KANSAS DEPARTMENT ON AGING

Kansas State Plan on Aging

Federal Fiscal Years 2010 - 2013

Executive Summary............................................................................................................................................... 1

Verifi cation of Intent............................................................................................................................................. . 2

Overview of the Kansas Aging Network.............................................................................................................. 3 Kansas Department on Aging (KDOA) Vision and Purpose....................................................................... 3 Organization of the Kansas Aging Services Network..................................................................................4 Offi ce of the Secretary................................................................................................................................. 4 Silver Haired Legislature................................................................................................................. 4 State Advisory Council.................................................................................................................... 5 Area Agencies on Aging.................................................................................................................. 5 Kansas Long-Term Care Ombudsman............................................................................................. 5

Kansas Aging Demographics................................................................................................................................ 6 Geographic Distribution...............................................................................................................................7 Housing / Living Arrangements................................................................................................................... 7 Racial and Ethnic Composition.................................................................................................................. . 7 Language Use and English-Speaking Ability.............................................................................................. 7 Employment and Retirement....................................................................................................................... 7 Education..................................................................................................................................................... 8 Disability and Activity Limitations.............................................................................................................. 9 Poverty......................................................................................................................................................... 9 Grandparents Raising Grandchildren........................................................................................................... 9

Challenges and Opportunities............................................................................................................................ 10 University of Kansas School of Social Welfare, Offi ce of Aging and Long-Term Care’s Report:

Planning for Long-term Care Services in Kansas Before the Boom......................................................... 10 Unmet Needs - Today’s Elderly Kansans.................................................................................................. 11

KDOA Strategic Goals: 2010 - 2013................................................................................................................... 13

Priorities, Innovation, and Progress...................................................................................................................18 OAA Title VI/III Coordination.................................................................................................................. 18 OAA Title VII Vulnerable Elder Rights Protection Activities................................................................... 18 Disaster Preparedness................................................................................................................................ 20 Faith-Based Initiatives............................................................................................................................... 21 Health Care System Coordination............................................................................................................. 21 Lifelong Communities................................................................................................................... 21 Mental Health Information............................................................................................................ 22 Senior Health Insurance Counseling for Kansas (SHICK)............................................................22 SMP................................................................................................................................................ 22 Person-Center Hospital Discharge Model (HDM) Grant.............................................................. 23 Aging and Disability Resource Center (ADRC)............................................................................23 Home Telehealth Grant.................................................................................................................. 23 Client Assessment, Referral, and Evaluation (CARE) Program....................................................23 Money Follows the Person Proviso / Demonstration Grant.......................................................... 24 Culture Change in Long-Term Care.............................................................................................. 24 Workforce Enhancement Grant (WEG) Program..........................................................................25 Joint Provider Training.................................................................................................................. 25

Table of Contents

Looking Toward the Future................................................................................................................................ 26

AppendicesIntrastate Funding Formula and BackgroundA. KDOA Organization ChartB. Kansas Area Agencies on Aging Map and Contact InformationC. Kansas Long-Term Care Ombudsman Strategic Action PlanD. KDOA’s Programs and ServicesE. KDOA’s Annual ReportF. Kansas Area Agencies on Aging SFY 2008 Innovation and AccomplishmentsG.

1

In accordance with the Older Americans Act of 1965, as amended, the Kansas Department on Aging (KDOA), as the designated State Unit on Aging, is mandated to submit a “State Plan on Aging” to the U.S. Administration on Aging. This plan describes the agency’s vision and purpose, including the goals and strategies to achieve this vision. Development of this plan was accomplished through continuous collaborative interaction with the state’s Aging Network, including the State Advisory Council, the Silver-Haired Legislature, the Area Agencies on Aging, the Kansas Long-Term Care Ombudsman and other state divisions, and many of the seniors we represent.

KDOA staff continues to assess shifting demographics to evaluate the ever-changing number and percentage of Kansas seniors in an effort to determine current and future needs. According to the U.S. Census Bureau, the population of Kansans 65 years of age and older was 360,000 in 2007, representing 13% of Kansas’ total population, with many of these citizens residing in rural areas. Recent projections estimate that from 2000 to 2025, 69 Kansas counties will experience a decrease in the age 65 through 84 cohort while Johnson County is projected to have a 74% increase in this segment of the population. However, all 105 counties are projected to have an increase in individuals 85 years of age and older.

The U.S. Census Bureau predicts that 1 in 5 Americans will be 65 years of age and older by 2030, compared to 1 in 8 in 2010. This shift will likely have a dramatic effect on the labor force as many older workers will continue to work well into what is typically considered retirement years. In addition, the increase in labor force participation rates for women over the past 20 years and the increase in educational attainment of the workforce overall will have a signifi cant impact. Many Kansans nearing retirement are better educated and, as higher levels of education are typically associated with higher incomes, will likely be better prepared fi nancially for retirement. These older Kansans also represent a large pool of volunteers as seniors often give back to their communities through activities associated with various civic organizations.

KDOA’s mission is to promote the security, dignity, and independence of Kansas seniors and envisions communities that empower seniors to make choices about their lives. The agency has established the following goals to advance its vision for Kansas seniors:

Enhance Kansans’ expectations towards person-directed options in the community and adult care homes•

Enable more seniors to remain in their homes by promoting an array of high quality community services • and supports

Help Kansas Seniors achieve healthier, more active lives through prevention and intervention•

Enable more seniors to live a dignifi ed existence by promoting senior rights and reducing the incidence of • abuse, neglect, and exploitation

KDOA will continue to pursue its mission by providing a variety of programs and services to meet the changing needs of Kansas seniors. KDOA, along with the Aging Network, will continue to advocate and educate, to provide services necessary to keep seniors in the environment of their choice, to provide oversight to maintain quality services and care, and to support promising innovative programs. We will continue to promote the right of each and every Kansas senior to follow their personal vision of a meaningful life.

Executive Summary

2

The state plan on aging for the period October 1, 2009 through September 30, 2013 is hereby submitted for the state of Kansas by the Kansas Department on Aging. The state agency named above has been given the authority to develop and administer the state plan on aging in accordance with all requirements of the Older Americans Act, as amended, and is primarily responsible for the coordination of all state activities related to the purpose of the Act. This includes, but is not limited to, the development of comprehensive and coordinated systems for the delivery of supportive services, including multipurpose senior centers and nutrition services, and to serve as the effective and visible advocate for the elderly in the state. This plan is hereby approved by the Kansas Secretary of Aging, designee of the Governor, and constitutes authorization to proceed with activities under the plan upon approval of the U.S. Assistant Secretary for Aging.

The state plan hereby submitted has been developed in accordance with all federal statutory and regulatory requirements.

This plan is based upon projected receipts of federal, state and other funds and thus is subject to change depending upon actual receipts and/or changes in circumstances. Substantive changes to this plan will be incorporated into the annual amendments to the plan.

I hereby approve this state plan on aging and submit it to the U.S. Assistant Secretary for Aging.

___________________ ________________________________ Date Martin Kennedy, Interim Secretary Kansas Department on Aging

Verifi cation of Intent

3

Kansas Department on Aging Vision and Purpose The Kansas Department on Aging (KDOA) was created in 1977 as the single state agency for receiving and disbursing federal funds made available under the Older Americans Act (OAA) and for other programs for the aging. Its mission is to promote the security, dignity, and independence of Kansas seniors. KDOA envisions communities that empower seniors to make choices about their lives. KDOA pursues its mission by providing a variety of programs and services through multiple funding sources. OAA resources provide many of these services for elderly Kansans including access, in-home services, congregate and in-home nutrition, and legal assistance. Complementary programs expand the services available to many more elderly. For example, the Senior Care Act (SCA) program, a fee-for-service program funded by state general funds, was established in 1989. This program provides services in the customer’s home and is designed to prevent premature nursing home placement for persons who have not exhausted their fi nancial resources. The Home and Community-Based Services for the Frail Elderly (HCBS/FE) waiver, implemented in 1997, provides Medicaid-eligible customers the opportunity to receive cost-effective community-based services as an alternative to nursing home care, thereby promoting independence in the community and encouraging residency in the most integrated setting. In 1997, Medicaid long-term care programs predominantly serving persons 65 and older were passed from the Kansas Department of Social and Rehabilitation Services (SRS) to KDOA. These programs included not only the HCBS/FE waiver, but also Targeted Case Management (TCM) for waiver participants and the Nursing Facility (NF) Program. The NF program is responsible for enrollment of nursing homes and hospital-based long-term care units providing Medicaid services to frail elderly and disabled residents, and reimbursement for those services. The Offi ce of the State Long-Term Care Ombudsman, which was originally a KDOA program, was transferred to the Kansas Department of Administration following 1998 legislative action. The mission of the Kansas State Long-Term Care Ombudsman (KLTCO) is to advocate for the well-being, safety, and rights of residents of Kansas long-term care facilities by assisting them in attaining the highest possible quality of life. KDOA provides funding for this program by means of a pass-through and continues to collaborate with the Ombudsman on senior issues. The Licensure, Certifi cation, and Evaluation (LCE) Commission was moved from the Kansas Department of Health and Environment (KDHE) to KDOA in 2003. This commission is responsible for protecting public health through the inspection and licensing of adult care homes, which is defi ned in Kansas to include nursing facilities, nursing facilities for mental health, intermediate care facilities for the mentally retarded, assisted living facilities, residential health care facilities, homes plus, boarding care homes, and adult day care facilities. LCE develops and enforces regulations related to adult care homes, and fi eld staff document compliance with state regulations and federal certifi cation standards through on-site surveys. Investigations of alleged abuse, neglect, or exploitation are also conducted. The Commission is comprised of three divisions: Licensure and Certifi cation, Long Term Care, and Mental Health and Residential Care Facilities. The Kansas State Plan on Aging conveys the many ways KDOA touches the lives of Kansas seniors and their families. From helping to fund senior nutrition programs to inspecting nursing home care for safety and quality, to helping seniors understand their Medicare options, KDOA plays a vital role for Kansas seniors. KDOA also plays a major role in advocating for the programs and services that seniors need and depend on. We do this

Overview of the Kansas Aging Network

4

through educational programs, testimony before the state legislature, and interaction with our stakeholders, including senior services-related organizations.

Organization of the Kansas Aging Services Network

Offi ce of the Secretary

The Kansas Department on Aging is a cabinetlevel agency administered by a Secretary who is appointed by, and serves at the pleasure of, the Governor. The Secretary, who serves as the chief executive offi cer, oversees all aspects of agency operations and has the authority to sign all documents, letters, contracts, and grants related to state and federal aging programs. Reporting directly to the Secretary are the Deputy Secretary; the Directors of Public Affairs and Human Resources; the Commissioner of Program and Policy; the Commissioner of Licensure, Certifi cation, and Evaluation; the Commissioner of Administrative Services; and the Chief Legal Counsel. (See Appendix B for KDOA’s Organization Chart.)

Silver Haired Legislature

The Silver Haired Legislature is a body of individuals, age 60 and older, who are elected by their peers to develop bills and resolutions that are of interest to Kansas elders and their families. The Silver Haired Legislature then will work with the Kansas Legislature to get its bills and resolutions introduced and passed. The following bills and resolutions were approved during its 2008 session, which were then presented to the 2009 Kansas Legislature:

SHL Bill No. 2501 - Resolution to urge the Kansas Legislature to enact legislation during the 2009 regular session to help combat predatory payday lending practices and predatory practices by consumer loan agencies and Income Tax Refund Advance lending practices that adversely affect elderly and other residents of Kansas.SHL Bill No. 2502 - Resolution supporting increased funding for home and community-based services and nutrition programs.SHL Bill No. 2503 - Resolution requesting cities, counties, and other municipalities with traffi c signals to adjust or otherwise provide adequate pedestrian crossing times at traffi c light crosswalks for seniors and persons with disabilities.SHL Bill No. 2504 - Bill providing for mandatory reinstatement of certain insurance policies.SHL Bill No. 2505 - Bill imposing an excise tax on wind-generated electricity, with proceeds going to the Senior Services Trust Fund for senior services funding.

5

The Silver Haired Legislature presented its 2008 Caring Award to the employees of the Kansas Department on Aging for “their exceptional concern for seniors of Kansas.” This is the fi rst time a state agency has received the award.

State Advisory Council

The State Advisory Council on Aging was established by K.S.A. 75-5911 to advise the Governor and the Secretary about the needs of older Kansans and to advocate on their behalf. The Council, which meets quarterly, is composed of 15 members, 11 of whom are appointed by the Governor. The remaining four are appointed, one each, by the majority and minority leaders of the State House of Representatives and the Senate. The 15 members represent diverse geographical, social, and ethnic groups and at least half of the membership must be 60 years of age or older. In addition to serving in an advisory capacity to the Governor and the Secretary, members also advise other public and private, state and local agencies on issues affecting the elderly, as required by the OAA, and have the duty to review and comment on KDOA activities.

Area Agencies on Aging

Kansas’s 105 counties are served by 11 Area Agencies on Aging (AAAs), which are either units of county government or private, not-for-profi t corporations. AAAs use funds, made available by KDOA, to provide a continuum of choices in services and supports for the elderly through subgrants and contracts with local providers. The AAAs’ responsibilities include the following:

Serve as a community planning agency to improve services to seniors; Act as an advocate for seniors; Purchase services which help seniors remain in the community and avoid unnecessary or premature moves from their homes; andDevelop coalitions and networks of support for seniors and their caregivers to avoid or reduce the need for publicly funded services.

Each AAA has the responsibility to coordinate services in its geographic area and manage its service area effectively and effi ciently. In carrying out its responsibilities, each AAA exercises leadership by working with community agencies, service providers, and senior organizations to expand and improve services at the local level. (See Appendix C for a list of, and contact information for, the 11 AAAs.)

Kansas Long-Term Care Ombudsman

The Kansas Long-Term Care Ombudsman (KLTCO) Program protects the rights of individuals located in adult care homes throughout Kansas, including nursing homes, hospital-based long-term care facilities, assisted living facilities, residential health care facilities, homes plus, adult day care facilities, and boarding care homes. Presently, ombudsman services do not extend to nursing facilities for mental health, intermediate care facilities for the mentally retarded/developmentally disabled (MR/DD), or private homes and other non-licensed settings. The ombudsman program provides advocacy assistance to residents. In 1998, the KLTCO separated from the Kansas Department on Aging, the state unit on aging (SUA), and became an independent sub-agency under the Kansas Department of Administration. The KLTCO operates in nine regional offi ces located throughout the state, including a new regional offi ce opened in Kansas City, Kansas, in 2007. The Kansas Ombudsman Program has one ombudsman for every 3,100 residents. The Institute of Medicine (IOM) recommends at least one ombudsman for every 2,000 residents.

The KLTCO Certifi ed Volunteer Program meets OAA statutory requirements. Advocacy efforts of 183 certifi ed

6

volunteer ombudsmen cover 28% of adult care homes in Kansas. This effort represents nearly $250,000 in unpaid volunteer contributions. The success of the volunteer program is attributed to the creation of a Certifi ed Volunteer Ombudsman Advisory Board. The board reviews activities, training sessions, volunteer newsletter editorials, annual training, and retention issues.

Kansas Aging Demographics

According to the U.S. Census Bureau, the total population in the U.S. in July 2007 was 301.6 million. Kansas had a population of 2.8 million at this time, representing 0.9% of the national population and ranked 33rd nationally in terms of population gain for the preceding year.

The population of Kansans 65 years of age and older was 360,000 in 2007, which represents 13.0% of Kansas’ total population, compared to 12.6% nationally. Although the population of Kansas is aging, it is at a slower pace than the rest of the U.S. As of July 1, 2007, the median age was 36.2 years of age, compared to the national median age of 36.6 years.

The “baby boomers,” the generation born between 1946 and 1964, begin to turn 65 in 2011, which will increase the share of the population age 65 and over dramatically. Nationally it is projected to expand from 13.2% in 2010 to 20% in 2030 – from 39.4 million elderly to 69.4 million. However, the average annual rate of increase for this age group during these 20 years is projected to be just 2.8%, which is less than the rate of growth in the elderly population from 1920 to 1960. Large increases in the oldest of the elderly population beginning in 2030 will be attributed to increases in the number of people 75 years and older.

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

2000 2005 2010 2015 2020 2025

KS POPULATION PROJECTIONSBased on Governor's Demographic Report (DOB)

As of July 1, 2007

Total KS Pop

Age 55 thru 64Age 65 thru 84Age 85 & Older

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

2000 2005 2010 2015 2020 2025

KS POPULATION PROJECTIONSBased on Governor's Demographic Report (DOB)

As of July 1, 2007

Age 55 thru 64

Age 65 thru 84

Age 85 & Older

Age 55 & Older (Combined)

7

Geographic Distribution

In 2008, 34.1% of the total Kansas population resided in rural areas and cities with populations of less than 5,000. However, there has been a shift in the rural population to urban areas, which is expected to continue. From the 2000 census to 2007, the Kansas population increased 3.2%; however, 86 counties experienced a net loss in population and 29 of these counties declined by 10% or more over this period of time. It is projected that, from 2000 to 2025, only 36 Kansas counties out of 105 will have an increase in the age 65 through 84 cohort with Johnson County, the fastest growing county in Kansas, projected to experience a 74% increase in this segment of the population. All 105 counties are projected to have an increase in individuals 85 years of age and older, ranging from 10% to 210%.

Housing / Living Arrangements

In 2005, 80% of the Kansas population age 65 and older owned their homes, which closely mirrors the national average. According to a report published by AARP, 48% of Kansans age 65 and older lived in a non-metropolitan area in 2006, ranking Kansas 10th in the nation for rural elders.

According to the U.S. Census Bureau, 29.7% of Kansans age 65 and older lived alone in 2000, including 16.6% of older men and 38.7% of older women. In 2007, Kansas ranked 16th in the nation for percentage of individuals age 75 and older living alone, with 35% compared to 33% nationally.

In 2007, Kansas also ranked 6th in the nation for the percent of residents age 65 and older living in nursing homes, despite a decline in nursing home residents from 22,411 in 2000 to 20,170 in 2007, a decline of 10%.

Racial and Ethnic Composition

Between 2000 and 2007, the demographic makeup of Kansans by race and ethnicity has remained relatively stable. In 2007, 88.9% of the population self-identifi ed as white alone; 6.1% self-identifi ed as black alone; 2.2% self-identifi ed as Asian alone; 1.0% as American Indian or Alaska Native alone; only 0.1% self-identifi ed as Native Hawaiian or other Pacifi c Islander alone; and 1.8% self-identifi ed as two or more races. In 2007, there were 244,000 Hispanic individuals in Kansas representing 8.8% of the total population, increasing from 7.0% of the total population in 2000.

Language Use and English-Speaking Ability

According to the U.S. Census Bureau’s 2000 Report, 8.7% of Kansans speak a language other than English at home, compared to the 17.9% national average. Of those, 3.9% speak English less than “very well,” compared to 8.1% nationally. In addition to Spanish (5.5%), other languages spoken at homes in Kansas include Indo-European languages (1.6%) and Asian and Pacifi c Island languages (1.3%).

Employment and Retirement

According to the U.S. Census Bureau, there were approximately 20.8 million American workers age 55 to 64 in 2007, representing 13.6% of the labor force (civil, non-institutionalized), most of whom can be expected to leave the workforce during the next decade. However, many will continue to work well into what is typically considered retirement years. Although the increase in labor force participation rates of women over the past 20 years have allowed more women to earn their own Social Security benefi ts, health insurance, and pension, women continue to be disproportionately disadvantaged in preparing for retirement compared to men.

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In 2007, 5.8 million Americans age 65 and older (16.0%) were in the labor force (working or actively seeking work), including 3.2 million men (20.5%) and 2.6 million women (12.6%), constituting 3.8% of the U.S. labor force. The U.S. Census Bureau has projected that 5% of the labor force will be 65 years of age and older by 2020.

The Kansas labor force totaled 1,478,800 in 2007 according to the Kansas Department of Labor, of which 217,000 (14.5%) will be eligible for retirement in the next ten years. The decision to retire is often determined by economic, social, familial, and health factors. A 2008 U.S. Department of Commerce publication reported that in 2004, 18.0% of Kansas workers statewide, age 55 and older, were employed in manufacturing, the highest proportion for that age group. The highest proportion of workplaces for that age group in nonmetropolitan areas was health care and social assistance.

U.S. Dependents per 100 PersonsAge 18 to 64 Years: 1900 to 2050

Source: U.S. Department of Commerce(Estimates 1900 thru 1990; Projections 2000 thru 2050)

-

20

40

60

80

100

1900

1910

1920

1930

1940

1950

1960

1970

1980

1990

2000

2010

2020

2030

2040

2050

Total Dependents Under Age 18 Age 65 and Over

According to a 2005 U.S. Census Bureau report, with the older population growing at a faster pace than the total population, the differential growth will result in nearly 1 in 5 Americans being age 65 and older in 2030, compared to approximately 1 in 8 in 2010.

Education

Kansans have increased educational attainment which will benefi t an aging population. According to the U.S. Census Bureau, in 2000, 86% of Kansans age 25 and older have graduated from high school, compared to 80.4% nationwide, and 25.8% have received a bachelor’s degree or higher, compared to 24.4% nationwide. In 2007, Kansas ranked 24th nationwide for the percentage of individuals age 65 and older who have a bachelor level of education or higher, or 19% as compared to 14.9% in 2000. Thus, Kansans nearing retirement are better educated and, as higher levels of education are typically associated with higher incomes, will likely be better prepared fi nancially for retirement.

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Disability and Activity Limitations

Some form of disability (sensory, physical, or mental) was reported by 52% of non-institutionalized Americans age 65 and older in 2002, according to “A Profi le of Older Americans: 2007” published by the Administration on Aging. While some of these disabilities may be relatively minor, others cause people to require assistance to meet important personal needs. Almost 37% of these older individuals reported a severe disability and 16% reported needing some type of assistance. Reported disability increases with age as 57% of individuals over 80 reported a severe disability and 30% of the over 80 population reported needing assistance.

The following table compares Kansans age 65 and older with disabilities to the U.S. average.

DISABILITY – Persons age 65+, 2007 KS RANK U.S.Sensory 16% 25 16%Physical 30% 24 31%Mobility 14% 41 18%Self-care 8% 40 10%Cognitive/mental 10% 34 12%Any (one or more of the fi ve listed above) 40% 23 41%Cognitive/mental disability + any other disability 9% 34 11%Persons age 65+ with Alzheimer’s disease, 2010 (projected) 14% 13 13%

Source: AARP’s Across the States: Profi les of Long-Term Care and Independent Living: Kansas 2009

Poverty

According to a report entitled “A Profi le of Older Americans: 2007” published by the Administration on Aging, approximately 3.4 million elderly individuals (9.4%) were below the poverty level in 2006, with older women at a higher poverty rate (11.5%) compared to older men (6.6%). Older individuals living alone were much more likely to be poor (16.9%) than were older persons living with families (5.6%). The highest poverty rates were experienced among older Hispanic women (40.5%) who lived alone and older black women (37.5%) living alone.

The Kansas Department of Labor reported 310,666 Kansans, or 11.7%, were estimated to be living below the poverty threshold in 2005 compared to 13.3% nationwide. According to AARP’s Public Policy Institute, 8.1% of Kansans age 65 and older were living at or below the poverty level in 2007, ranking Kansas 36th in the nation for this indicator. Not surprisingly, 12% of Kansas women age 75 and over were at or below the poverty threshold.

Grandparents Raising Grandchildren

According to a 2005-2007 survey by the U.S. Census Bureau, there were 2.5 million grandparents living with and responsible for grandchildren under 18 years of age, of which 798,055, or 32%, were 60 years of age and older. This survey reported that in Kansas, 18,600 grandparents were living with and responsible for grandchildren under 18 years of age, of which 4,836, or 26%, were 60 years of age and older.

A 2000 Census Special Report found that nationally, over one-fourth of grandparents age 65 and over were living with and responsible for grandchildren under 18 years of age. Approximately 30.1% of grandparents age 65 to 74 were living in households with one or more grandchildren under 18 years of age, as were 17.5% of grandparents 75 to 84 years of age and 8.9% of grandparents 85 years of age and older.

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University of Kansas (KU) School of Social Welfare: Planning for Long-Term Care Services in Kansas Before the Boom

AARP published a report in 2002 entitled “Before the Boom: Trends in Long-Term Supportive Services for Older Americans with Disabilities.” This report examined specifi c trends impacting long-term care, along with insight into how these trends might continue to impact future long-term care needs. The predominant trends included in this report were: nursing facility utilization; demographic population shift; disability rates and their causes; changing characteristics that will impact caregiving supports; and the changes in long-term care delivery and policy.

KDOA and SRS contracted with the KU School of Social Welfare, Offi ce of Aging and Long-Term Care, to do an analysis, examining each trend for Kansas and then comparing this information with the national trend. Following are highlights from this 2006 report:

Trend 1: Nursing facility utilization rates in Kansas have declined substantially in the past decade for older adults in all age groups.

Trend 2: Over the next two decades, the growth in the older adult population in Kansas will incrementally increase in all 65 and over age groups, in contrast to national increases where it will shift from the 75 and older age groups to the younger 65 to 74 year old age group.

Trend 3: Disability rates for older adults in Kansas are consistently lower than national disability rates.

Trend 4: Increased educational attainment has reduced disability rates among older Kansans.

Trend 5: Medical advances are creating more opportunities for Kansans to live without disability in old age.

Trend 6: Older Kansans with disabilities continue to utilize privately funded nursing facility care at higher rates than nationally, despite similar socioeconomic improvements.

Trend 7: The narrowing gender ratio of older adults in Kansas contributed to an increase in available spousal support and will most likely continue to do so over the next few decades.

Trend 8: The “birth dearth” cohort (born 1926 to 1945) has more adult children providing a larger supply of informal caregivers than previous cohorts in Kansas, which is consistent throughout the U.S.

Trend 9: The older adult population in Kansas is becoming more diverse and disparities in disability and poverty among racial and ethnic groups exist that could impact their demand for long-term care. In Kansas, black/African American older adults utilize community-based services and informal care more than white non-Hispanics but utilize nursing facility care similarly.

Trend 10: Assisted living plays an important role in the array of long-term care services available in Kansas and the U.S., though Kansas assisted living residents are less disabled and a higher proportion are receiving Medicaid waiver services compared to national levels.

Challenges and Opportunities

11

Trend 11: Home health care utilization and expenditures in Kansas during the 1990s closely refl ected the national expansion and reduction caused by change in federal Medicare policies.

Trend 12: The nature of Kansas nursing facilities is changing with more diversifi cation, specialization, and medicalization.

Trend 13: Kansas has begun to shift a greater proportion of Medicaid long-term care expenditures from nursing facilities to home and community-based services for older adults.

Trend 14: Kansas nursing facilities are providing more Medicare-reimbursed post-acute care, similar to nursing facilities nationally.

Analysis of Annual Medicaid Average Caseload: Nursing Home and HCBS-FEState Fiscal Years: Actual 1998 through 2007

KANSAS LTC MEDICAID AVERAGE CASELOAD

3,332

4,284

10,58210,508

10,89011,12510,78810,77410,97911,16211,39411,34011,788

5,697 5,7655,8025,820

5,5444,848

5,1395,2374,877

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

NF Average Caseload HCBS/FE Average Caseload

HCBS-FE waiting list April 2002 – April 2004Maximum point – June 2003: 2,007 people on the waiting list for services

It should be noted that, although there has been an 8.1% increase in the number of individuals served from 1998 to 2008, the number of Kansans 65 years of age and older increased from 351,463 to 374,620, or by 6.6%, from 1995 to 2008.

Unmet Needs – Today’s Elderly Kansans

Each of the 11 AAAs submit a report to KDOA annually that describes the Unmet Needs for seniors in their respective Planning and Service Areas (PSAs). These unmet needs are derived based on a number of resources, including: regional surveys; stakeholder comments received at public hearings and other public events; input from case managers and providers; and unfulfi lled requests to AAAs for services. Following are the predominant themes from the 2008 reports:

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Seven of the 11 AAAs reported concerns expressed by elderly in their PSA and by staff regarding senior nutrition, including increasing costs for food and food supplements, rising gas prices which are a special concern for meal deliveries in rural areas, and the need for alternative dining options to meet a more diverse elderly population.

Six of the 11 AAAs reported concerns by seniors about medication, including both costs and information regarding Medicare Part D. Following is an excerpt from one of the Unmet Needs reports that refl ects the concerns expressed by several of the AAAs:

“Prescription medicines, both their availability and their costs, are huge concerns for nearly every senior in our PSA. A number of area seniors, despite a signifi cant education campaign we conducted, chose not to participate in the Medicare Discount Card program. The program is far too confusing for many seniors, and too many seniors in our PSA do not use the Internet to keep abreast of the program. We simply do not have enough funding to contact every Medicare eligible person in our area to explain the benefi ts. In fact, in FY 2007 we lost over $6,000 in operating the SHICK program in our PSA.” (“SHICK” refers to the Senior Health Insurance Counseling for Kansas program.)

Six of the 11 AAAs reported concerns about transportation for seniors, including transportation needs for medical appointments, shopping, and for senior activities. Rural areas have an added disadvantage as seniors are often required to travel long distances for medical appointments and treatments.

Other predominant areas of concern expressed in the AAA reports included housing, dental care, mental health needs, both funding and an adequate number of providers for in-home services, and waitlists for services due to insuffi cient funding.

KDOA also determines unmet needs from the Client Assessment, Referral and Evaluation (CARE) Program. This program screens individuals seeking long-term care in Medicaid-certifi ed nursing homes for mental illness and mental retardation/developmental disabilities to ensure individuals with these diagnoses are served in the least restrictive setting. CARE assessors also work with individuals considering nursing home care to discover personal preferences, make referrals to appropriate long-term care resources, evaluate data on unmet service needs, and recommend areas for expansion of services in Kansas based on these unmet needs. The following table lists the 10 most frequently named services reported as needed in state fi scal year (SFY) 2008 that would enable continued community tenure for these customers. For many of these CARE customers, more than one of these 10 services would be needed to continue living in the community.

2

3

4

5

6

7

8

9

10

11

12

E F G H I J K

RANK Service# Indicating

Service Need Waiting List Cannot Afford

Service Not

Available

Total UnMet Needs

1 Attendant Care (Personal or Medical) 4166 256 308 81 645

2 Night Support 1723 20 180 388 588

3 Homemaker 3755 287 192 43 522

4 Nursing 4203 17 92 233 342

5 Assisted Living 1229 29 84 100 213

6 Shopping 2394 74 83 54 211

7 Transportation 2368 45 64 57 166

8 Meals (Home Delivered) 2758 32 44 75 151

9 Adult Day Care 720 1 40 84 125

10 Chore 654 35 51 27 113

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AoA Strategic Goal #1:Empower older people, their families, and other consumers to make informed decisions about, and to be able to easily access, existing health and long-term care options

KDOA GOAL:Enhance Kansans’ expectations towards person-directed options in the community and adult care homes. OBJECTIVE: Consumers are educated about person-directed options.STRATEGIES: Provide on-going education, with emphasis on person-centered education, to consumers and

providersPromote quality of life and quality of care, which includes choiceProvide human interest stories to the media that refl ect real life examples of person-centered care

Measures:Number of direct care staff attending training sessions on person-centered care Number of Joint Provider training sessions that include resident-centered care Number and percentage of community-based services customers with current Customer Choice form documented in fi leNumber and percentage of community-based services customers who report providing instructions to people paid to assist them Number of PEAK awards presented for implementation of culture change Number of press releases featuring PEAK award recipients and stories supporting person-centered care Number of KDOA staff presentations promoting person-centered care

OBJECTIVE: Leaders embrace person-directed care.STRATEGIES: Pilot self-management, disease management, and new technology in community-based settings

Award or obtain grants to fund innovative programs and processesProvide supporting research to document the benefi ts of person-centered care

Measures:Distribution of research results supporting person-directed care to legislators and stakeholders Number of grant awards received to pilot innovative care delivery systems and technology Number of customers benefi ting from pilot programs supported by grants

OBJECTIVE: Adult care homes and community service providers all support and provide person-directed care.STRATEGIES: Person-directed care is included in the educational curriculum of all levels of provider staff

Promote quality of life and quality of care, which includes choiceHelp providers operationalize culture change, provide quality care, and build or adapt their physical plants to create a home environment

KDOA Strategic Goals: 2010 - 2013

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Measures:Number of direct care staff attending person-directed care training Number and percentage of providers supporting person-directed care Percentage of community-based consumers self-directing care Number of stakeholders attending Governor’s Conference/Summit promoting person-directed option Number of KU School of Nursing culture change assessment tools distributed Percentage of culture change assessment tools completed by adult care home providers Percentage of staff turnover and retention in Kansas nursing homes Number of facilities creating long-term care household model

PERFORMANCE OUTCOME: More Kansans will expect and receive person-directed options in the community and in adult care homes.

AoA Strategic Goal #2:Enable seniors to remain in their own homes with high quality of life for as long as possible through the provision of home and community-based services, including supports for family caregivers

KDOA GOAL:Enable more seniors to remain in their homes by promoting an array of high quality community services and supports.

OBJECTIVE: The array of services provided meet seniors’ expectations for quality and standards of care.STRATEGIES: Promote resident safety and delivery of appropriate community-based services

Survey seniors and monitor providers to ensure customers receive appropriate, high quality care

Award grants for innovative programs and processes

Measures:Number of customers receiving community-based services in their residence of choice Number and percentage of adult care home defi ciencies Number and amount of civil money penalties assessed to adult care homes Community-based services customer ratings of providers/attendants/worker/staff Percent of community-based services customers who would recommend provider to others Number of customers benefi ted by use of innovative technology

OBJECTIVE: The percentage of seniors seeking nursing home placement decreases.STRATEGIES: Provide information, assistance, and counseling to the public to increase awareness and access to

available community servicesAssist providers in building and remodeling adult care homes that provide alternatives to nursing homesProvide consumers information about all adult care home options

Measures:Number of CARE assessments Percentage of CARE diversions Number of Medicaid-qualifi ed hospital patients who are able to return to the community through provision of discharge assistance and community servicesNumber of PACE participants Number of community-based services customers Number of nursing home residents Percentage of Kansas seniors living in nursing homes

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OBJECTIVE: Seniors will reside in the community later into the life cycle, thereby enhancing their quality of life.STRATEGIES: Build capacity for long term supports in the community

Purchase services for eligible seniors through a network of providersProvide the assistance and community services necessary to enable seniors to live in the community

Measures:Percentage of customers receiving community-based services according to Plan of Care Average length of time community-based services are provided to customers Number of communities participating in Lifelong Communities Program Number of Unmet Needs reported at time of CARE assessment Average age of residents admitted to nursing homes Average length of stay for residents living in nursing homes Number of nursing home residents transitioned to the community by means of the “Money Follows the Person” program

PERFORMANCE OUTCOME: More seniors remain in their homes and receive an array of high quality community services and supports.

AoA Strategic Goal #3:Empower older people to stay active and healthy through Older Americans Act services and the new prevention benefi ts under Medicare

KDOA GOAL:Help Kansas seniors achieve healthier, more active lives through prevention and intervention.

OBJECTIVE: Kansas seniors will have access to a greater array of health-based services.STRATEGIES: Increase senior awareness of available preventive services

Improve information fl ow to seniors about mental health servicesProvide “Best Practices” and technical support to long-term care providers

Measures:Number of customers receiving counseling on Medicare Preventive Services from SHICK volunteers Number and percentage of Kansas seniors receiving immunizations (infl uenza and pneumonia) Number of KDOA Mental Health Guides distributed Number of Suicide and Older Adults Brochures distributed Number of customer referrals to Community Mental Health Centers Number of exemplary awards given to adult care home providers Number of “Best Practices” posted on KDOA’s provider website Number of KDOA staff presentations to adult care home providers

OBJECTIVE: More Kansas seniors will participate in health-based programs.STRATEGIES: Advocate for seniors’ needs within statewide health planning initiatives

Improve nutrition options and educational opportunitiesIncrease opportunities for physical activities

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Measures:Number of health planning initiatives in which KDOA is represented Number of seniors receiving meals funded by nutrition programs Number of meals provided to seniors through nutrition programs Number of sustained STEPS classes Number of seniors participating in STEPS classes

OBJECTIVE: Kansas seniors maintain their health and delay the need for support services.STRATEGIES: Increase awareness among Kansans about long-term care risks, costs and payment options, and the

importance of planning for future long-term care needsProvide medication management education and services to reduce medication errors

Provide information and support to hospitalized seniors to enable them to return to their home

Provide home telehealth to enable elderly that are chronically ill to manage their health conditions

Measures:Percentage of long-term care paid for by Medicaid Average age of customers receiving community-based services Number of community-based services customers receiving Medication Management services Number of Medicaid-eligible hospital residents who are able to return to the community through provision of discharge assistance and community servicesNumber and percentage of hospitalizations Number and percentage of nursing home placements

PERFORMANCE OUTCOME: Kansas seniors are healthier and lead more active lifestyles as a result of prevention and intervention.

AoA Strategic Goal #4:Ensure the rights of older people and prevent their abuse, neglect and exploitation

KDOA GOAL:Enable more seniors to live a dignifi ed existence by promoting senior rights and reducing the incidence of abuse, neglect, and exploitation.

OBJECTIVE: Kansas seniors will have effective advocates to protect and promote their rights.STRATEGIES: Monitor legislative activity for bills that will impact seniors and provide testimony when warranted

Represent senior interests in public and private venues Provide senior “Rights and Responsibilities” information to providers and other organizations serving seniors

Measures:Number of bills that KDOA staff testify on behalf of Kansas seniors during legislative session Number of presentations given by KDOA staff Number of workgroups in which KDOA staff actively participate Number of case managers receiving training on senior “Rights and Responsibilities” Number of “Explore Your Options” publications distributed

OBJECTIVE: More Kansas seniors will be aware of their right to a secure living environment with caregivers who are respectful of their needs and preferences.

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STRATEGIES: Inform seniors of their rights during Quality Review and ensure this information was received during their assessments Increase consumer and staff awareness regarding Resident Rights in adult care homes Coordinate activities designed to educate seniors about their rights and steps to take to prevent abuse, neglect, and exploitation.

Measures:Number and percentage of community-based customers reporting awareness of their rights and responsibilities Number and percentage of adult care homes providing Resident Rights to each new resident Number and percentage of community-based services customers responding that attendants/workers have not asked for anything, or taken anything from the customer without their permissionNumber and percentage of community-based services customers with health or welfare concerns observed or identifi ed by quality review staff

OBJECTIVE: More Kansans will be aware of the signs of senior abuse, neglect, and exploitation and will take corrective action.STRATEGIES: Promote awareness of senior abuse, neglect, and exploitation by funding education and training

programs on this topicTrain assessors and case managers to identify signs of abuse, neglect, and exploitation

Promote awareness of senior abuse, neglect, and exploitation by collaborating with other state agencies and stakeholders to promote public awareness and implement preventive measuresEnforce statutory and regulatory requirements, including the reporting, investigation, and prosecution of ANE

Measures:Number of PEANE Workshops Number of case managers attending training sessions on ANE Number of referrals by Quality Review staff to KDOA Complaint Hotline and SRS Adult Protective Services Percentage of adult care homes meeting regulatory requirements for reporting and investigating ANE and taking appropriate action

PERFORMANCE OUTCOME: More Kansas seniors live a dignifi ed existence, are aware of their rights, and live a life free of abuse, neglect, and exploitation.

KDOA continues to revise and refi ne its Output and Outcome Measures as part of the state’s annual budgeting process. Performance Measures as defi ned by the Administration on Aging (AoA) and promoted through its Performance Outcomes Measures Project (POMP) will be established for the HCBS/FE waiver during SFY 2010 and similar measures applicable to OAA and state-funded programs will be developed based on national and state benchmarks and data available through the Kansas Aging Management Information System (KAMIS), the Medicaid Management Information System (MMIS), the Center for Medicare and Medicaid Services’ (CMS) Automated Survey Processing Environment (ASPEN), and customer surveys.

Please refer to Appendix D to see the Kansas Long-Term Care Ombudsman Strategic Action Plan. For more information on the programs referenced above, please see the “Priorities, Innovations, and Progress” section of the State Plan, the list of KDOA’s Programs and Services (Appendix E) and KDOA’s Annual Report (Appendix F).

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OAA Title VI/III Coordination

KDOA and the Aging Network strive to coordinate OAA Title VI and Title III services to avoid duplication of services and maximize available resources. Kansas has four federally recognized Indian tribes: Kickapoo Tribe of Indians in Kansas; Iowa Tribe of Kansas and Nebraska; Prairie Band Potawatomi Nation; and Sac and Fox Nation. All four tribes are located in PSA 09 in northeastern Kansas, served by NEK-AAA, and each tribe has a seat on NEK-AAA’s Advisory Council. Native Americans also serve as representatives in the Kansas Silver Haired Legislature.

NEK-AAA staff take pride in the many ways they collaborate with the tribes to provide senior services and respond to the broad array of issues and concerns impacting seniors and their families. NEK-AAA provides each tribe with copies of its quarterly newsletter, funded by OAA Title III-B, for their senior centers, which includes publicity for its annual Medicare enrollment assistance program (SHICK). NEK-AAA also provides Explore Your Options (EYOs) and program-specifi c brochures to the tribal senior centers, and makes presentations on specifi c senior programs and services upon request.

Staff participate in the tribes’ annual tribal health fairs, where they provide various OAA Title III-D presentations and screenings, and distribute information on NEK-AAA services. For example, NEK-AAA participated in the 2009 Employee Wellness Day at Prairie Band Casino and Resort Convention Center and provided information on agency services. NEK-AAA recieves signifi cant funding from the Prairie Band Potawatomi (PBP) Nation for its annual Senior Expo, which is open to all seniors in the area, and the PBP Nation typically sends a bus load of seniors to participate in the event.

OAA Title VI nutrition services are provided to members of all four tribes; however, some Native Americans regularly participate in NEK-AAA’s OAA Title III-C(1) and C(2) programs. Native Americans also receive services funded by the Senior Care Act and HCBS/FE waiver both on and off the reservations, which are not separately funded for Native Americans. Efforts are under way to collaborate with the tribes to provide Family Caregiver Support Services using OAA Title III-E and Title VI funding.

OAA Title VII Vulnerable Elder Rights Protection Activities

Legal Assistance Services are provided throughout the state to Kansans 60 years of age and older in an endeavor to protect and promote elder rights. These services are provided by Kansas Legal Services, which maintains contracts with each of the state’s 11 AAAs. Legal services are provided to the elderly under the following categories: health; protective arrangement; income preservation; public benefi ts; housing/real estate; consumer/fi nancial; and individual rights. Services are prioritized based on the needs of each PSA’s target population. Historically, the most prevalent needs provided are fi nancial/tax consultation; wills/estate planning; powers of attorney; and collections. KDOA’s Legal Assistance Developer provides guidance to, and coordinates services among, the various state and regional agencies and organizations. In addition, training is provided through workshops and community education programs.

KDOA is also actively involved in the protection of elderly Kansans from abuse, neglect and exploitation (ANE). KDOA provides ANE education and resources to customers, families, and professionals involved in the aging network through the agency’s Prevention of Elder Abuse, Neglect, and Exploitation (PEANE) grant program. These special project grants, awarded to a variety of agencies and organizations, are designed to provide education, training, and research for the prevention of elder abuse, neglect, and exploitation.

Priorities, Innovation and Progress

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KDOA and the Aging Network seek to identify and report instances of ANE of the customers they serve. The Uniform Assessment Instrument (UAI), completed for individuals seeking assistance from a AAA, assesses a variety of environmental and behavioral factors that might put customers at risk, including abuse, neglect, and exploitation. KDOA staff and case management entities work closely with SRS Adult Protective Services (APS) to address issues and to report situations of concern.

KDOA Quality Review staff assess and identify health and welfare issues for customers receiving community-based services, wherein participants are interviewed by staff to determine if their health and welfare needs are being met. Whenever staff encounter a customer with an identifi able health and/or welfare issue, a referral is made to KDOA’s Complaint Hotline or SRS APS, or concerns are reported to the case management entity, depending on the severity of the situation.

Data from the Quality Review reports is included in the following table:

Statewide DataCase File Review Question SFY 2008 SFY 2007 SFY 2006 SFY 2005

The reviewer did not observe or identify any customer health or welfare concerns. 98% 99% 98% 97%

The customer feels safe and secure in his or her home. 97% 98% 97% 99%

The customer feels secure when receiving services from provider/attendants/informal supports. 99% 98% 99% 99%

The above data was gathered in quarterly case fi le reviews performed in all service areas.

KDOA and the KLTCO represent the interests of older Kansans on various inter-agency workgroups and committees. For example, KDOA staff are participating in a workgroup involving various state agencies responsible for administration of Kansas statutes concerning ANE of dependent adults. The group identifi es statutory changes that may afford better protection to vulnerable adults, and coordinates and reviews statutory amendments needed to address the growing problem of exploitation committed by persons who hold a position of trust. Participants attend meetings of the Kansas House of Representatives’ Aging and Long-Term Care Committee’s hearings on fi duciary abuse, providing information to its members.

KDOA and the KLTCO also monitor legislative activity and provide testimony on bills affecting the elderly, particularly those bills that impact elder abuse, neglect, and exploitation. KDOA introduced legislation during the SFY 2009 session that would further restrict individuals with a criminal history from providing adult care services and the KLTCO testifi ed on a separate bill that would provide stronger laws to protect the elderly from fi duciary abuse. In addition to advocating for residents in adult care homes, the KLTCO collects information by utilizing an internal data system and submits it annually to the AoA. The report includes 133 types of complaints grouped into fi ve main categories: Resident Rights; Resident Care; Quality of Life; Administration; and Non-Provider. Ninety percent of all complaints are partially or completely resolved to the satisfaction of the resident or complainant. The ombudsman annual report can be found at www.kansasombudsman.ks.gov.

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Disaster Preparedness

KDOA coordinates activities and has developed long-range emergency preparedness plans with the 11 AAAs, other state agencies, local governments, local emergency response agencies, relief organizations, and other institutions that have responsibility for disaster relief service delivery. AAAs and licensed adult care homes are required to establish an emergency response plan, including procedures to follow in the event of a disaster.

KDOA has a memorandum of understanding with each of the 11 AAAs to provide emergency services to older Kansans. These agreements require each AAA to prepare for an emergency or disaster by developing plans and procedures for responding to emergencies, and to involve local agencies and organizations that are part of the emergency response network. These emergency plans must include, among other requirements, the development of a communication system for staff, providers, the general public, and emergency management team; education and training of AAA and service program staff, including volunteers to fulfi ll designated responsibilities during an emergency; and conducting training events for seniors at congregate dining, senior centers, and other community events regarding emergency preparedness.

KDOA and AAA Disaster and Emergency Plans are cross-walked with federal, state, and local emergency operation plans. The Kansas Division of Emergency Management (KDEM) is the state agency responsible for coordinating disaster response by all state agencies during a state or federally declared disaster. KDEM has developed the Kansas Emergency Operations Plan, which is implemented when a disaster is declared by the Governor of Kansas. This plan includes duties and responsibilities for all state agencies and works directly with the Federal Emergency Management Agency (FEMA). KDOA regularly participates in KDEM-directed planning meetings, graded and ungraded disaster drills and training exercises.

KDOA is a member of the Pandemic Infl uenza Task Force and the Kansas Bioterrorism Task Force coordinated by the Kansas Department of Health and Environment. KDOA also participated in the Kansas Department of Agriculture’s training workshop focusing on Agriculture and Natural Resources. KDOA assists the AAAs by applying for federal disaster funding, if needed when a disaster occurs. For example, in 2006-2007, Kansas experienced an unprecedented blizzard and ice storm in western Kansas, followed in the spring by fl ooding in southeast Kansas, and a tornado in southwestern Kansas that destroyed approximately 95% of the town of Greensburg. Fortunately, in each incident, the state and local response was quick and effective, a result of careful planning and implementation of the Kansas Emergency Operations Plan. KDOA applied for federal disaster grant funds for the effected AAAs and participated in responding to each of

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these disasters, assisting elderly Kansans as needed and potentially averting what could have been an even more catastrophic outcome. Faith-Based Initiatives

KDOA and the Aging Network seek opportunities to participate in activities with faith- based organizations to assist older individuals and their families to meet home and community-based needs. Beyond the many faith-based organizations that are part of the Medicaid provider network, KDOA has also relied on faith-based organizations’ participation in programs such as the Kansas Senior Farmers’ Market Nutrition Program, wherein fruits and vegetables grown by local farmers were distributed to qualifi ed seniors. KDOA partnered with United Methodist Urban Ministries, along with other organizations, to qualify individuals and distribute coupons to meet program goals.

Faith-based activities providing social services occur frequently at the local level and are specifi c to each area, depending on needs. AAA staff participate in faith-based activities in their local communities, often serving as the “aging expert” for church-affi liated organizations. Staff take these opportunities to reach elderly church members and distribute information such as the “Explore Your Options” booklet, which is a guide to information and in-home services for the elderly that is regionalized for each PSA. For example, NEK-AAA’s Executive Director is an active member of an “Unmet Needs Committee” with representatives from many churches, the Salvation Army, and other social service organizations. Although this is a faith-based initiative, it is not limited to churches. This group seeks to fi nd out about community needs for all ages, and the AAA Executive Director serves as the “aging issues expert.” KDOA has established a database with e-mail addresses and contact information for religious organizations located in Kansas and actively seeks to involve faith-based communities in state-sponsored senior programs and projects. For example, regional churches and synagogues were contacted by e-mail to inform members about the Senior 911 Summit held in Topeka in May 2009. KDOA also used this method of communication to invite members of faith-based organizations to a public meeting seeking stakeholder feedback on the Kansas State Plan on Aging and will continue to explore opportunities to utilize this mode of communication to involve faith-based organizations in senior initiatives.

Health Care System Coordination

The Kansas Department on Aging uses a variety of strategies, which are continually evaluated, to participate in, and to promote coordination within, the health care system throughout the state on behalf of consumers. This coordination has become essential with the transfer of the Adult Care Home Licensure, Certifi cation, and Evaluation Division from KDHE to KDOA. The various programs and initiatives benefi t seniors throughout the state, from those individuals living independently in the community to those in need of, and receiving services from, a licensed adult care home. Following are some of the KDOA programs and initiatives that refl ect agency interaction and coordination with the health care system.

Lifelong Communities

The Lifelong Communities Initiative is a KDOA-sponsored grassroots project which assists Kansas communities in planning better services for seniors. The initiative is designed to help Kansas communities become better places to live and to improve the quality of life for seniors through collaboration involving local leaders, businesses, organizations, and government agencies. Participating communities complete a community self-assessment tool and develop an action plan in the six Lifelong categories: Community Service; Business; Government; Transportation; Housing; and Health Care.

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Community projects are evaluated by a KDOA Community Evaluation Team. Once projects are certifi ed, the community is named a “Lifelong Community” by KDOA and provided a highway sign with the designation at a community media event.

Mental Health Information

Although mental disorders are not part of normal aging, circumstances can contribute to the development of mental health disorders in older adults including social isolation, stressful living conditions, bereavement, acute and chronic health conditions and the burden of having to take care of a seriously impaired family member. Many older people develop mental health problems for the fi rst time when they are in their later years. It is important to remember that these problems are treatable. A small number of older adults have a history of serious and persistent mental health problems that began in younger years and continue to require treatment as they become older.

KDOA partnered with SRS and Kansas State University (KSU) to update and re-publish the “Mental Health Guide for Older Kansans and Their Families,” which is distributed throughout the state and also available on KDOA’s website. In addition, KDOA staff actively participate on the Governor’s Mental Health Services Planning Council, including sub-committees addressing mental health and aging, suicide prevention, and traumatic brain injury (TBI), which often occurs in the elderly as the result of a fall.

Senior Health Insurance Counseling for Kansas (SHICK)

CMS funds a nationwide network of State Health Insurance Assistance Programs (SHIPs). In Kansas, the SHIP is known as Senior Health Insurance Counseling for Kansas (SHICK). This counseling program helps seniors navigate their way through the health insurance and Medicare systems, and helps them access privately administered Prescription Assistance Programs. The SHICK program is free to Kansas seniors and provides a reliable, confi dential, and unbiased source of information.

SHICK uses a statewide network of sponsoring organizations, call centers, and trained volunteers to provide information, assistance, and counseling to Medicare benefi ciaries in their communities. The SHICK team has also established partnerships with many community-based organizations and other agencies that provide services to people with Medicare and Medicaid in Kansas. SHICK counselors and partners across Kansas spent nearly 13,000 hours helping more than 20,000 Medicare benefi ciaries in the grant year ending March 2008. Since the passage of the Medicare Modernization Act in 2003, SHICK has been at the forefront of efforts to educate Medicare benefi ciaries in Kansas about their new Medicare options. Medicare Prescription Drug Coverage (Medicare Part D) continues to be a complex program with more than 50 insurance plans to choose from in 2008. In addition to helping benefi ciaries understand their options and select plans of their choice, SHICK staff have taken a lead role in helping benefi ciaries resolve problems with their Part D coverage. They also continue to provide education and counseling about Part D; the new preventive benefi ts available under Medicare; the Low Income Subsidy that can help benefi ciaries with prescription costs; and long-term care insurance options.

SMP

KDOA has received a three year grant to continue educating Kansas Medicare and Medicaid benefi ciaries about health care error, fraud, and abuse. As one of the SMP projects funded by the AoA, KDOA collaborates with community-based organizations across the state to recruit retired professionals and train them as volunteer educators. Together with partner organizations, these volunteers create a statewide network of fraud experts who educate benefi ciaries about identifying and reporting health care errors, fraud, and abuse.

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Since January 2006, a special focus of the SMP program has been fraud related to Medicare Part D. SMP outreach efforts have helped numerous Medicare benefi ciaries recognize and report everything from unethical selling practices to outright scams. SMP has worked with the Kansas Attorney General’s offi ce, the Kansas Insurance Department, the FBI, and the Offi ce of Inspector General to process reports of fraud and abuse.

Person-Centered Hospital Discharge Model (HDM) Grant

KDOA is developing a Person-Centered Hospital Discharge Model designed to put the patient and caregiver(s) at the center of the discharge planning process, with the focus on discharging patients home with community-based services, thereby reducing the number of default discharges to nursing facilities. The target population for this pilot is Medicaid-eligible individuals of any age with physical disabilities or chronic illness. The project goals are to: 1) create a program that elicits patients’ input and encourages them to request discharge planning if a referral has not already been made; 2) develop a comprehensive assessment, information, and education program to support caregivers; and 3) build a strong, collaborative discharge team to support the patient’s and caregiver’s goals and needs during the discharge planning process and ensure that resources are available to meet the patient’s discharge goals. The grant period runs from October 2008 through September 2011, with three pilot locations selected.

Aging and Disability Resource Center

In 2005, KDOA was awarded a grant from the AoA and CMS to develop an Aging and Disability Resource Center (ADRC) in Kansas. ADRCs use a “no wrong door” approach to improve access to federal, state, and local services. Currently, people who need services must know where and how to fi nd them, and they often must work with several different agencies to get what they need. ADRCs create single-point access to program information, application processes, and eligibility determination for all aging and disability services. Kansas ADRC staff are working with the AAAs and the Centers for Independent Living, and community partners in Wichita and Hays.

Home Telehealth Grant

KDOA awarded a grant to establish a long-term care home telehealth pilot project in Southeastern Kansas. This proactive care model, involving technology and telecommunication, provides participants with chronic diseases the opportunity to take an active role in their health care by helping to identify the need for preventive intervention before situations become acute. The pilot project, awarded to Windsor Place At-Home Care in Coffeyville, is for the period of February 1, 2007 through to October 31, 2009. KDOA and the Kansas Health Policy Authority have signed a research contract with Kansas University Medical Center (KUMC) Research Institute to determine the effectiveness in terms of cost and quality of life of this type of care delivery system on a frail, elderly population living in a community environment.

Client Assessment, Referral, and Evaluation (CARE) Program The CARE Program’s primary responsibility is to manage the statewide screening of applicants for nursing home services and provide information and referrals for other optional community-based services. Hospitals and AAAs employ a network of CARE assessors to conduct nursing home pre-admission assessments to screen for appropriate nursing home placement. The program has expanded its objectives to include assisting customers in returning to the community whenever possible. Often a person who is admitted to a nursing facility is able to recover and could return home with supportive services. One study showed 18% of these individuals staying in the community as long as fi ve years (KU Offi ce of Aging and Long Term Care, Real Choice Final Report, 2007).

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The federal requirement for Pre-Admission Screening and Resident Review (PASRR) is to ensure that persons with Mental Illness, Mental Retardation and/or Developmental Disabilities do not move into a nursing home if they could be served in a less restrictive setting. The Kansas CARE program complies with the federal PASRR requirement through a two-step process. The Level I CARE screening identifi es Mental Illness, Mental Retardation or Developmental Disability, which then triggers a Level II assessment. A Level II assessor completes an in-depth assessment and forwards the information to KDOA for a determination as to the most appropriate setting for the individual. In addition to compliance with the federal PASRR law, the CARE program works with individuals to discover their preferences, makes referrals to appropriate long-term care resources, evaluates data on unmet service needs, and recommends areas for expansion of services in Kansas based on these unmet needs.

Money Follows the Person State Program / Demonstration Grant KDOA and SRS implemented a legislative proviso in July 2003, which was renewed annually until passed into law in 2008, allowing funding to follow individuals who wish to leave a nursing facility and move back into the community and receive services provided under a Home and Community-Based Services (HCBS) Waiver. These individuals are elderly and/or disabled consumers qualifying for services through either the Medicaid HCBS waiver that serves persons over the age of 65 or the Medicaid HCBS waiver that serves persons with physical disabilities. The state program was expanded in 2009 to include the traumatically brain injured and mental retardation/developmentally disabled populations. Kansas also implemented a federal Money Follows the Person (MFP) fi ve-year rebalancing demonstration program that not only permits nursing facility funding to follow the person to the most appropriate Medicaid HCBS waiver, but includes assisting Kansans in making long-term care decisions by providing information and the opportunity to discuss their choices, and to learn how they can be served in the community as an alternative to nursing facility care. The MFP demonstration program provides services available to the individual applicable to the waiver, and also includes enhanced services called “Transition Services,” allowing for the payment of utility deposits and other expenses to re-establish a residence. This program is helping to shift Medicaid’s traditional emphasis on institutional care to a system offering greater choices that include HCBS and is eliminating barriers that prevent residents from transitioning back into the community. The four populations served by this demonstration are: Frail Elderly (FE); Physically Disabled (PD); Traumatic Brain Injured (TBI); and the Mental Retardation/Developmentally Disabled (MR/DD).

Culture Change in Long-Term Care KDOA has been involved in numerous culture change activities and continues to seek opportunities to promote culture change. The Promoting Excellent Alternatives in Kansas (PEAK) Nursing Home program promotes and supports culture change in nursing homes as they pursue person-directed care in the areas of resident control, staff empowerment, home environment, and community involvement. The two components of PEAK are recognition and education. KDOA has partnered with Kansas State University’s Center on Aging to provide the education component, which includes developing resources and training nursing home staff in how to begin and sustain the culture change journey. KDOA has also contracted with the KU School of Nursing to establish a valid and reliable culture change survey instrument and determine the impact culture change has on staff turnover, survey defi ciencies, and quality of care. In August 2007, Governor Kathleen Sebelius appointed the KLTCO to implement culture change at the two state-owned and operated long-term care Veteran communities. These culture change initiatives included open dining, quality assurance, formation of family councils, Medicare and Medicaid implementation, nurse station removal (scheduled), and the hiring of an assisted living operator for the domiciliary. Presently, Veterans in the domiciliary and cottages do not have ombudsman services available to them. The ombudsman program

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introduced legislation to change the statutory jurisdiction to cover these areas.

Workforce Enhancement Grant Program KDOA initiated the Workforce Enhancement Grant (WEG) Program in 2004, using monies from the Civil Monetary Penalty Fund (CMP) to provide educational programs for unlicensed staff in nursing homes and hospital-based long-term care units. The program was expanded in its third year to allow one licensed staff for every two unlicensed staff attending a training from the same facility. The objective of the grant program is to improve the quality of life and quality of care for residents by aiding in the development of ongoing statewide education programs. Topics are varied and include themes such as: Person-Centered Care and Choices; Restraint Reduction; Care of Residents with Dementia; Communication and Teamwork; and Pressure Ulcer Prevention. In order to assess the effectiveness of this program, KDOA has contracted with the KU Offi ce of Aging and Long-Term Care to investigate the impact of these educational programs. Specifi cally, KU will explore the outcomes of quality of care, quality of life, resident-centered care/culture change, and staff retention. In addition, KU will examine the sustainability of free- or low-cost education provided by the educational entities that were awarded the grants.

Joint Provider Training KDOA’s LCE commission, in cooperation with the adult care home provider associations including Kansas Association of Homes and Services for the Aging, Kansas Health Care Association, and Kansas Adult Care Executives, provide educational offerings semi-annually for surveyors of adult care homes and the adult care home provider community. Both groups attend the same training, providing an opportunity for an exchange of ideas and interaction in a congenial environment. Topics vary and have included culture change, resident activities, prevention of accidents, pressure ulcer prevention and treatment, and weight and nutritional concerns. KDOA staff also provide regulatory updates and address current issues, such as the regulations in which surveyors have found providers to be most frequently non-compliant, and CMS changes to the survey protocol. KDOA staff also advocate for the elderly by staying actively involved with a number of organizations, including the Kansas Medical Directors Association, the Adult Care Home Advisory Committee, the Kansas Association of Area Agencies on Aging (K4A), and the Kansas Foundation for Medical Care, Inc., which is the state’s Quality Improvement Organization.

For a complete list of KDOA’s Programs and Services, see Appendix E. Please go to Appendix G for examples of AAA Innovation and Accomplishments.

26

As Kansas prepares for the advent of aging baby boomers and the average life span continues to increase, it faces many challenges including societal ageism, retirees with insuffi cient savings, and soaring health care costs. Older workers will be competing for jobs against an ever more technologically advanced generation. Retiree reliance on Social Security, which accounted for 39% of personal income for the U.S. population age 65 and older in 2001, will likely continue to grow. The combination of poor nutrition and lack of physical activity could place an even heavier burden on an already over-taxed health care system. However, even with these daunting challenges, there is much hope for the future. “Technology’s Promise,” published by the World Future Society, provides highlights from the TechCast Project, an ongoing study of technology forecasts by leading experts, which predicts breakthroughs in energy, information technology, health care, transportation, and other critical fi elds. Following are examples of how this pool of high-tech executives, scientists, engineers, academics, consultants, futurists, and other leading experts around the world believe technology will provide for a promising future:

Precision Farming: “Computerized control of irrigation, seed, fertilizer, and pesticides to suit variations in land involves onboard GPS, geographic information systems, and other forms of information technologies. Twenty percent of farmers in the United States are adopting these practices because precision farming reduces the need for harmful chemicals, raises yields, and protects the environment. A review of 108 studies found 63% of sites using these technologies were more profi table than those that did not.” TechCast projects precision farming will be mainstream by about 2010-2015.

Virtual Education (VE) or Distance Learning: “Improvements in technology and instructional methods are allowing some institutions to thrive with online courses, and 100 million Americans take continuing education, the prime target. E-Training now accounts for about 30% of corporate training and is expected to exceed 50% soon.”

Medical Care: “Medicine is probably the least computerized industry in the world, which suggests enormous possibilities for improvement. Health care is a very complex fi eld, which partly explains the problem, but it is also stalled by resistance of physicians and hospital administrators. More powerful IT systems could help reduce the skyrocketing costs of treatment, however, so progressive hospitals are embracing such technologies as online medical records, computerized diagnostics, virtual exams with your physician, and a host of other forms of telemedicine.” TechCast goes on to predict that “advances could enter the mainstream by about 2015, saving hundreds of billions of dollars, greatly improving health care, and providing more convenient services.” TechCast also predicts enormous advancements in artifi cial organs and other body parts, and a cure for cancer. Many elderly and their families have faced the devastation disease can cause, and we are hopeful that pharmacologic, research, and technical innovations will enable more elderly to lead healthier, happier, and more functional lives.

A shortage of skilled health care workers is a universal concern. However, a combination of technology and human innovation will have a tremendous impact on this problem. For example, intelligent robots may fulfi ll many of our future healthcare needs. “The Japanese and Koreans are now gearing up to sell millions of robots to serve important roles in industrial work, home services, health care, military, and leisure activities. They intend to start placing robots in homes by 2010.” TechCast estimates robot use will likely mainstream no later than 2020.

Looking Toward the Future

27

Although technology is proving to be very exciting and will continue to alter the way we deliver and receive services and support, there will always be the need for human touch. The boomers represent a large pool of caregivers and volunteers, with many caring for aging family members. According to a recent AARP article, “more than 44 million Americans are involved in caring for an aging relative or friend, and about 29 million of them are employed . . . Among boomers, 35 percent say they are, or have been, responsible for their parents’ care.”

Many seniors will want to continue working outside the home or will have to for fi nancial reasons. Older individuals will face challenges in the labor market, including negative perceptions of older workers’ abilities and the need for renewed skills. We will likely see more “seniors” in virtual school, re-training to pursue a new career or pastime. Many seniors may elect to follow in the path of Nola Ochs, the Kansan who broke a Guinness World Record when, in 2007, she graduated from Fort Hays State University at the age of 95. These predictions challenge the imagination and illustrate the exciting changes many of us can expect to see during our lifetime. Although some may seem implausible, we need only think of the way technology has impacted our daily lives over the last 30 years. With the advent of the Internet, we now have computer connections that allow us to use the World Wide Web to send emails and look up information on just about any topic simply by typing a few key words into a search engine. We can now bank, shop, and plan our vacations on-line. It’s almost impossible to stay current with changing technology, from mobile phones to iPods, and terminology, such as texting and twittering, is altering the way we communicate.

With these changes have come innovations in services for the elderly. Home telemonitoring systems are already being utilized to provide in-home health monitoring, medication management, and safety and security for the elderly. Seniors of the future will have more options than ever before. Aging Kansans will have the same desire to stay mentally acute and physically active as do today’s seniors. They will want a secure, dignifi ed, and independent existence and KDOA will continue to adapt to their changing needs. There is much work to be done and progress to be made. KDOA, along with the Aging Network, will continue to advocate and educate, to provide services necessary to keep seniors in the environment of their choice, to provide oversight to maintain quality services and care, to pilot innovative programs and analyze the results. KDOA will continue to provide a cohesive, interdependent system to serve aging Kansans.

Intrastate Funding Formula

Base AllotmentA base allocation of $150,000 is allotted to each planning and service area (PSA) from the OAA III B social services allotment. This base allocation takes into consideration the special needs of the rural planning and service areas.

Remaining AllotmentThe remaining OAA III B social service allotment, OAA III C nutrition services allotments, OAA III D health promotion and disease prevention allotment, OAA III E the National Family Caregiver Support Program allotment, and any future allotments under Title III shall be allotted using the following method:

Each PSA shall be allotted an amount based on the ratio of the population age 60 and older, plus two (2) times the low-income population age 60 and older, plus two times the minority population age 60 and older in the PSA.

OR(A + 2B + 2C) / (D + 2E + 2F) = PSA allocation percentage

A = PSA’s age 60 and older populationB = PSA’s minority age 60 and older pop.C = PSA’s low-income population age 60 and olderD = State’s age 60 and older populationE = State’s minority age 60 and older populationF = State’s low-income population age 60 and older

The low-income population consists of the number of persons with incomes at or below poverty level as established by the Census Bureau.

Allocation of Funds

PSAPercent of Total

1 9.55%2 18.79%3 5.05%4 9.80%5 8.70%6 8.50%7 3.80%8 11.28%9 3.89%10 9.02%11 11.62%

100.00%

Reallocation of Unearned Federal Funds (Carryover)

For each part or subpart under Title III, unearned federal funds (carryover) in excess of 5% of each AAA’s previous year’s award will be pooled, reduced by any amount designated for special or model projects, and (if a balance remains) allocated only to AAAs with carryover of 5% or less based upon their intrastate funding formula relative share.

Appendix A: Interstate Funding Formula and Allocation of Funds

Appendix A-1

Appendix B: KDOA Organizational Chart

Appendix B-1

AREA AGENCIES ON AGINGPSA 01 – Wyandotte-Leavenworth AAARuth Jones, Director1300 North 78th Street, Suite #100Kansas City, KS 66112-1540913-573-8531 / 1-888-661-1444Fax: 913-573-8577

PSA 05 – Southeast KS AAAJohn Green, Director1 West AshChanute, KS 66720-1010620-431-2980 / 1-800-794-2440Fax: 620-431-2988

PSA 09 – Northeast KS AAAJim Beckwith, Director526 OregonHiawatha, KS 66434-2222785-742-7152 / 1-800-883-2549Fax: 785-742-7154

PSA 02 – Central Plains AAAAnnette Graham, Director2622 W. Central, Suite 500Wichita, KS 67203-3725316-660-7298 / 1-800-367-7298Fax: 316-383-7757

PSA 06 – Southwest KS AAADave Geist, Director236 San Jose DriveDodge City, KS 67801-1636620-225-8230 / 1-800-742-9531Fax: 620-225-8240

PSA 10 – South Central KS AAAJodi Abington, Director304 S. SummitArkansas City, KS 67005620-442-0268 / 1-800-362-0264Fax: 620-442-0296

PSA 03 – Northwest KS AAAGreg Hoover, Director510 W 29th Street, Suite BHays, KS 67601-3703785-628-8204 / 1-800-432-7422Fax: 785-628-6096

PSA 07 – East Central KS AAAElizabeth Maxwell, Director132 South MainOttawa, KS 66067-2327785-242-7200 / 1-800-633-5621Fax: 785-242-7202

PSA 11 – Johnson Co AAADan Goodman, Executive Director11811 S Sunset Drive, Ste # 1300Olathe, KS 66061-7056913-715-8800 / 1-888-214-4404Fax: 913-715-8825

PSA 04 – Jayhawk AAA 2910 SW Topeka Blvd.Topeka, KS 66611785-235-1367 / 1-800-798-1366Fax: 785-235-2443

PSA 08 – North Central Flint Hills AAAJulie Govert-Walter, Director401 HoustonManhattan, KS 66502785-776-9294 / 1-800-432-2703Fax: 785-776-9479 Updated July 1, 2008

Appendix C: Kansas Area Agencies on Aging Map and Contact Information

Appendix C-1

Five Priorities

Make it easier for residents/resident families to access, utilize, and visualize 1. the Long-Term Care (LTC) Ombudsman program resources.

Staffi ng regional ombudsman in each of the 11 AAA service areasa. Phone/Fax/Computer (upgrade all computer systems and enhance the OZBUD customized b. program, current programs)Computer system that truly supports system c.

(Shared Server, Website, Webcam)More actual and virtual visits to LTC facilities regional/volunteersd. Increase volunteer ombudsman to 300 (Currently 202 from 100) e.

Help residents stay active and healthy by supporting facilities and programs that promote resident choice 2. and independence.

Culture changea. Money Follows the Person Home (MFP) b. Disaster Assistance and Planning (planning and assistance)c.

Support families in their efforts to care for their loved ones at the nursing home, assisted living facilities, 3. Home Plus and Home in the community.

Work before entering system—organizations(AAA, AARP, Disability Groups, KABC)a.

Ensure the rights of residents and prevent their abuse, neglect and exploitation.4. Collect data for National Ombudsman Reporting System (NORS)a. Trend data and report to the Governor and Legislatureb. Lobby on behalf on the population represented on behalf of their needs c. Create programs that promote residents rights and ANE prevention to the resident, resident’s d. family member, DPOA, DPOH or legal guardian. (“OMBUDDY”)

Promote effective advocacy and responsive program management.5.

Development and Update of Action Plan

Developed in 2006-2007Can take into account annual planning cycles, policy changes, and budget environment.

Updated at annual implementation plan in July

Our Mission: To help residents achieve the highest quality of life.

Vision: Advocacy for Kansans needing LTC services in any part of community.

Appendix D: Kansas Long-Term Care Ombudsman Strategic Action Plan 2007 - 2012

Appendix D-1

Core Values:Listen to residents, resident families, and organizations that serve them.• Capitalize on the experience and unique attributes of our program—fl exibility, federal conference • laws, accessibilities, and recognize.Identify and promote the best health delivery systems and model available in long-term care.• Produce measurable outcomes that have signifi cant impact on residents and resident families.• Respond to the changing needs and preferences of a diverse and growing elderly population across • spectrum.Take advantage of external opportunities to advance our ombudsman program•

Our Strategies to Advance Ombudsman Leadership Mission

Advocacy, which encompasses ombudsman responsibility to represent the needs, concerns and issues of 1. residents.Dissemination of program information and conduct public education activities.2. The allocation of ombudsman resources to goals.3. Knowledge development, harnessing of experiences, research translation, resident community 4. implementation (policy analysis, research families, new model research).Effective management and administration that is responsive to and supports the policy and program 5. activities of the ombudsman program.

Ombudsman Goals:

Advocacy1. Information and Public Education2. Knowledge3. Development4. Project Research Translation5. Community Implementation6. Technical Assistance7. Effective/Responsive Management and Administration8.

Five-Year Goals

Goal 1: Increase Program Utilization to accomplish set objectives

Objective: Strengthen ombudsman capacity to provide information or access of program.Strategies:

Educate the resident and facility policy makers about accessing services and address challenges a. to this strategy.Disseminate more information—administrator and nursing conferencesb. Increase technical assistance compliance program developmentc. Increase volunteer ombudsman ranks to 300d.

Appendix D-2

Goal 2: Promote independent healthy (to best ability) resident communities

Objective: Support individuals/organizations that promote and implement person centered care in their facilities. Strategies:

Support role of culture change models that promote mental and physical a. health (resident rights)

Develop increased role in culture change—create ombudsman excellence award for best b. programs, not duplicate. Identify and disseminate knowledge, information, and technical assistancec. Support new development of reliable models and techniquesd. Conduct analysis and research visits and conversationse. Increase ombudsman volunteers and support stafff. Administrator and nursing seminarsg.

Goal 3: Increase number of families who are supportive in their efforts to care for their support of residents.

Objective: Strengthen ombudsman capacity to provide information to families, facilities, and family councils on importance of due diligence in representing a resident.Strategies:

Educate family, facilities and family councils.a. Educate public on importance of helping residents in all care models.b. Increase volunteer ranksc. Partner with affi liates of families and advocates (AAA, KABC)d. Begin using technology to conduct volunteer trainings and advocacye.

Goal 4: Increase benefi t program, decrease ANE

Objective: Strengthen ombudsman capacity to prevent ANE Strategies:

Educate resident, facilities, publica. Provide information, structures, graduated systemsb. Develop and implement unique preventative ANE programc. Support other organization in effort to eradicate ANE from Kansas LTC facilities. d.

Goal 5: Strengthen the effectiveness of ombudsman management and administrative practices. Objective 1: Improve the strategies of management and administration Strategies:

Enhance communication throughout programa. e-mail, telephone, video conferencing and web casting1. case management direct line of communication2.

Maintain and regularly update a workforce plan.b. Proactively seek opportunities to gain support of other agencies, organization, and policies.c. Use employee performance plans and evaluations to measure contribution of all employees.d. Increase by two regional ombudsman.(increase in volunteers)e. Increase volunteer support stafff. Create a special projects coordinatorg.

Appendix D-3

Objective 2: Stabilize, improve, and maintain strong fi nancial management practices.Strategies:

Find and analyze cycles to sound fi scal amount.a. Find new internal mechanisms.b. Look for new sponsorship act for conferencec. Replace needed and new program equipment.d. Develop management report that accurately refl ects program needs and goals.e. Promote idea and fund creation of Ombudsman II classifi cation. f. Proactively make decisions that maintain fi scal health.g. Develop continuous approach to cycles.h. Develop ongoing fi nancial vehicles that sustain program.i. Search for ideas in budgeting projects, from staff on needs.j. Actively use technology to assist with all program goals.k.

Goal 6: To implement Culture Change at the Two Veteran Communities.

Objective 1: Improve the strategies of management and assist the KCVA administrationStrategies:

Create a Task Force for the Governora. Assist in State and Veteran Administration Health Compliance b. Find and analyze cycles to sound fi scal amountc. Find new internal mechanisms-Nursing pool, on-calld. Implement Medicare/Medicaid Programe. Replace needed and new program equipment.f. Purchase Software that will update fi nancial systems to refl ect current LTC practices g. Develop management report that accurately refl ects program needs and goals.h. Promote idea and fund creation of Veteran Ombudsman Position. i. Proactively make decisions that maintain fi scal health.j. Develop continuous approach to cycles.k. Develop structure that ensures ongoing cultural change and accountabilityl. Increases salaries as needed to provide the safe amount of services to facilitiesm. Search for ideas in budgeting projectsn.

Goal 7: To advocate and assist eligible residents to the least restrictive environment

Objective 1: Participate in the Money Follows the Person Demonstration Grant Strategies:

Permanent member of the steering committee creating guidelines for granta. Program participation maintaining Mission and no Confl ict of Interestb. Create Money Follows the Person Coordinator/Regional Ombudsmanc. Assist in State MFP meetings d. Develop management report that accurately refl ects program needs and goals.e. Develop continuous approach to independence and advocacy for residents in any LTC setting.f.

Appendix D-4

Aging and Disability Resource Center (ADRC) – provides streamlined access to program information, appli-cation processes, and eligibility determination for all aging and disability services.

Case Management (CM) (state-funded) – provides long-term case management to non-Medicaid frail elders who are seeking assistance to remain in their homes or community. CM services include developing and updat-ing plans of care, resource development, assisting the customer in acquiring needed services, and ensuring that public and private resources are being used effi ciently.

Client Assessment, Referral and Evaluation Program (CARE) – provides an assessment to identify custom-er preferences on long-term care service options to determine appropriate placement in long-term care facilities, and collects data regarding individuals being assessed for possible nursing facility placement.

Complaint Hotline – receives complaints about the health, safety, sanitation, nutrition, or care of residents in adult care homes, ensures an investigation is completed, and appropriate action taken in the event abuse, ne-glect, or exploitation of a resident is confi rmed.

Home and Community-Based Services – Frail Elderly (HCBS/FE) – provides Medicaid-eligible custom-ers with the opportunity to receive cost-effective community-based services as an alternative to nursing facility care. Services include: adult day care; assistive technology; attendant care services (provider- and self-direct-ed); comprehensive support (provider- and self-directed); nursing evaluation visit; oral health services; personal emergency response and medication reminder; sleep cycle support; and wellness monitoring.

Information and Assistance (I&A) – operates in conjunction with the AAAs to provide information about community and public assistance programs for seniors and link people with appropriate agencies.

Legal Assistance – provides access to the system of justice by offering advice and representation by a legal pro-vider who, in turn, acts as an advocate for the social and economically needy older individual, thereby helping that individual gain access to essential services or fi nancial resources, and protecting the individual’s rights to be autonomous and to retain their dignity.

Licensure and Certifi cation Division – promotes excellence in health care and living conditions for nursing home residents through the initial nursing home provider licensure process and annual surveys to assure federal and state regulatory standards are met.

Lifelong Communities Initiative – assists communities in providing better service to seniors in six areas: Busi-ness; Community Service; Health Care; Housing; Transportation; and Government.

Long Term Care Division – provides consultation to consumers, adult care home providers, health care facility surveyors, and other stakeholders in the long term health care industry. Services include education and training, technical support, and participation in various workgroups.

Mental Health and Residential Care Facilities Division – evaluates intermediate care facilities, assisted liv-ing facilities, and other state-licensed only facilities for state licensure and federal certifi cation.

Appendix E: KDOA’s Programs and Services

Appendix E-1

Money Follows the Person (MFP) – assists eligible nursing home residents in returning to the community and allows funds for persons living in nursing homes to be transferred to the HCBS/FE or other applicable partici-pating waiver program upon the customer’s relocation to the community.

Nursing Facility Medicaid Rate-Setting – establishes reimbursement rates for, and provides payment to, Medicaid-certifi ed nursing homes; rates are cost-based, facility-specifi c, and case mix adjusted based on the acuity level of each facility’s Medicaid residents.

Older Americans Act – Title III-B Access, Community and In-Home Services – provides access services such as information and assistance, case management, legal services, and transportation; in-home services such as attendant care, homemaker, respite care, and adult day care; and community services such as newsletters, program development, legal assistance, recreation, and counseling.

Older Americans Act - Title III-C Nutrition Program – provides meals to eligible participants in a congre-gate setting or in a homebound individual’s place of residence.

Older Americans Act – Title III-D Disease Prevention and Health Promotion Services – provides Disease Prevention and Health Promotion Services grants to Area Agencies on Aging, which support any of the 15 health-related services such as health risk evaluations, screening for physical or mental health concerns, nutri-tion counseling, health promotion programs, and physical fi tness and exercise programs.

Older Americans Act – Title III-E Family Caregiver Support Program – provides a multi-faceted system of support services to assist caregivers, including information and assistance, counseling, respite, support groups, and training. Supplemental services may include attendant/personal care, bathroom items, chore, fl ex service, homemaker, transportation, and repair/maintenance/renovation.

Partnership Grant Program (PGP) – provides competitive matching grants for projects such as improvements in the quality of case management services for home and community-based service programs and for adult care home improvements. (Unfunded beginning SFY 2009)

Partnership Loan Program (PLP) – supports the expansion of housing alternatives for senior Kansans or the improvement of services in long term care by providing low interest loans. (Unfunded beginning SFY 2009)

Person-Centered Hospital Discharge Model Grant (HDM) – develop and pilot a hospital discharge model that elicits patients’ input and encourages them to request discharge planning; develop a comprehensive assess-ment, information, and education program to support caregivers; and build a strong, collaborative discharge team to support the patient’s and caregiver’s goals and needs during the discharge planning process and ensure resources are available to meet the patient’s discharge goals.

Prevention of Elder Abuse, Neglect and Exploitation (PEANE) Special Project Grants –provides educa-tion, training, and research for the prevention of elder abuse, neglect, and exploitation; or to study the nature or extent of fi nancial exploitation of the elderly.

Program for All-inclusive Care for the Elderly (PACE) – combines services and health care available from both Medicare and Medicaid programs into a single managed care program with the goal of enabling individu-als to live independently in the community with a high quality of life.

Appendix E-2

Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK) – supports and promotes culture change in nursing homes in the areas of resident control, staff empowerment, home environment, and commu-nity involvement as they pursue person-directed care. Includes recognition through the PEAK Awards Program, and education by means of grants awarded to Kansas State University’s Center on Aging to develop resources for culture change and train nursing home staff.

Senior Care Act (SCA) – coordinated system of in-home services for people age 60 and older who face diffi -culties in self-care and independent living, to prevent inappropriate or premature institutionalization of persons who have not yet exhausted their fi nancial resources. Services include assistance with activities of daily liv-ing (ADLs) such as bathing, dressing, and eating; instrumental activities of daily living (IADLs) such as house cleaning, laundry, and bill paying; and health maintenance activities such as monitoring of vital signs, wound care, and medication administration and assistance.

Senior Farmers’ Market Nutrition Program (SFMNP) – promotes better nutrition for low-income seniors by providing fresh fruits and vegetables purchased from local farmers, thereby expanding revenue base for farmers; also provides nutrition education to participating seniors. (Unfunded beginning SFY 2009)

Senior Health Insurance Counseling for Kansas (SHICK) – organizes and trains SHICK volunteers to help Kansans understand their Medicare benefi ts. SHICK counselors provide information and assistance with Medicare claims and appeals, Medicare Prescription Drug Coverage (Part D), Medicare supplemental insurance (Medigap) policies, and long term care options and fi nancing. SHICK counselors also help eligible consumers access assistance programs offered by pharmaceutical companies.

Seniors Together Enjoy Physical Success (STEPS) – provides training to instructors and exercise equipment for community fi tness classes addressing the unique physical needs of seniors age 60 and over. Participants are assessed before beginning classes and throughout to evaluate overall strength and balance.

SMP (formerly Senior Medicare Patrol) - educates Medicare and Medicaid benefi ciaries and providers on how to recognize and report health care error, fraud, and abuse. SMP collaborates with community-based orga-nizations across the state to recruit retired professionals and train them as volunteer educators.

Targeted Case Management (TCM) – provides long-term case management to Medicaid-eligible frail elders who are seeking assistance to remain in their homes or community. TCM services include developing and updating plans of care, resource development, assisting the customer in acquiring needed services, and ensuring that public and private resources are being used effi ciently.

Workforce Enhancement Grant (WEG) Program – provides grants using Civil Money Penalties (CMPs) to fund educational programs for staff in nursing homes and hospital-based long-term care units, thereby improv-ing the quality of life and quality of care for residents by aiding in the development of ongoing statewide educa-tion programs.

Appendix E-3

KANSAS DEPARTMENT ON AGING

Annual Report

SFY 2008 - July 1, 2007 - June 30, 2008

Kathleen Sebelius, Governor Kathy Greenlee, Secretary

Appendix F: KDOA’s Annual Report

Appendix F-1

As you review KDOA’s annual report, you will see the many ways KDOA touches the lives of Kansas seniors and their families. From helping to fund senior nutrition programs to inspecting nursing home care for safety and quality to helping seniors understand their Medicare options, KDOA plays a vital role for Kansas seniors.

We also have a major role in advocating for the programs and services that seniors need and depend on.

We do this through educational programs, through testimony at the Legislature, through interaction with our stakeholders, including senior services-related

organizations. In Kansas, seniors are an important constituency. The 65-and-older population comprises more than 13 percent of the state’s population, and in several Kansas counties, seniors represent one-fourth of the population.

Our goal at KDOA is to help seniors enjoy the best possible lifestyle they can. One way we do that is by promoting the Lifelong Communities Initiative. So far, four Kansas communities – Great Bend, Dodge City, Chase County and Topeka – have earned Lifelong Community designation by providing improvements and services that make their communities more accessible. Many of the improvements benefi t not only seniors but citizens of all ages. I’m please that more cities are working toward that designation.

Although we strive to keep people in their own homes as long as possible, we also know that in-home services are not always the best option. Sometimes, an adult care home, whether it be assisted living or a nursing home, becomes necessary. KDOA plays an important role in this area, too, through its licensing, inspection and certifi cation duties.

Beyond that, we also encourage those homes to adopt a new culture, away from the institutional models of the past toward creating a homey atmosphere. I’m pleased that Kansas has earned a reputation for being a leader in this area. At KDOA, we recognize outstanding achievements in this through our PEAK Awards. PEAK stands for Promoting Excellent Alternatives in Kansas nursing homes.

Secretary of the Kansas Department on Aging

A Letter from Secretary Greenlee

Front Cover Photograph: Kansas Silver Haired Legislators meet for their annual sessionPhoto courtesy of Irv Hoffman, Silver Haired Legislator, Lenexa, Kansas

January 2009

Appendix F-2

KDOA Organizational Chart and Directory ..................................................................................................... 1

Choices in Consumer Services.................................................................................................................................2Senior Care Act....................................................................................................................2Home and Community Based Services - Frail Elderly........................................................ 2Targeted Case Management................................................................................................. 3Client Assessment Referral and Evaluation Program.......................................................... 3Money Follows the Person ................................................................................................. 4Nursing Facility Rate-Setting ............................................................................................. 4Senior Health Insurance Counseling for Kansas................................................................. 5SMP..................................................................................................................................... 6Lifelong Communities Initiative ........................................................................................ 6Nursing Facility Audits and Quality Review ..................................................................... 7Program for All-inclusive Care for the Elderly .................................................................. 7Aging and Disability Resource Center ............................................................................... 7Older Americans Act - Title III-E ....................................................................................... 8Older Americans Act - Title III-B ....................................................................................... 8Prevention of Elder Abuse, Neglect and Exploitation Special Projects Grant ................... 9

Culture Change in Long Term Care.....................................................................................................................10Promoting Excellent Alternatives in Kansas..................................................................... 10Long-Term Care Division .................................................................................................10Mental Health and Residential Care Facilities Division....................................................11Licensure and Certifi cation Division ................................................................................ 11Partnership Loan Program/Partnership Grant Program .................................................... 13

Healthy Aging...........................................................................................................................................................14Older Americans Act - Title III-C..................................................................................... 14Senior Farmers Market Nutrition Program........................................................................14Seniors Together Enjoy Physical Success......................................................................... 15Older Americans Act - Title III-D......................................................................................15

Funding Sources........................................................................................................................................................16

Area Agencies on Aging.......................................................................................................................................... 17

State Advisory Council on Aging......................................................................................................................... 19

Silver Haired Legislature.........................................................................................................................................20

Table of Contents

Appendix F-3

KDOA Organizational Chart and Directory

Senior Staff

Secretary Kathy Greenlee............................................................................................785-296-5222

Deputy Secretary, Martin Kennedy..............................................................................785-296-6681

Chief Counsel, Joann Corpstein...................................................................................785-368-7228

Administrative Services Commissioner, Alice Knatt...................................................785-296-6464

Acting Licensure, Certifi cation and Evaluation Commissioner, Greg Reser...............785-291-3374

Public Affairs Director, Barbara Conant......................................................................785-296-6154

Program and Policy Commissioner, Bill McDaniel.....................................................785-296-0700

Other Helpful Numbers

Executive Assistant, Traci Ward...................................................................................785-296-5222

Human Resources Director, Carmen Sellens................................................................785-296-6361

Nursing Facility Complaint Toll-Free Hotline..........................................................1-800-842-0078

Long-Term Care Consultant Vera VanBruggen............................................................785-296-1246

Senior Health Insurance Counseling for Kansas Hotline..........................................1-800-860-5260

KDOA TTD..................................................................................................................785-291-3167

KDOA Toll Free........................................................................................................1-800-432-3535

KDOA Fax...................................................................................................................785-296-0256

Appendix F-4

Choices in Consumer Services

Senior Care Act

Purpose:The Senior Care Act provides for the development of a coordinated system of in-home services for people age 60 and older who face diffi culties in self-care and independent living to prevent inappropriate or premature institutionalization of persons who have not yet exhausted their fi nancial resources. According to last year’s Quality Assurance Review of customers, 41% reported services received were the primary reason they were able to stay in their home.

Dollars:Although this program is funded through State General Funds, it also includes local funding and customer co-payments. Each customer is charged a fee taken from a sliding scale based on the customer’s family size, monthly income and liquid assets. Depending on those factors listed, the fee can be anywhere from a small donation to 100% of the cost of the services. State General Funds along with a Social Services Block Grant provided $7,559,539 and with adding local match and customer fees the total amount for Senior Care Act expenditures in FY 2008 equaled $8,013,389.

Number of persons who received Senior Care Act services during FY 2008: There were 6,069 seniors statewide who received one or more services during the SFY 2008. Approximately 3,008 seniors received one or more services per month. The chart below shows the most common types of ser-vices and number of customers served during FY 2008.

Home and Community Based Services - Frail Elderly (HCBS-FE)

Purpose:The Home and Community-Based Services for the Frail Elderly program provides Medicaid eligible custom-ers with the opportunity to receive cost-effective community based services as an alternative to nursing facility care.

Persons served:An average of 5,765 seniors a month received services, such as adult day care, sleep cycle support, installation and rental of personal emergency response equipment, wellness monitoring, attendant care services levels I and II, assistive technology, nursing evaluation visit, medication reminder, and oral health services.

Goal: Make an array of high-quality supports and services available to Kansas seniors and other individuals.

Senior Care Act Dollars

94%

6% State GeneralFunds & SocialService Block Grant

Local Match &Customer Fees

Service Acronyms SFY 2008Case Management – Senior CMGTS 4,509Assessment ASMT 4,119Homemaker HMKR 3,096Attendant Care ATCR 1,310Other All Other Services 2,360

Appendix F-5

Service providers: Through FY 2008, the average monthly number of HCBS/FE providers increased slightly to 339 unduplicated active providers per month from 336. With the implementation of the dental progam in 2008, dental providers have increased to 24.

Dollars:In FY 2008, $65,740,826 was expended for services. The average cost per customer for HCBS/FE services was $950 per month. Of this amount for services, approximately 60% is federally funded and 40% is state funded.

Targeted Case Management

Purpose: Targeted Case Management (TCM) provides long-term case management to Medicaid eligible frail elders who are seeking assistance to remain in their homes or community. TCM services include developing and updating plans of care, resource development, assisting the customer in acquiring needed services, ensuring that public and private resources are being used effi ciently. As of April 2008, assessment and re-assessment became a part of TCM services for Title XIX Medicaid eligible individuals, which had previously been a separate component funded through Medicaid Administration. The service is funded as a Medicaid State Plan Service expense rather than an expense to the Home and Community-Based Services/Frail Elderly waiver.

Persons Served:TCM SFY 08 served a monthly average of 4,455 customers.

Dollars: In FY 2008, the average cost per customer per month for TCM was $99, which breaks down to approximately 2.28 hours of service delivery per customer per month. The total cost of TCM services was $5,276,487. These services are broken down with an approximate match of 60% federal funds and 40% state funds.

Client Assessment Referral and Evaluation Program (CARE)

Purpose:The Client Assessment Referral and Evaluation provides an assessment to identify customer preferences on long-term care service options to determine appropriate placement in long-term care facilities and collects data regarding individuals being assessed for possible nursing facility placement. The CARE program complies with Federal PASRR laws, evaluates needs for community services, provides information and education regarding long term care choices, and diverts over 19% of long term care residents to community living. A savings of $1,778 per month is realized for each individual utilizing Medicaid services and able to return to the community after a nursing facility stay. Persons served:A total of 12,926 Level I assessments were completed for individuals; 151 individuals received more than one assessment due to a signifi cant change in their physical and/or mental health condition. A total of 510 Level II assessments were completed. Of those, 410 were for persons with mental illness, and 100 with mental retarda-tion/developmental disability. Follow-up contact is made 30 days after receiving the CARE assessment. In SFY 2008, at the 30-day follow-up, 2,359 individuals (19.4%) had been diverted from nursing home care.

HCBS-FE Dollars

60%

40% Federal FundsState Funds

Appendix F-6

Diversion emphasis:The CARE program had a diversion rate at 30 days for SFY ‘08 of 19.4%, compared to SFY ‘07 of 14.5%. This achievement means that in Kansas nearly 1 in 5 persons who enter a nursing facility are able to return to the community.

Dollars:In SFY 2008, the average contracted cost for a Level I assess-ment was $89 and the total assessment costs were $1,153,847. The average costs for a Level II assessment was $282. Total Level II assessment costs were $144,000.

During SFY 2008, the average monthly Medicaid payment for a resident in a nursing facility was $2,831. Dur-ing the same time, the average monthly Medicaid payment for a person served by the Home and Community-Based Services-Frail Elderly (HCBS-FE) waiver program was $950. Ap-proximately 61% of the Medicaid cost is federally funded, while 39% is state funded. Although additional costs are incurred for HCBS-FE custom-ers, the potential overall saving from those individuals who were diverted from more costly nursing facility care for an entire year is approximately $29.8 million.

Money Follows the Person

Purpose:The Money Follows the Person Project allows funds for persons living in nursing homes to be transferred to the Home and Community Based Services (HCBS) Frail Elderly (FE) or Physically Disabled (PD) waiver program upon relocation to the community. Qualifi -cations for this program require a 90-day continuous stay.

Persons served:Twelve people moved from nursing homes to the HCBS-FE waiver program and 17 people moved to the HCBS-PD waiver program.

Dollars:The state general funds were transferred from the nursing home budget (KDOA) to the HCBS-Physically Dis-ability waiver budget (SRS) twice a year. The total state general fund transfer in SFY 2008 was $94,910 for the Frail Elderly Waiver and $140,759 for the PD Waiver, for a total of $235,669.

Nursing Facility Rate-Setting

Purpose:KDOA is responsible for setting Medicaid rates for nursing homes. At the end of SFY 2008, 323 Medicaid certi-fi ed nursing homes provided 24-hour skilled nursing care. The Medicaid rates are case mix adjusted based on the acuity level of Medicaid residents.

Persons served:Services were provided to an average of 10,581 Medicaid eligible residents each month during the year, a decrease of 0.7% from the previous year. Approximately 92% of all nursing facility residents were over age 65,

CARE Dollars

39%

61%

Federal FundsState Funds

Status at 30-Day Follow-Up Remain in Nursing Home

56%

Diverted With Services In Community

19%

Other *11%

Alternate Housing in Community

3%

No Services in Community

4%

Deceased7%

Other includes those in the hospital or correctional facility, those that have moved out of state, and those that cannot be located.

*

Appendix F-7

and about 72% were female. The average age of female nursing home residents was 85, and the average age for male residents was 80. The combined average age was 83.

Dollars:The total nursing home expenditure in SFY 2008 was $355.5 million ($143.4 million state funds), a 3.3% in-crease from the previous year. The budget is approximately 60% federally funded and 40% state funded.

Senior Health Insurance Counseling for Kansas (SHICK)

Purpose:More than 400 Senior Health Insurance Counseling for Kansas volunteers, working through 15 regional Sponsoring Organizations across the state, help Kansans understand their Medi-care benefi ts. SHICK counselors provide information and assistance with Medicare claims and appeals, Medicare Prescription Drug Coverage (Part D), Medicare supplemental insur-ance (Medigap) policies, and long term care fi nancing and options. SHICK counselors also help eligible consumers access the assistance programs offered by pharmaceutical companies to reduce medication costs.

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0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

HCBS/FE Nursing Facility

Kansas LTC Medicaid Average Caseload

Demographics of those served (Resident Acuity Level Profi le as of July 1, 2009):

RESIDENT CASE MIX

CATEGORYEXAMPLES OF RESIDENT CHARACTER-

ISTICS

PERCENT TOTAL

RESIDENTS

PERCENT MEDICAID

ONLY Rehabilitation Rehabilitation therapy received 11.16% 6.79%

Extensive Services In past 14 days, received intravenous medica-tion, tracheotomy care, required ventilator/respirator, or in past 7 days received intrave-nous feeding

5.73% 4.34%

Special Care Multiple sclerosis, cerebral palsy, quadriple-gia, or respiratory therapy 8.49% 8.67%

Clinically Complex Comatose, have burns, septicemia, pneumo-nia, internal bleeding, dehydration, dialysis, or receive chemotherapy 20.05% 22.22%

Cognitive Impairment Alzheimer’s disease or other types of demen-tia

12.47% 13.32%

Behavior Problems Resists care, combative, physically and/or verbally abusive, wandering, or delusional 1.26% 1.64%

Physical Function Restricted physical functions 40.84% 43.02%

Appendix F-8

Number of persons served during GFY 2007:SHICK services are available to all Kansas Medicare benefi ciaries at no cost to the customer. The SHICK pro-gram provided counseling services to 21,902 Kansans and reached 1,077,888 people thru media and outreach events in the 2007 grant year.

Dollars:SHICK is funded by a grant from the Centers for Medicaid and Medicare Services (CMS). CMS provided a SHIP Basic grant of $378,512 for the 2007 grant year.

SMP

Purpose: The Kansas SMP program (formerly Senior Medicare Patrol) educates Medicare and Medicaid benefi ciaries and providers on how to recognize and report health care error, fraud and abuse. Kansas SMP collaborates with community-based organizations across the state to recruit retired professionals and train them as volunteer educators.

Persons served:SMP trained 65 new volunteers in grant year 2007. Staff and volunteers provided education about health care fraud and abuse to nearly 6,000 people through community education and media events. Kansas SMP also helped process 106 fraud inquiries.

Dollars:Kansas SMP is funded by a grant from the Administration on Aging (AoA), with 75% federal funds being matched with 25% state funds. In grant FY 2007, AoA provided $63,930 and the state provided $21,311.

Lifelong Communities Initiative

Purpose:The quality of life for senior citizens in Kansas communities is enhanced through participation in the Lifelong Communities Initiative. KDOA assists communities to plan for and better serve seniors in the six Lifelong areas: Business, Community Service, Health Care, Housing, Transportation and Government. The Initiative was previously recognized as a “Program Champion” by the U.S. Administration on Ag-ing (AoA). The honor is designed to highlight programs and initiatives that demonstrate principles of the AoA strategy to modernize health and long term care for senior citizens and those with disabilities.

Communities designated lifelong:This year Topeka was offi cially named a Lifelong Community. In 2007, Dodge City, Great Bend and Chase County were offi cially named Lifelong Communities. Communities are recognized for innovation in providing community service projects for seniors. Projects that benefi t seniors benefi t everyone in a community.

A Lifelong Communities Tool Kit was developed to help Kansas communities become familiar with how to participate in the Initiative. The Tool Kit contains the community assessment tool, template for action plans and implementation of community projects. Technical assistance is provided to each community throughout the process by KDOA staff.

SMP Dollars75%

25%

Federal Funds

State Funds

Appendix F-9

The four-step process involves the follows: 1) Obtain support from local government; 2) Complete community assessment tool; 3) Develop and implement action plan; 4) Verifi cation, designation.

Dollars:KDOA does not have a budget line item for this Initiative. Money needed to participate in the Initiative is driven by the community’s action plan. Minimal expenses are covered through the administrative budget.

Nursing Facility Audits and Quality Review

Purpose:The KDOA auditors perform desk reviews and fi eld audits on nursing home cost reports to ensure that reim-bursement rates for Medicaid residents are in compliance with state and federal regulations and policies. The auditors perform fi nancial compliance reviews of other programs funded by KDOA as required.

Audits done:In SFY 2008, 327 Medicaid cost reports were desk reviewed and 42 nursing home fi eld audits were completed. Also, fi eld work was completed on two nursing home chains. Because nursing home rates are determined from a rolling three year period, fi eld audit work involves reviewing several years of cost data. The single audit reports were also reviewed for the 11 Area Agencies on Aging (AAA) and other large service providers.

Savings:Nursing home cost reports were reduced $3.3 million as a result of desk review adjustments.

Program of All-inclusive Care for the Elderly (PACE)

Purpose:The Program of All-inclusive Care for the Elderly (PACE) is a form of long term managed care. The provider accepts a capitated rate in the form of a monthly premium to provide all Medicaid/Medicare long term care and medical services. The capitated rates are paid by KDOA, Kansas Health Policy Authority (KHPA)) and the fed-eral Centers for Medicare and Medicaid Services (CMS).

Persons served:Kansas has PACE projects operated by Via Christi Health Systems in Wichita and Midland Care Connection in Topeka with an average of 204 participants. The average cost per customer per month is $1,325.

Dollars:The total PACE expenditures for KDOA was $3.2 million ($1.3 million in state funds). The budget is approxi-mately 60% federally funded and 40% state funded.

Aging and Disability Resource Center (ADRC)

Purpose:The Aging and Disability Resource Center (ADRC) grants create streamlined access to program information, application processes and eligibility determination for all aging and disability services. In Kansas, the ADRC project is collaborating closely with the Social and Rehabilitation Services Real Choice Systems Transformation project as well as other projects that are focused on improving access to community services.

Appendix F-10

Progress:The Kansas ADRC has pilot sites in Wichita (Central Plains Area Agency on Aging and Independent Living Resource Center) and in Hays (Northwest Kansas Area Agency on Aging, Living Independently in Northwest Kansas, and Southeast Kansas Independent Living Resource Center). Staff members from the pilot site agen-cies are working with staff from KDOA, KHPA and SRS as well as community organizations, service providers and consumers to develop tools that will improve access to services. Work teams are developing a searchable online database of available resources; a referral and assessment process that will speed up referrals between partner agencies; and a web-based interface that will help streamline the Medicaid application process.

Dollars:ADRC is funded by a combined grant from the Administration on Aging (AoA) and the Centers for Medicare and Medicaid Services (CMS). AoA provides 56% of the funding, CMS provides 39%, and the state provides 5%. In the 2007 grant year, AoA provided $146,125; CMS provided $103,875; and the state provided $13,158.

Older Americans Act - Title III-E Family Caregiver Support Program

Purpose:The Family Caregiver Support Program provides a multifaceted system of support services to assist caregiv-ers. Each Area Agency on Aging determines which services are needed within its planning and service area. Services may include: assistance, information, respite, counseling, support groups, training, and supplemental service (attendant/personal care, bathroom items, chore, fl ex service, homemaker, transportation, and repair/maintenance/renovation). No fees are charged to the caregiver for services.

Grant Award:$1,398,920 (Federal only)

Older Americans Act - Title III-B Access, Community and In-Home Services

Title III-B of the Older Americans Act (OAA) provides for Access, Community and In-Home services.Access Services• provide seniors with community services, such as Information and Assistance (receiving

current information from KDOA and AAAs regarding opportunities and services), Case Management (determining types and amounts of services needed), Legal Services (provides seniors access to the system of justice by offering advice and representation by an attorney) and Transportation (assisting an individual to get to a location where services are provided).

In-Home Services• help seniors remain in their homes and communities and include attendant care services, homemaker services, respite care and adult day care.

Community Services• are designed for seniors with the ability to travel to the point of service and encourage seniors to remain active members of the community. Services are provided either directly by the AAA or under contract or grant by other agencies.

Dollars:Expenditures reported for FFY 08 as of December 31, 2008, were estimated at $4,204,881. This includes OAA, program income, match, in-kind and mill levy.

Appendix F-11

Prevention of Elder Abuse, Neglect and Exploitation (PEANE) Special Project Grants

Purpose:The Special Project Grants, awarded to a variety of agencies and organizations, are designed to provide either education/training or research for the prevention of elder abuse, neglect, exploitation; or a study of the nature or extent of fi nancial exploitation of the elderly. The grant period is May 1, 2008, through April 30, 2009.

Persons served:Participants include professionals in the fi elds of social work, health care, law enforcement, local government services and caregiving.

Dollars:Title VII FY 08 state award was $45,843.

III-B Access Services

Service Persons Served

Information & Assistance* 85,737Transportation* 601Outreach* 3,017Case Management 1,075Assessment (Abbrev & Full) 719

OAA III-B In-Home Services

Service Persons Served

Attendant Care 283Homemaker 653Visiting* 192Telephoning* 1,000

OAA III-B Community Services

Service Name Persons Served

Legal Assistance* 2,527Screening* 774Advocacy/Representation* 299Public Education/Training* 26,879Newsletter* 180,890Recreation* 513Repairs/Maint/Renovation* 150Shopping* 122Supervision* 70Material Assistance 184

Data as of 1/21/09* From Manually Reported Data

Appendix F-12

Goal: Enhance Kansans’ expectations toward person-directed options in the community and adult care settings.

Culture Change in Long Term Care

Promoting Excellent Alternatives in Kansas (PEAK)

Purpose:The Promoting Excellent Alternatives in Kansas (PEAK) program promotes and sup-ports culture change in nursing homes as they pursue person-directed care in the areas of resident control, staff empowerment, home environment, and community involve-ment. The two components of PEAK are recognition and education. KDOA has part-nered with Kansas State University’s Center on Aging to provide the education component, which includes developing resources and training nursing home staff in how to begin and sustain the culture change journey.

PEAK Awards:Since 2002, KDOA has recognized homes for their achievements in person-centered care. The 2008 PEAK win-ners were:

Atchison Senior Village, Atchison.• Brandon Woods Retirement Community, Lawrence.• Brewster Health Center, Topeka.• Brookside Retirement Community, Overbrook.• Cheney Golden Age Home, Cheney.• Greeley County Long-Term Care Unit, Tribune.• Johnson County Nursing Center, Olathe.• Minneapolis Good Samaritan Center, Minneapolis.• Parkside Homes, Hillsboro.• Village Shalom, Overland Park.•

Dollars:There are no funds budgeted for the PEAK Nursing Home initiative. Fund raising is conducted annually to cover the cost of the recognition. The Civil Monetary Penalty fund was used to provide a small cash gift to the homes recognized.

Long Term Care Division

Purpose:The Long Term Care Division professional staff, which consists of two registered nurses, a registered licensed dietitian, and an environmental specialist, serve as consultants to consumers, adult care home providers, health care facility surveyors and other stakeholders in the long term health care industry. Consultation is provided through individual technical support and participation in workforces. Division staff are also responsible for the development of state adult care home regulations and conducting physical environment inspections of adult care homes following construction projects.

Appendix F-13

2008 activities:Staff presented 45 education programs attended by 2,000 individuals. Topics included regulatory updates, care practices and culture change initiatives.

Division staff continued to assist adult care homes transitioning to person-centered care both in practice and in their physical plant. Staff met with 30 adult care home owners/providers to review regulatory requirements for construction and remodeling projects. In addition, 35 onsite licensure inspections were conducted.

Through the Workforce Enhancement Grant, monies totaling $298,475 were awarded to eight entities to provide education for unlicensed staff in free standing nursing homes and long term care units of hospitals.

Dollars:In FY 2008, $500,924 was budgeted from Medicare, Medicaid, state general funds and fee funds. Expenditures were $499,688.

Mental Health and Residential Care Facilities Division

Purpose:The Mental Health and Residential Care Facilities Division evaluates intermediate care facilities, assisted living facilities and other “state licensed only” facilities for state licensure and federal certifi cation. These facilities serve several thousand elderly, physically impaired, developmentally disabled and chronically mentally ill indi-viduals who reside in a variety of institutional and community-based settings.

State licensing:Of the 9,417 beds in state-licensed facilities, 5,762 are within licensed Assisted Living Facilities, 1,551 are in Residential Health Care Facilities, and 790 are encompassed by state institutions for the mentally ill and de-velopmentally disabled. The remaining 1,314 beds are in community-based facilities including boarding care homes, Homes Plus and adult day care centers.

Quality review:The division also administers the Quality Review Program responsible for collecting fi eld data for use in deter-mining compliance with state and federal regulation by the Area Agencies on Aging (AAAs) and service provi-sion through the state general fund, the Older Americans Act and the Home- and Community-Based Services/Frail Elderly waiver. On-going reviews are completed on a statewide, statistically signifi cant sample of custom-ers.

Dollars:In FY2008, $1,526,776 was budgeted from Medicare, Medicaid, Older Americans Act, state general fund and fee funds. Expenditures were $1,415,560.

Licensure and Certifi cation Division

Purpose:The Licensure and Certifi cation Division promotes excellence in the health care and living conditions of the 18,314 individuals residing in nursing homes through the application of federal and state regulatory standards. Through initial licensure processes and ongoing annual surveys, state surveyors review a variety of aspects of nursing home care. Federal and state regulations assure that residents receive care that meets accepted stan-dards. Other regulations assure that residents’ rights are protected and they are protected from abuse, neglect and exploitation. In addition, the surveyors examine the physical environment to assure facilities provide safe

Appendix F-14

and sanitary conditions for residents. Fire and safety inspections are provided under contract by the State Fire Marshal.

This division is also responsible for surveyor training and orientation; survey quality improvement efforts; policy and procedure development; survey management; enforcement activities; complaint intake; referral and investigation management. Many of the activities of the Division are performed under contract to the federal Centers for Medicare and Medicaid Services (CMS).

The Division is required to survey all nursing facilities within an overall 12-month average, with no individual facility exceeding 15 months.

Nursing home complaints:KDOA investigated 6,310 complaints about adult care homes, including some for abuse, neglect and/or exploi-tation of residents.

Dollars:In FY2008, $5,187,461 was budgeted for licensure and certifi cation programs, including complaints, from Medicare, Medicaid, state general funds and fee fund. Expenditures were $5,093,180.

Kansas Facilities by Category SFY 2008 Certifi ed Long Term Care Units LTCU 47 Nursing Facilities NF 293 Nursing Facilities for Mental Health NFMH 11 Assisted Living Facilities ALF 123 Residential Health Care Facilities RHCF 47 Boarding Care Homes BCH 18 Home Plus HP 77 Adult Day Care ADC 12 Intermediate Care Facilities for Mentally Retarded ICF/MR 31 Mental Retardation Hospitals MRH 2

TOTAL 661

Number of Complaint Intakes SFY 2008 Long-Term Care Providers 5,031 Unlicensed Facilities - ICFMR 186 ALF, RHCF, BCH, HP, ADC 648 Non-Long Term Care Providers Regulated by KDHE 445

TOTAL 6,310

LTCU

NF

NFMH

ALF

RHCF

BCH

ICF/MR

MRHADC

HP

Kansas Facilities by Category

Non-Long Term Care Providers Regulated

by KDHE

ALF, RHCF, BCH, HP, ADC

Unlicensed Facilities

ICFMR

Long-Term Care Providers

Number of Complaint Intakes - SFY 2008

Appendix F-15

Partnership Loan Program and Partnership Grant Program

Purpose:The Partnership Loan Program supports the expansion of services and housing alternatives for senior Kansans by providing low interest loans. The Partnership Grant Program uses interest income from the PLP loans to fund competitive matching grants for the benefi t of long term care programs.

PLP Projects:Since the inception of the PLP, 10 housing projects with a total of 150 units have been funded. They are located in Anthony, Caldwell, Dighton, Eskridge, Holyrood, Newton, Norton, Hutchinson, Wilson and Winchester. The PLP focuses on rural communities lacking adequate housing options for seniors and more recently, innovation in the long term care environment. In FY 2007, KDOA fi nanced Green House® projects in Newton and Hutchinson. These group homes for elders, built to residential scale, provide the necessary clinical care found in nursing homes in a more social environment. Residents and staff benefi t from the homes’ person-centered approach to daily living.

PGP Projects:A grant was awarded in FY 2007 from the PGP to establish a long term care home telehealth pilot project in Southeastern Kansas. A second grant was awarded in FY 2008 to extend the pilot for an additional year and increase the number of participants. This proactive care model, involving technology and telecommunications, provides participants with chronic diseases the opportunity to take an active role in their health care by helping to identify the need for preventive intervention before situations become acute. KU Medical Center has signed a research contract to determine the effectiveness in terms of cost and quality of life for this type of care delivery system on a frail elderly population living in a community environment.

Dollars:Total funds distributed or committed for distribution from program inception through SFY08: Partnership Loan Program, $5,638,491; Partnership Grant Program, $486,609.

Appendix F-16

Goal: Help Kansas seniors achieve healthier, more active lives through prevention and intervention.

Healthy Aging

Older Americans Act - Title III-C Nutrition Program

Meals are provided to eligible participants on a contribution basis in a congregate setting (Title III-C(1)), or within a homebound individual’s place of residence (Title III-C(2)).

Persons served:There were 24,911 congregate customers (67%) provided with 1,564,311 meals and 12,323 home delivery customers (33%) provided with 1,827,515 meals in FFY 2008.

Demographics of those served:Characteristics of persons receiving meals are shown in the following table:

Dollars:$17,811,494 from all sources was spent to provide meals to seniors in FFY 2008.

Senior Farmers Market Nutrition Program

Purpose:The Senior Farmers Market Nutrition Program promotes better nutrition among low-income seniors age 60 and up and expands the revenue base for farmers marketing fresh, locally grown produce at organized farmers markets, roadside stands and community supported agriculture farms.

People served:5,217 low-income seniors (benefi t as checks) and 5,299 low-income seniors (benefi t as bundles) served•

through two food assistance programs each received fresh fruits, vegetables and herbs. The food assistance programs were the Commodity Supplemental Food Program (CSFP), the Emergency Food Assistance Program (TEFAP).143 growers received $161,030 (federal) and $12,192 (state).•

Characteristics Congregate Home DeliveredMale 36% 32%Female 64% 68%Lives alone 44% 54%Under 60 6% 1%Aged 60 to 74 38% 27%Aged 75 to 84 38% 38%Aged 85 or older 18% 34%

Appendix F-17

Locations:The program was available in 18 Kansas counties: Atchison, Bourbon, Cowley, Dickinson, Douglas, Finney, Harvey, Johnson, Leavenworth, Lyon, McPherson, Reno, Republic, Riley, Saline, Sedgwick, Shawnee and Wyandotte.

Dollars:The program was funded under a $188,580 USDA grant and $33,157 in state funds for 2008.

Seniors Together Enjoy Physical Success (STEPS)

Purpose: The Seniors Together Enjoy Physical Success (STEPS) program funded community fi tness classes addressing unique physical needs of seniors age 60 and over. Instructors are nationally certifi ed and trained in fi tness for seniors. STEPS is a component of the Governor’s Healthy Kansas Initiative. Participants are assessed before they begin classes and throughout to evaluate overall strength and balance.

Persons served:In 2008, STEPS classes were offered in Concordia, Cottonwood Falls, Dodge City, Garden City, Great Bend, Haysville, Hiawatha, Oberlin, Osawatomie, Topeka (YMCA and YWCA), and Winfi eld. Each location can have up to 25 participants.

Dollars: This project is a three-year grant for the period of 2006 through 2008 and is funded by The Sunfl ower Foundation: Health Care for Kansans. The total grant amount is $150,000.

Older Americans Act - Title III-D Disease Prevention and Health Promotion Services

Title III-D of the Older American Act provides Disease Prevention and Health Promotion Services grants to Area Agencies on Aging. These grants support any of the 15 health-related services, such as health risk evaluations, screening, nutrition counseling, health promotion programs, physical fi tness and exercise programs, home injury control screening and the screening for the prevention of depression.

Budget/Funding Source/Actual Expenditures:$210,530 from all sources was expended for health-related services in FFY 2008.

Senior Farmers' Market Nutrition Program Dollars

85%

15%

USDA Grant State Funds

Number of estimated persons served during FY 2008: (as of 1/21/09):

Services Persons Served

Screening 1,435Nutrition Education 132Health Promotion Programs 2,543Physical Fitness and Exercise Programs 1,062Medication Management Education 3,736Information on Age-Related Disorders 721

Appendix F-18

Sources of Funding

Following are the Kansas Department on Aging’s major program groups and sources of funding:

Medicaid programsNursing homes• Program of All-inclusive Care of the Elderly (PACE)• Client Assessment Referral and Evaluation (CARE)• Home and Community-Based Services for Frail Elderly (HCBS/FE)• Targeted Case Management (TCM)•

Older Americans Act (OAA) programsIII-B Access, In-home and Community Services• III-D Disease Prevention and Health Promotion• III-E National Family Caregiver Support Program• VII Allotments for Vulnerable Elder Rights Protection Activities•

Older Americans Act (OAA) Nutrition ProgramsIII-C Nutrition• Match and Non-Match• U.S. Department of Agriculture•

State funded ProgramsSenior Care Act (SCA)•

OtherSenior Health Insurance Counseling for Kansas (SHICK) – Centers for Medicare & Medicaid Services •

(CMS) Seniors Farmers Market Nutrition Program – U.S. Department of Agriculture (USDA)• SMP – Administration on Aging grant with 25% matching state funds• Aging and Disability Resource Center – Grants from the Administration on Aging and Centers for Medi •

care and Medicaid Services, with 5% matching state fundsSeniors Together Enjoy Physical Success (STEPS) – Grant from The Sunfl ower Foundation: Health Care •

for KansansPartnership Grant Program (PLP) – Kansas Intergovernmental Transfer• Partnership Loan Grant (PGP) – Interest from Partnership Loan Program loans•

Appendix F-19

Area Agencies on Aging

The Department on Aging administers many of its programs through grants and contracts of state and federal funds to the 11 Area Agencies on Aging (AAAs) and other providers serving designated geographical areas. For programs not funded by Medicaid, the AAAs may directly provide services or award sub-grants and contracts to other community organizations to provide services. In FY 2008, the AAAs provided services through the following programs:

Older Americans Act (OAA);• Congregate Meals;• Home Delivered Meals; • In-Home Services for the Frail Elderly;• Disease Prevention and Health Promotion;• Elder Abuse Prevention;• Home and Community Based Services for Frail Elderly (HCBS-FE);• Targeted Case Management (TCM);• State-funded Case Management;• Senior Care Act (SCA);• Client Assessment, Referral, and Evaluation (CARE) program; and• Family Caregiver Support Program.•

Each AAA serves a Planning and Service Area (PSA), required under the Older Americans Act, and has a director, staff members, and a local advisory board. Employees of the AAA are not state employees but are employed by each AAA’s governing body, which can be a governmental entity or nonprofi t organization.

Appendix F-20

Area Agencies on Aging Directory

PSA 01 Wyandotte-Leavenworth AAARuth Jones, director1300 N. 78th St., Suite 100Kansas City, KS 66112-1540913-573-8532 / 1-888-661-1444Fax: 913-328-4577

PSA 02Central Plains AAAAnnette Graham, director2622 W. Central, Suite 500Wichita, KS 67203-3725316-660-7298 / 1-800-367-7298Fax: 316-383-7757

PSA 03Northwest KS AAAGreg Hoover, director510 W. 29th St., Suite BHays, KS 67601-3703785-628-8204 / 1-800-432-7422Fax: 785-628-6096

PSA 04Jayhawk AAAJocelyn Lyons, management team leader2910 SW Topeka Blvd.Topeka, KS 66611785-235-1367 / 1-800-798-1366Fax: 785-235-2443

PSA 05Southeast KS AAAJohn Green, director1 W. AshChanute, KS 66720-1010620-431-2980 / 1-800-794-2440Fax: 620-431-2988

PSA 06Southwest KS AAADave Geist, director236 San Jose Dr.Dodge City, KS 67801-1636620-225-8230 / 1-800-742-9531Fax: 620-225-8240

PSA 07East Central KS AAAElizabeth Maxwell, director132 S. MainOttawa, KS 66067-2327785-242-7200 / 1-800-633-5621Fax: 785-242-7202

PSA 08North Central Flint Hills AAAJulie Govert-Walter, director401 HoustonManhattan, KS 66502785-776-9294 / 1-800-432-2703Fax: 785-776-9479

PSA 09Northeast KS AAAJim Beckwith, director526 OregonHiawatha, KS 66434-2222785-742-7152 / 1-800-883-2549Fax: 785-742-7154

PSA 10South Central KS AAAJodi Abington, director304 S. SummitArkansas City, KS 67005620-442-0268 / 1-800-362-0264Fax: 316-442-0296

PSA 11Johnson County AAALinda Wright, director11811 S. Sunset, Suite 1300Olathe, KS 66061-7056913-715-8800 / 1-888-214-4404Fax. 913-715-8825

Appendix F-21

2008 Annual Report of the State Advisory Council on Aging

The 15 members of the State Advisory Council on Aging represent diverse geographical, social and ethnic groups and by statute, at least half of the membership must be 60 years of age or older. The council meets at least twice a year. It serves in an advisory capacity to KDOA, the Governor and other public and private, state and local agencies affecting aging issues as required by the federal Older Americans Act and has the duty to review and comment on KDOA activities.

State Advisory Council members:Trish Moore, Overland Park, chair• Rep. Bob Bethell, Alden• Leo Bracciano, Lawrence• Rita Griffi th, Overland Park• Sen. David Haley, Wyandotte• Irv Hoffman, Lenexa• Barbara Hutchinson, Circleville• Luella “Lu” Janzen, Hillsboro• Patrick Lawless, Jr., Osage City• John Lehman, Sabetha• Bill Moriarity, Hays • Rep. Shirley Palmer, Fort Scott• Sen. Vicki Schmidt, Topeka• Jean Taylor, Topeka• Larry Turner, Wichita•

The State Advisory Council on Aging (SAC) met quarterly in SFY 08. Secretary Kathy Greenlee provided agency updates at each of the meetings.

On September 7, 2007, Teresa Schwab, Executive Director with Oral Health Kansas, and Bill McDaniel, Commissioner, Program & Policy, the Kansas Department on Aging, presented to SAC Members on dental services.

On December 7, 2007, Irv Hoffman, President of the Kansas Silver Haired Legislature, provided information to members on the outcome of the 2007 Kansas Silver Haired Legislative Session.

On March 7, 2008, Cindy Hermes from the Kansas Insurance Department discussed the Long-Term Care Partnership Program; and Barbara Conant, Director of Public Affairs with KDOA, gave a legislative review and review of KDOA’s SFY 2007 Annual Report.

On June 6, 2008, KDOA’s McDaniel and Angie Reinking, Money Follows the Person Project Manager with the Kansas Department of Social and Rehabilitation Services, presented to the group on that project.

Several of the SAC members attended the 2008 Governor’s Conference on Aging Services. They also provided input regarding Older Americans Act programs to ensure that they were consistent with the statute mandates.

Council members were active in representing senior interests in their communities.

Appendix F-22

2008 Report of the Kansas Silver Haired LegislatureThe Silver Haired Legislature is a body of individuals age 60 and older who are elected by their peers to develop bills and resolutions that are of interest to Kansas elders and their families. The Silver Haired Legislature then will work with the Kansas Legislature to get its bills and resolutions introduced and passed.

SHL offi cers are:

President: Irv HoffmannVice President: Rosalie SeemannTreasurer: Bill DeanSecretary: Ted HutchcraftSpeaker: Jim SnyderSpeaker Pro Tem: Mary Ann FlunderFloor Leader: Carlton McNair

The following bills and resolutions were approved during its 26th annual session October 1 and 2, 2008, at the Ramada Hotel & Convention Center located at 420 SE 6th Avenue in Topeka, Kansas:

SHL Bill No. 2501 - Resolution to urge the Kansas Legislature to enact legislation during the 2008 regular session to help combat predatory payday lending practices and predatory practices by consumer loan agencies and Income Tax Refund Advance lending practices that adversely affect elderly and other residents of Kansas.

SHL Bill No. 2502 - Resolution supporting increased funding for home and community based services and nutrition programs.

SHL Bill No. 2503 - Resolution requesting cities, counties and other municipalities with traffi c signals to adjust or otherwise provide for timing of traffi c lights at crosswalks for seniors and persons with disabilities to allow adequate pedestrian crossing times.

SHL Bill No. 2504 - Bill providing for mandatory reinstatement of certain insurance policies.

SHL Bill No. 2505 - Bill imposing an excise tax on wind generated electricity with proceeds to the Senior Services Trust Fund for senior services funding.

In other business, the Silver Haired Legislature handed out its Caring Award to all the employees of the Kansas Department on Aging for “their exceptional concern for seniors of Kansas.”

Awards also were presented to:Mary Ann Flunder, Kansas City, KS, Verna Devine, Iola, and • Dorothy Zook, Hesston, for exceptional contributions to the SHL.Marva Williams, who serves as KDOA’s liaison to the SHL, • for outstanding contributions to the SHL.Silver Haired Legislators Mel Henderson, Leawood, and •

Rosalie Seeman, Levant, for meritorious service.

A list of Silver Haired legislators can be found on the KDOA website at: http://www.agingkansas.org/Advocacy_Legislation/Legislative/silver/2008roster.htm

Silver Haired Legislators, Irv Hoffman and Jim Snyder present the Caring Award to KDOA at a staff meeting. KDOA employee Heidi Burris accepted the award on behalf of the department.

Appendix F-23

Caregiver Support:

PSA 05: SEK-AAA continues to fund fi ve Caregiver Breakfast Clubs, providing an opportunity for participants to assist other caregivers and receive assistance when needed.

PSA 05: The SEK-AAA’s Caregiver Van has enabled the AAA to provide additional information about services and materials needed to help caregivers in the daily routine of helping loved ones.

PSA 07: ECK-AAA sponsored for a third-year its three day trip to Branson for nine caregivers, who were nominated by ECK-AAA staff, providers, and community members. Respite was arranged with appropriate facilities for those needing a replacement caregiver during the trip. Based on this year’s experiences, AAA staff have decided to sponsor caregiver day trips in the future, rather than one three-day trip.

Health Care System Coordination

PSA 03: NWK-AAA has contracted with county health departments to provide medication management training at meal sites and senior centers, distributing pill boxes with the AAA name and toll-free number to participants.

PSA 06: SWK-AAA sponsored a successful Senior Expo in April 2008 at the Dodge City Civic Center, with over 900 caregivers and older southwest Kansans in attendance. The AAA also held its annual fall “Health and Wellness Conference” in Dodge City, with 130 professionals and caregivers attending.

PSA 07: ECK-AAA Information and Assistance staff have worked for the last year organizing the various agencies serving older adults in Linn County to establish an active interagency group. Currently, there are 13 agencies that meet every three months.

PSA 09: NEK-AAA held its annual Senior Expo, securing 24 sponsors and 58 exhibitors, with over 375 people in attendance. Screenings included cholesterol, pulse oximetry, blood sugar, blood pressure/pulse, osteoporosis, spirometry, physical assessment/grip strength, body mass index, range of motion, digital muscle testing, glaucoma, hearing, and skin cancer.

Healthy Lifestyle / Prevention Programs:

PSA 03: NWK-AAA has provided funding to Fort Hays State Stroke Research and Rehabilitation Center, which is providing aerobic exercise, balance exercises, and strengthening exercises to stroke survivors in western Kansas, thereby reducing participants’ risk of another stroke and improving their well-being.

PSA 07: ECK-AAA has established exercise programs at senior centers and senior housing complexes in four or its six counties, with some of the programs incorporating health education. This has been accomplished utilizing a combination of staff, volunteers, and partnering with local hospitals and recreation centers. Walking groups have been established in all six counties and a 5 and 10K run/walk was held in November 2008 to celebrate the many activities funded by a grant received from the Sunfl ower Foundation. Nearly 100 individuals took part in the run/walk, with three age 70 and older completing the 5K and one individual in the age 70 and over category completing the 10K.

Appendix G: Kansas Area Agencies on Aging SFY 2008 Innovation and Accomplishments

Appendix G-1

PSA 11: JOCO-AAA formed a partnership with two other county departments to optimize its budget for Title III-D Disease Prevention. The AAA continues to fund its Flexercise Program at seven sites including two that offer Tai Chi classes. Through a contract with Johnson County Parks and Recreation, 637 classes were offered and attended by 1,277 clients from January through September 2008.

PSA 11: JOCO-AAA has offered fi ve classes of “You Can! Steps to Healthier Aging,” which includes bone density screenings, pre and post program blood pressure, blood sugar and cholesterol screenings. Individual step goals were provided weekly based on the number of steps participants walked the previous week. Outcome studies of participants showed improved blood sugar and cholesterol and increased levels of satisfaction in health and mobility. A post program survey indicates the success and interest of participating seniors in eating better and moving more.

Information:

PSA 01: The WYCO-AAA staff created and performs the traveling skit “Mrs. Bunker Meets Tina Turner” to increase community awareness of services and resources available through the AAA. It portrays an older woman living alone and neglected until a neighbor fi nally takes notice and contacts the AAA. The case manager is able to secure services and a happy ending is celebrated with a classic Tina Turner song and dance routine. The skit, designed to be informative yet humorous, has been presented to audiences ranging in age from 15 to 75, including minority populations, family caregivers, the professional community, and emergency response personnel. WYCO AAA received national recognition for this skit with the n4a Aging Innovations and Achievement Awards.

Medication Management:

PSA 01: The WYCO-AAA has implemented the S.T.O.P. (Seniors Tracking Own Prescriptions) Program to assist senior citizens with an effective way to manage their own prescriptions. “With the average senior receiving medical services from three or more physicians, the potential for cross-medicating or duplicate medicating increases. All this places the senior at a higher risk for complications relating to medication errors.” The S.T.O.P. Program was developed by the agency to address this major concern. Participating seniors receive a laminated wallet card or plastic encased keychain listing their current medications, emergency contacts, allergies, and current medical diagnosis, which the senior can carry with them at all times. Approximately 200 seniors are served annually.

PSA 05: SEK-AAA contracts with a nurse to provide medication management education to seniors. The program goal is to prevent improper use of medication and adverse drug reactions. Topics presented include: 1) what to know about medications; 2) age-related medication issues; 3) systems for organizing medications; 4) drug interactions; 5) medication do’s and don’ts; and 6) adult immunizations.

Mental Health Programs:

PSA 03: NWK-AAA has contracted with a retired mental health professional to provide caregiver training entitled “Know When to Hold Them and Know When to Fold Them” at meal sites in the 18-county area.

PSA 11: JOCO-AAA has entered into an agreement with Johnson County Mental Health to provide mental health discussions at congregate sites and to provide mental health services to homebound clients and their caregivers. These clients were referred for services by care managers and assessors.

Appendix G-2

Nutrition:

PSA 11: JOCO-AAA implemented a nutrition voucher program in April 2008. This program offers meals fi ve days a week to participants at a Hy-Vee grocery store cafeteria. Participants have a wider variety of nutritious menu items to choose from and a broader time frame in which to dine than at traditional congregate sites. Due to the success of the program, additional Hy-Vee grocery store locations will provide this service in 2009 and the Nutrition Service Program Manager was invited to present this concept at the national Meals on Wheels conference.

PSA 11: JOCO-AAA partners with the National Meals on Wheels Association and Humana for the home delivery of frozen meals to Johnson County residents returning home from the hospital. As of August 2007, 3,740 meals had been delivered to 374 county residents. With the growth of this program and other needs, JOCO-AAA has constructed a stand-alone freezer for frozen goods.

Transportation:

PSA 01: WYCO-AAA provides transportation for one week to children being raised by their grandparents to attend a day camp. In 2008, twenty grandparents received respite while fourteen grandchildren attended the day camp. “We were very happy to provide this respite for the grandparents.”

PSA 11: JOCO-AAA provides a “Catch-A-Ride” program, wherein volunteer drivers transport and accompany frail older adults to medical appointments, shopping, and for other activities. Drivers provide minimal personal assistance and reassurance to their riders.

Volunteer Programs:

PSA 03: NWK-AAA sends information on relevant topics and new programs and services to a network of volunteers called “Key Communicators” monthly who, in turn, inform participants at senior centers, meal sites, senior groups, and senior housing residents.

Appendix G-3