The writing is on the wall.

Kansas, like other states, will face huge difficulties trying to meet the needs of a vulnerable, aging population in the coming years. Faced with a Division of Budget-projected 112 percent increase in the number of people over age 85 the next decade and a nursing facility budget that has already more than tripled in the past decade, something must change.

According to Linda Lubensky, executive director of the Kansas Home Care Association, our state has begun the process of meeting this challenge head on."

The Kansas Home Care Association, a trade association of between 200 and 300 private companies providing home care for persons with long term care needs,

Lubensky has been working with about 80 other long term care specialists on a Department of Social and Rehabilitation (SRS) task force helping to design system changes.

Lubensky said SRS has been very open to provider input.

What SRS has done is look at the entire system, including providers, and tried to address the issues and get over barriers to make the system work," Lubensky said. You don't see that very often; most states have a paternalistic view -- they make all the decisions."

Because much of the redesign of the long term care system involves privatization of services previously provided by the state, the private home care agencies Lubensky represents will be deeply involved in the new system. The Kansas Department on Aging, expected to take over long term care programs for people over age 65 in July, 1997, has also been involved in the process.

It truly is a collective effort to try to reach those with most need with something that will last into the future," Lubensky said.

After input from consumers, advocates and providers like Lubensky, SRS has recently submitted a request to the federal government for approval to redesign long term care programs in Kansas. The proposed changes, in the form of the Home and Community-Based Services waiver for the Frail Elderly (HCBS/FE), will greatly increase the number of persons who can receive Medicaid services in their homes and communities.

HCBS is funded by the state/federal Medicaid program under a waiver granted by the federal Health Care Financing Administration. It provides long term care assistance to people who meet medical and income guidelines. A requirement of the waiver is that without home-based services, recipients would require nursing facility care.

The new long term care program, called Living Independence for Everyone (LIFE), will lower the threshold for acceptance into HCBS/FE. With this change, services will be available at an earlier point in the lives of elderly persons in a less restrictive setting with the intention of reducing the need for nursing facility beds.

A second part of the modifications to the waiver involves people still in nursing homes whose level of care does not require the intense services offered in this session. New categories of less intense services funded by Medicaid will be available to persons living in nursing homes through reclassification of a section of beds.

This change will allow persons in nursing facilities who can be served by the HCBS/NF waiver to continue living in the nursing facility under a new category of service. While these persons' health care needs are not great enough to warrant intense nursing facility care, nonetheless they would not have to move out of the nursing facility by only to another category of Medicaid-funded care.

Lubensky said with the changes, Kansas is on the front line in making needed adjustments to meet growing need.

"I think its terribly exciting that a state such as Kansas is not only on the front line, but doing something incredibly innovative," she said. It's a very scary time for the public sector and the private sector. At least I have hope that here in Kansas, we're trying to meet the challenge head on.

(Barriers......small providers, limited finances;)

It is important to make the public understand that we are not removing services," Lubensky said. We are making changes in the system, but those changes will be beneficial. They are tailored to each person's needs."

The design changes the group put together have been submitted in the form of waiver applications by the Kansas Department of Social and Rehabilitation Services (SRS) to the federal government. Called Living Independence for Everyone, or LIFE, the waiver

Because changes are coming so quickly, Linda Lubensky calls it a scary time" for people who life work involves providing for the long term care needs of elderly Kansans and Kansans with disabilities.

It's a very scary time for both the public sector and the private sector," she said. For the frail elderly in particular, the whole system is changing."

The design changes, called Living Independence for Everyone, have been pulled together in two waiver requests that have been submitted to the federal government. The Kansas Department of Social and Rehabilitation Services, working in conjunction with the Kansas Department on Aging which is expected to take over long term care programs for people age 65 and over in July, 1997,

she has been involved with other long term care providers, consumers, advocates and state officials in changing

Page Last Updated: May 29, 2001