Kansas and regional news

Kansas and regional news

U.S. to move elderly, disabled from institutions

Kansas seeks portion of federal money earmarked for community homes

October 9, 2006


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."

Money Follows The Person Grant

  • Stems from Section 6071 of the federal Deficit Reduction Act.
  • The act authorizes $1.75 billion to be spent nationally on elderly and disabled people moving out of institutions.
  • Money would increase federal Medicaid matching funds from 60 percent to 80 percent per person for the first year after a person moves out of an institution.
  • Kansas will apply for the grant by Nov. 1.
  • Money could be awarded as soon as Jan. 1, 2007.

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.


geekin_topekan 11 years, 5 months ago

Will this be voluntary move?Or are we doing to the elderly as we did to the mentally ill and closed the doors in their face and let them hit the streets?

BigDog 11 years, 5 months ago

When checking into this more, I found out several things. First this would be a voluntary movement of seniors who can and want to leave a nursing home to move out. They would be moving back into homes or apartments in the community and receiving home health services. They are not being forced out and put out on the streets. Currently thousands of seniors in Kansas are recieving these services in their home.

mopmoh 11 years, 5 months ago

I agree that sometimes community based solutions can be a nightmare for everyone involved, however sometimes it is a real win-win for both the people receiving services and the service providers. This is one area where Kansas is ahead of the rest of the country. Kansans should be proud that they have figured out a way to make community based care work. I am thrilled that the federal funds are available and that Kansas is trying to get some of the money.

We will never be able to close down institutions permanently because some people really need the 24/7 support provided by institutions, but no one should have to live in an institution just because it was the only option they were given.

Confrontation 11 years, 5 months ago

I like what some nursing homes are doing in the state of Kansas. They are creating multiple homes, rather than one institutional-like nursing home. They get more freedom in terms of decision making. It becomes more of a family-style home, rather than a large building with long, smelly hallways. Here's some info from wiki:

"Nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less "hospital-like." In these homes, nursing home units are replaced with a small sets of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they want to do during the day. They also have access to more companionship such as pets. Some organizations working toward these goals are the Pioneer Network, the Eden Alternative, and the Green House Project. Many of the facilities utilizing these models refer to such changes as the "Culture Shift" or "Culture Change" occurring in the LTC industry."

BigDog 11 years, 5 months ago

I guess holygrailale would rather live in the past where we didn't give seniors or people with physical or cognitive disabilities a choice; instead we forced them into institutions away from society "for their protection."

At what age do we decide a person has no choice in whether they live at home or we put them in a nursing home. What they are talking about here is giving a person a choice to remain in the nursing home or return to the community. Not everyone in a nursing home "can't make it in the community."

At one time there were over 3000 individuals with mental retardation in state institutions in Kansas; today there are about 300. Doctors at the hospital used to just tell parents to send their baby to the state institution, the state would take care of them for their lifetime; often removing family from the persons life.

Not that many yours ago the only choice for a senior was going to a nursing home but this has changed too with the advent of communty services and assisted living facilities.

I'll agree with Confrontation that many good changes have come about in nursing homes in Kansas.

I believe the changes that have come from community services and nursing home changes have been a very good change for the state and people in need of the care provided both in the community and nursing homes.

BigDog 11 years, 5 months ago


Please show me where I said this had anything to do with the mentally ill? Also show me where I said people leaving the nursing home or state institution are in the community living independently?

And if you wanna talk about dishonesty, keep trying to tell everyone that all residents in a nursing home needs to be there. Thats pure BS, I can show you many who have moved and moved successfully WITH COMMUNITY SERVICES.

Seniors and persons with disablities are living in communities all over this state with community services, many who once resided in institutions. People across Kansas have been for years, I too have worked in social services for many years.

"A bad outcome to you is a "risk to be managed", not a dead person."

Are you trying to tell me that no one dies or is abused if they are in an institution?

BigDog 11 years, 5 months ago

Holygrailale ..... you seem to need to re-read what I said previously ....again .... I can help you with the big words if necessary. ---BigDog

"Please show me where I said this had anything to do with the mentally ill? ---- BigDog

"At one time there were over 3000 individuals with mental retardation in state institutions in Kansas; today there are about 300. Doctors at the hospital used to just tell parents to send their baby to the state institution, the state would take care of them for their lifetime; often removing family from the persons life." ----BigDog

**** Thank you holygrailale. You proved my point .... you don't know the difference between mental illness and mental retardation. ---- BigDog


"Also show me where I said people leaving the nursing home or state institution are in the community living independently?" --- BigDog

"Not everyone in a nursing home "can't make it in the community." -- BigDog

** OK, again nothing in that statement says that I said they were living in the community independently. ---- BigDog


"And if you wanna talk about dishonesty, keep trying to tell everyone that all residents in a nursing home needs to be there." ---BigDog


That's the funniest thing I've read this week.

People are just flocking to nursing homes because it's so great to live at a place that smells like human waste.


*Actually people are flocking from nursing homes. You might want to look how nursing home populations have dropped over the last 10 years while the aging population has grown. ----- BigDog

People are in nursing homes because they want to be there rather than living independently.


Statements like that only demonstrate that you have never been in a nursing home. Like I correctly assumed, you deal with budgets, not people.

* I've probably been in far more nursing homes than you can name. --- BogDog

"A bad outcome to you is a "risk to be managed", not a dead person."



"Are you trying to tell me that no one dies or is abused if they are in an institution?" ---- BigDog

A misrepresentation of my statement, but I can see why you would want to redirect the subject.

**** I can't help it you can only see one side of things. I see people as having a choice .... you seem to think institutional care is the only option.

Linda Endicott 11 years, 5 months ago

Just because someone appears to be with it enough to live independently doesn't mean that they are. Some forget to take their medications. Some have medical problems that need to be monitored. What do you do if an elderly person is living on their own, has a diabetic coma at 2 AM, and no one is there to help them?

Where are all the nurses and doctors going to come from to go to patient's homes and give them the care they need? Don't we have a nursing shortage as it is?

As for alternative care, community based services, etc., etc... they're mainly talking about group homes, and I'm sure most elderly people don't consider living in a group home as being any more independent than being in a nursing home. Go visit a group home and see if you'd like to live the rest of your days there, either. It isn't a whole lot different than a nursing home. There are fewer residents, that's all.

Just because this is the cause of the day doesn't mean that they have the best interests of the residents at heart. They never do when the dollar signs are mentioned more than the needs of the people. How many times did the article mention how much money could be saved?

FatElvis 11 years, 5 months ago

Actually, this grant does not effect people who are mentally ill as there is no HCBS (Home and Community Based Services) waiver for mental illness in Kansas. It can only be used for people who are eligible for the Frail/Elderly waiver, MR/DD waiver, or the Tramatic Brain Injury waiver so that they can be moved to a less restrictive setting.

While one of the longterm goals is to eventually save money, that isn't the sole primary focus of the grant. Money Follows the Person means just that: the money that was used to serve people in either a state institution, ICF/MR or a Nursing Facility would be used to serve the person in the community. It is a dollar for dollar transfer of funds for the first year. What you have to understand is that a HUGE percentage of money that is allotted for care of an individual in any institutional based setting doesn't go to their care at all; it goes to the maintainance of outdated and unused infrastructure.

I think you would be really surprised at how many people, especially the elderly, are put into nursing homes simply because they don't understand that they have other options. Many people who are put in nursing homes can be diverted back into the community with simple modifications to either thier homes, services or both. A recent pilot program in Reno County, I believe, under the Real Choices grant was able to divert approximately 64 people from longterm nursing facilities to home and community based services at average cost of ~$768 per person. It was found that in many cases, something as simple as a wheelchair ramp, or even in one case, a pair of diabetic shoes, was all that was needed to keep a person out of a nursing home. What you need to understand is that these people still recieve services, but they are services that they chose--not crammed down thier throat--resulting in them being able to continue living in their own homes increasing their quality of life. Understand that these are people that were given the option of going to a nursing home, but THEY chose to live at home. By providing people with the option to CHOOSE the services they recieve and WHERE they recieve them, a net savings of over $2M/year was realized in this small sample alone. So yes, money was saved (a lot of it given the sample size), but it was a secondary outcome.

FatElvis 11 years, 5 months ago


Ultimately, the Money Follows People grant is about providing consumers more choices. I know this may surprise some of you folks, but people with developmental disabilities not only vote, but they actively lobby their elected officials for more service options. The Money Follows People grant is an issue that has been pushed for by the DD community for a long time, not only in Kansas, but nationwide. In fact, SABE (Self Advocates Becoming Empowered), the national organization of people with developmental disabilities has stated that their #1 goal for 2006 is:

"1. Eliminate institutions through the use of Money Follows the Person legislation, mentorship by self-advocacy organizations to individuals to assist in the choosing the support they need in the community."

To simply dismiss this grant as an attempt to push ("mentally ill") people out in the street only reflects a gross misunderstanding of who this program targets and what are the foundations for the desired outcomes.

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