the United States Department of Health, Education, and Welfare for title XX of the Social Security Act, or, in the alternative, a level determined by the department and approved by the legislature. (7) "Income" shall have the same meaning as RCW 74.04.005 (12), as now or hereafter amended; except, that money received from section 6 of this act shall be excluded from this definition. (8) "Resource" shall have the same meaning as RCW 74.04.005 (11), as now or hereafter amended. (9) "Need" shall have the same meaning as RCW 74.04.005 (13), as now or hereafter amended. New Section. Sec. 3. (1) The program of community based services authorized under this chapter shall be administered by the department. Such services may be provided by the department or through purchase of service contracts, vendor payments, or direct client grants. The department shall, under stipend or grant programs provided under section 6 of this Act, utilize, to the maximum staffing level possible, eligible persons in its administration, supervision, and operation. (2) The department shall be responsible for planning, coordination, monitoring, and evaluation of services provided under this chapter but shall avoid duplication of services. (3) The department may designate area agencies in cities of not less than twenty thousand population or in regional areas within the State. These agencies shall submit area plans, as required by the department. They shall also submit, in the manner prescribed by the department, such other program or fiscal data as may be required. (4) The department shall develop an annual State plan pursuant to the Older Americans Act of 1965, as now or hereafter amended. This plan shall include, but not be limited to: (a) Area agencies' programs and services approved by the department; (5) The department shall establish rules and regulations for the determination of low income eligible persons. Such determination shall be related to need based on the initial resources and subsequent income of the person entering into a program or service. This determination shall not prevent the eligible person from utilizing a program or service provided by the department or area agency. However, if the determination is that such eligible person is non-low income, the provision of section 5 of this act shall be applied as of the date of such determination. New Section. Sec. 4. The community based services for low income eligible persons provided by the department or the respective area agencies may include: (1) Access services designed to provide identification of eligible persons, assessment of individual needs, reference to the appropriate service, and follow-up service where required. These services shall include information and referral, outreach, transportation, and counseling; (2) Day care offered on a regular, recurrent basis. General nursing, rehabilitation, personal care, nutritional services, social casework, mental health as provided pursuant to chapter 71.24 RCW and/or limited transportation services may be made available within this program; (3) Night services offered on a regular, recurrent basis which provide therapeutic programs at other than regular working hours; (4) In-home care for persons, including basic health care; performance of various household tasks and other necessary chores, or, a combination of these services; (5) Counseling on death for the terminally ill and care and attendance at the time of death; except, that this is not to include reimbursement for the use of life-sustaining mechanisms; (6) Health services which will identify health needs and which are designed to avoid institutionalization; assist in securing admission to medical institutions or other health-related facilities when required; and, assist in obtaining health services from public or private agencies or providers of health services. These services shall include periodic health screening and evaluation, in-home services, health education, and such health appliances which will further the independence and well-being of the person; (7) The provision of low cost, nutritionally sound meals in central locations or in the person's home in the instance of incapacity. Also, supportive services may be provided in nutritional education, shopping assistance, diet counseling and other services to sustain the nutritional well-leing of these persons; (8) The provisions of services to maintain a person's home in a state of adequate repair. insofar as is possible, for their safety and comfort. These services shall be limited, but may include housing counseling, minor repair and maintenance, and moving assistance when such repair will not attain standards of health and safety, as determined by the department. (9) Civil legal services, as limited by RCW 2.50.100, for counseling and representation in the areas of housing, consumer protection, public entitlements, property, and related fields of law. Sections 1 through § and section 10 of this act shall constitute a new chapter in title 74 RCW and shall terminate January 1, 1978. New Section. Sec. 5. The services provided in section 4 of this act may be provided to non-low-income eligible persons: Provided, That volunteer workers and public assistance recipients shall be utilized to the maximum extent possible to provide the services provided in section 4 of this act: Provided Further, That when volunteer workers and public assistance recipients are not available, the department shall utilize the bid procedure pursuant to chapter 43.19 RCW for providing such services to low-income and non-low-income persons whenever the services to be provided are available through private agencies at a cost savings to the department. The department shall establish a fee schedule based on the ability to pay and graduated to full recovery of the cost of the service provided; except, that nutritional services provided in section 4 of this act shall not be based on need. New Section. Sec. 6. The department may expand the foster grandparent, senior companion and retired senior volunteer programs funded under the Federal Volunteer Agency (ACTION) (Public Law 93–113 title II), or its successor agency, which provide senior citizens with volunteer stipends, out-of-pocket expenses, or wages to perform services in the community. New Section. Sec. 7. Sections 1 through 6 of this act shall be known and may be cited as the “Senior Citizens Services Act”. New Section. Sec. 8. In the event federal funds are applied for the purposes of obtaining a demonstration project relative to the implementation of this chapter, the department shall submit the demonstration proposal first to the social and health services standing committees of the legislature for review and approval and to the ways and means standing committees of the legislature for review and approval as to costs. [The above section 8 was vetoed by Governor Evans.] New Section. Sec. 9. There is hereby appropriated from the general fund seven million five hundred thousand dollars, of which five million six hundred thousand dollars shall be from federal sources, to carry out the provisions of this act: except. that funds shall be expended only upon approval and receipt of federal funds. New Section. Sec. 10. If any provision of this act, or its application to any person or circumstance is held invalid, the remainder of the act, or the application of the provision to other persons or circumstances is not affected. Passed the House March 24, 1976. John L. O'Brien, Speaker Pro Tempore of the House. Passed the Senate March 24, 1976. John A. Cherberg. President of the Senate. Approved April 19. 1976, with the exception of Section 8 which is vetoed. David Evans, Governor of the State of Washington. Filed April 19, 1976, 1:32 p.m., Secretary of State. ITEM 2. NEW JERSEY STATE SENATE INSTITUTIONS, HEALTH AND WELFARE COMMITTEE STATEMENT TO SENATE BILL NO. 944 Dated: June 4, 1976. STATE OF NEW JERSEY PURPOSE AND PROVISIONS. Residents of nursing homes are all too often given inferior treatment because they are old, feeble or poor. They are in need of a bill of rights similar to the bill recently passed by the legislature and signed into law, enumerating certain rights of the mentally ill. This bill not only declares that nursing home residents have certain rights; it also lists a number of responsibilities that nursing homes have with regard to the care of residents. The Federal government has established clear standards of care for residents of skilled and intermediate care nursing facilities who are Medicaid or Medicare recipients. However, this bill makes similar standards of care applicable to all nursing homes and nursing home residents in the State and, moreover, makes such standards an expression of legislative policy and intent. The responsibilities of nursing homes under the provisions of the bill include the following: 1. Maintaining a complete record of all funds and possessions deposited by residents for safekeeping; 2. Providing for the spiritual care of residents, if such care is desired; 3. Admitting only that number of residents which can be safely accommodated; 4. Ensuring that no physical restraints are used, except upon written order of a physician, and that drugs are not used for purposes of punishment; 5. Permitting members of certain groups which render assistance without charge to nursing home residents, full access to nursing homes at reasonable hours and under specific conditions; and 6. Ensuring compliance by the nursing home with all applicable State and Federal statutes and rules and regulations. The rights of nursing home residents under the provisions of the bill include the following: 1. To manage their own financial affairs: 2. To wear their own clothing and retain their own possessions, unless unsafe or impractical; 3. To have mail delivered unopened, have access to a telephone and be allowed personal visitation by any person of their choice; 4. To present grievances to the nursing home administrator, without threat of discharge or reprisal; and 5. To discharge themselves upon presentation of a written release, under eertain circumstances. If the rights of any persons or residents as defined in the bill are violated, they would have a cause of action against any person violating such rights. COMMITTEE AMENDMENTS The committee made numerous minor amendments to the bill. However, some of its amendments are significant and deserve attention. One amendment to the section defining "nursing home," ensures that homes maintained, supervised or controlled by agencies of the State or counties or municipalities would also be covered by the bill. Federally controlled nursing homes (such as veterans' facilities) would not, in any case, be subject to State supervision. The committee extended another responsibility to nursing homes: that of giving each resident a written list of the services provided by the nursing home and of related charges. The committee also added to the bill's list of residents' rights. Under the committee's amendments, residents would also have the right. 1. To participate in the planning of their total care, to refuse treatment, and to refuse to participate in experimental research; 2. To refuse to perform services for the nursing home; 3. To reasonable opportunity for interaction with members of the opposite sex; and 4. To notice of nonemergency transfer or discharge at least 30 days in advance. In other amendments, the committee required nursing home administrators to give each resident a list of the rights and obligations set forth in this act; gave the Department Christian Science nursing facilities from any requirement to provide medical care or treatment. 83-524 O-77 - 17 In most of tor per 10 b×118, 1nd in wards which treat a significant number of grame prate patenta, po grans of reality orientation are almost routine so faut the win and destini enicments are actively working to red see the expenesee Eenfi, a ind Es cecratiza which often result from the instanceIDDE As one of the major outpatient mental health programs, our Day Treatment Centers whith tina teen fizetnog sore 167 are allowing many of our World War I and II maramins remain in the wommunity which providing a stimulating and theraperne expemence and envir ament wirdent which hospitalization would be required for many of them. There are warrently 52 day treatment programs treating During 1977, it is antivipared that there wil he increasing efforts in the treatment, research and edɔatul in f the Mental Health and Behavioral Sciences Service te dareet its attentica even more to the aged veteran who is becoming such a major resumer of var health care services. 4. SOCIAL WORK SERVICE Social Work Service provides a full range of services to older veterans and their families at all points of contact from preadmission screening through treatment and discharge planning and followup community services. Social workers provide consultation concerning problems of the elderly to hospital and regional office staffs, liaison servics to community agencies on behalf of veterans, and direct services to beneficiaries and families to assist in the resolution of social problems affecting the use of health care resources. A major thrust of social work programing has been the development of community support systems to allow and encourage the older veteran to maintain himself in surroundings that are conducive to his social and health care needs. In many cases an outreach community services program can obviate the need for hospitalization by providing vital support services to veterans and families living in their own homes. The impact of social intervention as social problems germinate is particularly important in helping veterans to maintain an optimal degree of independent functioning. Veterans who are not able to return to their own homes immediately after a period of VA hospitalization may be placed in nursing homes, personal care homes, or other special placement facilities inspected and approved by VA inspection teams. Through the Community Care program which encompasses services to veterans in the above facilities, a full range of social and other supportive health care services may be provided by hospital or community based staff. Personal care home programing for medical and surgical patients was given added impetus at a workshop held in Salt Lake City in May 1976, attended by over 40 representatives of Social Work. Nursing. Dietetics, Rehabilitation Medicine Service, and Engineering Service. Over 35.000 veterans were provided followup social services in the program during fiscal year 1976 and it is anticipated that this number will increase significantly during fiscal year 1977 and beyond as the number of elderly veterans in need of services continue to increase. Every VA facility is expected to develop capability in this vital program area. In fiscal year 1976, a total of 73,405 veterans enrolled in the Community Care program were provided services by social workers and other health care personnel. Most of these veterans are elderly or appoaching the later years. There is increased interest in developing methods for measuring and upgrading the quality of care provided terminal patients and their families as differentiated from treating terminal disease. This is a contributing factor in the general public's concern for the right of these patients to participate in decisions involving use of life-extending equipment and procedures, obtain social and psychological supports from staff, receive assistance in control of pain, and be assured of privacy for self and family when desired. Phase 1 of the program to be completed in fiscal year 1978 from VACO resources will be to conduct a VA-wide survey of existing policies, practices, and attitudes in terminal care. Information obtained will serve as a baseline for clinical, educational, and research efforts from which appropriate standards can be developed. With volunteer assistance, Social Work Service continues to operate Telecare programs in many VA hospitals through which contact is maintained with elderly veterans returning to their homes in isolated areas. In this way, a network of VÅ and community services remain available to assist those who might not otherwise be able to make their needs known, particularly in an emergency. Social Work Service is vitally interested in the needs of the chronically ill and the elderly and has actively encouraged hospitals affiliated with graduate schools of social work to include content on the health needs of the elderly in course offerings. VA social social workers provide consultation to schools of social work in the development of appropriate course content. 5. REHABILITATION MEDICINE SERVICE With the emphasis on the aging veteran within the VA, Rehabilitation Medicine Service (RMS) has identified the elderly as one of its major concerns. RMS has a strong involvement in rehabilitation, health maintenance, and socialization programs for the aging patient. Current programs encompass dysfunction problems, socialization, physical maintenance, and community followup. The various therapies are involved with patient care in nursing home care units, intermediate care wards, halfway houses, personal care homes, compensated work therapy, incentive therapy, and others. The various rehabilitation medicine therapy programs provide a means to a better and more meaningful life for many aging veterans through the understanding by therapists of what the involvement of the total person means. As an example, therapeutic recreation focuses not on the activity itself but on awareness of leisure time, life-styles, interelationships, needs, and the meaning of activity for the elderly. Assessment of social and a vocational skills by the occupational therapist enables patients to learn how to expand the horizons of their existence for improved functioning in whatever environment they may find themselves-home or institution. A variety of services are provided to the veteran and/or family by RMS personnel. Included among these are life-style counseling, reality orientation, ambulatory and bedside activities such as talking books, music programs, exercises, life skills activities, games, and hobby programs. Adult educational experences which encompass current event discussion groups, movie or film strips are available as well as outdoor recreation activities such as fishing, boating, hiking, bird watching, and limited camping. The availability of these latter activities have been made possible by the formation of a cooperative agreement between the VA and the Forest Service, U.S. Department of Agriculture. RMS has involvement in various work therapy programs enabling the older veteran to feel that he/she is a contributing member of the community with numerous skills to offer. RMS at two hospitals, VAH Sepulveda, Calif., and VAH St. Cloud, Minn., have been particularly successful in involving elementary and high school students in remotivation programs with elderly patients. A number of RMS programs focus on having older veterans contribute their special skills in fabricating articles for needy children's activities in the community. RMS continues to provide and support activities of senior citizen groups, special geriatric calisthenics/exercise programs, and social and picnic outings in cooperation with community Golden Age groups. In addition, the USO show committee has added college or university shows as a touring group to VA health care facilities. Care of the elderly is being stressed at many RMS workshops, conferences, and hospital visitations. The concept of rehabilitation that encompasses a meaningful life-not custodial and apathetic-is the major focus in providing care. 6. NURSING Nursing Service feels a commitment to improve both the amount and kind of services it makes available to the aged ill veteran. Knowledge is expanded in the field of gerontology and geriatrics and Nursing Service strives to keep abreast of new developments in improved means of meeting the needs of this significant group. Nursing Service has as objectives the improvement of the knowledge base for gerontological nursing practice by all levels of nursing personnel in the field. We seek innovative models of care delivery. Standards of gerontologic care have been completed by Nursing Service in fiscal year 1976 and will be published by the VA early in 1977 along with educational guidelines for gerontologic nursing. Both the standards and the educational guidelines have applicability to health professionals other than to nurses. The format allows each team member, irrespective of disciplinary orientation, to assess his or her performance in meeting the needs of the aged individual. Full implementation of the gerontological standards will require interdisciplinary |