across
the
country,
but
also
the
major
gaps
in
the
workforce,
and
so
I
just
very
quickly
wanted
to
touch
on
a
few
additional
points.
J
Kind
of
looking
at
you
know
the
why
the
need-
and
you
know
the
impact
that
this
would
then
have
so
obviously,
when
we
understand
the,
why
I
mean
even
prior
to
a
pandemic,
you
had
a
general
proclivity,
I
think
in
this
country,
both
federally
and
and
at
the
state
level
of
individuals.
Wanting
to
you
know,
age
in
place.
This
sort
of
became
this
new
term
in
the
2000s
right.
So
if
you
look
back
in
the
year
2000
there
were
about
1.5
million
people
who
lived
in
long-term
care
facilities,
specifically
nursing
homes.
J
We
know
that
the
amount
of
money
that
is
saved
by
the
state
whenever
you
enable
someone
to
stay
in
their
home
and
community
as
long
and
as
safely
as
possible,
rather
than
pushing
them
into
a
health
care
system
or
pushing
them
into
a
long-term
care
facility.
Those
costs
are
obviously
much
higher
and
in
the
case
of
a
global
pandemic,
you
know
we
need
to
ensure
that
we're
not
overwhelming
that
health
care
system
that
we
saw
was
very
much
overwhelmed.
J
So
we
have
a
growing
need
of
individuals
living
longer
wanting
to
stay
home
and
the
other
issue
is
these
individuals
are
living
longer
now
with
more
complex,
chronic
conditions
like
alzheimer's
and
dementia.
I
think
something
that's
incredibly
important,
especially
here
in
kentucky,
is,
if
you
look
at
our
last
round
of
state
data,
when
we
were
taking
a
telephonic
survey
of
individuals
45
and
over
in
the
state
who
indicated
some
type
of
cognitive
impairment
or
memory
loss
that
they
were
experiencing
of
those
individuals,
94
also
had
another
underlying
chronic
condition,
namely
diabetes,
heart
disease
or
copd.
J
So
you
have
a
a
growing
population
that
has
alzheimer's
or
another
form
of
dementia,
in
addition
to
managing
these
other
complex,
chronic
conditions.
So
it's
sort
of
this
confluence
of
issues
that
are
all
coming
together
now
and
really
that
is
falling,
then,
on
the
shoulder
shoulders
of
our
home
health
workers,
both
those
medical
home,
health
aides,
as
well
as
those
non-medical
personal
service
aides.
So
the
fact
of
the
matter
is,
unfortunately,
the
training
standards,
and
this
is
not
unique
to
our
state
by
any
means.
J
There
are
some
federal
requirements
and
kentucky
follows
that
75
hours
of
required
training,
but
when
you
drill
down
a
bit
and
look
at
our
actual
curriculum
that
is
provided
by
our
fantastic
kctcs
system
here
in
the
state.
Unfortunately,
cognitive
impairment
is
taught,
alongside
with
mental
health,
for
a
total
of
four
hours,
which
means
an
individual
could
be
receiving
as
few
as
one
to
two
hours
of
training
on
cognitive
impairments
and
that's,
not
even
dementia
specific
training
as
far
as
the
personal
service
aids,
because
their
services
are
not
reimbursable
by
traditional
medicaid.
J
There
are
no
federal
requirements
whatsoever,
and
this
is
where
things
get
a
little
crazy
is
that
this
is
almost
a
wholly
unregulated
part
of
the
direct
care
workforce.
It's
really
up
to
the
discretion
of
states
and
employers
to
decide
what
type
of
training
they
provide
for
their
workers
and,
as
the
senator
meredith
mentioned,
there
are
some
outstanding
personal
service
providers
out
there
that
do
great
dementia
training,
but
that
is
completely
up
to
their
discretion
and
it
is
not
by
any
means
mandated
by
the
state.
F
Thank
you,
ma'am
chair.
I
don't
have
really
a
question
because
I
I
cannot
thank
you
enough,
senator
and
all
your
efforts
and
as
well
as
senator
alvarado,
on
taking
taking
care
and
address
this
particular
issue
on
the
way
home.
Last
night,
I
got
a
call
from
my
father,
who's
93.
F
he's
he
might
as
well
he's
basically
better
health
mentally
and
physically
than
I
am,
but
my
mother's
86
and
she
has
she's
not
doing
well
she's
got
dementia
she's
got
multiple
problems
and
issues
and
having
this
type
of
direct
care
training
can
really
significantly
help
our
situation
out
and-
and
I
know
this
is
an
ongoing
and
probably
increasing
issues
and
problems,
and
I
think
you
all
taking
the
lead
to
jump
ahead
of
the
game
onto
this
home
health
care
issues
and
direct
care.
F
It's
so
so
valuable
important,
so
so
important
to
to
go
through
this
process
to
help
support
families.
I've
talked
to
representative
bentley
on
several
occasions
about
how
we
need
to
help
out
home
health
care
and
support
our
families.
So,
thank
you
all
very
much
so
now
I've
brought
on
you'll
be
up
next,
but
thank
you
all
very
much
for
all
your
efforts,
and
I
know
the
chair
chairwoman
has
been
very
instrumental
in
this
area
as
well,
and
I
can't
thank
her
enough
for
all
her
efforts.
Thank
you,
madam
chair.
I
Thank
you,
representative
fleming.
I
just
want
to
mention
very
briefly
that
there's
another
element
of
this
that
we
think
is
very
positive
and
creates
a
career
ladder
for
people,
and
we
have
a
lot
of
people
who
start
as
personal
care,
attendants
or
maybe
nursing
home
assistants,
and
with
this
kind
of
training
and
certificate
in
in
their
portfolio,
so
to
speak,
it
may
spur
them
to
further
their
education
and
fill
the
pipeline
for
registered
nurses,
physicians
and
so
forth.
So
we
think
that
really
is
a
win-win
situation
for
everyone.
A
Thank
you
very
much.
Thank
you
for
your
work
on
this.
This
is
this
is
critical
work.
We
we
know
how
important
it
is
to
help
individuals,
older
individuals
and
and
those
suffering
with
dementia,
of
any
sort
to
to
stay
in
their
homes,
and
we've
seen
the
effects
of
loneliness
and
isolation.
Certainly
this
year
more
than
ever,
I
think
that
any
time
we
can
standardize
training,
improve
our
training
and
put
those
important
family
supports
in
place.
A
It's
a
win
for
everyone.
I'm
actually-
and
I
keep
talking
about
this
to
my
members-
I'm
actually
reading
this
book
right
now
being
mortal
and
it's
about
folks.
I
I
think
that
everyone
should
read
this
it's
about
how
we
support
individuals
in
their
older
years
and
what
we're
doing
as
a
society
and
how
we
can
help
people,
whether
they
stay
at
home
or
not
function
and
and
not
have
that
loss
of
independence.
So
I
appreciate
your
work
very
much.
A
Do
we
have
any
other
questions
all
right?
We,
I
would
we'll
entertain.
Oh,
we
do
have
a
motion
in
a
second,
I
believe.
Okay,
please
take
the
role.
Thank
you.
B
D
F
H
Yes,
I
just
wanted
to
thank
senator
for
bringing
this
forward.
I
served
as
co-chair
with
with
senator
mills,
and
I
hope
that
this
is
the
first
of
many
objectives
that
we
that
we
identified,
because
it
was
very
eye-opening
and
quite
alarming-
the
not
only
the
need,
but
the
lack
thereof
and
and
somehow
trying
to
address
both
of
those
at
the
same
time.
So
this
is
a
very
good.
First
start,
I'm
happy
to
vote.
Yes,.
D
B
A
A
Thank
you.
Next,
we
have
senator
alvarado
here
to
discuss
senate
bill
74.
welcome
and
I
believe
your
guest
is
already
here.
So
that's
right
just
introduce
yourselves
for
the
record
and
please
proceed
absolutely.
K
Ralph
alvarado
state
senate
28th
district.
It's
good
to
see
you
all
again
here
today.
You
know
several
years
ago
and
I've
told
miss
longoria
this
story.
At
an
ncsl
conference,
I
heard
a
presentation
regarding
dementia
services
and
what
states
could
be
doing
better
for
dementia
and
working
in
long-term
care.
K
You
know
it's
obviously
very
important
for
me
for
the
people
that
I
take
care
of,
and
so
I
realized
at
that
time
that
kentucky's
ranking
when
it
came
to
elderly
to
the
elderly
was
rather
poor
and
other
states,
like
wisconsin,
were
doing
a
really
good
job
or
ranked
first
or
second
and
in
addressing
a
lot
of
those
problems,
and
I
remember
the
presenter
was
from
wisconsin
asking
for
some
information.
K
They
gave
me
a
whole
litany
of
things
that
they
had
done
as
a
state
to
help
improve
their
rankings
on
it
and
since
then,
we've
been
looking
for
ways
to
improve
the
care
and
our
ranking
as
a
state
and
senate
bill.
74
is
another
attempt
to
help
us
achieve
that
goal.
We
know
that
kentucky's
programs
are
in
services
are
rather
fragmented
when
it
comes
to
the
elderly
with
dementia
care.
K
This
bill
establishes
a
permanent
position
with
the
cabinet
by
amending
krs-194a
600,
to
turn
the
office
of
alzheimer's
disease
and
related
disorders
to
the
position
of
dementia
services
coordinator.
The
office
has
been
in
existence
for
two
decades,
but
has
never
been
staffed
and,
frankly,
not
funded.
K
K
It
also
assesses
dementia
specific
data
that
comes
in
for
the
state
evaluates
state-funded
services.
It
streamlines
applicable
government
services
to
increase
efficiency
and
improve
the
quality
of
care.
It
eliminates
unnecessary
costs
by
identifying
duplicative
services
that
we
might
have
and
also
identifies
and
applies
for
grant
opportunities.
K
It
updates
the
composition
of
the
council
by
adding
a
current
caregiver
as
a
representative
for
long-term
care
industry
provider
of
the
adult
daycare
industry,
a
rep
from
the
home
care
industry
from
a
physician
advisory
group
and
from
a
nurse
advisory
or
advocacy
group,
rather
from
both
of
those.
So
the
question
becomes.
Why
do
we
need
this
and
frankly,
right
now
in
kentucky?
K
So
missing
we're,
I
think,
we're
missing
out
on
millions
of
federal
dollars
that
could
be
available.
Virginia
establish
a
coordinator
and
brought
in
over
5
million
dollars
in
federal
grants
and
11
other
states
that
all
excel
at
dementia
care
have
established
this
position
in
their
state
governments
as
well.
So
I
think
it's
a
good
start
to
have
somebody
coordinate
things
for
us
again,
there's
a
long
way
to
go.
I
think
we'll
be
seeing
a
lot
more
legislation.
K
I
think,
as
representative
fraser
had
mentioned,
some
work
has
been
done
at
a
task
force,
a
lot
of
recommendations
that
we've
got
to
look
at
as
a
state
that
we
can
gradually
kind
of
help
implement
to
make
our
care
for
dementia
and
here
in
the
state,
and
make
us
one
of
the
top
ten
rather
than
one
of
the
bottom.
Ten.
The
battle
turned
over
to
motion.
A
Okay,
we
have
a
motion
in
a
second
I
if
you
would
like
to
give
us
a
very
brief.
Okay.
J
Senator
alvarado
that
pretty
much
covers
all
of
it.
I
do
have
one
representative
mojo.
You
had
asked
for
some
information
from
other
states,
dementia
services
coordinator,
so
I
was
able
to
reach
out
to
a
former
colleague
of
mine
in
georgia
that
now
serves
as
their
their
coordinator,
and
she
was
getting
some
more
information
about
what
kind
of
federal
dollars
they
brought
in.
They
did
receive
three
about
300
000
from
a
bold
grant,
which
is
actually
something
the
association
passed
at
the
federal
level.
J
But
she
did
tell
me
something
very
interesting
is
she
has
actually
already
done
a
lot
of
work
to
quote
harness
and
coordinate
numerous
already
available
community
and
state
resources
that
has
enabled
us
to
expand
access
and
improve
services
without
any
moving
of
state
funding
or
requests
for
the
state
budget?
So
I
thought
that
was
helpful
as
well
and
kind
of
showcase.
J
One
of
the
things
that
we're
hoping
for
is
that,
in
addition
to
applying
for
federal
funds
to
improve
our
services
and
supports
this
person
wouldn't
be
able
to
really
look
at
what
is
already
available
in
this
state.
How
can
we
make
it
better
and
how
can
we
improve
upon
on
it,
and
I
know
that
senator
meredith
is
fond
of
saying
that
there
is
money
to
be
had
it's
just
a
matter
of
how
we're
spending
it.
So
I
think
that's
a
that's
a
great
example
from
georgia.
One
of
the
states
has
implemented
this
position.
A
Thank
you
very
much
that
that
is
great
information,
and
I
I
look
forward
to
getting
this
this
implemented
and
the
position
funded,
because
I
think
you're
right
that
we
will
once
we
get
this
really
coordinated
and
and
some
of
the
the
the
provisions
or
the
the
the
things
that
we
need
in
our
state
to
to
really
pull
down
those
federal
grants,
we're
going
to
see
a
big
difference.
So
thank
you
for
bringing
this.
Thank
you
for
working
on
this
again.
I
will
pass
over
my
companion
bill,
but
I
am
very
supportive.
A
So
thank
you.
Do
we
have
any
questions
from
the
committee
representative.
F
Thank
you.
Thank
you.
Ma'am
chair,
senator
alvarado.
I
I
once
again
I'd
I'm
a
great
admirer
yours
and
I
think
you've
always
done
a
fabulous
job
in
the
medical
medical
community,
as
well
as
pushing
the
policy
and
pushing
the
needle
further
out
there.
Just
more
of
a
curiosity,
it's
more
my
financial
background,
and
I
talked
to
the
chairwoman
some
time
ago
about
this.
K
Perspective,
I
appreciate
that
I
I
think
it
can
be
absorbed
internally
I
mean
some
have
heard.
I
mean
we've
had
committed
hearings
during
the
interim.
I've
been
a
little
bit
critical,
the
cabinet's
using
funds
to
help
advertise
medicaid
services,
which
is
about
seven
million
dollars,
and
I
keep
thinking
you
know.
150
thousand
dollars
probably
would
help
fund
this
position.
They
could
take
it
from
that
and
probably
get
a
lot
more
long-term
benefits,
putting
it
into
this
position
and
trying
to
advertise
medicaid
when
people
are
easily
signing
up
for
medicaid.
K
Right
now
is
what
I
would
argue:
we've
got
a
record
number
ever
in
the
medicaid
system,
so
I
think
it
can
be
absorbed.
Obviously
they're
going
to
request
that
we
add
more
into
the
budget
for
this
at
some
point
in
the
future.
So
that's
something
I'm
sure
that
you
know
to
make
it
safe.
I'm.
I
suspect
that
ms
longoria
would
say:
hey,
please
make
it
a
line
appropriation
in
our
budget
at
some
point
in
the
future.
K
K
I
think
it's
money
better
spent
than
what
they're
using
it
in
some
other
parts
of
in
in
their
budgets,
but
I
think
if
we
want
to
direct
it
specifically,
we'd
have
to
put
it
in
the
future
to
make
sure
they're
going
to
allot
it
for
that.
But
I
think
it's
a
small
investment
for
the
amount
of
grants
you
could
bring.
In
I
mean
it's,
it
pays
for
itself
time
and
time
again.
So
that's
how
I
think
it
could
be
financed.
A
Okay,
all
right,
thank
you.
I
I
would
agree
that
this
is
a
critical
investment
in
in
infrastructure
that
will
help
move
kentucky
forward
in
in
this
area.
Specifically,
okay,
I
will
entertain
a
motion.
We
already.
C
A
Oh,
we
have
a
motion.
A
second,
that's
right.
Okay,
please
take
the
role.
Thank
you,
representative.
F
D
F
F
K
G
E
Brief
explanation,
if
I
may,
I
just
it,
was
an
enormous
privilege
to
be
able
to
serve
on
the
dementia
work
group
in
2019
with
ms
longoria
and
some
wonderful
legislators,
and
this
issue
is
personal
for
my
family
as
it
is
so
many
kentucky
families,
and
so
it's
I'm
really
happy
to
vote.
Yes,
I've
said
it
built
before
and
to
see
both
this
and
senate
bill
61
past
that
committee.
It's
really
a
great
culmination
of
the
tremendous
work
that
we
did
in
2019.
A
K
J
E
A
Right
if
you're
online,
if
you're
virtual,
if
you
could
please
mute
your
device,
that
would
be
helpful.
Thank
you.
A
D
Represent
I
would
like
to
record
a
vote
for
h.r
59,
a
yes
vote
senate
bill
55
a
yes
vote
and
senate
bill
154
a
yes
vote.
B
A
B
E
A
L
L
This
is
something
that
the
cabinet
has
already
been
working
on,
and
I
know
there
have
been
several
comments
about
this
part
of
the
bill.
I
have
a
draft
of
the
regulation
that
they
are
providing
and
you
all
know
there
was
controversy
about
the
limited
duration
centers
that
were
assigned
throughout
the
state.
L
What
I'm
seeing
through
this
regulation
that
they
are-
and
this
is
a
draft
I
want
to
be
clear
on
that-
is
that
certified
and
licensed
centers
will
be
given
preference
in
this
process
and
it
will
be
done
on
an
emergency
to
emergency
basis.
So
if
emergency
comes
up,
then
a
licensed
certified
center
could
apply
to
be
a
center,
an
emergency
care
center.
L
They
would
be
able
to
do
that
a
certain
number
of
days
before
that
certification
is
actually
approved,
and
they
would
also
give
the
ability
say:
should
a
tornado
come
through
an
area
and
wipe
out
an
entire
area,
and
there
are
no
centers
standing.
It
would
give
the
ability
for
a
new
provider
to
step
in
and
be
certified
as
emergency
care
center.
So
what
I've
seen
of
this,
I
think,
is
fair
to
those
existing
licensed
certified
centers.
L
But
again,
this
is
a
draft,
and
I
want
to
to
thank
the
the
cabinet,
dr
van
over,
for
cooperating
and
and
trying
to
work
together
on
these
issues.
I
very
much
appreciate
that
and
madam
chair,
the
the
final
sections
of
the
bill
deal
with
family
care,
family,
child
care
homes
in
this
bill.
L
It
states,
by
january
1st
2022,
a
local
government
that
has
adopted
zoning
regulations
within
their
jurisdiction
and
that's
chapter
100
within
statutes
shall
specifically
name
family
child
care
homes
in
the
text
of
zoning
regulations,
to
authorize
separate
consideration
of
the
applications
of
family
child
care
homes
for
conditional
use
permits.
What
this
means
is
in
a
residential
area
when
a
when
a
business
wants
to
go
in
and
operate
in
a
residential
area,
they
have
to
file
a
permit
for
a
conditional
use
and
oftentimes.
L
Within
these
cities
counties
they
will
be
denied
simply
because
they,
it
is
a
business,
and
this
bill
will
will
require
those
local
governments
to
consider
a
child
care
home
for
what
it
is
in
the
essential
nature
of
what
it
is
in
making
that
decision.
So
we
feel
like
that
this
will
help
with
some
of
the
child
care
deserts
in
our
state.
That
will
facilitate
make
it
easier
for,
for
many
folks
to
open
up
family
child
care
homes,
which
will
help
provide
additional
services
that
are
badly
needed
throughout
our
commonwealth.
M
Well,
thank
you
for
having
us
and
thank
you
to
senator
carroll.
As
you
can
see,
that's
why
I
was
really
hoping
he
was
going
to
show
up.
He
articulates
this
issue
incredibly
well,
so
I
don't
have
anything
to
add
to
that
other
than
to
point
out
that
you
know
this
is
critical
legislation
to
pass,
because
child
care
is
critical
to
all
families
in
kentucky,
and
we
know
that
at
least
14
percent
of
parents
lost
their
job
quit
their
job
or
had
to
stay
home
to
take
care
of
their
children
under
the
age
of
six.
M
N
Hi
again,
thank
you
so
much
for
giving
our
voice
the
opportunity
to
be
heard
today.
My
name
is
jennifer
washburn,
I'm
the
executive
director
of
I
kid's
childhood
enrichment
center
here.
In
far
western
kentucky
and
marshall
county,
we
are
a
naci
accredited
center,
we're
accredited
by
the
national
association
for
the
education
of
young
children.
N
We
are
one
of
only
86
nationally
accredited
centers
early
childhood
providers
here
in
the
state
of
kentucky
and
and
what
I
wanted
to
just
take
a
minute
to
share
with
you
is
how
these
the
restrictions,
as
they
currently
are
written,
have
affected
child
care
within
our
state.
We
have
lost
to
date,
180
licensed
and
certified
homes
within
the
state
of
kentucky,
and
that's
just
from
march
of
2020
till
now
that's
180
facilities
that
are
no
longer
operating
for
our
children
and
families.
N
We
also
have
144
centers,
that's
that's
both
certified
and
licensed
that
are
temporarily
closed,
they're,
not
they're,
not
reopened
yet,
and
in
my
center
alone
last
year
I
lost
a
hundred
and
fifty
thousand
dollars
in
order
to
to
try
to
do
all
that
we
can
to
fight
this
the
coded
and
to
to
work
through
and
work
with
the
restrictions
as
they
stand.
N
For
me,
the
really
hard
part
is,
is
the
part
at
this
point
about
combining
in
the
morning
in
the
afternoon
as
a
nationally
credited
center?
My
ratios
are
by
my
choice,
lower
than
what
the
state
recommends,
so
we
currently
and
we
have
always
operated
with
a
lower
capacity
in
operating
with
that
lower
capacity.
N
It
is
important
to
us
as
a
business
model,
to
be
able
to
stagger
employees
as
they
come
in
throughout
the
day
and
as
they
leave
in
the
afternoon
in
order
to
meet
the
restrictions
as
as
mandated
by
the
executive
orders,
we
have
to
have
our
staff
here
from
open
to
close.
N
Well,
I
say
open
to
close,
because
previously
our
open
to
close
was
6am
to
6pm
in
order
to
try
to
save
a
little
bit
or
not
even
save.
In
order
to
try
to
to
be
operational,
we
had
to
adjust
our
operating
hours,
so
we
accept
children
at
6
30
in
the
morning,
and
then
children
have
to
leave
by
five
and
what
that's
meant
for
our
families
is
that
they
too
have
had
to
adjust
their
working
hours
in
order
to
accommodate
our
need
to
have
have
lower
operating
times.
N
For
them
we
need
assistance,
and
the
only
reason
that
I
am
still
here-
and
I
am
very
thankful-
is-
is
from
the
stipends
that
that
we
have
received
from
the
state
that's
going
to
run
out
and
it's
going
to
run
out
very
soon,
and
so
we
need
to
have
the
opportunity
for
that
combining
beginning
and
end
of
the
day
here,
so
that
we
can
get
back
to
serving
our
parents
and
serving
our
families,
as
we
have
done
so
well
for
the
past
over
20
years
here
in
western
kentucky.
N
I
know
this
isn't
something
that
I'm
the
only
one
working
through
and
dealing
with
here.
I
am
licensed
for
97
children.
Currently,
we
care
for
about
67..
We
have
a
classroom
that
we
cannot
open.
That
would
normally
serve
10
children
and
we
simply
can't
open
it,
because
I
cannot
afford
the
staff
during
the
working
hours
that
we
are
required
so
that
we
can
maintain
cohorting
and
again
those
10
additional
families
that
are
unable
to
be
served
simply
because
we
can't
open
that
space,
because
we
can't
afford
to
motion
on
the
bill.
A
Okay,
we
have
a
motion
and
a
second
on
the
bill.
I
just
want
to
thank
you
both
all
three
of
you
actually
for
being
here
today.
Thank
you,
senator
carroll,
for
your
really
hard
work
on
this.
I
know
that
you've
spent
a
great
deal
of
time
working
with
cabinet
and
working
with
our
wonderful
providers.
I've
been
part
of
some
of
those
conversations
and
certainly
have
heard
from
many
of
my
constituents
and
child
care
centers
around
the
state
during
the
pandemic.
A
I
think
that
the
pandemic
has
really
highlighted
a
lot
of
a
lot
of
the
needs,
and
you
know
when
we,
when
we
think
about
180
centers
having
closed,
who
are
no
longer
you're,
no
longer
available
as
a
support
for
children
and
families,
but
you're
also
small
businesses,
and,
to
your
point
jennifer.
A
I
don't
know
many
folks
who
could
absorb
the
kind
of
losses
that
you
all
have
had
to
deal
with
this
this
year,
and
you
know
certainly
as
at
a
time
when
we
talk
about
family,
supports
our
license
and
our
accredited
child
care.
Centers
are
really
those
critical
partners
for
getting
our
families
back
to
work
and
also
when
we
talk
about
early
childhood
learning,
these
facilities
are
licensed
and
accredited
and
are
developmentally
appropriate
and
doing
great
work
in
this
space.
A
D
Thank
you,
madam
chair,
my
wife,
and
I
we
we
currently
have
owned
a
daycare
there
in
winchester
kentucky
for
the
last
20
years,
so
we
too
have
made
so
many
adjustments.
We've
lost
about
180
to
200
000
this
year
as
well.
I'm
just
trying
to
juggle
things
around
make
the
thing
you
know
make
things
as
best:
we
could.
D
You
know
if
it
hadn't
been
for
the
stipend
and
the
ppp
money
that
we
were
able
to
receive,
we
would
definitely
would
have
folded,
but
I
just
want
to
reiterate
and
concur
with
what
has
been
said
here
now.
The
question
I
have
is
that
we
received
noticed
that
march.
The
15th
that
we
can
go
back
to
full
capacity
is
that
correct.
L
I
don't
know
that
it
it's
it
hasn't.
I
think
it
was
if
there
were
no
spike
in
cases,
so
I
think
it
was
provisional
gotcha
and
there
is
an
emergency
clause
on
on
this
bill,
so
either
the
governor
signs
it
or
after
ten
days,
if
he
doesn't
sign
it,
it
goes
into
effect
at
that
point.
Okay,.
G
I
want
to
thank
all
three
of
you
for
being
here
today,
shannon
it's
always
good
to
see
you
jennifer.
I
appreciate
your
comments
and
your
story.
Senator
carroll
you
and
I
have
served
together
in
several
capacities
down
here
and
I've
enjoyed
every
bit
of
it.
I
want
to
thank
you
and
I'm
going
to
commend
you
publicly
right
now
for
bringing
this
one
of
the
things
that
that
has
burned
me
up
over
the
past
year
has
been
an
industry
that
was
vital
to
this
state,
was
abused
and
treated
in
a
terrible
and
shannon.
G
M
G
I
I
don't
doubt
you're
the
14.
and
I,
and
but
but
still
at
14,
that
is
so
high
and
I've.
I've
heard
it
from
families
who
were
who
were
in
situations
where
they
were
forced
with
either.
Do
I
keep
my
job
or
do
I
stay
home
because
I
don't
have
child
care
to
provide
and
and
many
families
have
had
to
make
adjustments.
I've
talked
to
families
that
have
lost
their
homes
and
they're
living
with
relatives
now.
So
I
appreciate
you
bringing
this
forward.
G
D
D
D
D
G
A
L
Thank
you,
madam
chair
and
members,
very
grateful.
Okay,.