Ky. must move long-term care into community

Kentucky ranked last in the Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities and Family Caregivers, which was produced by AARP Public Policy Institute with support from The SCAN Foundation and The Commonwealth Fund.

Not only is Kentucky last, but the score is worse in 2013 than it was in 2011.

We can do better. The title to the report is "Raising Expectations, 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities and Family Caregivers" and can be obtained from AARP. Here are some suggestions on how to raise our expectations in Kentucky:

■ Use the funds that currently go for institutional care to serve seniors and disabled individuals in their own homes and communities.

This includes shifting funds from nursing homes to home-health agencies and families serving folks in their homes. The funds that now go to intermediate-care facilities should be reassigned to follow the disabled persons into communities.

■ Review the "Money Follows the Person" program which helps transfer individuals from institutional settings to community settings to see how effectively it is operating. Kentucky is one of six states with the highest rates of re-institutionalization of persons in this program (between 10 and 36 percent of current participants) according to a report by Mathematica Policy Research called "Money Follows the Person Demonstration: Overview of State Grantee Progress, January to June 2013, Final Report, December 13, 2013" (page 18). Confer with the states that had the lowest rates of re-institutionalization for ways to improve the rates in Kentucky.

■ Increase funding for Hart Supported Living Program to help folks stay in the community with adequate supports. This program was created to allow for flexible spending by and for the elderly and both physically and intellectually disabled persons. Ensure that the decisions under this funding source truly are flexible based on the needs of the individuals.

■ Review Kentucky's plan, based on a 1999 U.S. Supreme Court case, to increase the number of folks served in the community, and take actions to implement whatever parts are inadequate.

■ Allow nurses to delegate more of their health maintenance tasks to trained direct care workers. The report reveals that in the top states (Alaska, Colorado, Iowa, Minnesota, Missouri, Nebraska, Oregon, Vermont and Washington) nurses can delegate 16 of 16 health maintenance tasks. Kentucky only allows four of the 16 tasks to be delegated.

■ Require vocational rehabilitation to review its efforts at finding jobs for persons with physical disabilities. Compare Kentucky's results and consult with similar agencies in other states that are more successful in developing work opportunities. Then take appropriate action to improve the number of individuals with physical disabilities who are adequately employed.

■ Increase the funding for the Medicaid Waiver Programs such as Supports for Community Living and the Michelle P. Programs so there will be no qualified persons waiting to receive services. While the report did not include persons with intellectual disabilities or autism, there are long waiting lists in Kentucky for such persons to be served in their communities.

Institutions are no longer the way to provide service for such persons. An individual living in a state institution costs over $300,00 per year, while the average cost of living in the community is about $70,000 per year.

The success of Medicaid's Supports for Community Living and Michelle P. Waivers are prime examples that community living at a reduced cost is far superior to institutional living.

The Legislative Research Commission needs to conduct a study of the state of current services, job training, employment and outcomes in the community for individuals with intellectual disabilities, including autism.

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