Tennessee: Tennessee State Senate, District 13

Candidates

Bill Ketron, Republican
Bobby Sands, Democrat

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

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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: Bill Ketron

If elected I will work to roll back the most recent sales tax increase. I will support an independent audit of each state department to identify and eliminate wasteful spending that we know exists. I will work for the removal of the illegal TennCare recipients that will result in over $500 million in wasteful spending in Tennessee this fiscal year. Unlike my opponent, I will not support a tax on residential energy use (House Bill 3364 6/1/00) or an increase in the sales tax (House Bill 1781 7/7/01), both of which would harm persons of fixed income. If elected I will sponsor a Homestead Act which would cap local property taxes from age 65 until death allowing our seniors peace of mind.

Candidate Response: Bobby Sands

I voted for the 2002 Tax Reform Bill. The fundamental test of tax policy is that it should be fair and equitable. It should not unduly penalize one sector of our economy or one segment of our population. The present system of Tennessee taxation does both. The sales tax is too high. It is regressive and more burdensome to working families and retired persons on fixed incomes.

It will be my responsibility to work with the existing system to ensure that government is efficient and it allocates its available resources to the issues of the greatest importance. I am hopeful that long-term care alternatives can be funded by redirecting resources and increasing choices in how Medicaid funds are spent.

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: Bill Ketron

In order to provide quality care, nursing homes must recruit a well trained staff. I would also support measures that would require through preparatory training specifically target for each facility to be conducted by the nursing home administrators, as opposed to on the job training by fellow co-workers. I feel that the New Life Safety Codes are sufficiently stringent quality care guidelines, but that they need to be closely monitored to ensure that they are being adhered to. Finally, I would support improving the Medicaid payment system by recruiting higher quality ombudsmen and instituting a streamlined, more efficient system of paperwork in that would lighten their workload resulting in quicker and more responsive payment.

Candidate Response: Bobby Sands

If the executive branch fails to implement or enforce their regulations, I would support and/or sponsor legislation which would require, by statute:

• Staffing requirements sufficient to ensure patient care and safety.
  
  
• Regular facility inspections; public disclosure of such inspections; and sanctions to enforce deviations from the rules.
  
  
• I support greater flexibility in the Medicaid payment system to provide senior citizens with a wider range of services.
  
  

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: Bill Ketron

I would support the use of some dollars directed at nursing homes to be redirected to develop collateral senior day-care facilities. This would serve the dual function of helping streamline the common needs of such facilities as well as easing the financial burdens on those providing part-time care for our seniors who can no longer care for themselves full-time. Such a centralized system would prove mutually beneficial to each individual system of care and to us all.

Candidate Response: Bobby Sands

I support the expansion of services and funding for home and community based services. It has been a source of great frustration to see well-designed proposals, which were not implemented due to inadequate funding. It is of the highest priority that seniors be afforded choices and options, including home and community based services as an alternative to nursing home care.

I support efforts to find an alternative source of funding which could be designated specifically for these programs. It seems that under the current state of the Tennessee Tax system, this is the only method by which a program could receive new funding. I would support such an effort on behalf of community and home based services.