Pete Stark

Mr. STARK

Mr. STARK. Mr. Speaker, I wish today to support H.R. 621, designating the James C. Corman Federal Building. Jim Corman was a true statesman who served his constituents in California, and indeed, the people of the United States, with great distinction. Jim cared passionately for the poor and worked to see that their interests were heard in Washington. He was one of the great leaders in the Congress seeking health insurance for all and he worked hard to enact a decent, humane social policy for the disadvantaged. Jim rejected the voices in Congress who seek to help those already blessed with wealth while neglecting those who cannot put food on their tables. ``I don't think there is anything uplifting about hunger,'' he once said. Jim was a tireless advocate for the uninsured and he passed on his sense of passion to his colleagues, including me. When I was first assigned to the House Ways and Means Committee, Jim taught me ``how things were done.'' I am grateful to have served with Jim Corman and I know his constituents were grateful for his service. Naming this Federal building after Jim Corman is a proper tribute to a man who dedicated his life to public service. Jim will be best remembered, however, for his tireless work on behalf of those who are less fortunate.

Mr. STARK

Mr. STARK. Mr. Speaker, I am proud to introduce the ``Gift of Life Congressional Medal Act of 2001.'' This legislation creates a commemorative medal to honor organ donors and their survivors. Senator Frist, a heart and lung transplant surgeon himself, is introducing companion legislation in the Senate. There is a serious shortage of available and suitable organ donors. Nearly 75,000 people are currently waiting for an organ transplant, and every 14 minutes a new name is added to the list. Because of low donor rates, over 6,000 people died in 1999 for lack of a suitable organ. Incentive programs and public education are critical to maintaining and increasing the number of organs donated each year. We are very happy to hear that Secretary Thompson has made this a priority issue that he plans to address during his first 100 days as Secretary. He has promised to mount ``a national campaign to raise awareness of organ donation'', and to ``do more to recognize families who donate organs of a loved one.'' The Gift of Life Congressional Medal Act is a great opportunity for us to work with Secretary Thompson to draw attention to this life-saving issue. It sends a clear message that donating one's organs is a self-less act that should receive the profound respect of the Nation. The legislation allows the Health and Human Service's Organ Procurement Organization (OPO) and the Organ Procurement and Transplantation Network (OPTN) to establish a nonprofit fund to design, produce, and distribute a Congressional Medal of Honor for organ donors or their family members. Enactment of this legislation would have no cost to the Federal Government. The Treasury Department would provide an initial loan to OPTN for start-up purposes, which would be fully repaid. From then on, the program would be self-sufficient through charitable donations. The donor or family member would have the option of receiving the Congressional Gift of Life Medal. Families would also be able to request that a Member of Congress, state or local official, or community leader award the medal to the donor or donor's survivors. Physicians can now transplant kidneys, lungs, pancreas, liver, and heart with considerable success. The demand for organs will continue to grow with the improvement of medical technologies. According to the United Network for Organ Sharing (UNOS), an average of 9,600 donations was made per year between 1995 and 1999. Without expanded efforts to increase the supply of organ donation, the supply of suitable organs will continue to lag behind the need. This is non-controversial, non-partisan legislation to increase organ donation. I ask my colleagues to help bring an end to transplant waiting lists and recognize the enormous faith and courage displayed by organ donors and their families. This bill honors these brave acts, while publicizing the critical need for increased organ donations.

Mr. STARK

Mr. STARK. Mr. Speaker, I commend Steve Meyers, upon his retirement after twenty-three years, for dedicated service to the city of San Leandro. Mr. Meyers has served as City Attorney and Redevelopment Agency Counsel to the city of San Leandro since 1979. He has worked with six mayors and four city managers during his tenure as City Attorney and Agency Counsel and has played a central role in many projects during his employment with the city. He has negotiated a number of real estate transactions for both the city and the Redevelopment Agency, which have resulted in achievements such as affordable housing and business expansion in San Leandro. Mr. Meyers graduated from the University of California at Santa Barbara and received his J.D. degree from the University of California Hastings College of the Law, where he was a member of the Order of the Coif. Upon his graduation in 1973, Mr. Meyers devoted his practice to municipal law serving in the Sacramento City Attorney's Office until moving to San Leandro in 1977. He is admitted to practice in the State courts and the United States Supreme Court. Mr. Meyers was Chairman of the Executive Committee of the State Bar Public Law Section in 1994 and served as editor of the Public Law Journal. He has served on the Legislation Committee of the City Attorneys Department of the League of California Cities; served as president of the Bay Area City Attorney's Association and is a recipient of the John J. McCoy Fellowship in Urban Studies. He is currently chairman of the Board of the Bay Planning Coalition. Upon his retirement from his position with the city of San Leandro, Mr. Meyers assumed the role of Special Counsel to the City on January 1, 2001. I join his friends and colleagues in thanking him for his past contributions and wishing him well in his continued service to the community of San Leandro.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise in strong support for the purported purpose of this legislation before us today. We can and should ``lockbox'' our Social Security and Medicare surpluses so that monies put into them by the working people of America are used as they were intended--to provide financial and health security for them in their senior years or if they become disabled--not to provide a tax break aimed mostly at those with upper incomes. Unfortuantely, the bill before us today talks the talk, but fails to walk the walk. This bill will not guarantee that either the Social Security or Medicare surpluses are protected from being used to finance tax breaks or any other government spending. While the bill states that it protects Medicare and Social Security trust funds, it creates a giant exception that if a bill is brought up on the House floor that contains the words ``Social Security reform legislation'' or ``Medicare reform legislation,'' then the protections for either trust fund no longer exist. It doesn't define what would constitute ``reform'' of either program. It would be very simple for anyone to circumvent the stated intent of this bill by simply referring to legislation as either Medicare or Social Security reform and then the protections against using the trust funds would be overridden. I could see the argument that a ``Star Wars'' missile defense system will protect seniors--therefore it is a Medicare reform. The legislation contains a further loophole that allows the President to dip into the Social Security and/or Medicare surpluses in any budget he presents to Congress as long as the budget claims to reform each of the programs. The public should not be fooled one moment. President Bush is pushing a tax cut proposal in Congress that he admits costs $1.6 trillion. The unstated reality is that the proposal costs $2.5 trillion by the time you count all of the pieces that he's left out of his early version, but that will be included in the end. The entire surplus over the next ten years--if you really protect Medicare and Social Security surpluses--is $2.7 trillion (and even that figure is highly speculative). What am I leading up to? There is no way that this tax cut package can pass Congress and get signed into law in a way that leaves money for other government priorities like education, Medicare prescription drug coverage, improved Medicare solvency, or Social Security reform without putting the Medicare and Social Security trust funds on the chopping block. Anyone who believes otherwise is fooling themselves and passage of this legislation today does nothing to change that fact. Larry Lindsey, President Bush's chief economic advisor has already been asked whether government should dip into the Social Security surplus to make room for tax cuts and he responded: ``It's a question that needs to be asked.'' President Bush's Director of the Office of Management and Budget Mitch Daniels has already stated with regard to protecting the Medicare trust fund from any other use that he would be: ``very hesitant to treat those funds in the same way as we do in Social Security where I think it is in order.'' A February 5 Wall Street Journal article states that, ``The Bush Administration also won't wall off Medicare's current surpluses in a `lockbox' . . . In fact, Mr. Daniels has said he's told his staff not to talk about a Medicare surplus. Finally, Senate Majority Leader Trent Lott has yet to make a commitment on a Medicare lockbox. A recent BNA Daily Report for Executives, asked him about whether he'd decided to lockbox Medicare and he responded, ``We're going to think that through.'' I will vote for this legislation today. But, I do so with the firm knowledge that my vote--and that of every other member of the House of Representatives--really means nothing about whether we stand for protecting the Medicare and Social Security surpluses for their intended purposes. I hope that the weaknesses of the legislation are not intended and that this vote is a good faith commitment by my colleagues on the other side of the aisle to protect both the Social Security and Medicare surpluses from use for tax cuts or any other new spending. If that commitment is real, we've got a tough job in front of us to ensure that the upcoming tax cut debate doesn't absorb all available government monies--in addition to the Medicare and Social Security trust funds.

Mr. STARK

Mr. STARK. Mr. Speaker, today I rise with Mr. Waxman, Mr. Coyne, Mr. Frost, Mr. Lantos, Mr. Miller, Ms. Schakowsky, and Mr. Strickland to re-introduce a joint resolution calling for a White House conference to discuss and develop national quality of care recommendations for assisted living facilities (ALFs). Between 800,000 and 1.5 million American seniors currently reside in ALFs and these numbers may double in the next 20 years. Until recently, the industry has been almost entirely private-pay. But times are changing and ALFs increasingly seek and receive federal funding through Medicaid's Home and Community-Based Services waiver. In fact, overall spending for this waiver swelled 29% between 1988-1999, due in part to growing numbers of ALF placements. In many states, industry expansion has not been accompanied by a tightening of quality standards or accountability measures. Instead, the definition and philosophy across ALFs varies from state to state and their is little consistency in state regulatory efforts. Furthermore, a 1999 General Accounting Office report found that 25% of surveyed facilities were cited for five or more quality of care violations between 1996-1997 and 11% were cited for 10 or more problems. Frequently cited problems ranged from providing inadequate care, particularly around medication issues, to having insufficient and unqualified staff. I'd like to call attention to an article entitled, `` `Assisted Living' firm prospers by housing a frail population,'' published on January 15th in the Wall Street Journal. This article discusses industry trends and carefully details the business practices and policies of Sunrise Assisted Living, Inc., one of the country's most successful ALF companies. At a time when many of its competitors are posting large operating losses, Sunrise earns millions of dollars in profits each year. How do they do it?--by accepting elderly applicants with serious health conditions and collecting extra-care fees, sometimes as high as $1640/month (on top of regular monthly fees) for very sick or cognitively impaired residents. Paul Klassen, Sunrise's chief executive, makes no bones about this marketing strategy. At a recent orientation for new Sunrise managers, he urged that ``the frailest of the frail'' be considered as candidates for assisted living. Although originally developed as an alternative to nursing homes, this article makes abundantly clear that ALFs are now recruiting the same frail seniors that might otherwise be served by nursing homes. Yet the average Sunrise facility (housing 90 residents) maintains only one registered nurse on duty for 8-12 hours per day. Nursing homes of that same size average four to five nurses on duty at all times. Furthermore, nursing homes must comply with federal quality regulations, but ALFs answer only to states, where there is considerable variation in terms of regulation and oversight. This regulatory variation can have deadly consequences. As reported by the Wall Street Journal, staffing issues contributed to the death of a visually-impaired Sunrise resident in Georgia, who was awaiting delivery of a liquid herbal supplement. At the resident's request, a substitute concierge delivered a package that was not specifically addressed to the resident. After drinking what they thought was an herbal supplement (but was really caustic bathroom cleaner), both the resident and his wife became critically ill and she died several days later. Perhaps as disturbing as the incident itself, is the fact that the facility's only penalty to date has been a paltry $3000 state fine. Closer to home, last August in my district, an elderly woman passed away in an assisted living facility due to hemorrhaging from her dialysis shunt. Two times, she pressed her call pendant for help, but no help came. Instead, the ALF staff cleared the alarms and reset the machines both times. The facility did not place a 911 call for assistance until 1 hour and 34 minutes later. There was no nurse on duty, and all four resident aides in the facility at the time have denied responding to the calls or clearing/resetting the call system. This situation is still under investigation, but it highlights the seriousness of inadequate quality of care in these facilities. I believe that ALFs that receive federal funding should be required to meet reasonable, commonsense quality standards to protect residents. This joint resolution presents a valuable opportunity for policymakers, industry stakeholders, and consumers to discuss and debate how best to develop these needed quality standards. Frail, elderly ALF residents must be protected and sub-par facilities must face real consequences. I look forward to working with my colleagues on both sides of the aisle to protect frail seniors in ALFs throughout our country. The resolution has been endorsed by the Consumer Consortium on Assisted Living. California Advocates for Nursing Home Reform, National Association for HomeCare, and Elder Care America, which are organizations active in protecting consumer interests in assisted living and other settings. The January 15, 2001 article by Ann Davis of the Wall Street Journal appears below: ``Assisted Living'' Firm Prospers By Housing a Frail Population (By Ann Davis) Atlanta.--Early last year, Tom Spiro, the director of a Sunrise Assisted Living Inc. home here, warned his boss he might lose another resident. It wasn't welcome news. The home's 71% occupancy was already far below the corporate target of 95%. But the resident, an 82-year-old woman just out of a hospital, could no longer walk, took a battery of medications and was being fed from a tube. Mr. Spiro felt that his assisted-living facility--a nursing-home alternative that provides less care--was in no position to accommodate someone so frail. He was told he was being too cautious. ``There was pressure to take everybody,'' he says. Ultimately, Mr. Spiro retained the resident, along with several others he considered too infirm. Even so, with the home's performance still lagging a few months later, he was asked to resign. Linda Selvidge, who was his boss but has also since left the company, says it made sense to keep the elderly woman as a resident because her husband was in the facility. But Ms. Selvidge acknowledges urging Mr. Spiro to accept residents despite his reservations. ``Being frail is nothing to be nervous about,'' she recalls telling him. The Mission Why such eagerness to enroll clients whose care would seem sure to mean extra cost, complexity and risk? One reason is the company founders' longtime commitment to offering a homelike alternative to nursing homes. But accepting residents who are infirm also helps to fill beds, at a time when the assisted-living industry is burdened by overcapacity. And Sunrise, more so than its competitors, has figured out how to make serving such clients a profitable business. The assisted-living industry is at a crossroads, two decades after springing up amid dissatisfaction with nursing homes. Its mission was to offer attractive housing--for those who could afford it--where the elderly could get help with daily routines like bathing and dressing, but no intensive nursing care. Yet while the initial target was the relatively healthy elderly, providers have increasingly targeted frailer and frailer people since a capacity glut developed in the late 1990s. Sunrise's founders, Paul and Terry Klaassen, make no apologies for housing ailing seniors. The couple, who own 13.2% of the McLean, Va., company, refer to shunting old people into nursing homes as ``the dreaded act of our society.'' At a recent orientation session, Mr. Klaassen, who is Sunrise's chief executive, urged new managers to see ``the frailest of the frail'' as candidates for assisted living. Meanwhile, Sunrise facilities have higher operating-profit margins than those of other public assisted-living companies that disclose this information. A key reason for its success is occupancy. A rule of thumb in the business is that facilities don't produce much profit till they reach about 90% occupancy, but can throw off rich profits above that level. Sunrise averages 91.4% occupancy at homes open at least a year; most competitors are below 90%. Sunrise credits its customer service. In addition, says David Schless of the American Seniors Housing Association in Washington, some other companies ``have had much shorter resident stays'' because they ``haven't ever been willing to provide some of the supportive-care services to care for the truly frail elderly'' that Sunrise does. Sunrise doesn't just enroll more people--it also charges them more. The company ``has figured out how to price its services better than its competitors,'' Mr. Schless adds. Sunrise makes the business pay by charging hefty premiums for care beyond assisted living's basics, which are help with dressing, bathing and getting around. Competitors do something similar in pricing, but Sunrise collects extra-care fees from a larger percentage of residents, about 60%, than most. Extra-care fees average $517 a month per resident at Sunrise; they come to about $200 a month at one major competitor, Alterra Healthcare Corp. And despite the industry overcapacity, Sunrise manages to raise fees. it has increased the base rent about 5% a year (now an average of $2,700 monthly). And lately it has made a concerted effort, when residents grow frailer, to reassign them to higher-care, higher-price categories. In typical homes, residents' monthly bills are $677 higher than they were in 1998, figures supplied by Sunrise show. The company's costs for resident care have risen just $180 a month per resident, the same figures show. Mr. Klaassen says fees went up because local Sunrise managers realized they weren't charging enough, given the costs and staff time that frailer residents require. The CEO also says Sunrise spends more to run its homes than others do, and that the key to success is offering consumers such high quality that it contrasts sharply with a nursing-home environment. ``Competitors that are not as full charge less,'' Mr. Klaassen says, ``and that's their problem. Most assisted-living communities do not charge enough and do not spend enough.'' Sunrise earned $15.5 million the first three quarters of 2000, including gains on the sale of several properties it is managing under contract. Rival Alterra had a $35 million net loss in the nine months, and another big competitor, the Marriott Senior Living Services unit of Marriott International Inc., had a $6 million operating loss. Sunrise's stock is up about 50% from a year ago, making the Klaassen's stake worth about $60 million. Sunrise's methods have been put to a severe test in Atlanta. The city seemed an ideal market when Sunrise was launching a big expansion in the 1990s. It targets metropolitan areas ``with dense rings of relatively affluent people,'' says the company's president, Tom Newell. Sunrise ultimately built or acquired six assisted-living facilities in the Atlanta area and two more elsewhere in Georgia. Targeting Elder Daughters Its marketing focus isn't the elderly themselves but their grown children. The target customer is a 45-to-64-year-old eldest daughter who is deciding how to care for an octogenarian parent. The chain adapts ideas from other franchises, setting out to emulate, as Mr. Klaassen puts it, the pleasant environment of the Ritz-Carlton and the personalized customer service of Nordstrom. Many Sunrise buildings resemble sprawling Victorian mansions, with curving staircases. They have hair salons, libraries and small kitchens in rooms, whose doors have locks for privacy. To avoid an institutional feel, handrails in hallways look like molding Signature touches include ice- cream parlors with jukeboxes that play Sinatra and exhibits of antique wedding dresses to stimulate memories. Peggy Farris of Atlanta jumped at the chance to put her mother in a special Sunrise unit for Alzheimer's patients rather than in a nursing home. Now her mother is taking part in flower-arranging and music programs and ``seems to be flourishing more than she was in my home,'' Ms. Farris says. A great many other customers are similarly pleased. Sunrise was part of a building boom that added about 3,700 assisted-living beds in Atlanta in four years, quintupling the supply, according to market-research firm AZ Consulting. The facility Mr. Spiro managed was half-empty and losing tens of thousands of dollars a month for parts of 1998 and 1999, Sunrise records show. Competitors resorted to price wars. Sunrise experimented with discounting, too, but mostly it threw its energy into recruiting residents. Marketing directors at five of its homes were asked to log 20 face-to-face meetings, 100 phone calls and 200 mailings a week to potential customers and medical professionals, some recall. One incentive: a commission of about $250 whenever a new customer made a deposit. Chris Boyce of Atlanta says that after Marriott expressed reluctance in 1998 to take his mother, who was incontinent, the Sunrise in Decatur, Ga., accepted her, along with her husband. ``Sunrise told us they would handle my parents until they died,'' Mr. Boyce says. Nonetheless, he eventually moved them to a nursing home when their health declined further. Sunrise also scored points with hospitals' ``discharge planners,'' making it easy for them to place patients needing too much care to go home. With Sunrise, ``we can make a call in the morning and by the afternoon it's taken care of and the patient is moving in,'' says John Dornbusch, a planer at DeKalb Medical Center in Decatur. In handling health needs, Sunrise facilities are quite different from nursing homes. Despite nursing homes' chronic problems with short staffing, those the size of Sunrise's homes--about 90 residents--average two registered nurses and two or three licensed practical nurses on duty at all times, according to federal data. Sunrise says it usually has one registered nurse on duty the eight to 12 hours during the day and none the rest of the time. Nursing homes also have to have an on-call medical director. Assisted-living homes rely on residents' own outside doctors. While nursing homes are supposed to meet numerous federal requirements, assisted-living homes face only state regulation. In about half of the states, they come under antiquated rules covering ``board and care'' group homes. Such homes, which fell out of favor in the 1970s provided meals and minimal assistance, often in private houses and for just two or three residents. While many states have strengthened the regulations, there is still lots of leeway. Medication is a particularly knotty issue. A key function of nursing homes is administering medicines to residents, whether pills, IVs or injections. Not so at assisted-living facilities, in most states. Georgia's rules say that with a few exceptions, notably insulin shots, assisted-living homes' staffs are allowed only to prompt residents to take their medication. Putting a pill in a resident's mouth and helping him or her hold a glass of water to swallow it isn't permitted. But some aides feel they have no choice. Sharon Thompson, a former caregiver on the Alzheimers' floor at Sunrise at East Cobb (County) says that if she merely left a pill on a table, the resident, often wouldn't take it. While the rules said that in such a case she should simply note on the resident's files that the person refused the medication, she says she routinely placed pills to people's mouths and got them to swallow. Otherwise, ``in an Alzheimers' unit, they'll never get their medications, I know you're not supposed to administer medicine, but what are you going to do?'' Admissions Rules Tim Cox, a Sunrise senior vice president, says there are various ways around this problem, including asking the family to give the medicine and developing an eating or drinking routine that gets the resident accustomed to taking medicine at a certain time. ``It is never appropriate to administer if the regulations to do not permit us to,'' he says. A Georgia regulator says the medication issue is one of the reasons for restricting whom assisted-living homes can admit. Georgia bars assisted-living facilities from taking certain kinds of residents, such as people too weak to propel a wheelchair or walker in an emergency evacuation. In six months, the state has cited Sunrise's six Atlanta-area homes for accepting 27 residents who needed more care than the homes were licensed to provide, Alterra and Marriott, which together have seven Atlanta homes, were each cited just once. David Dunbar, Georgia's top long-term-care regulator, calls Sunrise's number of citations ``unusual.'' Yet the state has never asked Sunrise to discharge a resident, he says. When cited, a facility can simply apply for a waiver to keep the person. The state routinely grants one if it is the resident's A government ombudsman wasn't so lenient in 1998, when Sunrise at East Cobb sought to admit a man to its Alzheimer's unit who couldn't communicate, dress, feed himself or walk. Laura Formby, who had been notified of the case by a social worker, says she found the man ``totally unacceptable'' for assisted living and contacted the facility, which canceled the admission. Sunrise President Tom Newell says Sunrise tries to ``balance risk'' against the preferences of residents and family. It sometimes asks the relatives of people who want to remain, despite worsening health, to supplement the care at their own expense. ``We work with the regulators to explain how we will be able to care for them,'' Mr. Newell says. ``Part of the plan that's developed to allow them to live in assisted living would be private-duty aides they would bring in or home-care agencies.'' Gwen Birchall says she paid Sunrise $930 a month in extra- care charges for her aged mother but still felt obliged to hire an aide. She says she also did certain chores that Sunrise staff had promised to handle, and her husband routinely washed dishes after meals to free up frazzled Sunrise caregivers. She moved her mother to a nursing home in January. Told of the case, Tiffany Tomasso, Sunrise's president of resident-care operations, says such an experience is ``unfortunate'' but when the company is made aware of these concerns, it addresses them right away. Fine-Tuning Sunrise calibrates its staffing levels precisely with residents' ``acuity level''--how medically needy they are-- and facilities quickly adjust workers' hours when the resident mix changes. Sometimes, Sunrise appears to cut it too close. After a Dec. 5 inspection of Sunrise at Huntcliff Summit in Atlanta, Georgia regulators said the facility ``has consistently operated with fewer employees than needed to properly safeguard the health, safety and welfare of all residents.'' Muriel Flournoy, an 87-year-old resident of the facility, says, ``If you need help at night, it can be almost impossible to get an answer.'' Ms. Tomasso says Sunrise's review of its hours at that home indicates staffing was ``well within the parameters of our model'' and exceeded minimum state staffing ratios. She adds that Sunrise increases staff hours when a resident is reassessed at a higher-care level. ``It's a very fluid process,'' she says. As for Ms. Flournoy's complaint, ``We're never happy when customers don't feel their needs are being met,'' Ms. Tomasso says. A company spokeswoman adds that Sunrise has recently taken steps to improve response time at night to address her complaint. In 1999, Sunrise rolled out new, more-expensive pricing tiers, such as ``Plus Plus'' for extra-sick residents and ``Reminiscence Plus'' for those with later-stage dementia. Such care levels can add as much as $1,640 a month in fees. Families say they were told that residents placed in higher- care categories would get more staff time. But Carla Neal, former head of the Alzheimer's floor at Sunrise at East Cobb, says her boss told her she was ``overstaffing'' her floor and should stick more closely to the staffing formula. She says she wound up giving residents less attention than before, even though they were now paying more. ``There wasn't any way we could deliver the care needed,'' says Ms. Neal, who left Sunrise. Rick Gagnon, who was her boss but who also has since left, terms the staffing guidelines ``quite appropriate.'' Caregivers, he observes, ``tend to err on the side of the person whom they're caring for.'' But also important, in his view, are managers with ``the corporate mentality to make the system work.'' Staffing issues contributed to a death at Sunrise at East Cobb last July. A volunteer was filling in at the front desk for an absent concierge when a visually impaired resident asked for a package he thought contained a liquid herbal supplement he was expecting. Though the box was addressed to Sunrise, not to the resident, the volunteer delivered it to the man's room, a state ``complaint narrative'' says. The liquid was a caustic bathtub cleaner. The man and his wife each drank some. He became critically ill and she died a few days later. The state fined the company $3,001 after alleging that it had failed to provide the care these residents needed. Sunrise's Mr. Cox says the facility erred in not training the volunteer to safeguard all packages in the mailroom. Since Mr. Cox was interviewed, the surviving husband has filed suit against Sunrise. Fighting an Eviction Some of Sunrise's rivals have also drawn regulatory scrutiny. For instance, Michigan regulators cited Alterra last summer for accepting a number of patients the state deemed too sick for assisted living. Alterra helped two of the residents find an attorney, and the residents then sued the state of Michigan, alleging that their eviction would violate federal laws barring housing discrimination against the disabled. The suit is pending, but in the meantime, Michigan has enacted a law saying regulators must let a resident stay in an assisted-living facility if the resident, the family, the resident's doctor and the facility all agree the person can remain. It isn't clear whether the new law applies to the two who sued. In the Atlanta area, Sunrise's efforts to recruit and accommodate increasingly infirm residents finally paid off. Its facilities there now have occupancy and operating-profit rates in line with company averages. Meanwhile, marketing and pricing efforts continue. To interest younger seniors in its facilities, Sunrise is testing a new service, Sunrise At Home, which sends aides and nurses to private residences. It is also casting about for new ways to cater to the oldest and frailest of Americans. Internally, the initiative is dubbed ``Plus Plus Plus.''

Mr. STARK

Mr. STARK. Mr. Speaker, I rise in support of H.R. 132, designating the Lanai City Post Office the Goro Hokama Post Office. To bring just some of the Stark family remembrance to this occasion, my family and I have been visiting the Island of Lanai for at least 10 years and, with all due respect to the rest of the Hawaiian islands, pretty much the same hibiscus, and pretty much the same bougainvillea, pretty much the same marvelous climate, pretty much the same sand. What is so different about Lanai? It is the people. It really is. They have made us and our children feel welcome there, at home, comfortable, not overburdened, just a wonderful group of people. And when we have someone like Goro Hokama, who is almost a legend on the island of Lanai, he has served the people as a public servant for the County of Maui, the State of Hawaii, over 40 years, long before it became the tourist mecca that it is today. He has been a labor leader, an elected official, a Little League volunteer, and he typifies the kind of pitch-in spirit of togetherness that the Hawaiian people on the island of Lanai have every right to be so proud of. I am delighted to be here with my colleagues from Hawaii today in support of H.R. 132.

Mr. STARK

Mr. STARK. Mr. Speaker, one of the world's most thoughtful health policy experts and advocates, Dr. Milton L. Roemer has passed away. His brillance and insights will be sorely missed by all those who were his students and who had the privilege of working with him. Few of us in Congress ever get a law named after us, and even fewer people throughout the world get a law of nature or science named after themselves--but Roemer's law is a law that all of us in health policy and finance must live and deal with daily. In popular language, Roemer's law is ``build it and they will come''--which he postulated way before the movie was ever dreamed of. In health policy, it means that in an insured population, if you add beds to a health care facility, they will get filled. In medicine and health care, supply can drive demand. The implications for health policy, costs, and financing are key to many of the problems we face and will be facing in the decades to come. Roemer's law is just one of the innumerable contributions he gave the world. Since earning his medical degree 60 years ago, he worked on public health problems in 71 nations, published as sole author 20 books[!!], co-authored 12 other books, and 430 articles. The doctor was obviously possessed of energy and talent almost beyond imagination. Dr. Roemer earned the MD degree from New York University in 1940, along with a masters' degree in sociology from Cornell University in 1939, and a public health degree from the University of Michigan in 1943. As a medical officer of the New Jersey State Health Department, he supervised 92 venereal disease clinics, as they were called in 1943. During World War II as a member of the commissioned corps of the US Public Health Service, he served as Assistant to the Chief Medical Officer of the War Food Administration and Associate in Medical Care Administration to the Chief of the State Relations Division. His 1948 book, written with F.D. Mott Rural Health and Medical Care was the first to analyze systematically rural health care needs and services in the United States. As county health officer of Monoghela County, West Virginia, he introduced public health innovations, including pioneering a cancer detection clinic, for this mining community, against the objections of organized medicine. Dr. Roemer explained to the doctors that this screening clinic would provide more patients for them to treat. This experience led him later to establish a prize for a creative, local public health leader who had overcome opposition to advances in public health. He early called for the integration of public health and medical care and launched the Medical Care Section of the American Public Health Association. Dr. Roemer's international work began in 1951 when he served as chief of the Social and Occupational Health Section of the newly formed World Health Organization (WHO) in Geneva, Switzerland. In 1953, in the midst of the McCarthy hysteria, he was forced to leave Switzerland and his work as an international civil servant, when the US government withdrew approval of his appointment at WHO. In 1953 the Province of Saskatchewan, Canada, had just introduced hospital insurance for its people in this prairie province and was on the verge of extending it to include insurance for doctors' care Dr. Roemer was appointed Director of Medical and Hospital Services of the Saskatchewan Department of Public Health, North America's first social insurance program for hospital care. After teaching at Yale and Cornell Universities, in 1962, Dr. Roemer came to the UCLA School of Public Health, where he taught health administration for 38 years and served as chairman of the Department of Health Services for eight years. The capstone of Dr. Roemer's many publications was his 2-volume work, National Health Systems of the World, a monumental, comparative analysis of national health systems of countries of the world set within a logical and coherent framework. At UCLA, Dr. Roemer's research encouraged the development of not for profit HMOs, promoted the use of ambulatory care, and documented the need for a national health insurance covering the total population. He advocated the development of doctoral training in health administration to prepare students for leadership in public health practice and established an endowed fellowship to support students in this program. The American Public Health Association awarded Dr. Roemer its International Award for Excellence in Promoting and Protecting the Health of People in 1977. In 1983, APHA awarded him its highest honor-- the Sedgwick Memorial Medal for Distinguished Service in Public Health. In 1992, the Centers for Disease Control gave Dr. Roemer its Joseph W. Mountain Award. In 1997, he was given the Lifetime Achievement Award of the APHA International Health Section and the Distinguished Career Award of the Association for Health Services Research. Dr. Roemer is survived by his wife of 61 years, Ruth Roemer, his son, John E. Roemer, of New York City, his daughter, Beth Roemer Lewis, of Berkeley, California; and six grandchildren. A memorial service will be held at UCLA in the spring. Contributions in Milton Roemer's memory may be made to the American Public Health Association, Washington, DC, the Department of Health Services, UCLA School of Public Health, or Physicians for Social Responsibility. To repeat, America and the world have lost a wonderful teacher who truly had a sense of the whole and of the oneness of mankind--and that a just and honorable society should join in helping ensure that no member of that society goes without health care.

Mr. STARK

Mr. STARK. Mr. Speaker, today I join my colleague, Representative Matsui and several other colleagues to introduce the ``Disabled Workers Opportunity Act.'' This bill will remove a persistent employment barrier facing people with disabilities--the fear of losing their health insurance. It builds on the Work Incentives Improvement and Ticket to Work Act enacted last year. That law extended Medicare coverage for disabled, working beneficiaries who qualify for SSDI for eight and a half years. The legislation we are introducing today would make Medicare coverage permanent for these workers. According to a recent survey commissioned by the National Organization on Disability, 79% of unemployed people with disabilities want to work. Yet, only one-third of them are actively working. Despite major advances in disability services and technologies, less than 1% of SSI/SSDI disability enrollees leave the rolls each year to return to work. In large part, this gap can be explained by the fact that SSI/ SSDI disability beneficiaries risk losing health insurance coverage if they return to work--and many jobs lack the health benefits they require to maintain employment. Health insurance is vital for all workers, but for someone who is disabled, it can be a matter of life or death. On December 17, 1999, the ``Ticket to Work and Work Incentives Improvement Act'' was signed into law (P.L. 106-170). This important piece of legislation extended and improved healthcare and vocational rehabilitation opportunities for people with disabilities. Yet it does not go far enough in one fundamental respect. Instead of allowing disabled workers to permanently retain access to Medicare, people with disabilities who have worked a total of 8.5 years (whether consecutive or not) will still lose their Medicare benefits under existing law. While 8.5 years may sound like a sufficient transition period, let's not forget an important fact--managing a physical or mental disability is often a lifelong process. Someone with a spinal cord injury or a serious mental illness can face health challenges and vulnerabilities throughout their lives. The original version of the Work Incentives bill--as introduced in the House with bi-partisan support--recognized this fact and extended Medicare coverage permanently. Our legislation would improve the Ticket-to-Work and Work Incentive Improvement Act by making Medicare Part A coverage permanent for disabled, working beneficiaries who qualify for SSDI. This small but critical fix will help remove an ongoing barrier facing disabled workers--the threat of losing healthcare coverage after returning to work. It is time to give our disabled workers the opportunity to succeed by providing permanent Medical coverage. Enacting this legislation will allow the Ticket to Work and Work Incentives Improvement Act to live up to its name and really make it possible for those on SSDI to become permanent, active members of the workforce. Last week, President Bush announced his ``New Freedom Initiative'' which shares the same goal as our disabled workers bill--to help people with disabilities becoming working members of our community. I look forward to working with President Bush and my Congressional colleagues to pass this small, but important piece of legislation that would make a real difference in the lives of those people on SSDI who are able and willing to remain in our workforce. I submit the following co-sponsor listing as well as a letter from the Consortium for ``Citizens With Disabilities'' into the Congressional Record. The full list of original co-sponsors is as follows: 1. Mr. Stark. 2. Mr. Matsui. 3. Ms. Morella. 4. Mr. Rangel. 5. Mr. Lewis of Georgia. 6. Mr. Cardin. 7. Mr. Coyne. 8. Mr. Doggett. 9. Ms. Thurman. 10. Mr. Jefferson. 11. Mr. McNulty. 12. Mr. Waxman. 13. Mr. Bonior. 14. Mr. Kucinich. 15. Mr. Frost. 16. Mr. Murtha. 17. Mr. Holden. 18. Mr. Frank. 19. Mr. Kildee. 20. Mr. Hilliard. 21. Ms. McCarthy of Missouri. 22. Mr. Berman. 23. Mr. Allen. 24. Mr. Hinchey. 25. Mr. Baird. 26. Mr. Green. 27. Ms. Christensen. 28. Mr. Lantos. 29. Mr. George Miller of California. 30. Ms. Baldwin. 31. Mr. Abercrombie. 32. Mr. McDermott. 33. Mr. Rush. A letter of support from the Consortium for Citizens with Disabilities follows: Consortium for Citizens with Disabilities, February 5, 2001. Hon. Pete Stark, Cannon House Office Building, Washington, DC. Dear Congressman Stark, The undersigned members of the Consortium for Citizens with Disabilities (CCD) Work Incentives and Social Security Task Forces are pleased to support your legislation that allows for Social Security Disability beneficiaries who go back to work to permanently retain their Medicare coverage. As you know, the lack of quality affordable health care is one of the largest barriers facing disabled beneficiaries who want to work. Witnesses with disabilities have testified before the House Ways and Means and Commerce Committees and the Senate Finance Committee that the loss of healthcare or the inability to afford healthcare because of limited incomes prevents them from working. In addition, we know that this fear keeps people on the rolls who might try to go back to work simply because they might lose their healthcare coverage. This is wrong and it must be changed. Congress and the President went to great lengths to remedy this problem with P.L. 106-170, The Ticket-to-Work & Work Incentives Improvement Act. This law improves access to rehabilitation services, eliminates many disincentives to work with SSA, and extends Medicaid and Medicare coverage for those who work. Unfortunately, during last minute consideration of the bill, a limit was imposed on the Medicare coverage despite the fact that 249 members of the House and 79 Senators cosponsored legislation that provided permanent coverage under Medicare. We believe that this limit must be lifted so that beneficiaries can work without the fear that one day they will be left with the choice of either working without coverage or being forced back onto the disability rolls. That's not fair and it's not right. We urge Congress to support and pass this legislation. Sincerely, American Association on Mental Retardation. American Association of University Affiliated Programs. American Congress of Community Supports and Employment Services. American Council of the Blind. American Network of Community Options and Resources. Association for Persons in Supported Employment. Brain Injury Association. Inter-National Association of Business, Industry and Rehabilitation. International Association of Psychosocial Rehabilitation Services. National Alliance for the Mentally Ill. National Association of Developmental Disabilities Councils. National Association of Protection and Advocacy Systems. National Council for Community Behavioral Healthcare. National Down Syndrome Congress. National Mental Health Association. National Organization of Social Security Claimants' Representatives.

Mr. STARK

Mr. STARK. Mr. Speaker, I was a cosponsor of H.R. 460, the Federal Firefighters Retirement Age Correction Act in the 106th Congress and would have voted to support H.R. 93 yesterday. Unfortunately, due to an unforeseen family illness, I was absent and not able to vote in support of H.R. 93, the Federal Firefighters Retirement Age Correction Act. I would like the Record to reflect my support for H.R. 93.

Mr. STARK

Mr. STARK. Mr. Speaker, today, I rise in support of this resolution expressing sympathy for the victims of the January 26, 2001, earthquake in India. The earthquake and the subsequent aftershocks have killed tens of thousands of people. On the heels of a large earthquake and mudslides in El Salvador, the earthquake in India has again challenged the international community to respond to people in need. And again we have responded with overwhelming support. Countries from the United States to Great Britain to Israel to countries around the world responded with humanitarian aid. Most heartening is the aid provided by Pakistan. Despite the ongoing conflict over the disputed territory along the Indian-Pakistani border, Pakistan has reached out to its neighbor to help in a time of need, just as India has during natural disasters that have devastated Pakistan. It is my hope that through this tragedy these two enemies can put aside their differences to create a lasting peace. I applaud the pledge of support by USAID, and hope that this Congress will provide further resources to help the people of India recover from this disaster. This resolution also commits the Congress to providing additional funding to disaster assistance. It is my hope that when it comes time to appropriate this money, this body will consider disaster assistance a higher priority than a tax cut or an aircraft carrier or a national missile defense system. Wherever and whenever there are people suffering around the world the United States should respond to those people in need through support of international efforts. We should make it the cornerstone of our foreign policy to help those who suffer from not only natural disasters, but also those who suffer under inhumane sanctions, disease, and war. On behalf of the many Indian-Americans and constituents in my district, I join with my colleagues in expressing our deepest sympathies with the people who have lost family members, homes, and businesses in this disaster. I am confident that with the outpouring of international aid and support coupled with the enduring resilience of the Indian people, that they will be able to rebuild and continue to move forward. Also, we thank all those individuals, organizations, and countries who respond to disasters throughout the world.

Mr. STARK

Mr. STARK. Mr. Speaker, I rise to pay tribute to Capt. Connie R. Van Putten upon her retirement from the Union City Police Department after nearly 36 years of total service to the law enforcement profession. Captain Van Putten began her career with the San Diego Police Department on November 19, 1965, and became the first woman patrol officer with the San Diego Police Department on April 15, 1973. She served with distinction in a variety of assignments and venues in her capacity as officer, detective, sergeant and Lieutenant. She began her career with the Union City Police Department on March 21, 1988 at the rank of captain and became the first female command officer in the Union City Police Department. Captain Van Putten was commander for the Field Operations Division, Administrative Services Division, and Records and Communication Division. During her exemplary tenure at the Union City Police Department, Captain Van Putten has continuously displayed integrity, diligence and faithfulness in executing her duties. She has earned the respect and admiration of her subordinates, peers, chief executive officer, and other law enforcement professionals as well as the community of the city of Union City. In addition to her dedicated service to the Union City Police Department, Captain Van Putten has been continuously committed to assisting youth. She received national recognition in 1998 for her outstanding service to youth with the presentation of the Silver Beaver award by the National Council of the Boy Scouts of America. Captain Van Putten has left her fine mark on the city of Union City and the law enforcement profession and I join her colleagues in thanking her and wishing her all the best on her well-deserved retirement.

Mr. STARK

Mr. STARK. Mr. Speaker, Medicare and many others pay for prescription drugs on the basis of the average wholesale price (AWP). Unfortunately, the AWP is a completely fictitious price which has been manipulated by a number of drug companies in ways the companies believe will influence physician prescribing practices. Have they succeeded? While the AWP payment loophole is an abuse of taxpayers, I am concerned that it may be causing unnecessary utilization and prescribing of drugs in a way that can be an abuse of the patient. I would appreciate hearing from medical experts whether the following data can be explained by good medical practice, or whether it is another example of pharmaceutical company success in using price differentials to shape prescribing patterns, which may, or may not, be good for the patient. For example, in 1995, Medicare paid $3.11 a unit for the inhalation drug Ipratropium Bromide. That's exactly what it cost the doctor at wholesale, and total Medicare usage and expenditure on the drug was only $14,426,108. In 1996, a `spread' developed between what Medicare paid ($3.75 a unit) and what the doctor paid, $3.26 a unit, and utilization went to $47,388,622. In 1997, Medicare paid $3.50 but doctors only paid $2.15 and utilization doubled, to $96,204,639. In 1998, the spread increased as Medicare paid $3.34 but doctors could get the drug for $1.70, and utilization doubled again, to $176,887,868. Does anyone really believe that the need for this drug doubled in one year? The data is just in for 1999, and shows that the spread and usage widened again: Medicare paid $3.34 a unit. Doctors could get the drug for $1.60 a unit, and Medicare spent $201,470,288 for Ipratropium Bromide. The abuse of the taxpayer in this situation is serious. But what is even more serious is the question that must be raised about the doctor- patient relationship and whether patients can trust doctors to prescribe appropriately when they can make 108% profit on the prescription of a drug?

Mr. STARK

Mr. STARK. Mr. Speaker, books, toys, flowers, clothes and insurance? Now you can shop for just about anything on the web, including insurance. I recently window-shopped for insurance using ehealthinsurance.com; the same program Republican health care staffers received a briefing on last week. My window-shopping included looking at available health insurance options in Florida, Montana, Louisiana and Georgia through the eyes of people who were 25, 35, 45, 55 and 60, both married and single. The data reiterated our findings from March, which proved that in order to help the uninsured we cannot simply give them refundable tax credits; the tax credits have to be coupled with major insurance reform. Many people who are uninsured are working poor and may not qualify for Medicaid; therefore if the tax credit does not cover almost the entire cost of insurance they will still not be able to afford it. The results also proved that with age, tax credit becomes even more useless because health insurance prices rapidly increase as one ages. For example, a 25 year old low income couple in Billings, Montana could initially get by with a $316.00 credit per month, but by the time the couple reached age 60 they would need $1,032.00 per month to sustain the same plan from the same insurance company. Shopping on the web is like shopping at wholesale; it allows us to buy books, clothes and the like at prices that most people can afford. The same thing cannot be said about insurance: without insurance market reform, health insurance will remain unaffordable for tens of millions. To view charts relating to this issue, please visit my website at www.house.gov_stark.

Mr. STARK

Mr. STARK. Mr. Speaker, the Medicare bill before us gives a $200 million gift to the nation's drug manufacturers--undoubtedly a pay-off for the industry's massive, $80 million contribution to the Republicans and Governor Bush. In section 429, as passed by the House, and in the versions of the bill circulating as late as December 12, Medicare was prohibited from either increasing or decreasing the rates of reimbursement for drugs. This section blocked an effort by the Justice Department, the HHS Office of the Inspector General and Medicare to save the taxpayer hundreds of millions of dollars a year in overpayments. CBO scored the blockage as costing about $200 million. To offset the cost, the original bill, as passed by the House, also blocked drug companies from increasing their charges to Medicare. Sometime between December 12th and last evening, someone in the Speaker's office or the Senate Majority Leader's office dropped the word ``increase''--thus allowing the drug companies and doctors who profiteer from huge mark-ups on drugs to continue to rip-off patients and taxpayers. The bill before us now only blocks the cuts in reimbursement that had been recommended by the Department of Justice. What a travesty. Senator McCain is right: it is way way past time for campaign finance reform.

Mr. STARK

Mr. STARK. Mr. Speaker, today I pay tribute to Joanne Lothrop, a longtime community activist in San Leandro, where she has served on the city council since 1996. Her involvement in public service began nearly 22 years ago as a volunteer with the Girls, Inc. program. As a staff member, she learned the importance of being a role model to youth and understood the importance of introducing life skills to young women to foster leadership and independence. She was a program director of Health Initiatives for Youth and has an extensive background in community organizing. Whether advocating on behalf of inter-city children, farm workers, or HIV positive youth, Joanne's focus is unwavering and her commitment is exemplary. Joanne is always available to lend a hand be it fundraising, advocacy, legislation, education, or community organizing. As a San Leandro City Councilwoman, Joanne has worked toward a regional cooperative approach in the areas of environmental justice and sustainable communities. She brought together citizens, business leaders, and environmental interests to form the West San Leandro Advisory Committee to study the environmental impacts of both industrial and residential development. Joanne has demonstrated leadership in maintaining the jobs-housing balance in San Leandro and adjacent communities. She has worked to retain high wage employers in the city and attract new businesses to increase job opportunities for San Leandro and East Bay residents. Joanne has received numerous awards and special recognition including five National Girls Inc Outstanding Program Awards. I join her colleagues in thanking her for her community service as well as her contributions to the city of San Leandro during her tenure on the city council. Joanne has chosen not to run for another term on the city council. Her voice on the council will be missed but we look forward to many more years of her dedicated community service.

Mr. STARK

Mr. STARK. Mr. Speaker, Medical Care Research & Review recently released a special issue, compiling ten articles from our nation's leading researchers in the area of racial and ethnic health disparities. Taken altogether, these investigations add to a growing body of evidence that leaves little doubt as to the pervasive and persistent presence of racial and ethnic disparities in health insurance coverage and access to care. Many variables are thought to contribute to racial and ethnic disparities in health care, such as status of health care coverage and income level. Yet across each investigation, regardless of outcome measured, racial and ethnic disparities persisted--even when the effects of income, health care coverage status, and other individual characteristics were controlled. As our country continues to diversity, with growing populations of African Americans, Latinos, Asians & Pacific Islanders, and Native Americans, we, as a nation, must be responsive to the needs of all citizens. As reflected in the following findings, this special issue of Medical Care Research & Review highlights areas that need to be addressed to ensure equitable health care access for everyone. People of color are far more likely to lack health care coverage as compared to whites, primarily due to lower rates of private health insurance coverage, especially employment-based coverage. In 1996, people of color comprised only one quarter of the non-elderly population, yet they represented 41% of the uninsured. The effects of race and ethnicity extend beyond insurance coverage to encompass the entire treatment process. For example, the referral process for invasive cardiac procedures involves multiple steps and decisions. At every step, ranging from the initial recognition of symptoms by the patient to obtaining referrals for coronary angioplasty or coronary artery bypass surgery, race and ethnicity issues can (and often do) enter into the equation. Hispanics and African Americans are much more likely to lack a usual source of health care and less likely to use ambulatory care as compared to whites. The disparities are greatest for Hispanics--for whom the probability of lacking a usual resource of care increased from 19.9% in 1977 to 29.5% in 1996. By way of contrast, this figure represents twice the risk faced by whites in 1996. Race and ethnicity are also factors in the likelihood of being hospitalized for a preventable condition, which is an indicator of limited access to primary care. When preventable hospitalizations are compared across minority groups and whites, those that fare the worst are Hispanic children, African American adults, and Hispanic and African American elderly. Even among elderly Medicare beneficiaries, all of whom have equal health insurance coverage, the odds of minority beneficiaries requiring a preventable hospitalization are 6 to 21% greater than for white beneficiaries. These many differences are not simply due to unresponsive attitudes of a few individual physicians, but the health care delivery system as a whole. People of color are twice as likely to say that racism is a major problem in health care. Two-thirds of African Americans and more than half of Latinos believe they receive lower quality care than whites, but most whites believe everyone receives the same quality of care. Not surprisingly, those patients who perceive more racism and who are more distrustful of the medical system are less satisfied with their health care. These findings illustrate the importance of delivering culturally competent health care at the provider level and throughout the health care delivery. One model, presented in this special issue of Medical Care Research & Review, illustrates how cultural competency is comprised of nine major components, including interpreter services, recruitment and retention of bilingual and bicultural health care professionals, and the inclusion of family and community members throughout treatment. As a result of these techniques, positive changes in clinician and patient behavior, such as improved communication, increased trust, and expanded understanding of how cultural and environmental factors affect patient behavior, can occur. Such positive changes can lead to the provision of more appropriate health care services and better outcomes--not just in health status but also in quality of life, well being, and satisfaction across all ethnic groups. These findings further support the need for eliminating disparities that persist in health care and treatment. In order to truly be an inclusive society, we must continue to work toward an equitable and fair health care system. The Minority Health and Health Disparities Research and Education Act (S. 1880), which was signed into law this year, along with health disparities provisions in the possible Balanced Budget Act relief legislation are two positive steps in that direction. I hope we can build on these successes in the upcoming Congress and I look forward to working with my colleagues on this important endeavor.

Mr. STARK

Mr. STARK. Mr. Speaker, today I commend and congratulate Irvington High School in Fremont, California for receiving a New American High School Award from the United States Department of Education. The U.S. Department of Education New American High School Award is given to high schools that demonstrate a commitment to ensuring that all students meet challenging academic standards and are prepared for colleges and careers. This program is part of the Department of Education's effort to reform our schools. Irvington High School was one of only 27 schools in the country to win this award for 2000. Irvington High School won this award by making a schoolwide effort to refuse to accept subpar schoolwork from any student. To make sure all students can earn good grades, the school offers extra help to pupils with academic difficulties. To aid these students, the teachers help the student identify their weaknesses and develop a pact for rectifying them. The school also fosters responsibility to one's community by requiring students to complete a minimum of 40 hours of community service as a requirement for graduation. Finally, the school requires that all seniors participate in a ``personal quest'' by doing a research project and oral presentation on a subject that fascinates them. Students have embarked on ``personal quests'' to learn about careers that they want to pursue after graduation. These quests have ranged from one student learning about becoming a photographer to another learning about becoming a marine biologist. Each student must work with a school advisor and must gain actual work experience in the occupation in which they are interested. This combination of innovative teaching and emphasis on public service has made Irvington High School a shining example to other schools across America on how to educate our students to thrive in the 21st century. Again, I want to extend the highest commendation and congratulations to Irvington High School for its outstanding performance in educating our children. This award recognizes what the citizens of Fremont, California have always known, that the faculty and students of Irvington High School are first rate in every aspect.

Mr. STARK

Mr. STARK. Mr. Speaker, the Institute of Medicine will shortly release a publication entitled, ``Improving the Quality of Long-Term Care.'' A committee of our nation's leading experts in the area of long-term care compiled information on quality in various long-term care approaches, including assisted living. The report finds that there are few studies of outcomes and quality in assisted living facilities, primarily because of the lack of a uniform definition of this category of facilities. Assisted living facilities can have enormous variation in services and environment, and the varying definitions from state to state make comparisons difficult. The report also finds that the small body of research that does exist illustrates that ``residential care facilities, including assisted living, present a mixed picture in terms of both quality of care and quality of life. Some offer individualized, high-quality care in facilities that afford privacy, dignity, and individualization. However, others appear to lack adequately trained staff, and offer neither sufficient amount of care nor privacy and `homelike' settings. Also, there are indications that consumers may receive too little information to make informed choices regarding these facilities and the services provided.'' Many consumers are drawn to the philosophy of assisted living, a model developed to combine the care of other long-term care settings with an environment promoting dignity and independence. This upcoming IOM report, though, highlights the disconnect that exists between the philosophy of assisted living and its implementation. It references a study that found only 11 percent of facilities provided high levels of both privacy and service, the philosophy of assisted living. On the contrary, the majority of assisted living facilities, 65 percent, offered low levels of service (e.g., no full-time registered nurse on staff) and 40 percent offered low levels of privacy. Another disconnect between assisted living philosophy and practice is the concept of ``aging in place.'' Despite the marketing claims of consumers being able to live out their lives in their assisted living homes, consumers are finding out they may not be able to obtain needed services or be allowed to stay if they develop conditions that require more care. The IOM report references a survey of assisted living facilities that found 76 percent of assisted living facilities would discharge anyone who needed skilled nursing care for more than 14 days, and 72 percent had already done so within the past 6 months. The wide variation in definitions of assisted living facilities also poses problems for states in developing regulations that ensure quality. Some states view assisted living as an alternative to nursing home care while others view assisted living as a model for people with less serious conditions than nursing home residents. These differing perceptions as to what constitutes assisted living leads to varying standards from state to state. In my view, there needs to be a more consistent approach to ensuring quality and protections for the residents in these facilities. IOM provides further support for the need to focus on quality of care in assisted living facilities. I introduced H.J. Res. 107, calling for a White House conference for conducting a national dialogue on this issue and for developing recommendations. I hope that my colleagues will join me in ensuring the safety of our nation's elderly in their assisted living homes and make this an important effort of the 107th Congress.

Mr. STARK

Mr. STARK. Mr. Speaker, I yield 2 minutes to the gentleman from California (Mr. Hunter).

Mr. STARK. Mr. Speaker, having heard from Julian's colleagues from California and across the Nation, I yield back the balance of my time.

Mr. STARK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am about to make the usual motion to adjourn, but I would like also to ask that because today's adjournment, at least for Julian, will be sine die, that we save the gavel for his family.

Mr. STARK. Mr. Speaker, I yield 1 minute to the gentleman from Florida (Mr. Davis).

Mr. STARK. Mr. Speaker, I yield 1 minute to the distinguished gentleman from Washington (Mr. Dicks).

Mr. STARK

Mr. STARK. Mr. Speaker, pursuant to House Resolution 671, I move that the House do now adjourn in memory of the late Honorable Julian C. Dixon.

Mr. STARK

Mr. STARK. Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks on H. Res. 671.