Moving disabled and elderly people from institutions to community homes has become a priority for the federal government – so much so that it’s ready to throw more than a billion dollars at the movement.

Now, Kansas officials say they want a share of those funds.

“The idea is to serve a person in the least restrictive facility possible,” said Kyle Kessler, deputy secretary for the Kansas Department of Social and Rehabilitation Services. “It’s a pretty enduring philosophy.”

This month, SRS and the Kansas Department on Aging will work with more than a dozen state and advocacy groups to hunt for a chunk of the $1.75 billion the federal government has allocated to help move people out of public and private institutions and nursing homes.

If the state’s application is successful, the grant would increase federal Medicaid matching funds for hundreds of eligible institutionalized Kansans from 60 percent to 80 percent – adding millions to help pay for their food, medication and other expenses when they move into the community.

The grant money acts as an incentive to move people into community-based services, said Michelle Ponce, special projects manager for SRS. If the state wins the grant, a person moving out of an institution gets the increased federal funds for a year after the move.

But the prospective grant has caveats. Among them:

¢ A person must have been established in an institution or nursing home for at least six months.

¢ The infrastructure must exist to move people into the community. Smaller, home-based services often are rare in rural communities.

¢ As part of the Medicaid section of the federal Debt Reduction Act, the state must rebalance its budget to prove that community care costs less than care provided in an institution. State officials say data show this is often the case.

¢ The state must provide community services after the grant’s five-year demonstration ends.

“We have to track those individuals and report it” after a person leaves a group home setting, said Janis DeBoer, deputy secretary and commissioner of program and policy for the Kansas Department on Aging. “For us, it’s well worth the tracking. It’s very attractive to us.”

Evidence, experience

The program is attractive, DeBoer and others said, because experience and empirical evidence show that seniors, given the choice, often would prefer to live at home or in the community rather than in large, multibed nursing homes.

“That’s based on our experience,” she said. “If a senior is aware of community-based services, they may go back.”

Some advocates hope that if and when seniors and the disabled do move back to communities, the state will close unused beds in institutions and nursing homes.

Speaking specifically about state-regulated institutions for the disabled, Jane Rhys, executive director of the Kansas Council for Developmental Disabilities, said she hoped the additional dollars could be a step toward permanently closing institutions.

Several other states have closed their multibed institutions.

But if there are funded beds sitting vacant in institutions after disabled people and seniors move, the state should consider closing them, said Craig Kaberline, executive director of the Kansas Area Agencies on Aging Assn.

“If there are unnecessary beds out there that are funded, we need to take a long look at that,” Kaberline said.

As the clearinghouse for Kansas aging associations, Kaberline’s group has been polling officials across the state to gauge the needs and wants of elderly people in group homes. He then rolled that information into the grant proposal.

From what he’s seen, seniors wanting to get out of institutions and back into their homes face obstacles that he hopes the influx of federal money can address.

Community resources – like in-home care providers, or day care facilities – aren’t always available.

“Sometimes you get into small rural communities, and there’s a choice of nursing home or nothing,” Kaberline said.

Additional options

To add community-based choices, Ponce said the state would use an already-awarded $2.2 million fund in tandem with the proposed grant to build infrastructure.

Once that infrastructure is built and the people begin moving, the state then would consider what to do with empty beds in nursing homes and institutions, Ponce said.

“There’s the possibility of some of those beds closing and providing (community) services as well,” she said, speaking more toward homes for the disabled rather than nursing homes.

The state has been reducing the number of beds in large-scale institutions for some time, using its own waiver system to move people out of institutions.

During fiscal year 2006, SRS spent $307 million on home-based and community care waivers – an amount that has increased steadily since the program began in 1981.

But the operating costs of nursing homes and large institutions demand that a certain number of beds remain, Kaberline said.

If too many beds close, Kaberline said, “it doesn’t necessarily mean you can operate the same way.”

Still, state officials have said they want this grant – and have constructed a team of more than a dozen stakeholder organizations and advocates to help put it together.

The proposal is due Nov. 1, and, with the money kicking in Jan. 1, the state should hear soon if the disabled and elderly here will get more cash to go back home.

“It’s a great opportunity for the state,” Kaberline said.