Last week, the House Appropriations Committee proposed cutting an additional 5 percent — about $1.8 million — from the Kansas Department on Aging budget.
The Senate Ways and Means Committee proposed a 2.5 percent reduction.
“We can survive 2.5 percent,” said KDoA Secretary Kathy Greenlee. “Five percent would be pretty deep for us. I would, for the first time, have to cut nutrition programs and I’d probably have to take another look at the Senior Care Act.”
Senior Care Act dollars are used to pay for services for frail seniors who are not eligible for Medicaid but who cannot afford the services they need to avoid having to move to a nursing home.
Already, lawmakers have agreed to cut $1.38 million from the $8.8 million Senior Care Act, which
is funded solely by the state and does not receive federal money.
“This is ugly and it’s going to get uglier,” said Jim Beckwith, executive director at the Northeast Kansas Area Agency on Aging.
“I’ve been going over every one of our clients’ care plans, trying to shave about 20 percent off my costs,” Beckwith said. “Just about everybody — like, almost 100 percent — really, truly needs the services they’re getting. So now I’m in a position of having to either terminate or cut back on some services.
“I’m going to be telling people, ‘Instead of us helping you take a bath once a week like we do now, we’ll help you take a bath once every two weeks,’” Beckwith said.
Other cuts in KDoA spending, thus far, include dropping $750,000 in operational support for the state’s 11 Area Agencies on Aging, and freezing Medicaid rates paid to nursing homes.
The freeze is expected to reduce KDoA’s draw on the State General Fund by $6 million in fiscal 2010, which begins July 1. Because of the reduction, nursing homes will lose an additional $9 million in federal matching funds.
“We’re not happy with the freeze,” said Debra Zehr, executive director at the Kansas Association of Homes and Services for the Aging, an association representing the state’s nonprofit nursing homes.
“But we understand the dire circumstances the state is in,” Zehr said, “and we’ve been fortunate in receiving cost-of-living increases in the last years. So we’re in better shape than a lot of other states.”
The freeze, she said, will likely force some nursing homes to lay off workers or leave vacant positions open.
“There are probably some things that can be done more efficiently to save some money,” Zehr said. “But when 60 to 70 percent of your budget is devoted to staffing, wages and benefits, and the rest of it is tied up in fixed costs like utilities and food, it’s staffing that’s ultimately at risk. And yet study after study has shown that the best indicator of quality care is adequate staffing.”
Some nursing homes, she said, may close. “We have a lot of rural homes that are operating on the edge,” Zehr said. “This will put them and, more importantly, the older people in the smaller communities, at risk.”
KDoA expects to spend $370 million, all funds, on nursing home care in fiscal 2009.
Greenlee admitted the rate freeze is shortsighted, noting that the $6 million reduction in state spending will end up costing the state’s nursing homes $16 million. But the department’s choices, she said, are limited.
“Ninety-two percent of our budget is tied to Medicaid,” Greenlee said. Since April 1, the federal government puts up 68 cents for every 32 cents spent by the state.
“There’s not much you can do without hitting Medicaid,” she said.
If told to cut spending by another 5 percent, it’s likely, Greenlee said, that Medicaid-funded, in-home services for the frail elderly would be cut.
“I really don’t want to do that,” she said.
Such a move, Beckwith said, would be disastrous.
“These are people who are low-income, they don’t have any money; they’re frail, they’ve all been cleared to go to a nursing home if need be,” he said. “Now, if they end up going to a nursing home because they can’t get services, they’ll end up costing the state, on average, $3,000 a month.”
Medicaid-funded, in-home services, on average, cost $106 a month per person, Beckwith said.
“These are people who will do without,” he said. “They will go without electricity, they’ll go without that one home-delivered meal a day, and in the long run they’ll get sick and end up in the hospital or in the emergency room. After that, they’re in the nursing home.”
Greenlee did not defend the cuts.
“No one wants to do this,” she said. “It’s unpalatable to me, to the governor and, I suspect, to just about every legislator. No one is taking this lightly.”
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at dranney@khi.org or at 785-233-5443, ext. 128.