A $49 million federal pilot program that gets Kentucky Medicaid recipients out of nursing homes and into a more independent setting is not living up to its potential, say advocates for the disabled.
Kentucky Transitions, which began in 2008, has been criticized for moving only one-fifth of the number of people it is set to transition into the community by the end of 2012. Meanwhile, the state official who was the program's director voluntarily transferred this summer after being reprimanded for allegedly ridiculing a disabled employee and making other slurs, according to state records.
Jim Kimbrough, chairman of a group called Advocates for Reforming Medicaid Services, said Kentucky Transitions should be helping more people.
The goal is to transition into the community a total of 546 people by the end of 2012, said Vikki Franklin, a spokeswoman for the Cabinet for Health and Family Services.
As of Sept. 15, 115 people had been moved out of institutional care and into the community. An additional 116 people have been accepted into the program and are in the process of finding appropriate housing, Franklin said.
Kimbrough said the number of people in the program is "disappointingly low."
"The state is not maximizing the funds," he said.
Mary Hass, an advocate for people with brain injuries, said program officials "have not worked well with the disability community."
Kimbrough and Hass, a member of the citizens advisory panel for Kentucky Transitions, said the advisory panel had not met in almost a year. After The Courier-Journal of Louisville wrote about problems with the program in August, state officials set a meeting for October, Kimbrough said.
So far, the program has spent around $6.5 million, Franklin said. All Medicaid-eligible people who are elderly, physically or mentally disabled, or who have an acquired brain injury may be eligible for the program.
One person who has moved out of a nursing home — Steve Schultz, 57, of Morehead — said he is an example of the good the program can do for a Medicaid recipient.
Four years ago, Schultz, who was already challenged by cerebral palsy, suffered gastric bleeding that led to his placement into a nursing home for 2½ years.
Schultz recovered from his medical problem, but he said that without money or resources, he faced a lifetime of monotony that confinement in a nursing home can bring.
As the first person helped by Kentucky Transitions, Schultz lives independently in an apartment in Morehead where he buzzes around downtown in an electric power chair, going to church, eating at local restaurants and enjoying his photography hobby.
"I have my life back," Schultz said. "Here, I have a life. Before, I was warehoused."
Despite the program's problems, Schultz is complimentary of officials who have worked with him.
A California native who had once supported himself as a switchboard operator, Schultz moved to Kentucky in 1997. He said he ended up in Life Care Center of Morehead nursing home in 2006 because gastric bleeding left him too weak to roll over and he had no family close by.
Schultz said many employees at the nursing home "cared very deeply for us ... cared a lot about us, but they could only do so much."
Having lived independently for nearly 30 years, Schultz said he found the surroundings in the nursing home limiting and depressing.
When he had lived in the nursing home almost 2½ years, an ombudsman told him about Kentucky Transitions. Within three months, Schultz said, the program had covered moving costs, furniture, utility deposits and food.
In 2008, program officials helped him move into Boodry Place, a new rental community in Morehead for the elderly and disabled.
Schultz, who does not walk, lives in a wheelchair-accessible, one-bedroom apartment with a window that allows him to see the Eastern Kentucky mountains as he works at his rug-making frame.
At first, Schultz received home health care and received Medicaid and Medicare. But he said he now mostly takes care of himself with the help of a friend who visits a few times each month. His personal income increased recently, and he no longer needs Medicaid.
While Schultz said he got cooperation from the nursing home where he resided, Kimbrough said he thinks some of the delays in Kentucky Transitions have been caused by a hesitancy on the part of nursing home officials to tell residents about the program.
Slurs and disrespect
Kimbrough said he and others on the citizens advisory panel also have been concerned about issues with Kristina Hayden, who from February 2009 until July 1 was head of Kentucky Transitions.
According to state personnel records, Hayden was placed on leave in May, then received a written reprimand and took a voluntary transfer to a position in the Cabinet for Health and Family Services' commissioner's office.
The written reprimand cited "inappropriate slurs and your intimidating, berating, demeaning and disrespectful comments about Branch personnel and Medicaid Management staff."
The reprimand alleged that she ridiculed a disabled employee with a weak arm in front of other staff members, saying "She doesn't have no (expletive) disability, she's just a (expletive) idiot."
The reprimand alleged that Hayden had a "profound sense of resentment toward any contract vendor or provider whenever problems arose," saying about one provider, "I don't give a damn if he never gets paid."
On another occasion, the written reprimand alleged, Hayden referred to a manager using the term "smart-Honduras-ass."
The reprimand said Hayden denied making the comments.
Before she was put in charge of Kentucky Transitions, Hayden had been reprimanded in 2005 for continued failure to abide by the time and attendance policy regarding breaks and for removing confidential information from her supervisor's desk and sharing and discussing the information, the reprimand said.
Franklin said she could not discuss Hayden's personnel issues. Hayden declined to comment for this article, Franklin said.
Franklin said several steps have been taken to expedite getting more people in the program.
Kentucky Transitions, in conjunction with the Department for Aging and Independent Living, has received a federal grant for the purpose of increasing potential referrals from nursing homes, she said.
Additionally, Kentucky Transitions is actively hiring additional staff to increase referrals and reduce transition times, Franklin said. The average time from referral to transition is approximately three months.
During the first year of transition, participants receive all services necessary to move from an institutional setting into the community. After that, participants continue to receive the services they need to remain safely in the community, Franklin said.
Bernie Vonderheide, founder of Kentuckians for Nursing Home Reform, said the program provides an important option.
"One, no person wants to live in a nursing home, if they can avoid it, and this program enables people to be cared for in their own homes or communities," Vonderheide said. "Secondly, the program benefits the state because it saves on Medicaid funding that is under more pressure than ever before."