Long-term Care Public Policy Concerns
1. Maintain long-term care services and funding for frail and elderly Kansans. ACTION:
- Maintain and provide adequate funding of services that support frail elders and disabled adult.
- Avoid further reductions of services; Require KDADS to report impact by population to identify unique impacts for older Kansans and others.
- Avoid waiting lists for frail elders for Senior Care Act and Waiver programs, forcing elders into nursing facilities at much higher cost to the state; Governor’s 10% cuts will likely create waiting list for Senior Care Act Programs for near-Medicaid home-based services.
- Require data that allows tracking of individuals (caseloads) along with KanCare. “Member Months”.
- Require escrow of Civil Monetary Penalties for serious deficiencies and payment of penalty as fined without reduction in penalty amount that results from advocacy by the facility with no comparable advocacy on behalf of residents harmed. CMP funds are used to improve quality of care and life for adults in facilities and for staff training to assure such improvements.
2. Increase nursing staff hours from current 2.0 hours to Center for Medicare & Medicaid Services recommended 4.13/4.85 hours. ACTION:
- Raise care hours received by adults in nursing homes to meet the threshold that avoids injury, illness and death.
- Kansas requirements have remained at 2 hours per day for over 30 years while acuity and needs have dramatically increased.
- Serious health & safety inspection citations have decreased by half over the past 3 years, significantly reducing protection for elders living in nursing facilities. FY 11-161 actual harm +; FY 13-42 actual harm + for first 6 months, if doubled for 12 months, would total 84.
3. Assure access to dental and mental health services for older adults. ACTION:
- KanCare expands mental health access through Community Mental Health Centers, but provides for no funding to allow centers to expand their ability to fulfill – creating a de facto unfunded mandate.
- KanCare provides for dental prevention, but does not address the need for maintenance/routine care and the resulting serious health conditions enhanced by this lack, i.e. chronic, unchecked, infection resulting in falls, confusion, delusion, dehydration; and malnutrition resulting from inability to chew. KanCare does not cover the need for dentures.
4. Improve the reporting and enforcement system for elder deaths and injuries. ACTION:
- Legislative post-audit to examine current practice and effectiveness of coroner investigations related to deaths in longterm care facilities.
- Refer all nursing home deaths to the medical examiner/coroner – Arkansas model legislation.
- Report any suspicious deaths involving law enforcement (abuse cases) and any unnatural deaths (suicides/accidents) to the ME/Coroner,
- Establish a nursing home fatality review board or form a death review board for vulnerable populations of all ages, and
- Require national death investigator certification for all death investigation, and follow national standards for reportable deaths and referrals for forensic autopsies. (Statutory change)
5. Provide interpretative guidelines/policy about nursing home placement of persons with felony backgrounds. ACTION:
- Legislation requiring proper placement of and notification when sexual or violent offenders listed on the state’s registry need long-term care and that assures the protection of the health and safety of adults living in nursing or assisted living type facilities.
- Some surrounding states have passed legislation that resulted in offenders moving from those states to Kansas to receive long-term care.
- Kansas currently has no statutory or regulatory guidance that addresses the protection and safety concern for frail elders and disabled adults, specific to notification of residents, facilities or specific t appropriate placement of offenders.