KS Legislative Update: Governor's budget includes cuts in elderly services

Kansas Legislative Update: Governor's budget includes cuts in elderly services
KDoA told to cut employees costs by almost 25 percent

By Dave Ranney, KHI News Service

Originally published Feb. 14, 2011 at 10:13 a.m., updated Feb. 14, 2011 at 12:20 p.m.
TOPEKA — Hoping to avoid making frail seniors wait for services that help keep them out of nursing homes, Gov. Sam Brownback has told the Kansas Department on Aging to cut its salaries by $3 million. That’s almost one-fourth of the agency’s employee costs.

“I don’t see how they can do that,” said Jim Beckwith, a former executive director with the Northeast Kansas Area Agency on Aging in Hiawatha. “This is a department that doesn’t have that many employees to begin with and that, last year, said it was already operating in the red. So, here we are now, seven months into the state’s fiscal year and the demands being put on KDoA haven’t gone down, they’ve gone up.
“I think we’re headed for frail-elderly waiting list.” Beckwith predicted.
The Senate Ways and Means Subcommittee on KDoA is expected to begin its review of the department’s budget later this week.
Attempts to reach KDoA officials for comment were unsuccessful.
KDoA imposed its first and only waiting list for services for the frail elderly in 2002. That hold was lifted in 2004 after funding was restored.
Historically, KDoA has avoided a waiting list because limiting frail seniors’ access to services increases the likelihood more will be admitted to nursing homes, which generally ends up costing the state more than home- and community-based services.
States are required to cover nursing-home care for frail, low-income seniors; in-home services are not subject to a federal mandate.
More than 91 percent of KDoA’s $572.9 million annual budget is spent on nursing home care.
Brownback also proposed a 10 percent cut in the state-funded portion of the department’s home-delivered and congregate meals programs; a 20 percent cut in Senior Care Act-funded grants.

Across the state, area agencies on aging use Senior Care Act dollars — $6.3 million in the current fiscal year — to pay for in-home services for frail seniors who are low-income but ineligible for Medicaid.
Typically, if these seniors have to move to nursing homes, they’re soon eligible for Medicaid.
“It’s an incredibly effective program when it comes to keeping people off of Medicaid,” and out of nursing homes, said Annette Graham, executive director at the Central Plains Area Agency on Aging in Wichita. “In Wichita, we already have a waiting list for Senior Care Act services. We’ve made revision after revision in our budget, but the demands just continue to grow. We didn’t have a choice.”
The economic recession has put more pressure on the programs, she said.
“Judging from the phone calls we get from seniors and their families — they know they need help or they need services, but they also know they can’t afford them,” Graham said. “They’re maxed out. They’re coming to us because they have nowhere else to go.”
Jane Metzger, who runs the Meals on Wheels programs in Shawnee and Jefferson counties, said she’s worried that lawmakers will underestimate the impact of the proposed $300,000 cut to the meals program.

“I’m sure that in the scheme of things, that looks pretty insignificant and maybe it is — unless you’re that senior citizen who’s not going to be able to get on the program,” Metzger said. “We understand why all this is happening, but we also understand that people who are frail, elderly, homebound, and need a security check and a daily meal are going to suffer.”

Long-term care "Conversation Checklist" for families and seniors

Long-term care "Conversation Checklist" for families and seniors.

Having a conversation about long-term care with an aging loved one can be difficult. Initiating a conversation can be awkward or uncomfortable for family members or caregivers. Although it is impossible to know what the future will bring, SNAPforSeniors, a national database for senior housing, offers the following hints and checklist that may help to begin a conversation about housing options with your loved one.


1. Determine if it’s time to think about long term care facilities.
Reasons to seek long-term care vary from person to person. In addition to potentially offering a more comfortable and safer environment for the aging loved one, long-term care may be necessary for the mental and physical health of the caregiver.
To ensure your loved one is able to contribute to his/her future, introduce alternate housing options as early as possible, even before necessary. Ask your loved one questions about lifestyle or health-related challenges. Continue the conversation over time by sharing your observations and concerns, including any of the following physical and mental symptoms:


Physical Symptoms
• Are they able to move around easily given the physical layout of the home? For example, are stairs, carpet, bath/shower or door handles obstacles for mobility? Is the heating and lighting adequate for any sensory impairments including hearing, sight and circulation problems?


• Are they experiencing balance issues, especially when changing positions? Are you concerned about them falling?

• If they fell, are you confident he or she would be able to call for help? Is there a reliable source to respond to a call at all times?


• Is your loved one repeatedly complaining of physical aches and pains?

• Are they experiencing frequent incontinence? Can they attend to the problem when this happens or is help needed?

• Do they have difficulty dressing, bathing or with personal hygiene such as hair and foot care?


• Is your loved one experiencing frequent, significant sleep disturbances?


• Are they capable of cooking or preparing healthy meals?


• Have operating gadgets or appliances such as the can opener, stove or telephone become difficult?

• Have household chores become a burden? Is vacuuming, sweeping, taking out the garbage, cleaning the dishes or bathroom being done in timely ways?

• Are finances such as bill payment, deposits, and investments being handled in a timely manner?


• Is your loved one still driving? If so, are you concerned about his/her and others wellbeing? Is public transportation a safe and viable option?


• Are prescribed medications obtained and taken as indicated consistently?


Mental Symptoms:
• Is your loved one demonstrating personality changes, including but not limited to:
• Frequent irritability? • Insensitivity to others? • Disoriented to place and time?
• Aggressive behaviors? • Repetitive behaviors?
• Communicating with inappropriate language? • Is your loved one socially withdrawn and not able or not wanting to get together with friends or family? Are there signs of depression?
• Do they express negative comments about him or herself?
• Are they demonstrating an inability to make decisions or making poor decisions? Is your loved one able to understand communication or instructions from others?


2. Schedule a family meeting.
A family meeting can move the topic of long-term care to a more focused discussion that can lead to a plan. Here is a checklist for planning your family meeting:


• Determine the family members that should be involved directly or indirectly in decision making. This may include extended family members, close friends or paid caregivers. Always include the person if he/she is capable of taking part in any decision making.
• Consider including an independent third party to play the role of mediator. This could be a minister or other member of the clergy, a social worker or case manager.
• If necessary, find a neutral place to hold the meeting.
• Prepare an agenda to help you stay focused.

It may include:
• A medical update • Sharing of feelings about the illness and caregiving
• Daily caregiving needs • Financial concerns
• Who will make decisions • What support role each person will play
• What support the primary caregiver needs • Next steps moving forward

3. Continue to involve family.
The move to a long-term care facility is an immense transition for any family, so it’s important to involve everyone relevant to the person: • Reach out to siblings to secure their input and support. For example, share online information about long-term care facilities to secure greater involvement and participation. • Is there is an unequal financial or time burden to one family member? If so, acknowledge the distribution of resources and discuss a strategy for achieving a balance that appeals to everyone.


4. Continue to engage your parent or loved one.
• Have ongoing conversations at times when your loved one is feeling best and there are few distractions. • Introduce the idea of an overnight visit to a long-term care facility or an extended afternoon visit to get a feel for the various available options.

5. Begin researching long-term care options in your area.
• Go to snapforseniors.com to access a nationwide senior housing database.
• Enter your city, state, zip, county or address and begin researching options by category of housing.
• View the listing details or contact the facility to ask questions and schedule a site visit. • Read comments from consumers on the listing if available.
• Ask the facility you visit for a copy of their last annual licensing survey report.
• Contact your local senior ombudsman to get perspective from a local trusted resource.
• Check references from existing or prior residents or families.

This article is provided by SNAPforSeniors, the most current and comprehensive senior housing resource in the nation.Start a free search in your area at http://www.snapforseniors.com/.

What Seniors Need to Know on the Fifth Birthday of Medicaid Law, Deficit Reduction Act

Washington DC (ZeiglerSeniorNews.com) Happy fifth birthday, DRA. Only Medicaid workers, nursing home personnel and elder law attorneys would be likely to notice the anniversary of the Deficit Reduction Act. It was signed into law by President George W. Bush five years ago, on February 8, 2006.

Now universally called "the DRA", the act generated controversy from its first week and is still generating controversy.

The DRA made dozens of changes, but none were more important, controversial and confusing than changes in Medicaid rules for long-term care eligibility.

To read the full article, Click here: