A recent change in Kansas Department for Aging and Disability Services policy will reduce access to services that help the state’s frail elders avoid often-costly nursing home stays, according to directors of the state’s Area Agencies on Aging.
“This will have an impact on case management services, which we believe are pivotal when it comes to helping our customers remain in their homes,” says Janis DeBoer, executive director of the Kansas Area Agencies on Aging Association. “Case management is the glue that keeps everything together.”
Late last month, directors of the 11 Area Agencies on Aging in Kansas learned that KDADS officials were enacting a policy that, effective Oct. 1, prevents the programs from spending more than 20 percent of their Senior Care Act budgets on case management.
At the same time, those case managers are being required to conduct more in-person visits.
“About 30 percent of our Senior Care Act budget is for case management,” says Karen Wilson, who runs Northeast Kansas Area Agency on Aging (AAA), a seven-county program based in Hiawatha. “So this will be a major reduction for us.”
Five Area Agencies on Aging, DeBoer says, are spending more than 20 percent of their Senior Care Act budgets on case management.
The Senior Care Act refers to government-funded in-home services for frail elders who typically have low or modest incomes and are not eligible for Medicaid.
Because they are not eligible for Medicaid, many of these seniors pay for a portion of the services they receive. Payments are based on a sliding scale.
“That’s why people like it — they don’t see it as welfare,” says Dave Geist, executive director at Southwest Kansas AAA, which is based in Dodge City and covers 28 counties.
In Kansas, the Area Agencies on Aging divide $6.7 million in Senior Care Act funds annually.
Last year case managers helped more than 4,500 seniors find and pay for the services they needed to continue living at home.
Area Agencies on Aging directors say they were surprised when KDADS proposed the change.
“We were completely blindsided by this,” DeBoer says. “We frequently invite KDADS people to our monthly meetings, and there was no mention of this. Next thing we know, we get an email telling us that draft policies were posted on the KDADS website.
“We provided written comments and indicated we would have some concerns if that was what they were going to do,” she says. “Then, we get another email, telling us the policies were final. We were flabbergasted.”
Angela de Rocha, a KDADS spokesperson, said in an email that the agency “did not spring this on them (AAAs) out of the blue. We conferred closely with them, and they had to opportunity to provide feedback.”
In fact, she said, the department did not implement several of its proposals due to concerns that the Area Agencies on Aging directors raised.
De Rocha said KDADS made the change so that the Area Agencies on Aging can “put as much of the funding as possible into direct services to keep seniors living independently in their homes.”
But DeBoer says case management is a direct service that is “most crucial” in maintaining contact with seniors and making sure they’re getting the services they need to remain in the community.
“It’s as direct a service as you’re going to get,” she says.
The KDADS change also requires case managers to meet at least twice a year with each client known to be receiving Senior Care Act services in their regions. They’re also expected to call each of them at least twice a year.
“That may not sound like much, but that’s double what we’re required to do now for the same amount of money, or in some cases less money,” says Michelle Morgan, executive director at the Northwest Kansas AAA in Hays and president of the state Area Agencies on Aging Association.
For years, Morgan says, case managers have been able to visit their high-need clients more often than those with fewer needs.
“We’ve always been able to do that because there was flexibility built into the Senior Care Act,” she says. “You could transfer funds to wherever there was the most need. Now, there’s a cap and everybody has to be seen face-to-face at least twice whether they need to be or not.”
The loss of flexibility, she says, means the Area Agencies on Aging will take on fewer clients, ask their counties for more money or increase their fundraising efforts.
“We’ll do our best to minimize the effects of all this,” Morgan says. “But it doesn’t make a lot of sense to us.”
The change in policy also blocks the Area Agencies on Aging from spending more than 20 percent of their Senior Care Act funds on administration.
“That’s not a big deal,” DeBoer says. “Nobody spends that much on administration.”
Dave Ranney is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.