Betsy Johnson: For quality long-term care, realize that one size does not fit all

August 11, 2014 

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, is a former Kentucky commissioner of Medicaid.

  • About the author: Betsy Johnson, president of the Kentucky Association of Health Care Facilities, is a former Kentucky commissioner of Medicaid.

  • At issue: June 29 Herald-Leader editorial, "Ky. must do better by elders; State lags far behind in providing community-based, in-home care," and July 28 column from long-term care advocacy groups, "Ky. must move long-term care into community"

I have been thinking about long-term care services and supports a lot lately — and not just because I recently took the helm of the Kentucky Association of Health Care Facilities. I am also thinking about these services because they are personal to me.

I am watching my very active parents getting older. I see my beautiful niece benefit from the support she receives from a Medicaid home and community-based waiver. And, I also think about my own future and how and where I want to age.

Recent opinion pieces have called for Kentucky to do better in response to AARP's recently released Scorecard on Long-Term Services and Support for Older Adults, People with Physical Disabilities and Family Caregivers.

KAHCF agrees.

However, creating a one-size-fits-all approach to the long-term care needs of seniors is like trying to fit a square peg into a round hole.

By suggesting that Kentucky can build community-based services by shifting funds from nursing homes to home-health agencies and to individuals who care for family members at home is a broad over-simplification of a complex issue.

First, Medicaid is continuously underfunded and may face even more significant funding challenges in the near future. This creates a culture of money grabbing among people who share the well-intentioned goal of providing quality care.

While it may sound good in an editorial, there is simply no empirical data to show that community-based services — in the long run — cost less than services provided in a nursing facility. And, in many cases throughout the state, the infrastructure needed to safely care for individuals in the community does not exist.

Building this infrastructure would require even more money that will likely not be available given the state's tight budget constraints. Therefore, we must find ways to work together to solve these complex issues and invest in solutions that create the right continuum of care.

A recent article, "It's Time to Stop Long-Term Care State Rankings," quotes an interesting point from a Minnesota official — the top-ranking state in AARP's report — as to why some states score better. Loren Colman with Minnesota's Department of Human Services notes that, "it is important to build strong partnerships with nursing homes rather than seeing them as 'the enemy' preventing home-and community-based care."

His words are simple but true. We must work together to define, create, and fund the continuum of care that makes sense for all Kentuckians. And we must also agree that no two individuals have the same needs.

By working with all stakeholders, our association's members are the solution to helping build that care. Our members have been and will continue to be the experts in caring for the elderly and others in need of long term care services and supports.

I have made it my goal to visit as many of our member facilities as possible. To date, I have been as far west as Paducah and as far east as Ashland. I am truly amazed at the great work our members are doing in the area of post-acute care, including skilled nursing care, transitional care, personal care services, and inpatient and outpatient rehabilitative care services.

Although nursing facilities in Kentucky operate in a very difficult regulatory environment, our member facilities are continually seeking new and innovative ways to care for vulnerable populations.

I have no doubt that our membership — which includes for-profit, not-for-profit and government long-term health-care-service providers — are the high-quality care solution for the future.

We welcome the opportunity for an unbiased discussion about providing the very best continuum of care. Let's make it our joint mission to ensure Kentucky seniors receive the right care, at the right place, at the right time.

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