Testimony to

House Subcommittee on Social Services

Department on Aging

Melvin Neufeld, Chair

February 19th, 2002

My name is Gina McDonald and I represent the Kansas Association of Centers for Independent Living
(KACIL ). KACIL represents 13 Centers for Independent Living (CIL's). We advocate at a state and national level for the rights of all people with disabilities to live in the communities of their choice.

Thank you for the opportunity to testify today regarding the budget for the Department on Aging (DOA). KACIL has grave concerns about the budget for Seniors and some of the policies implemented by this department.

In spite of what has or has not been emphasized, this budget according to the DOA, will result in an HCBS waiting list of over 300 people by the end of next fiscal year. Senior Citizens on a waiting list will have to enter nursing facilities without these needed services. It has been proven repeatedly that services are less expensive in the community, yet in order to cover a budget shortfall in the short term we are willing to increase the budget substantially in the long term.

Many people who use or would use in home services require only one or two services which are the difference between giving up their homes and moving to high cost Nursing facilities.

You will not be saving money, in fact your budget will increase, but the money will be spent in facilities.

A Long Term Care group comprised of a small number of experts should be convened to look at a real plan for long term care for this state. This plan should look at aging in place, finding ways to fund in home services and should look at successful small congregate settings where people can live as independently as they choose.

Nursing facilities should only be used for acute care needs and only for short periods of time. People under 65 should never be placed in a facility, except for short-term acute care stabilization.

KACIL does not have confidence that the leadership at DOA can look "outside the box" to find alternatives that are not only cost effective, but are acceptable to the baby boomers who will be aging soon.

KACIL is deeply concerned with the policy DOA initiated in the last two years which caps hours of Personal Assistance Services at 8 hours per day. We are in the process of working with attorneys to file a complaint to CMS regarding this policy.

First, the DOA has indicated on their waiver that they will do an aggregate cost cap, not an individual cost cap. Second, DOA is required to assure the health, safety and welfare of individuals using the waiver. They complete a Uniform Assessment Instrument and determine the individual's needs, which may exceed 8 hours. Then they cut the hours to 8. How can they assure health safety and welfare when they do this? In some cases the individual has no option but to enter a facility.

It would be inconceivable for the DOA to tell NF's that they have to eliminate one meal per day or only give baths once a week to reduce costs, yet we have no problem doing it on the community program.

And while we are discussing this, let's clear up another myth. There is a myth that if someone is over the cost cap, it will be less expensive to serve him or her in a facility. Nothing could be further from the truth. In fact, if you listen to the Secretary's testimony, she'll tell you the reason that the cost for NF's has gone up while the number of people has gone down is that the acuity level of people left in the facility is higher, therefore the NF charges more. We agree! Every time you put someone "over the cost cap" into the facility, you don't save money. You increase the cost for everyone who receives services in the facility!

Recommendations:

I. KACIL requests that money be added to this budget to adequately fund the in home programs and HCBS waiver .

2. Create a Lone term Care think tank made up of experts to determine innovative methods of providing lone term care.

3. Identify ways to move dollars from facilities to communities. We are aware of a number of people who currently are in NF's because they are on a waiting list for HCBS services. They are on the PD Waiver, but if there is a waiting list for the FE waiver, this problem will occur on this waiver too.

4. Instruct DOA to remove the 8 hour cap on personal assistance services.

Thank you for the opportunity to discuss our concerns and recommendations. I would be happy to try to answer questions.

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