Tennessee: Governor

Candidates

Phil Bredesen, Democrat
Van Hilleary, Republican

Issues: Nursing Home Quality | Home and Community Based Services | Tax Reform |

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Question

What specific steps would you take to ensure that nursing homes provide quality care? Please state your position on enacting reforms to improve the quality of nursing home care, including strengthening staffing standards for those who provide direct care to residents; strengthening regulatory oversight and enforcement of quality standards; reforming the Medicaid payment system, improving ombudsman services; and establishing resident and community councils to provide feedback on quality issues.

AARP Response

Nearly 40,000 Tennesseans are receiving care in 360 nursing homes across the state. A great majority of nursing home residents are Medicaid recipients, with the state providing nearly $900 million annually for their care. AARP Tennessee supports reform legislation which improves the quality of care provided to nursing home residents. Legislation should include reforms in the Medicaid reimbursement system to provide incentives to deliver high quality care; increasing minimum nurse staffing requirements; strengthening the ombudsman program; barring providers with criminal records or whose facilities have been cited repeatedly for deficiencies in major quality-of-care requirements; improving the facility inspection program; employing a full range of sanctions for quality-of-care deficiencies, including civil money penalties, a ban on all new admissions, monitors, directed plans of correction, denial of Medicaid payment for new admissions and appointment of temporary managers and receivers, and imposing remedies swiftly, with harsher sanctions for recurring, serious or widespread deficiencies.

Issue	Yes	No	Unclear
Supports increased staffing requirements
Supports improved facility inspections and stronger sanctions
Supports reforms in the Medicaid payment system

Candidate Response: Phil Bredesen

Tennesseans deserve to grow older with dignity and independence. We must ensure that our seniors have quality, safe, and secure long term care alternatives, including nursing homes and home and community based options.

I strongly support better enforcement of Tennessee’s regulatory and statutory systems in this area. Government must work with groups like AARP and the nursing home industry to find common ground on protecting our seniors. We need well-trained inspectors who apply the rules firmly and consistently. We should explore ideas of creating quality care incentives in the Medicaid program. We must punish bad players, without inadvertently punishing nursing homes that serve our seniors with quality care, respect and safety. All of these measures should include an increased focus on family and community involvement.

Candidate Response: Van Hilleary

Our optimal situation is to encourage a continuum of care from home health and community based services to nursing homes. There is a role for both services in our health care system.

I am a big proponent of initiatives that promote independence. In Congress, I have supported options such as home health. However, we should insure that we do not ignore the sickest in need. Nursing homes must be brought into a fulfilling a quality role in their own right. We have to be prepared to address these needs.

This includes making sure that our personnel in nursing homes can deliver the quality care our senior population has earned and insuring that respect and dignity is given to our nursing home patients.

Question

What specific steps would you take to ensure that consumers in need of long term care have access to a full range of services outside of nursing homes? Please state your position on increasing funding for non-institutional long term care services through redirecting resources from nursing home services to home and community based services, or providing another realistic source of necessary funding.

AARP Response

Tennesseans needing long-term care should have the choice to stay at home rather than a nursing home as the only option. Home-and-community-based services are needed by persons of all ages with physical or mental impairments. These services include personal care, nursing and home health care, adult day care, case management, social services, habitation and rehabilitation and assistive technologies. Home-and-community-based services may be needed on a regular or respite basis over a period of several months, years, or a lifetime. People prefer to receive long term care services in their own home or in a community setting. AARP Tennessee supports increased funding for home-and- community-based services under a Medicaid waiver program and for services to persons who do not meet Medicaid eligibility requirements. We also support expanding available services to ensure a full continuum of long-term care services, that enhance choice, independence, dignity and individual well-being.

Issue	Yes	No	Unclear
Supports expansion of services and funding
Supports redirecting resources from nursing homes or specific funding source

Candidate Response: Phil Bredesen

Tennessee must join the rest of the nation in expanding viable home and community based long-term care options. We have an opportunity to design a responsible program before the federal court system does it for us. Home and community based options make sense economically and represent a humane, dignified way to care for our elderly.

Staying in one’s home is a source of comfort, dignity and security. My grandmother was able to stay at home in her later years, despite having serious physical limitations. It meant so much to her to stay at home. Many Tennesseans don’t have options to allow them to receive care at home. I will work to extend more opportunities for home and community based services to people across our state.

Candidate Response: Van Hilleary

We must support independence, allowing individuals to live and fully function at home and in their community as long as possible regardless of their age.

I have a strong record in Congress of supporting home healthcare for the elderly. In 1997, I bucked my party by voting against severe cuts in home health. In 1998, I introduced a bill called the HERO Act in order to save the home care industry. In my role on the House Budget Committee, I annually insist on including provisions to protect home health spending.

Innovative solutions like respite care and long-term care insurance might play a role. Moreover, we must acknowledge that having full-time responsibility for the care of an elderly family member is an immense responsibility.

Question

What would you propose to ensure that our state’s revenue system provides stable and adequate funding for needed government services such as education and health care? Please describe your views on the need for tax reform and your specific position on ways to make our tax structure more fair and responsive to the growing demand for high quality services.

AARP Response

AARP Tennessee believes that our state is facing a severe and deepening revenue crisis. The current tax system does not provide adequate funds to pay for basic, essential services, and relies heavily on the sales tax. The current system is regressive, with lower and middle-income families paying far more as a percentage of their incomes than higher income families. AARP supports tax reform legislation that provides adequate and stable revenue for basic services; keeps up with our state’s growing economy; and addresses the inequities now realized by many lower and middle-income families. We support tax reform that eliminates the sales tax on food, clothing and non-prescription drugs, lowers the overall sales tax rate, repeals the Hall tax on dividend and interest income, and replaces these with a broad-based, graduated-rate income tax. Such a plan would lower the tax burden on the vast majority of Tennessee families and retirees.

Issue	Yes	No	Unclear
Supports lower sales taxes and replacement with broad-based income tax
Supports specific plan to meet demands for needed services

Candidate Response: Phil Bredesen

The recent budget that passed is far from perfect. Most Tennesseans, including myself, had reservations about raising the sales tax another penny. Our state is still in a very fragile position. It is time to move ahead and start managing state government in a responsible manner.

I want to bring confidence and real leadership to state government. This will enable us to set priorities, restore fiscal discipline, and grow our economy. I believe that by focusing on creating better job opportunities and growing the economy, we can increase the state’s financial base and help fix the budget mess. We can then move past the paralysis of the past several years and focus on improving services in top priority areas like health care and education.

Candidate Response: Van Hilleary

Our budget problem is not the result of declining revenue. Over the last ten years our revenues have grown sufficient enough to cover inflation and population growth with millions to spare.

Our budget problem is the result of enormous growth in our spending, resulting in a recent tax increase. Once Tennessee gets its spending in line, I support rolling back the sales tax increase.

Raising taxes further will not solve the problem, especially through a state income tax that destroys jobs and disables economic development. It’s like giving aspirins for a cold. You treat the symptoms, but you don’t cure the cold. Tennessee can meet its needs by living within its means and promoting priorities, such as education and health care, and economic growth.