The Kansas Division of Budget projects that by the year 2005, the Kansas population age 85 and over will increase 112 percent to nearly 84,000 people.

This dramatic increase in the elderly population will challenge the system in place for providing long term care assistance to elderly Kansans. In the very near future, how are people in this age group going to find the help they need to live? How will the taxpayers of Kansas provide for the long term care needs of their fellow citizens?

There's a movement afoot in Kansas in the field of long term care.

People who need some assistance in performing the day-to-day tasks of living are choosing privacy, independence, and choice over institutionalization. As the projection listed above from the Division of Budget indicates, this change may be coming just in the nick of time.

Please consider:

*The number of persons receiving assistance through Medicaid-funded home and community-based services (HCBS) has steadily increased over the last several years. HCBS provides case management and various forms of direct care to persons over age 65 who meet medical and income guidelines. To be eligible for this program, recipients would require nursing facility care without the home-based services.

The number of clients in the program has increased from less than 2,000 in July, 1993 to over 3,500 today.

*Under a new Kansas Department of Social and Rehabilitation Services (SRS) program, Living Independence for Everyone (LIFE), the number of Kansans in HCBS will increase significantly. The medical threshold for acceptance into HCBS for the frail elderly is lowered under the LIFE program, allowing elderly persons to receive needed home services at an earlier point in their lives. Levels of care for HCBS/FE will be lowered to those of the present state-funded Income Eligible (IE) home care program. Many people now in the IE program will receive additional help through HCBS/FE.

SRS projects 5,000 people will receive services from HCBS/FE this year, and thousands more in coming years.

*The number of home health visits by long term care providers using Medicaid jumped from about 95,000 in 1990 to about 275,000 in 1994, according to the Kansas Department of Health and Environment (KDHE).

*This trend toward additional home care will continue as shown by a significant increase in the number of licensed home health agencies operating in Kansas. According to KDHE, the number of licensed home health agencies has increased from 207 in 1990 to 333 in 1996.

Several of the new home health agencies are owned by nursing facilities, which are branching out into community care as LIFE is implemented. Sharon McCabe, administrator at Shiloh Manor nursing home in Canton, said it is critical for the nursing home industry to provide services in the community. Shiloh Manor recently received a home health care license.

"We should be able to assist people to stay in their homes with our

services until just before they need full time nursing care," McCabe said.

A second modification of long term care programs under LIFE involves persons now living in nursing facilities whose level of care needs do not require all the intense services offered in the setting. In the waiver, new categories of less intense services funded by Medicaid will be available. As nursing facilities reclassify beds to Assisted Living or Residential Care, these people will remain in the facility and have their care paid for by Medicaid.

Without the trend toward home and community-based care and away from institutional care, Kansas taxpayers will be spending more and providing for the long term care needs of fewer people. The cost taxpayers are paying for the nursing facility care for persons who qualify financially and medically for Medicaid has increased more than $100 million in the last six years.

This cost increase for nursing facilities did not happen because more people are being served in nursing facilities -- those numbers have remained relatively stable. The increase came about because costs involved in providing nursing facility care to very frail individuals continues to escalate.

Ann Koci, Commissioner of Adult and Medical Services for SRS, pointed out that the cost of providing for the long term care needs of people in the community is about half of the cost in a nursing facility. She also said surveys show elderly persons prefer to stay in the homes and communities as long as possible.

Providing home assistance for people before serious problems requiring nursing home care occur is preventive health care at its finest." Koci said. This is the intent of the LIFE program.

We need to help more people up front so they do not get to the point they are so frail they need more expensive nursing facility care," she said.

A key to the success of the movement in long term care is the involvement of the nursing facility industry, Koci added.

Nursing facility diversification is vital," she said. Rather than reducing the importance of nursing facilities, we are working to encourage nursing facilities to expand home-based services and move into assisted living. These are key to the future of long term care in Kansas."

Page Last Updated: May 29, 2001