Norma Ballard, pictured doing her laundry in this September 2011
file photo, said she enjoyed the independence afforded her from living
at Rolling Hills Assisted Living in Topeka. The Kansas Department on Aging
has a list of 800 physically disabled or elderly Kansans who officials
believe could move from full-care nursing homes to less restrictive
and less expensive settings. Officials are offering $2,000 payments
to case managers who identify and help people from the list move.
(Photo by Mike Shields)
TOPEKA — The Kansas Department on Aging has put together a list of 800 nursing home residents who officials believe might be able to move to less expensive, less institutional settings.
The agency has asked the state’s Area Agencies on Aging and Centers for Independent Living to have their case managers meet with each of the 800 residents to see if they are able and willing to move.
The effort is part of Aging Secretary Shawn Sullivan's ongoing effort to reduce the number of people in nursing homes. Kansas, with its disproportionately elderly population, has a higher percentage of people in full-care nursing homes than all but a handful of other states.
KDoA officials have pledged to pay the case manager’s employer $2,000 for each Medicaid-funded nursing home resident who is able to move out of the nursing home and stay out for at least 90 days.
KDoA Secretary Shawn Sullivan said the payments were designed to offset some of the uncompensated case management costs that hamstrung earlier efforts to reduce the state’s nursing home population.
But the notion of rewarding someone for helping people move out of nursing homes has upset the state’s nursing home lobby.
“It’s a bounty. There’s no other word for it,” said Cindy Luxem, executive director of the Kansas Health Care Association, which represents most of the state’s for-profit nursing homes. “If a nursing home paid a case manager a bonus for every resident they got to move there from another nursing home – that’s a felony,” Luxem said. “It’s illegal, but here we have the state paying bonuses to case managers who are essentially doing the same thing. They’re being rewarded for getting people to move out.”
She also said it seemed unfair that nursing homes aren’t paid $2,000 when their social workers help residents return home or move to community-based settings.
“For us, this is just beyond belief,” Luxem said of the agency’s new policy.
But Sullivan said the nursing home industry was mischaracterizing the payments, which have not started because the policy is so new.
“It’s not a bounty,” Sullivan said. “It’s an attempt to cover some of the administrative costs that haven’t been covered in the past.”
Secretary on Aging Secretary Shawn Sullivan. (Photo by Phil Cauthon)
In recent years, KDoA stopped reimbursing Agencies on Aging for their case managers’ mileage and travel time.
The Kansas Department of Social and Rehabilitation Services has never covered the so-called “windshield time” incurred by case managers with the Centers for Independent Living.
Nor does either of the state agencies cover the costs of required training for the case managers.
The Area Agencies on Aging and Centers for Independent Living are the local agencies charged with assessing current or potential nursing home residents to determine what level of assistance each may need.
More independence, less cost
Sullivan said no one who’s living in a nursing home would be forced to move as a result of the new policy.
The initiative, he said, is designed to give the 800 residents and their family members information on services that could be made available to them in their communities. The result could be more independence for the beneficiaries and their families, and savings for the Medicaid program.
Sullivan said the $2,000 payments would be state-funded and come from the department’s administrative budget. Each payment will be made in three installments.
Case managers began reaching out last week to the 800 nursing home residents on the agency’s list, which is not a public document.
Sullivan said he couldn’t predict how many residents might move or how much money could be saved.
“We don’t have any set expectations,” he said. “There’s really no way to know. That’s why we’re having the case managers do their assessments.”
Past efforts to move nursing home residents to less restrictive, less expensive environments have had limited success, Sullivan said, noting that 620 moves had occurred since 2006.
Over the same period, the number of nursing home residents whose stays were covered by Medicaid ranged from 10,000 to 12,000.
“The overwhelming majority of people in nursing homes do need to be there,” said Sullivan, a former nursing home administrator. “But still, there’s a percentage that with proper support could be living in the community.”
Typically, a Medicaid-funded stay in a nursing home costs taxpayers about $3,400 a month. Services in a community-based setting, such as an assisted living center, cost about $1,000 a month.
Sullivan said he thought between 10 percent and 15 percent of the state’s Medicaid-funded nursing home residents could be living in in a less restrictive environment.
“But that’s not to say we’ll get 10 to 15 percent,” he said, noting that many nursing home residents are expected to fear and resist change.
Debra Zehr, executive director with LeadingAge Kansas, an association that represents most of the state’s nonprofit nursing homes, said her members have doubts about the list that was put together.
“We understand what the department is wanting to do,” Zehr said. “But I had one administrator tell me she has a 97-year-old resident who’s been living at her facility for 11 years – she’s on the list. This is a resident who has dementia and has no living family.
“So we’re OK with the concept, but we think a lot of time and energy is going to be spent reaching out to people who really shouldn’t be on the list,” she said.
The Area Agencies on Aging and the Centers for Independent Living support the measure.
“We’ve had community transition opportunities going on for probably 20 years,” said Ami Hyten, assistant director at the Topeka Independent Living and Resource Center. “What this shows, I think, is that (KDoA) is willing to come at this from a different angle, to take a different approach.”
Hyten said her center’s case managers had been assigned 55 people from the list, all of whom are under age 65 and physically disabled.
'Public needs to know'
Monte Coffman runs Windsor Place, a Coffeyville-based program that provides in-home and nursing home care for about 1,500 frail seniors and people with disabilities.
He said the initiative’s critics were off-base.
“The $2,000 payments are irrelevant,” he said. “They’re not the issue. The issue is that we’ve got capabilities to support people in their homes that weren’t there a year ago, and we need to be reaching out and letting people know what’s out there.”
Coffman, an ardent promoter of telehealth services to help keep the elderly in their homes, serves on an advisory committee that helped Sullivan craft the initiative.
“We’re not putting anybody at risk,” he said.
Coffman noted that KDoA late last year expanded the state’s Medicaid waiver to include telehealth services for the frail elderly.
“I think 400 of the 800 on the list could move out,” he said. “I think that’s a reasonable number. But there’s going to have to be some kind of campaign to change the public mindset that says ‘If Grandma or Grandpa have been in the hospital, the only place for them to go is the nursing home.’ There are kinds of supports that could be made available in the home now. The public needs to know that.”
The new policy is intended to help move people from full-care facilities to settings that provide more independence but with partial supports, such as those found at assisted living centers or Home Plus facilities.
The list of 800 names was compiled by reviewing individual nursing home assessments and selecting those who scores suggested they were most likely to be able to live outside a full-care facility.
The KHI News Service is an editorially independent program of the Kansas Health Institute and is committed to timely, objective and in-depth coverage of health issues and the policy making environment. Read more about the News Service.