As one of its first actions, the Territory of Alaska established the Alaska Pioneer Home in an old log building in Sitka in 1913 to care for indigent prospectors and others who had gone broke.
"Any worthy man incapable of supporting himself and who is qualified by five years of residence in Alaska may apply to the board of trustees for admission to the home," Gov. Thomas Riggs wrote in 1919. "As far as is consistent with orderly government, the inmates are freed from restraint and carefully attended."
The Sitka home had 62 "inmates" by then, with only a small number in private rooms, while the territory had also started to pay small pensions to indigent men and women, a practice that evolved into the Longevity Bonus.
The Longevity Bonus ended almost 15 years ago with the budget crisis that ensnared the administration of Gov. Frank Murkowski. It was a reasonable decision to end the program — though one that was costly to him politically — as the monthly payouts were no longer tied to need or dependent upon longevity in Alaska.
Through that budget crisis and this one, the Pioneer Home system remains a trusted and valuable Alaska tradition, but state commitment is lagging — a reduction of 36 staff positions over the past three years and a stagnant budget of about $62 million for the last four years, at a time of health care cost increases.
Hundreds of old Alaskans statewide — many with serious medical conditions that require round-the-clock care — are waiting to move into the homes, but 38 beds are being kept open because of staff shortages.
[Alaska's Pioneer Homes face layoffs, empty beds and long wait lists]
No one has demonstrated that privatizing the homes can become a paying proposition if the level of care is to be maintained, and opponents have taken issue with any move in that direction. The Legislature opted for a study of privatizing the pharmacy operation, but there were no bidders when the state sought proposals.
In the spring, you may recall, the desire to cut the state budget and avoid tax increases collided with the impulse to look out for people in the Pioneer Homes. There was brief talk about whether closing the Palmer home would be necessary, but that was never a real possibility.
However, it produced an important lesson in imaginary budgeting, demonstrating how it is easy to cut the budget until a specific service that people want is targeted. Then all hell breaks loose.
The Senate approved a 10 percent budget cut for the Pioneer Homes system, a $6.4 million reduction, but after the vote the senators said they didn't intend to force a shutdown of the Palmer home. They blamed the governor and they blamed a staff member for putting the wrong number on the wrong line, never acknowledging their failure to check a Senate budget summary or ask questions.
In the House Finance Committee, the Republicans tried and failed to cut the Pioneer Homes budget, offering no justification linked to facts, just pronouncements that everyone can do more with less: "Declining state revenues dictate that expenditures be reduced by taking a fiscally conservative approach to working hours and that state services be provided in a more effective and efficient manner."
The bureaucratic language disguises the reality. Telling staff members to "do more with less" may mean that a resident with serious dementia who would enjoy a walk outside on a summer day just has to stay inside with the TV.
The challenge facing the Pioneer Homes system and the commitment we should be making to some of the most vulnerable Alaskans is one reason why the dream of no statewide tax will survive only as long as people refuse to study the details.
In recent decades, the physical condition of people moving into the homes has declined because older Alaskans are waiting longer to abandon their own homes, helped in part by improvements in community facilities that allow people to live independently longer.
After Sitka, the state opened the second Pioneer Home in Fairbanks in 1967. Since then, we've added homes in Palmer, Anchorage, Ketchikan and Juneau. There are 498 beds statewide in the homes, with 74 vacancies, about half of them in the process of being filled.
More and more of the new arrivals are suffering from dementia or other problems that require round-the-clock care, as opposed to healthy residents who live in the homes and pretty much fend for themselves.
Amanda Lofgren, the new director of the Pioneer Homes, said she would like to see every bed filled in every home, but the state is already not close to the recommended national staffing standard for the most seriously ill patients — one staff member for every three residents. It is more like one to five or one to eight, she said.
Still, she said, the home managers will continue the balancing act of reviewing whether they have enough staff to care for new residents.
Admission to the homes is open to people 65 and older who have been in Alaska for at least 12 months. The average resident is 87 and some have private insurance; others receive government assistance.
Residents with financial resources pay fees from $2,588 a month for basic housing and meals, up to $6,795 a month for 24-hour care.
About half of the residents need 24-hour care and the waiting lists are packed with people suffering from serious conditions whose families have struggled to keep them at home as long as possible. That's the role the Pioneer Homes are filling in Alaska today.
Columnist Dermot Cole can be reached at dermot@alaskadispatch.com.
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