A Conversation with KDOA and KS Long Term Care ombudsman

1. A Conversation with KDOA and KS Long Term Care ombudsman KAHSA 2009 Fall Regulatory and Policy Conference Oct. 1, 2009 Bill McDaniel KDOA Commissioner of Program & Policy

2. KDOA’s structure Governor Mark Parkinson Acting Secretary Martin Kennedy Deputy Secretary (empty) Director of Public Affairs Chief Attorney Director of Human Resources Licensure, Certification and Evaluation Commission Administrative Services Program and Policy Commission Accounting & Financial Management Program Evaluation Division Licensure & Certification Division Nursing Facility & Audit Community Based Services Division MH /Residential Care Facilities & HCBS Eval Div Information Technology Division Budget Director LTC Program Division Complaint Division Information & Community Resources Div. Transition & CARE

3. Budget update FY 2010 and 2011

4. Proposed FY 2010 Expenditures Nursing 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)

5. Budget Process

6. 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

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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 programtoserve 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.

13. Reduced Resources FY 2011

14. 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.

15. 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 Operations Reduce 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.

16. Promoting Excellent Alternatives in Kansas nursing homes (PEAK) 2009 Winners

17. 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.

18. 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

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.”

26. 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.