Efforts by Kansas officials to keep frail, elderly people out of nursing homes have been hampered by the shortage of community-based alternatives, representatives of the industry told lawmakers today.
“There are a lot communities out there – especially the smaller ones - that don’t have access to community-based services,” said Cindy Luxem, chief executive of the Kansas Health Care Association, a group that includes most of the state’s for-profit nursing homes and assisted-living facilities.
Luxem was among the industry spokespersons who testified to the House Committee on Children and Seniors.
It’s not unusual, Luxem said, for nursing home administrators to be told that one of their Medicaid residents could and should be living in a community setting. But when a nursing home tries to arrange the services needed to make that happen, she said, the services often are not available.
Need for more wrap-around services
“I know people don’t want to hear this, but the people who are living in nursing homes now belong there,” Luxem said. “There may be some who could be living in the community, but the wrap-around services that have to be there for that to happen aren’t there. So if you’re in a nursing home, a lot of times it’s because you have nowhere else to go.”
Deborah Zehr of LeadingAge Kansas, which represents most of the state’s nonprofit nursing homes and assisted living facilities, agreed.
“There has not been an adequate effort to build community-based services,” she said.
Zehr and Luxem said their groups were willing to explore the possibility of providing services to help frail seniors stay in their homes. But state officials, they said, have shown little interest in making that happen.
“There are some problems to overcome,” Zehr said.
Zehr and Luxem later told KHI News Service that an earlier effort led by the Kansas Department for Aging and Disability Services to move 800 nursing home residents to community settings had been largely unsuccessful.
“It was a failed attempt,” Zehr said.
The initiative, launched in April 2012, paid case management organizations $2,000 for each Medicaid-funded nursing home resident they helped move out of a facility and into a community-based setting after the person remained there at least 60 days.
“I’ve heard of maybe two people who were moved back into the community,” Luxem said.
KDADS Secretary Shawn Sullivan defended the initiative in an email to KHI News Service, noting that 30 nursing home residents either had been or are in the process of moving to community settings.
“Those 30 people are better than none,” he said, “which is how many would have moved out without the program.”
KanCare expected to help
Sullivan said the effort had been marred by “distrust” and “tensions” between case managers and the nursing homes. His agency was able to mediate in some instances but not as much as he would have liked because officials were busy preparing for the launch of KanCare, Gov. Sam Brownback's Medicaid makeover, which was in the works for months before its launch on Jan. 1.
“In hindsight, the transitions project should have been undertaken in 2011 - or after KanCare was implemented,” Sullivan said.
Sullivan also predicted that KanCare would create a better framework for keeping seniors in their homes or other settings where they are not reliant on the expensive, full-time care they would get in a nursing home.
"Under KanCare there are several incentives for the (managed care companies contracted by the state to implement KanCare) to keep individuals independent and managing their chronic conditions at home," he said.
The three managed-care companies are: United Healthcare, Amerigroup, and Sunflower State Health Plan, a local subsidiary of Centene.
A year to rebalance
Luxem and Zehr said they were waiting to see whether KanCare would lead to more community-based services becoming available.
“I don’t think we’ll know anytime soon,” Zehr said. “I suspect it may take a year for there to be a rebalancing of the system.”
“They’re going to need to do something,” Luxem said, referring to the managed care companies. “How they’re going to generate services in communities that don’t have those services now, I don’t know. But I do know that we have a lot of county-seat towns in Kansas that have a nursing home and don’t have much in the way of community-based services.”
Sullivan said before KanCare, the state’s Medicaid policies included fewer incentives than KanCare for keeping “persons with higher levels of need” out of nursing homes.
“These are the clients that ended up in nursing homes, and why Kansas has the 6th highest nursing facility utilization rate in the nation for seniors,” he said.
Sullivan said KanCare’s design would reduce nursing home admissions by using a managed care model to better coordinate clinical services for the elderly.
“KanCare differs from old…Medicaid in that the care coordination model takes care of the whole person,” he said. “It will help them manage their chronic conditions, which wasn’t being done well” before.
Mitzi McFatrich, executive director for Kansas Advocates for Better Care, a watchdog organization that is often critical of the state’s nursing home industry, said her group shared Luxem and Zehr’s general concerns.
“Where we differ,” McFatrich said, “is that so far the conversation hasn’t been tied to quality, to weeding out the bad performers. If we’re going to be moving people out of nursing homes and into the communities, we want those moves to be safe.”
McFatrich said 27 percent of the state’s 345 nursing homes were cited last year for incidents that involved near or actual harm to a resident.
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