A Conversation with KDOA and KS Long Term Care ombudsman

A CONVERSATION WITH KDOA AND KS LONG

TERM CARE OMBUDSMAN

KAHSA2009 Fall Regulatory and Policy

ConferenceOct. 1, 2009Bill McDaniel

KDOA Commissioner of Program & Policy

KDOA’s structureGovernor

Mark Parkinson

Acting Secretary

Martin Kennedy

Administrative Services

Program Evaluation

Division

Budget Director

Program and Policy

Commission

Community Based

Services Division

Transition & CARE

Nursing Facility & Audit

Information & Community Resources

Div.

Deputy Secretary (empty)

Director of Public Affairs

Chief Attorney

Director of Human

Resources

Accounting & Financial

Management

Information Technology

Division

Licensure, Certification and

Evaluation Commission

Licensure & Certification

Division

MH /Residential

Care Facilities & HCBS Eval

DivLTC Program

DivisionComplaint Division

FY 2010 and 2011

Budget update

Proposed FY 2010 ExpendituresNursing Facility $ 365.1

Home and Community Based Services for Frail Elderly (HCBS/FE) $ 71.9

Program of All-inclusive Care for the Elderly (PACE) $ 5.8

Targeted Case Management (TCM) $ 5.8

Other $ 39.5 Congregate Meals Home Delivered Meals Older Americans Act (OAA) Senior Care Act (SCA) Licensure, Certification and Evaluation (LCE) Client, Assessment, Referral and Evaluation (CARE) SHICK & ADRC Administration

TOTAL $ 488.1(Totals in millions)

Budget Process

Stakeholder/Public Input

KDOA and SRS hosted a joint public hearing on long-term care issues July 24 in Topeka.

KDOA hosted 3 public hearings in July: Topeka – July 27 Wichita – July 28 Hays – July 29

We heard concerns from: Nutrition providers Area Agencies on

Aging Providers of services

to seniors Seniors concerned

about services they need and depend upon to stay in their homes

FY 2011 Enhancements

Nutrition Program -- $1,141,094 (all SGF)

Restores SGF funding to the FY 2009 level. A large part of the reduction was due to the receipt of American Recovery and Reinvestment Act (ARRA) funds. If funding is not restored, it could result in a loss of 211,314 meals.

Senior Care Act Program -- $1,308,588 (all SGF)

Restores the SGF cut in FY 2010. The funding reduction will eliminate services for an estimated 1,030 seniors. To make up the difference, the Area Agencies on Aging would either have to limit the HCBS-FE services provided or create waiting lists to stay within their FY 2010 allocations. Included in this request is $50,000 to restore and sustain funding for the Seniors Together Enjoy Physical Success (STEPS) program.

FY 2011 Enhancements

Home and Community Based Services-Frail Elderly (HCBS-FE): Maintenance of Effort -- $4,510,679 all funds ($1,577,294 SGF)

Funds an increase in the HCBS-FE caseload of 350 persons at a monthly increased cost of $23 per person. It restores base funding in FY 2010 and accounts for increased caseload and the cost increase. Without additional funding, the HCBS-FE program will need to start a waiting list to stay within the available resources.

Targeted Case Management: Maintenance of Effort -- $143,627 all funds ($50,223 SGF)

Funds an increase in the TCM caseload of 122 persons. As the HCBS-FE caseload increases, the TCM caseload also increases.

FY 2011 Enhancements

Area Agency on Aging (AAA) Core Services -- $750,000 (all SGF)

Restores AAA core services to the FY 2009 level. State funding supports core services provided by the AAAs but not reimbursed by other federal or state programs. Core services fall into five categories: access services, community based services, in-home services, housing and elder rights. The department received the $750,000 funding for one year in FY 2009.

The core funding will provide each AAA a base allocation of $60,000. The remaining core service allocation, $90,000, will be allocated to each AAA based on the percentage of the Kansas population aged 60 or older that resides in each AAA planning service area.

FY 2011 Enhancements

United Cerebral Palsy of Kansas (UCP)-Assistive Technology -- $125,000 (all SGF)

Restores the $60,000 SGF reduction in FY 2010 and provides expansion of the program which allows UCP to purchase assistive technology for Kansas seniors. UCP will match the state dollars and leverage additional funding from other sources i.e. Medicare, private insurance, etc.

In FY 2009, UCP expended the total $60,000 SGF, matched it and leveraged a total of $355,233 in expenditures. A total of 133 disabled seniors were served ranging in age from 60 to 94. There were 49 seniors requesting support when the funds ran out. The services provided included home modifications and medical equipment.

FY 2011 Enhancements

Nursing Facility Medicaid Rate Increase -- $11,631,693 all funds ($4,067,370 SGF)

Increases the payment rates for nursing facilities. The enhancement will fund an increase in the Medicaid rates based on the Data Resources, Inc., National Skilled Nursing Facility Market Basket Index for FY 2011. There was no provision for an inflationary adjustment to the Medicaid rates in FY 2010.

Geriatric Mental Health Program -- $1,800,000 (all SGF) Implements a geriatric mental health program, administered

by KDOA, to fund mental health specialists and the related overhead costs for the 11 AAAs. The program provides funding to support the Geriatric Mental Health Bill introduced during the 2008 legislative session.

FY 2011 Enhancements

Program for the All-inclusive Care of the Elderly (PACE): Expansion into Johnson and Wyandotte Counties -- $227,509 ($79,555 SGF)

Start a PACE program to serve Johnson and Wyandotte counties in FY 2011. The initial request funds 50 slots.

Home and Community Based Services-Frail Elderly (HCBS-FE): Telehealth Service -- $1,095,000 all funds ($382,900 SGF)

Adds a telehealth service to the HCBS-FE Waiver program. For the past 2 years, KDOA has funded a telehealth pilot study with a provider in Coffeyville with the Kansas University Medical Center is evaluating the program. A third year of the pilot study will be funded in FY 2010.The enhancement will fund 500 telehealth units at approximately $6 per day. If funded, up to 500 frail elderly with chronic illnesses will be monitored with the telehealth units each day of the year.

FY 2011

Reduced Resources

Reduced Resources

The Division of the Budget allocated KDOA a Reduced Resources target of 5% or $1,861,153 from its FY 2011 SGF Allocated Resources. Total all funds is $4,121,826.  

Program for All-Inclusive Care for the Elderly (PACE)

Reduce the state general fund (SGF) for the PACE program by $200,000 ($571,952 total funds). This will reduce the number of Medicaid eligible persons served by 30. Senior Care Act (SCA)

Reduce SGF for SCA direct services by $630,967. This represents a 30% reduction in the total SGF budget for direct services. It does not include a reduction in the federal Social Service Block Grant (SSBG) funds. The reduction will result in approximately 490 seniors no longer receiving SCA services during the year.

Reduced Resources

Home and Community Based Services-Frail Elderly (HCBS-FE) Rate Reduction

Reduce the SGF for the HCBS-FE program by $741,227 ($2,119,729 total funds). This represents a 3% rate reduction. This may result in the loss of service providers and less access to the HCBS-FE services.

Agency OperationsReduce its SGF operations $288,959 ($799,178 all funds) Professional fees reduced $18,412 through negotiation with

contractors to reduce fees and cutbacks on deliverables. 6.75% across the board reduction in travel. Shrinkage increased 4.06% for an agency-wide rate of

16.03%. Delay lifecycle capital information technology equipment

replacement for another year.

2009 Winners

Promoting Excellent Alternatives in Kansas nursing homes (PEAK)

PEAK Awards

The PEAK Award supports KDOA’s goal of enhancing Kansans’ expectations toward person-directed options in the community and adult care settings.

Awarded annually, recognizing adult care homes that provide exceptional person-centered care in the areas of resident control, staff empowerment, home environment and community involvement.

2009 PEAK Winners

Pleasant View Home, Inman

Rush County Nursing Home, La Crosse

Meadowlark Hills, Manhattan

Brookside Retirement Community, Overbrook

Village Shalom, Overland Park

Cornerstone Village, Pittsburg

Grisell Memorial Hospital, Ransom

Greeley County Health Services/Long-Term Care Unit, Tribune

Pleasant View Home, Inman

6x PEAK Award winner Residents participate in cooking and

preparing meals with the consistent staff within their households. Residents are involved in the interviewing and hiring process of any new employees.

Staff are all cross-trained. Some participate in the Registered Apprentice program for health support specialists. This apprentice program offers certification and a pay increase.

Rush County, La Crosse

Residents are encouraged to express their wants resulting in the residents creating a “bucket list.” This enabled the home to fulfill a resident’s dream to visit a casino just before he died.

Staff empowerment is heavily emphasized. The administration promotes team management and leadership at the unit level.

Meadowlark Hills, Manhattan 4x PEAK Award winner. Meadowlark Hills has 7 skilled households

that have recently been renovated or built. Four of these households have their own kitchens with staff that prepare three meals a day. Each household is self-contained and has the same caregivers on a regular basis.

Residents enjoy walking trails, flower gardens and vegetable gardens throughout the households.

Residents, family and staff complete culture change audits together to see what additional changes can be made.

Brookside, Overbrook

2x PEAK Award winner. Residents at this home are extremely active

and involved in the life of this home. They feel very comfortable asking for anything that they need or want.

All three nurses’ stations have been eliminated and replaced with a desk and décor.

A new addition to the home is a very large activity room where residents, staff and families can host dinners and a variety of community functions.

Village Shalom, Overland Park 3x PEAK Award winner Residents make their own choices and talk

with staff about any concerns they may have.

Two neighborhoods were recently remodeled and the nurses stations were replaced with elegant dining rooms for the residents and their families to enjoy.

Staff carry phones and pagers with their new wireless call system.

Numerous community events are hosted in the home and more than100 volunteers are involved in the volunteer program.

Cornerstone Village, Pittsburg

Residents live in “courts” where all meals are served in a small, homey dining area. Activities are provided within each court and the staff are very involved with organizing and participation of the activities.

Residents enjoy the outdoor patios and a well-stocked fishing pond. Each court has designated assistants who participate in the care planning with the managers.

Grisell Memorial Hospital, Ransom Residents have the luxury of hard wood

floors, their choice of paint and wallpaper borders, and made-to-order meals. Residents are treated like family, with staff even taking time off to take a resident to the doctor.

Several of the staff have been with the home for more than 30 years and the facility has an exceptionally low turnover rate.

One resident told the PEAK travel team that “This place feels like home to me and I don’t want to go home to my house.”

Greeley Co. Health Services, Tribune 3x PEAK Award winner. Residents serve on culture change and

advisory committees to make decisions for the home.

The nurses’ station was removed and replaced with a sitting area for residents and families to access the computer and eat ice cream.

The home is currently working with the community to raise funds for the home to purchase a new wireless paging system.