The Senate Committee on Health & Human Services met on March 10 to consider SB 25 (Kolkhorst) and SJR 19 (Kolkhorst) related to designating essential caregivers. The committee also heard invited testimony on health & Human Services COVID response and agency operations

This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

Vote outs occurred at end of hearing

  • CSSJR 19 adopted, CSSJR 19 passed 7 ayes 0 nays
  • CSSB 25 adopted, CSSB 25 passed 7 ayes 0 nays

SB 25 (Kolkhorst) Relating to the right of certain facility residents to designate an essential caregiver for in-person visitation.

SJR 19 (Kolkhorst) Proposing a constitutional amendment establishing a right for residents of certain facilities to designate an essential caregiver for in-person visitation.

  • SB 25 and SJR 19 laid out together, committee substitute laid out
  • SJR 19 establishes constitutional right to an essential caregiver for LTC, legislature to outline policies and procedures in general law
  • CSSJR 19 includes home and community-based services & intermediate care in addition to LTC
  • SB 25 codifies right to designate essential caregiver, establishes infection control measures, clarifies policies around caregiver visitation, clarifies that caregivers are not required to provide care and facilities cannot require this
  • Point is that people in care are never without the ability to see loved ones
  • Not saying anyone is at fault, just didn’t have anything in place to ensure visitation
  • Does not replace general visitation
  • CSSB 25 adds HCBS & intermediate care, allows guardian to designate essential caregiver, allows facilities to bar caregivers in certain situations, allows limited 7-day suspension, eliminates safety protocols tailored for COVID, changes personal to physical contact for procedures
  • Perry – Residents suffered without contact from loved ones, other side is oversight of facility practices
  • Kolkhorst – Rep. Frank has been a great partner in this legislation
  • Campbell – Bill is great, can not have this situation again
  • Miles – Thanks committee members, we saw a problem, fixed the problem; need to stay fluid, grandfather is in care and still has not had visitation

CSSB 25 and CSSJR 19 left pending temporarily to take testimony from DSHS

COVID-19 Response

Dr. John Hellerstedt, DSHS

  • Have seen surges in cases and hospital admissions higher than 2020, but have more tools to combat COVID now
  • DSHS has been closely monitoring cases and fatalities, seeing a significant decline currently, but we know winter storm affected reporting of deaths
  • Hospitalizations are on a sustained downward trend for now
  • DSHS has worked to ensure personnel and PPE are provided, also mindful of demobilizing resources as cases continue to decline
  • COVID has impacted cases and cashflow; federal awards currently at $6.7 billion, COVID expenditures at $5 billion; goes to response, labs, and IT support
  • >11k health care surge staff are in the field, have continually informing providers of need to wind down surge resources
  • Not at hospitalization peak, but continuing to decline; will monitor to ensure localized surges are responded to

Imelda Garcia, DSHS, EVAP

  • Kolkhorst discusses Garcia’s involvement in EVAP, appreciates the work done
    • Has been an honor to serve on EVAP, TX is one of the few states that has this type of workgroup that includes legislators
  • Vaccine effort is strictly restrained by supply, can only distribute doses allocated by the federal government, outcomes driven by vaccine doses available
  • Health care workers were the first to get vaccinated, TX was one of first in nation to vaccinate those over 65 and those with comorbidities; most deaths and hospitalizations are in the senior and comorbidity populations
  • Will be announcing distribution 1C eligible soon
  • Have released education vaccination guidelines
  • Will be making an announcement about 7 million doses administered across TX later day, providers have been moving rapidly
  • Clarifies that where doses are allocated doesn’t mean the vaccine is administered
  • Kolkhorst – In DFW, seeing good results on the left, not on the right; not sure what this is and I know you’re trying to do a deep dive
    • Yes, looking at doses administered; could be due to other counties coming to be vaccinated
    • We are talking with providers to ensure doses aren’t sitting on shelves
  • Continuing to push on senior vaccinations
  • DSHS has made changes to immunization registry on the front end and made ethnicity data required & entry streamlined
  • Kolkhorst – Were we able to get ethnicity data from the second dose administered or is that lost?
    • A lot of providers have collected this data on second dose, helping to build out data
  • Campbell – Can you explain the vaccine waste?
    • All providers are required to tell us when vials have broken, temperature loss, etc.; when doses cannot be used
    • Had 1,400 doses in total during the winter storm, nominal number given overall in TX
  • Hall – About how many doses do we receive in TX?
    • Fluctuates, this week over 1 million first doses, 1.7 million in total with second doses
    • Next week allocation is going down, no J&J next week
  • Hall – Why do we see that drop in week?
    • Due to J&J, got 220k last week, but federal government doesn’t have anymore to distribute
  • Hall – When will there be a plan to ensure we’ve made substantial vaccination everywhere, e.g. inner city, rural areas, etc.
    • Locals on ground spearhead this effort, talk extensively with local partners who know their communities best
  • Hall – You get this input day-to-day?
    • Many local governments have direct contact
  • Powell – Represent Tarrant county, concerned when we see stats; saw diminished vaccine allocation close to homes of those with difficulty in finding transportation
    • Just got allocation data, will be working with Dr. Hellerstedt and can share afterwards
  • Powell – Do you feel you have adequate info from county leaders?
    • Try to proactively not assume anything, trying to reach out and have conversation; data doesn’t always present full context
  • Powell – Do you feel that our processes for reporting tot eh state are working adequately?
    • Yes, there are some that fall off the radar for awhile; have strong communications with local health authorities and emergency management
  • Miles – At the outset, had an understanding that there would be efforts to reach communities with lower outcomes’ local entities were responsible for distribution, city and county health directors have your contact information
  • Miles – We have concerns in the African American and Hispanic communities, particularly in Houston; what percentage have we vaccinated?
    • Close to 5 million have received both doses out of 30 million, but only adults are eligible to receive vaccine
  • Miles – There has been concern about lack of vaccine reaching communities of color, do you feel that you have fulfilled the commitment to distribute the vaccine equitably? Also had a commitment that there would be a grass roots outreach program
  • Miles – I don’t feel that the commitments to communities of color have been fulfilled, hoping that there will be a hard push to reach these communities; need to do something quickly, feel like promises have been broken
    • Think about this commitment every single day
    • At the end of the day, we can put vaccine in certain places, but locals know community best and who they choose is on them
    • Will work to earn trust back, trying to fulfill commitment with communities of color and every Texan
  • Blanco – Minority groups have had trouble receiving equitable distribution of vaccinations, with data we’re starting to understand the communities are receiving vaccine at a lower rate, even though they’ve been disproportionately impacted by COVID; how is EVAP or DSHS planning to reach these communities?
    • Looking at El Paso data, it showed 90% of vaccinations being white; knew this wasn’t true on the ground, but data wasn’t being submitted
    • As vaccine supply grows, starting to be more targeted; have been trying to administer vaccines as quickly as possible to ensure more dose allocation
    • Know we have to target efforts more to get communities vaccinated
    • Many local governments take pieces of allocation and sends it to targeted communities; allocations based on provider address, but may be administered elsewhere
  • Blanco – Asks after local distribution
    • When community leaders reach out, we do see better uptake
    • DSHS conducts focus groups to see if procedures are working, shares resources targeting communities of color
  • Blanco – What are we doing with communities that lack broadband access, many registration sites are online
    • Looking at rural partners, utilizing Texas Military Department, mobile teams, etc.; trying to have a widespread consistent amount going to rural communities
  • Blanco – Commends Garcia’s effort to respond to communication
  • Miles – This is something killing people in our communities by mass numbers, equity is not necessarily translating into equality; this is the problem I’m having
  • Kolkhorst – Have been fighting for rural counties that are not receiving any vaccines, talk about strategies to reach communities constantly in EVAP; there is some vaccination hesitancy in some communities; we know who the most vulnerable are, seniors die at much higher rates
    • Garcia states she will visit Miles in his office
  • Kolkhorst – Need to look at metropolitan areas and how to reach the pockets within who are hesitant or not capable of reaching resources

Chief Nim Kidd, TDEM

  • Provides overview of collaboration across state agencies on COVID response; worked with provider for care, testing, vaccines, etc.
  • State fiscal threshold for disaster is $40 million of uninsured loss until we’re eligible for next disaster declaration; new census means this threshold will go up to $46 million & could go to $60 million if feds change per capita indicator
  • This will be a huge impact to agencies and local governments
  • Have large PPE resources, working to ensure it is never in shortage, have an abundance of testing supplies being used every day; until vaccine is all over the state, need to continue best practices
  • Gov has authorized 1.1k national guard members, moving to 2.2k to help get people vaccinated
  • Kolkhorst – Save our Seniors was launched last week, would like a better understanding for this initiative
    • Working with DSHS we know we have populations we need to get vaccinated
    • There were groups who were not taking the vaccine, have been working with local government partners to support access
  • Blanco – Asks about best practices learned in dealing with future pandemics
    • Have had a patchwork approach to CVOID response in this state, realized during pandemic that many local partners were not in contact with each other; needs to change
    • Gov’s EO required mayor and county judges to tell TDEM who their point of contact is, need to add local public health authority info to the list & have a central info repository
    • Need to ensure PPE is stockpiled and available
  • Hall – Appreciates work done on response
    • Have a great team, those in field and at SOC deserve the credit
  • Miles – Have learned forward-thinking and preparedness lessons, TDEM kept up with the response well
  • Campbell – How big is the team out in the field?
    • Emergency Management Council is handling field personnel, 38 state agencies in every county who know local officials; collaborative effort in support of local governments makes this possible
  • Powell and Seliger comment that they appreciate Chief Kidd’s responsiveness and TDEM’s efforts in combatting COVID
  • Kolkhorst – Appreciates work, next emergency is always around the corner
    • Already prepping for Atlantic hurricane season

Dr. John Hellerstedt, DSHS

  • Chair Kolkhorst recalls Dr. Hellerstedt to answer questions
  • Hall – How many doctors in your organization are there with recent clinical experience
    • Chief Infectious Disease Officer, Regional Medical Directors, Community Health Improvement Associate Commissioner, TB Management physicians are actively practicing
  • Hall – When this started, we were getting models that 200k Texans would be dead by August, that is spread everywhere, hospitals would be overrun, etc.
    • These were not models promulgated by DSHS
  • Hall – Not, but they were the reason behind what we were doing, behind drastic measures
    • Certainly voices out there that predicted potential for very serious consequences
    • My view of models is that they won’t tell you what will happen, but what might happen if actions aren’t taken to prevent the worst case
  • Hall – But they set the stage for the defensive measures in terms of masks, lockdowns, etc.
    • Not sure if the modelers were involved in the public health response; up to public health and other parts of the system to make recommendations on infection prevention
    • Taken as whole, models had a very dire prediction, was a reason for public health to emphasize what needed to be done to avoid possible futures
  • Hall – What was behind what Texas decided to do regarding the initial two weeks to flatten the curve turning into 12 months
    • Among other things, the Gov had a group of people advising, couldn’t see the future, but could see the potential for very serious consequences
    • Can’t have data for something that hasn’t occurred, data was useful to show whether or not the countermeasures were working
    • What we relied upon were basic standard principles of medicine, public health, and infection control
  • Hall – We took a strategy of defensive only, purposely avoided therapeutics; would we do anything different? CDC said no statistical difference
    • I don’t think the data or interpretation is all in agreement
    • One of the things we didn’t know was how important asymptomatic and pre-symptomatic spread was
    • Studies on effectiveness of masks will differ depending on when studies were done
    • All we had at the beginning were defensive measures, part of the response is getting out of range of the danger, incl. physical distancing and masks
    • Masks did help prevent people from inhaling droplets, but was especially effective at preventing those without symptoms from spreading the disease
    • One of the things that really supports all of the things we’ve done is the fact that influenza season is the lowest we’ve ever had by far, partially attributable to people adhering to these other measures
  • Hall – How was contact tracing initiated?
    • There is an active lawsuit, so feel constrained in how I can answer
    • I prefer the term outbreak investigation; investigating transmissible diseases has been a critical part of public health for many decades
    • Fundamental principle
  • Hall – How many lives did we save by spending $300 million on contact tracing?
    • Amount spent is an order of magnitude lower than that
    • Difficult to measure what we’ve prevented, investigations done and info provided has been important to individuals, did enable us to contact others for risk
  • Hall – Sent a letter in July about early treatment therapeutics, but we continued down the same path; why wouldn’t we inform those getting tested about effective therapeutics
    • What you’re speaking about is treating individual patients
  • Hall – Would disagree as many items are OTC, can at least provide them with information
    • Purpose and mission of DSHS was testing and then referring to physicians to make decisions in their situation; a matter of medical consultation
  • Campbell – Distribution of this info is left up to the doctor, can’t mandate that holistic medicine info is distributed; under relationship between doctor & patient

Major General Thomas Suelzer, Texas Military Department

  • 2021 looks just as challenging as 2020, guardsmen have brought extensive resources to support communities
  • Provides overview of Texas Military Department response; incl. mobile testing teams, call center, disinfection teams, and support teams
  • TMD is vaccinating thousands daily through the mobile vaccine teams, dramatically expanded access to vaccines
  • Kolkhorst and Campbell express appreciation for TMD’s response

Cecile Young, HHSC

  • Link to HHSC presentation, provides overview of COVID response
  • Federal measures provided increased FMAP of 6.2%, state was required to maintain Medicaid enrollment until end of public health emergency; beneficial now, but anticipating enrollment costs will overtake benefit provided by enhanced FMAP

Michelle Alletto, HHSC

  • Continues speaking from presentation
  • HHSC work focused on making sure Texans knew where to access COVID services; transitioned services to telehealth, set up crisis lines
  • Kolkhorst – Do we know how many calls we received on the crisis lines?
    • Can get this to you, believes over 10k
  • Down to only 1 positive resident patient in all state psychiatric hospitals and SSLCs
  • Kolkhorst – Remarkable, greatly appreciate state hospital and SSLC staff effort to avoid a disaster
    • Involved testing, treatment, and finding safe practices; still working on safe visitation
  • HHSC will be focusing on oversight, returning eligibility processes to normal for Medicaid & CHIP, and bringing census levels in state hospitals back to pre-pandemic levels

Victoria Ford, HHSC

  • Provides overview of policy and regulatory functions at HHSC; had to shift rapidly to bring expertise to LTC facilities, DSHS was extremely important in response
  • TDEM executes response for these facilities, had a very strong partnership guided by federal partners
  • HHSC and DSHS teams still are working very well together on vaccination, pulling facilities together to provide resources needed
  • Highlights LTC needs during the pandemic, incl. rapid testing, epidemiological consultation, disinfection, etc.
  • Kolkhorst – Did hear complaints from nursing home facilities about moving parts, heard different directives from different state and federal authorities
    • Now having twice weekly calls with all industry associations, even more communication as needed
    • This is something we had to finesse once the procedures were in place
  • 5 out of 1,222 assisted living facilities did not have a outbreak
  • Kolkhorst – Where are those 5?
    • Can get you to this
    • One facility in Travis testified previously that they did not have an outbreak
  • Blanco – This does not include veteran’s facilities, correct?
    • Can get this to you
  • Kolkhorst – I don’t think HHSC covers these, good point; if they’re not covered by the feds we could step in
  • Powell – One of the facilities impacted but overlooked are independent living centers, don’t get the attention on vaccinations because they aren’t assisted living facilities
    • Will discuss this with DSHS
  • Have also seen large numbers of recoveries at nursing facilities, death rates seem to be a little better at this point in the pandemic
  • When pandemic began, received guidance from feds that we should not investigate P2 and P3 complaints, only P1; P2 can include falls, etc.
  • These investigations were halted from March to Sept. of last year, have significant backlog, would take 4 years to move through the backlog
  • Had 16k P1 inspections, 12k infection control surveys; have been navigating visitation issues
  • Kolkhorst – Important to take care of mental side of the LTC patient as well as the physical

Stephen Brint Carlton, Texas Medical Board

  • Provides overview of TMB response, expanded telehealth significantly
  • One of TMB’s greatest challenges was EO elective surgeries prohibition in GA-09 and GA-15
  • TMB issued rule changes to continuing threat provision to comply with GA-09 requiring immediate reporting
  • Altered rules again to match GA-15 relaxed restrictions on elective procedures
  • TMB only modified rules to comply with EO, though TMB was not harsher on violation under these rules changes
  • Rule changes were designed largely to ensure proper records were maintained on why surgeries were necessary
  • Last July, TMB learned some were making claims of cures for COVID; the fact that claims were being made, but no cure was verified, caused TMB to issue a statement on cures
  • Misinformation was then spread about TMB stance on certain agents like hydroxychloroquine, TMB stance has always been hydroxychloroquine use has been permissible, no license actions were taken on this issue
  • TMB has not and will not prohibit specific COVID treatments
  • Campbell – It was initially felt that TMB was trying to impede physician practice, it is at the discretion of physician to use off-label treatments; TMB should be in the oversight role only, was appropriate for physicians to think outside the box
  • Kolkhorst – There were also physicians who felt like they would lose their license if they didn’t turn in another doctor
    • Main concern was that people were not making broad sweeping statements that hydroxychloroquine was a cure
    • Under EOs, TMB wanted to make sure we were preserving capacity and supplies for more serious cases
  • Kolkhorst – I saw you had 100 complaints related to hydroxychloroquine, of those complaints how many were TX and how many were out of state?
    • Don’t have the number, some complaints were from out of state; TMB looks at all complaints
    • 75 of the 100 complaints were dismissed outright, majority of the remaining 25 were dismissed later; no actions have been taken
  • Kolkhorst – How many are still open?
    • 38 active investigations on COVID, 3 have to do with hydroxychloroquine
  • Kolkhorst – Have you made a statement on ivermectin
    • Neutral as we are on any off-label, so long as no false claims are made
  • Hall – Answer concern me because it seems to miss the issues with aggressive way TMB enforced the EOs; had a number of physicians come forward with complaints
  • Hall – What’s the difference between off-label or alternative therapy?
    • Hydroxychloroquine was designed for malaria, using it for COVID is fine, but would be alternative or off-label use
  • Hall – Off-label is common, but putting it in alternative terms implies it is outside medical practice
  • Hall – In this process, the Texas State Board of Pharmacy told pharmacies they couldn’t fill hydroxychloroquine prescriptions; didn’t hear anything out of TMB on this issue, was this acceptable?
    • There are times when other regulatory agencies have an interpretation of a statute or rule that differs from TMB; TMB tries to talk with other agencies, but Pharmacy Board has oversight of pharmacies
  • Hall – Did you talk to Pharmacy Board in this case?
    • Do recall having a conversation about it, but there wasn’t any change

Dr. Debra Patt, Texas Medical Association

  • Faced several challenges; PPE was in short supply, work burden has increased generally, mental heath effects frequently complicate care, saw a stark drop in regular vaccinations
  • Physicians are struggling to get vaccinations for themselves and staff, private practices have systems to distribute vaccines effectively
  • Telemedicine has increased care and outcomes, but also increases admin burden in needing to teach patients how to use it, staff support needed, etc.
  • Recommendations
    • Texas should maintain a stockpile of PPE to respond quickly to health threats
    • Should bolster private practice by supporting telehealth and continuing payment parity
    • Should encourage patients to seek preventative care
    • Should prioritize private practice for vaccine distribution
    • Avoid prescribing medical practice into law and regulation
  • Kolkhorst – Point about allocation to physicians is well made, going to enter a new vaccine phase soon; push was to get as many vaccines done as possible to draw more from feds, but should consider and start to look at this
  • Kolkhorst – You have the ability to administer vaccines, but doctor’s offices are not necessarily set up for mass vaccinations and hours gave EVAP pause
  • Campbell – TMA is one of the best organizations, appreciate effort of physicians across the state
  • Kolkhorst – Asks after treatments, best practices
    • May have pandemics in the future with different needs, position of TMA
    • Therapy decisions belong between doctors and patients
  • Campbell – Agrees on doctor-patient relationship, Gov regulation and insurance always complicate this relationship; need to guard against interference & needs to be a mission
  • Hall – What is TMA’s position on early ambulatory treatment for COVID?
    • Should be a decision that doctors make with their patients, TMA doesn’t prescribe particular therapies
  • Hall – Question is more that there seems to have been no mention of early possible treatments
    • TMA doesn’t have an official policy statement on that, though many medical treatments would be entirely reasonable
  • Kolkhorst – Highlights that delays in cancer screening due to pandemic may lead to more mortality, need framework for future novel diseases
    • Have updated screening stats through November, still substantial decreases and many cancers have gone undiagnosed

Dr. Richard Urso

  • Initially put together list of possible therapeutics, hydroxychloroquine was effective in culture
  • Symptoms of COVID are very treatable, challenge is overcoming hierarchy telling doctors they shouldn’t use certain treatments
  • Have a drug cocktail developed in concert with other doctors, incl. hydroxychloroquine, aspirin
  • Posted about drug cocktail on social media and received letter from TMB requesting that this stop; many were scared off of treatment and many died
  • NIH also said there shouldn’t be early treatment; national journals and media blocked information on efficacy
  • Kolkhorst – Theme is making sure we don’t make these mistakes in the future
  • Campbell – TMB communication was very aggressive and scary at the outset
    • I thought TMB did a good job in the long run
  • Hall – What you said is not consistent with TMB testimony; heard of many doctors who tried to treat and were aggressively gone after, suppressed rate of treatment
    • Voices beyond TMB were saying and doing similar things
  • Hall – what is your thought on masks, lockdowns, closings, are these tools to use
    • Lack of evidence for lockdowns and masks, CDC showed .7% difference in mask mandates; in general it doesn’t make sense

Dr. Peter McCullough

  • Had doctors like Dr. Urso speaking out about effective treatments
  • Early on didn’t want patients to languish for 2 weeks without treatment, off-label treatments were available and effective
  • Treatment was not the focus of early literature
  • Released Youtube video that was well received, Youtube took video down; testified before the U.S. Senate about treatments
  • Was a near-total block about any sort of treatment info to patients, resources on treatments were not distributed and not covered
  • American Society of Physicians and Surgeons is the only source of treatment information, identified 35 facilities in Texas
  • Should enact a law to distribute treatment guides with positive test results
  • There was no concentrated effort among agencies and hospitals to prevent hospitalizations
  • When it became known in May that virus would be amenable to vaccine, other treatments were silenced
  • Asymptomatic spread is over-reported; COVID has always been treatable and could have prevented 85% of deaths
  • Kolkhorst – Treatment at the ambulatory stage is important
    • No single treatment worked alone
  • Hall – When we test someone we should at least provide them info of what we know can be used

Brief HHS Legislative Updates Overview

Cecile Young, HHSC

  • Link to presentation, HHSc is part of the foster care lawsuit

Victoria Ford, HHSC

  • Can provide more detail on foster care lawsuit; readjustment of caseloads, creation of heightened monitoring process, & implementation of quality assurance program

Dr. Manda Hall, DSHS

  • Providing brief update on maternal mortality & morbidity as well as vital statistics
  • Exceptional item from last session targeted maternal mortality and morbidity; provides overview of AIM bundles and maternal mortality statistics
  • Regarding vital statistics, able to eliminate 2019 backlog and have maintained progress in 2020

Jamie Masters, DFPS

  • Provides overview of DFPS operations, CBC has expanded across the state & is a major initiative for DFPS; asked for resources to continue roll out
  • Great potential for FFPSA by investing more in strategies and avoiding foster care

CSSB 25 and CSSJR 19 laid out and opened for public testimony

Ryan Harrington, Trinity Health Care – On

  • Currently 6 visits in nursing homes now; designating essential caregivers is important

Kevin Warren, Texas Health Care Association – For

  • Supports the committee substitute, impact lack of visitation has had on residents and staff is significant
  • Finding balance while allowing visitation has been very difficult; difficult to navigate federal, state, and local involvement

Pattie Ducayet, State Long-term Care Ombudsman – On

  • Ultimate goal is getting residents back to 24/7 visitation, visitors are often providing some type of hands on care
  • Concerned that we need flexibility at the agency level that accounts for other types of public health emergencies, concerned that we’re locked into COVID policy
  • Concerned that ability to remove essential caregivers could be misused
  • Kolkhorst – CS may have given a little flexibility, but will circle back; want to make sure goal of bill is that you cannot deny essential caregivers from seeing loved ones while accounting for public health
    • Appreciate clarification that this is for public health emergencies
  • Kolkhorst – Important that this establishes residents have a right to visitation and that bill provisions are only for public health emergencies

Sheila Hemphill, Texas Right to Know – For

  • Supports reigning in government policies with detrimental effects on residents
  • Research shows spike protein of COVID virus includes structures similar to HIV; evidence suggests virus is engineered

George Linial, LeadingAge Texas – On

  • Pleased to see CS for SB 25, associations are pro-visitation; associations sent letter to legislature previously asking for open visitation because we were seeing ill effects
  • Emergency rules around visitation are staff intensive, some have raised concerns about ability to accommodate visits
  • Want to make sure language between CSSB 25 and CSSJR 19 are in alignment
  • Kolkhorst – Asked for written testimony

Amanda Fredriksen, AARP – On

  • Appreciates intent to make this apply to public health emergencies
  • Needs to be clear that resident has right to designate another essential caregiver if one is blocked
  • Might need to be some language for nursing homes that makes hierarchy between state and federal regulation clear

Dr. Debra Patt, Texas Medical Association – On

  • Toll on residents is not just due to COVID affect on physical health, but also mental health
  • TMA recommends:
    • 7 day suspension may not be long enough to contain an outbreak
    • For some high-risk situations, visitation must be restricted for public health
    • Staffing shortages during a pandemic may require limitations on visitation
    • Shouldn’t have requirements on PPE, providers should decide
  • Visitation is critical for care, look forward to reviewing substitutes and changes

Diana Martinez, Texas Assisted Living Association – On

  • Visitation is one of the most challenging issues for facilities
  • Have concerns on several provisions, incl.: 1) 7 day suspension, 2) trigger being “serious community health risk,” could be a facility trigger e.g. for flu, 3) no mechanism for preventing someone being an EC in the first place, 4) if residents disagree with guardian decisions on ECs, 5) 2 hours per day is very staff intensive

Gavin Gadberry, Texas Health Care Association – On

  • CSSJR 19 binds future legislatures and should be cautious
  • Suggests tying right to legislative implementation, should also give guidance to future legislatures on ow far they can go, e.g. “reasonable time limitations”
  • Shares experience on visitation during the pandemic, HHSC and facility practices worked at his father’s facility

Kendra King, Nexion Health – For

  • Believe it is reasonable and necessary to designate essential caregivers
  • Would like to ensure there is consistency between local, state, and federal oversight
  • Miles – You feel like the bill helps you to understand authorities? You support the bill
    • I do support the bill, but does not assist in clearing up confusion
    • There are safety specifics from the local health authorities and federal authorities, want to make sure these provisions are in alignment
  • Miles – Is there an inconsistency with federal regulations in this bill?
    • Can get you this info
  • Kolkhorst – Because of these conflicts I didn’t want to get prescriptive in the bill to preserve rulemaking flexibility; do need to align these things and have some ideas
    • Miles – We’re here to fix the problem, would like to dig down on confusion that may still exist
  • Kolkhorst – Will likely be amendments on the floor to clarify that, Rep. Frank is in agreement

Mary Nichols, Texas Caregivers for Compromise – For

  • Organization was formed to advocate for the essential caregivers concept
  • Echoing concerns with substitute, anything that is prescriptive needs to be under guidance of HHSC
  • Removal of caregiver is already provided for in contracts with facilities
  • COVID was reason for limiting visitation, staffing was an issue long before COVID
  • Kolkhorst – Trying to find the perfect landing place between stakeholders, will be making a few changes and let the process work in listening to both sides
    • Appreciates this, adds that most facilities do not allow 2 hours of visitation, most only do 30 minutes to 1 hour/week
    • Assisted living facilities are more likely to allow 2 hours

Vote outs

  • CSSJR 19 adopted, CSSJR 19 passed 7 ayes 0 nays
  • CSSB 25 adopted, CSSB 25 passed 7 ayes 0 nays

Closing Comments

  • Miles – Appreciates Chair Kolkhorst’s attention on CSSB 25 and CSSJR 19, very surgical
  • Kolkhorst – Balance between operators and loved ones is very difficult; very proud of effort among Senators to come together on this issue
  • Kolkhorst – Will be jumping into the rest of the bills next week