Holly Noble, legislative committee chairwoman of the Kansas Adult Care Executives Association, told lawmakers Monday that the long-term care system is in turmoil. (Sherman Smith/Kansas Reflector)
TOPEKA — An advocate and long-term care worker said facilities across Kansas face sustainability issues amid low funding, insufficient testing, protective equipment scarcity and workforce shortages.
Holly Noble, legislative committee chair of the Kansas Adult Care Executives Association, a group dedicated to assisting long-term care administrators, said many KACE member facilities only project up to a year of financial stability as things stand.
“Our long-term care system is in a state of turmoil,” Noble said. “Due to the additional, unavoidable expenses of COVID-19, many adult care homes in Kansas are unsure of their long-term ability to operate and provide care for their residents. We feel like sitting ducks just waiting for the other shoe to drop.”
Noble was one of several Medicaid service providers who Monday shared concerns they have heard and experienced during the pandemic with legislators on a joint KanCare oversight committee. KanCare is the program through which the state administers Medicaid.
At Attica Long Term Care in south-central Kansas — where Noble serves as administrator — testing of staff and residents has incurred monumental costs and workforce issues.
Noble said many adult care facilities in rural Kansas like hers have yet to receive or are not scheduled to receive an antigen testing machine. Instead, many have turned to independent vendors that may charge up to $5,000 to $20,000 for one round of staff testing.
In addition, a federal mandate requires long-term care facilities to test the facility population monthly in green zones, areas where cases are low, to twice a week in red zones, communities with high case counts, Noble said.
Noble reported close to 50% of KACE members have already lost staffing because of the new requirements.
“This leaves us with the concern of sustainability of these requirements,” Noble said. “In addition to testing costs, adult care homes face an increased need for PPE and sanitation supplies.”
Rep. John Barker, R-Abilene, who last week expressed concern about a lack of rural voices on the State Finance Council, said he has heard of PPE issues in rural Kansas facilities.
“Just last week, we heard a story where they were ordering gowns and what they got was nothing but plastic trash bags with heads and arms cut out,” Barker said.
The Attica facility is experiencing the same issue, Noble said. The compounding effect of these issues has left facilities with uncertain futures and desperate for cost-effective ways to access the necessary PPE and testing, Noble said.
She called on legislators to aid in making sure long-term care facilities operate effectively beyond the pandemic.
“The sustainability of adult care homes to operate under the financial, regulatory, and medical safety practices required to keep residents safe is unknown amid COVID-19, and now is the time to step up and help plan a secure future for our elders,” Noble said.
Low funding for at-risk Kansans
Matt Fletcher, executive director of InterHab, an organization serving Kansans with intellectual or developmental disabilities, said the IDD community also faces a shortage in PPE and virus testing.
This is most concerning because a significant number of Kansans with IDD have co-occurring physical health conditions that make them more susceptible to complications from COVID-19, Fletcher said.
“Because of this, IDD service providers should be prioritized in acquiring these types of resources,” Fletcher said. “As we move further into the pandemic, accessing these types of resources will undoubtedly be even more critical.”
While the pandemic has worsened the situation for IDD providers, Fletcher said two decades of underfunding led to this moment of critical need. He said community-based provider networks for Kansans with IDD are feeling the financial squeeze, and service capacity is suffering as a result.
During the 2020 legislative session, InterHab introduced legislation to provide relief to the IDD provider network that included a 5% rate increase for providers.
“In late June, however, Gov. Laura Kelly removed those funds in order to address revenue shortfalls in the current fiscal year,” Fletcher said. “As a result, a needed lifeline of funds was taken from the IDD system at the worst possible time.”
Fletcher said the funds included by the Legislature in the fiscal year 2021 budget would have brought a total of $22 million in needed aid to the IDD provider network.
InterHab will advocate for the restoration of those funds during the coming legislative session, Fletcher said.
“We will also continue to push for a strategic approach to the restoration of lost IDD service capacity and elimination of the state’s waiting list,” Fletcher said. “We ask that there be some sort of substantive discussion about critical funds to the IDD system.”
Mental health spike
Mental health provider advocate Kyle Kessler said the spike in mental health conditions, substance abuse and suicidal thoughts amid COVID-19 is cause for a few policy changes that would assist community mental health centers during and after the pandemic.
Kyle Kessler, executive director for the Association of Community Mental Health Centers of Kansas, said the prevalence of symptoms of anxiety disorder was approximately three times those reported in the same period in 2019.
Telemedicine, Kessler said, has been instrumental in reaching more people who need these services and asked that the KanCare program continue to allow for parity in pay for treatment by phone or video.
“It allowed us to pivot very quickly, especially in urban areas when the pandemic began,” Kessler said. “We hope that Kansas continues to allow us flexibility in our telehealth rates.”
He also called for increased Medicaid rate reimbursement. The 2020 Legislature increased rates by 2%, but when the pandemic began, Kelly also froze this increase due to the state’s economic instability.
Lastly, Kessler asked that legislators consider the expansion of Medicaid. Kansas is currently one of 12 states yet to expand the program.
“More than half those who present for treatment at community mental health clinics have no insurance,” Kessler said. “Expansion of Medicaid will provide coverage for those who have a mental illness or mental health issues so they can access needed mental health treatment in their communities.”
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