Kansas Department On Aging
Secretary Kathy Greenlee
Presented by Gilbert Cruz
Kansas State Long-Term Care Ombudsman
February 24, 2009
The State Long-Term Care (LTC) Ombudsman Program represents the rights of nearly 28,000 individuals located in adult care homes throughout Kansas. A component of our ombudsman work is system advocacy as it deals with regulatory changes affecting residents of LTC facilities. This testimony addresses a concern with proposed regulatory changes to medication management dealing with insulin administration. To preface, it is understandable to strive for safer practices per the manufactures recommendations and encourage a professional dialogue between the many talented individuals in this process.
The ombudsman's apprehension with proposed changes is the adverse outcome it may create with an admission or discharge/eviction issue with residents. Many residents currently receiving assistance with medication management might be prematurely discharged to the nursing facility if new criteria is not met in K.A.R. 28-39-247(a)(b). To extrapolate into the future, a diabetes diagnosis can be criteria for the facilities that choose not to offer such services and opt out of care for this population. The care proposed could create a hardship foreseen as the costs increase for those who will offer the new proposed requirements.
Every year, the state LTC ombudsman office submits an annual report of advocacy complaint history to Governor Kathleen Sebelius and the Kansas Legislature. In this report, we use categories that breakdown complaints into five main groups. In reviewing fiscal year 2008 data, nearly 350 complaints involving discharge/transfer/eviction or discrimination in admission due to condition/ disability were filed against facilities.
Although required to assist residents in the discharge/eviction procedure there is no appeal hearing process for residents of LTC facilities other than nursing facilities. Therefore, the residents with diabetes in LTC facilities are scrutinized in a new medication management process that offers no independent discharge review. In present form the ombudsman is unable to offer assistance in remedy of the situation.
We are asking the Kansas Department on Aging (KDOA) to review the possible impact as it relates to proposed regulatory changes to medication management dealing with insulin administration, and to develop an appeal process for all residents in any LTC environment. At a time when Money Follows the Person (MFP) demonstration grant rightfully transfers qualified residents out of nursing homes to the least restrictive environment, we cannot expedite admissions of residents with diabetes to nursing facilities under K.A.R. 28-39-247(a)(b).
Joint Committee on Home and Community Based Services
Chairman Bob Bethel
Presented by Gilbert Cruz
August 27, 2008
The State Long-Term Care (LTC) Ombudsman Program represents the rights of nearly 28,000 individuals located in adult care homes throughout Kansas. This coverage is comprised of nursing home facilities, assisted living facilities, home plus facilities, and Long-Term Care Units (LTCU) in hospitals. The ombudsman program provides FREE advocacy assistance to LTC residents as per the Older Americans Act (OAA) guidelines.
The Ombudsman Program participates with the Money Follows the Person (MFP) demonstration grant in many ways. The program serves on the MFP steering and Community Bridge Building (CBB) committee. Furthermore, the program continues to represent resident rights through the MFP process. The ombudsman program is excited about our involvement and supports the placement of persons needing LTC in the least restrictive environment possible. Presently, ombudsman services do not include private homes or other non-licensed settings.
Historically, the position of ombudsman programs across the nation is not to expand beyond the Institute of Medicine's recommendation of one ombudsman for every 2,000 residents. The Kansas Ombudsman Program has one ombudsman for every 3,100 residents. Regardless, twelve states forged ahead to advocate for the resident at the home. The funding for these twelve states is State General Fund (SGF), Civil Monetary Penalty fund (CMP), Medicaid Match, Provider Tax, and MFP grant monies. The remaining funding available to the Ombudsman program is the OAA Title VII and III B grant money. Unfortunately, according to the Administration on Aging (AoA), the ombudsman program cannot use these grants to develop ombudsman services for the home.
The ombudsman program recommends the HCBS steering committee begin a dialogue on exploring advocacy options within the MFP demonstration grant. All stakeholders should analyze the following: current situation, costs, funding options, staffing recommendations, travel, specific HCBS waiver coverage, access to private homes or other non-licensed settings, collection of data, AoA National Ombudsman Reporting System (NORS) requirements, confidentiality, policy and procedure development, scope of responsibilities (quality of care vs. all complaints), new training considerations, conflict of interest and systems advocacy. After this dialogue occurs, a presentation should be made to the Joint Committee on the group's recommendation.
Please contact the ombudsman office if more information or assistance is needed. References: National Ombudsman Resource Center, Washington D.C. http://www.ltcombudsman.org/ombpublic/49_151_940.CFM
2008 Legislative Session
Senate Bill (SB) No. 493 - An Act Concerning crimes and punishments; relating to smoking; creating the Kansas uniform smoking prohibition act K.S.A. 21-4012 and 65-530. Gilbert Cruz, State LTC Ombudsman is opposed to SB 493. It would ban adult care homes from offering designated smoking rooms. Although the number of adult care homes that allow smoking is decreasing, there are still some that would like to continue to offer a smoking option for residents. The regulations on the smoking room have ventilation requirements that protect others from second hand smoking. You can find the entire bill at http://www.kslegislature.org/bills/2008/493.pdf - NO ACTION
Senate Bill (SB) No. 562 - An Act concerning elections; providing a procedure for mobile polling places in nursing homes and certain related facilities. The Kansas Long-Term Care Ombudsman is asking for support of SB 562. This bill will enable residents: To have one more voting option (mobile voting booths, To increase their participation in the electorate process, To have choice of the voting process (advance ballot, existing outside polling center, mobile polling), To have voting assistance from the Democratic and Republican parties, To reduce foreseeable advocacy cases due to lack of accessibility of a voting booth, To bring relief to families who currently assist the resident to the voting booth outside the LTC facility.
You can find the entire bill at http://www.kslegislature.org/bills/2008/562.pdf - ACTION
Senate Bill (SB) No. 671 - An Act concerning mistreatment and abuse of certain persons; amending K.S.A. 21-3437 and K.S.A. 2007 Supp. 39-1401 and repealing the existing sections. The Kansas Long-Term Care Ombudsman program is asking for support of SB 671 which would protect residents from: Financial Abuse, Neglect, and Exploitation; Mental anguish and trauma occurring after such incidents; Issues of possible discharge due to non-payment. SB 671 offers a pathway in dealing with the growing number of fiduciary abuse cases which is a serious matter to residents residing in adult care homes throughout Kansas. You can find the entire bill at http://www.kslegislature.org/bills/2008/671.pdf - NO ACTION