Janae Talbott of Smoky Hills Regional Prevention Center traveled to Norton to present about problem behaviors in older adults.  She focused on the prevalence of problem gambling in our older population, particularly the increase in the use of Internet gambling.

Help for problem gamblers is available by calling the state helpline at 1-866-662-3800.

Spending too much money at bingo or on scratch lottery tickets can be a problem.  This seems to be an acceptable social outlet for older people, but can be a very expensive habit.

There is a well-organized effort, originating in Lawrence, Kansas, called Kansas Compassionate Care Coalition (KSCCC) pushing to legalize medicinal marijuana.  Dr. Eric Voth has extensive research indicating how dangerous marijuana is for most people and how it truly doesn’t alleviate pain when smoked.  Resource are available online to further explain the subject.

The Regional Prevention Center has presented SPICE (Senior Prevention Intervention Counseling Education) training in the past.  Assessors received copies of the training handout.  The next SPICE training is undetermined due to funding concerns.

If you would like more information about problem behaviors, please contact Smoky Hills Regional Prevention Center at 1-785-625-5521.

Solution Outreach Center provides Durable Medical Equipment

The OCCK Solution Outreach Center in Salina allows assistive technology consumers to “try before they buy.”  The center offers an extensive inventory of assistive devices to loan to clients, typically for a period of 6 weeks.  There is an application to fill out to receive the equipment.

The center is able to ship most equipment via UPS at no charge to the consumer; bulky items may be more difficult to deliver to western Kansas.

Shellie Eddings explained that the organization works with consumers of all ages, with all levels of impairment.  If an item is not available at the time of the initial phone call OCCK is able to put the name on a waiting list, provide a tentative timeline for when it should be available, and call when it is returned to the DME pool.

Shellie can be contacted at (785) 827-9383 for more information about the products available through OCCK.

Blind services provides assistance at no cost to consumers

Many of our clients are affected by vision problems such as macular degeneration.  Mike Schmidt from SRS Blind Services explained how he was able to make the home environment more welcoming and convenient for people with vision problems.

All of the services Mike is able to provide are free.  There are no income guidelines.  Mike makes home visits; nobody is encouraged to meet in an office.  In addition, Mike does not advertise the program; all clients are referred by word of mouth.

He has taught clients to mark bottles with rubber bands (shampoo/conditioner, BenGay/toothpaste), use safety pins to organize clothes, clean glass shards with an oven mitt, vacuum according to a grid and pour liquids in a tray.

Most of the people Mike visits do not recognize faces due to the loss of their central vision.  Magnifiers may help, but may not be effective for all clients.

When services begin, Mike conducts a 45-minute interview to develop a teaching plan.  He visits the home once a week for the first 3 weeks of services, focusing primarily on safety issues.  Cosmetic issues are secondary.  He continues to periodically visit for the first 6 months before preparing to close the case.  Mike conducts a performance assessment before closing the case to prove the assistive devices are helping the client.

Mike’s contact information is as follows:

Mike Schmidt

Blind Services Rehabilitation Teacher

Hays SRS Service Center

3000 Broadway

Hays KS  67601

(785) 628-1066, ext 278 – office

(785) 628-8106 – fax

Mike.Schmidt@srs.ks.gov

Assisted Living is NOT Living Alone!!

SCA and HCBS services explained

Bernie Smith answered questions about Senior Care Act and Home and Community Based Services for the Frail Elderly particularly keeping in mind our clients who are planning to return home with services.

One of the most frequent comments both discharge planners and AAA case managers hear is “I don’t qualify.”  Clients may believe they don’t qualify for a variety of reasons, but as long as they have a need for services and are over 60 they do qualify for services on one of the Area Agency programs.

Clients cannot make “too much money” for Senior Care Act.  The enclosed sliding fee scale indicates that individuals who have high incomes will be asked to pay $14.50 per hour for services.  Clients who have very low incomes may not have a client obligation at all.

It is not necessary to determine which program you believe will best help your client.  When the client calls for an intake the person doing the intake will refer it to the appropriate program.  If, after the case manager assesses the client, it is determined that another program will best benefit the client the case manager will make the correct referrals.

A copy of the intake form is enclosed to allow you to help the client collect the appropriate information before calling for assistance.

The Area Agency is not able to force clients to accept services, even when it is in the best interest of the client.

There is not a waiting list for any services offered by the NWKAAA as of July 1, 2008.

For more information or to refer a client for services, please call our office at 1-800-432-7422.

Nursing Facility List Available Online

Clients seeking assistance choosing a nursing facility may be able to benefit from the new “compare” feature on the www.medicare.gov website.  Survey results are available to help consumers spot facilities with histories of non-compliance.  The lengthy plan is outlined more extensively in the enclosed pink handout.  Facilities are being held more accountable for their actions, hopefully resulting in better care for residents.

Kansas Neurological Institute Demonstrates Assistive Technology

The CARE Coordinators had the opportunity to tour Kansas Neurological Institute (KNI) at their last meeting in Topeka.  KNI works with individuals to help them maintain the most control over their lives as possible.  For example, it may not be possible for the client to dry their hair independently, but they may be able to push a button to turn the hair dryer off and on.

One part of the tour focused on assistive technology for eating.  The coordinators were really creative when determining what each device was intended to be used for.

KNI also helps customers find appropriate seat cushions that are customized to fit each individual to relieve uncomfortable pressure points.

Although KNI is not accepting new residents at this time, they work with members of the community through “seat fitting days” or other services available by appointment.  Please call KNI at 1-785-296-5300 with any special needs you have.

Housing Resource Available Online

Housing can be difficult to find.  Online resources, including kshousingsearch.org can help!

This website offers listings of rental properties, apartment features, pictures, property comparisons, current vacancy lists, handicapped accessible units, and much more.  It is a free locator service.  There are few areas in northwest Kansas listed, however it may be very helpful for clients looking to move to larger cities.

A bilingual call center can offer assistance.  Please call the call center at 1-877-428-8844 or visit the website for more information.

Rural low income housing can be found by searching the USDA website at http://www.rurdev.usda.gov/rhs.  This site primarily focuses on low interest loans for repair of existing property.

Low income housing can also be found at the HUD website at http://www.hud.gov/apps/section8.index.cfm.  This site is very user friendly and immediately shows a search form.  After entering basic location information a list of properties is generated.

Money Follows the Person Began July 1

Angie Reinking and Deb Schwarz came to Hays June 18 to explain the new Money Follows the Person program.

Money Follows the Person (MFP) is a 5 year demonstration grant from the Centers for Medicare and Medicaid Services (CMS) to help nursing facility residents transition back into communities to live.

Participants must be

Referrals will come from many sources, including the facility, family, client or MDS data.

A letter will be sent to the resident, facility, resident’s representative, and the ombudsman once the client has been identified as a potential program candidate.  This letter will explain the program, that community living is an option, how to decline the meeting, and that an ombudsman will be making contact with them to ensure they understand the letter and see if they are interested in community living.  The Ombudsman is a neutral 3^rd party with no vested interest.

A team, including a nursing facility social worker or staff member, Area Agency individual, Center for Independent Living representative, the resident’s representative (when they have one), peer support (as requested or needed), and the Ombudsman (as needed) will meet with the resident to explain the possible services available in the community.

MFP customers can receive transition services and home modification/assistive technology services in addition to traditional waivered services.

At the end of the 365 day program period the customer will seamlessly transition to regular waivered services, avoiding any possible waiting lists.

MFP customers can live in their own home/apartment or a family member’s home/apartment.  They may not live in assisted living, residential care home, hoe plus or board and care home.  MR/DD clients may live in up to a 4 bed group home too.

In addition to family and friends, a Targeted Case Manager will monitor and support MFP clients.

Further questions can be directed to Angie Reinking, Money Follows the Person Director, at 785-296-7744, or Deb Schwarz, Director of Transitions / CARE at 785-296-3691.

The CARE team at KDOA composed a list of reminders for CARE assessors.  We appreciate the wonderful job you currently do!  Hopefully this list will clarify any questions or concerns you may have.  If you have further questions, please call NWKAAA at 1-800-432-7422.  We will be happy to help you.  Thanks for your dedication to the CARE program – Without you it would not be possible to serve our clients in such a professional, timely manner.

CARE Assessor Alert:

Let’s all do our part to Make a Difference for the Future.

Guardian / Conservator

Guardian / Conservator (G/C) – KSA 59-3001 et al

Website for Kansas Guardianship Project – www.ksgprog.org

Guardian

A guardian makes personal and medical decisions promoting the comfort, safety, and health of an individual or ward.  Guardianship duties can be “limited” or “full.”  A guardian must file an annual report with the court.  

Conservator

Kansas law requires that the conservator acts on behalf of the ward (individual), to manage the estate for the benefit of the ward, and annually present to the court a verified account of the wards income and expenses.

A customer who is alleged to no longer have capacity to make Advanced Care Planning decisions is no longer able to sign the forms in good faith and understanding of the documents.

A family or other interested party who is at odds with each other or the health care providers may need to seek a guardianship to make healthcare decisions.

A family or other interested party who needs to handle the finances of an alleged incapacitated person may need to seek a conservatorship to manage finances.

1.        There must be a court proceeding to determine whether a person meets the legal definition of “An adult with impairment” and is in need of a guardian and/or conservator.

2.        The person who is alleged to be an adult with impairment is entitled to a notice that a petition has been filed, and a trial will be held.

3.         They are also entitled to be present at the hearing, if possible, as well as to have a court appointed attorney and a jury trial if requested.  The person may call witnesses to testify on their behalf.  

Out of State Guardian/Conservator – How do you work with them?

          The out of state Guardian/Conservator may be difficult to work with, as they will need to sign all needed paperwork and approval for all activities involving their ward.  The Guardian/Conservator may be able to appoint an individual to help with those duties with permission of the court.

Unavailable / Non Supportive Guardian/Conservator – How do you work with them?

In working with a non-supportive Guardian/Conservator, you will need to make sure that you are clear in the information that is being provided to them.  Since they have been appointed to make decisions for this individual, they may be hesitant to make major life changes.  Some of this fear/non-supportiveness may involve having to answer to the judge/courts, if things go wrong.

You can also enlist the support of an Ombudsman to act as an advocate for the customer.  The Ombudsman’s role is to advocate for the customer as a neutral third party.  They can work with a difficult Guardian/Conservator to help find resolution to the problem. (NF residents only)

Power of Attorney

Power of Attorney (POA)

A document by which one person (the principal) gives legal authority to another (the agent or attorney-in-fact) to act on behalf of the principal.  The authority the principal gives the agent can be very broad or can be limited to one or two specific acts.  (Caution – Consult with an attorney before signing this type of Power of Attorney).

          Limitations

a.                Authority only covers items expressed in the document.

b.                Loss of capacity ends the use of the document.

c.                Death ends the use of the document.

Durable Power of Attorney (DPOA)

          Provides authority to handle financial affairs / health care decisions

DPOA for Financial Affairs – It can be either broad or limited and is not affected by subsequent disability or incapacity of the principal.  It is called durable because it continues to be effective even after the principal has lost capacity due to illness or injury.  (Caution – Consult with an attorney before signing this type of Power of Attorney).

          Limitations

a.                Only for finances.

b.                Ends at death.

DPOA for Health Care Decisions – Is a written document in which you authorize someone who you name (your “agent” or “attorney-in-fact”) to make healthcare decisions for you in the event you are unable to speak for yourself.  Healthcare decisions include the power to consent, refuse consent or withdraw consent to any type of medical care, treatment, service or procedure.  In the document you can give any specific instructions regarding your healthcare which will require the agent to make decisions in accordance with your direction.  The document must contain language expressing that this power is to remain in force even if you are incapacitated.

          Limitations

a.                Only for making health related decisions.

b.                Ends at death except for decisions regarding disposition of the body, including autopsy.

c.                Ability to terminate/fire a DPOA.

Changing an Activated DPOA – What is involved?

An individual can fire their DPOA, they can sign a notarized letter indicating they no longer want the activated DPOA to represent them in their decision making activities.  This statement will need to be distributed to all involved parties and institutions (banks, attorneys, NF’s, etc…).  However, by the individual doing this, there could be severe consequences.  If the person has been shown to be incapacitated, firing their activated DPOA may be questioned.  The customer may still need someone to help them with making decisions.  At this point a guardian will then need to be appointed, due to the customer being incapacitated.  This is an extremely costly process and much more limiting that than a DPOA.

Critical New Information Added to Nursing Home Compare Website

Multi-year Plan for Improved Nursing Home Quality Also Released

          Medicaid beneficiaries and families searching for top quality long-term care services can find critical new information added today to the Centers for Medicare & Medicaid Services’ (CMS) Website “Nursing Home Compare.”

            For the first time, information about nursing homes on the Compare Website will list whether a home is or has been on CMS’ special focus facility (SFF) list.  The agency’s SFF initiative gives heightened scrutiny to nursing homes that have a history of poor performance or repeated violations of state and federal health and safety rules.

            “Today’s expansion of information on Nursing Home Compare will give beneficiaries a more complete picture of a nursing home’s history of providing quality care,” CMS Acting Administrator Kerry Weems said.

            The SFF initiative was created because a number of facilities were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next (for many of the same problems as before).  Such facilities with a “yo-yo” compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies.

            In November 2007, the agency began publishing a list of Medicare and Medicaid participating nursing homes that have a history of serious quality of care problems and had had failed to show significant improvement.  In February 2008, CMS took the next step and published an updated, expanded list of nursing homes in the SFF initiative and included the category they fell within such as new additions, not improved, improving, recently graduated or no longer in the Medicare and Medicaid programs.

            As of April 2008, there are 134 SFFs, out of about 16,000 active nursing homes.  CMS works closely with states to select participants and as homes improve their quality of care and “graduate” from the program, or fail to improve and are terminated from Medicare and Medicaid, new homes are added to the list.  This movement of homes off the list allows more facilities with problems to be added as the program continues.

           Once a facility is selected as an SFF, the state survey agency conducts twice the number of standard surveys and will apply progressive enforcement until the nursing home either (a) significantly improves and graduates from the SFF initiative, (b) is granted additional time due to promising developments, or (c) is terminated from Medicare and/or Medicaid.  CMS and the state can more quickly terminate a facility that is placing residents in immediate jeopardy.

          Nursing homes that have the SFF designation, including information about that designation, will now be noted on Nursing Home Compare, which can be accessed at www.medicare.gov.  The site helps families find nursing homes in their area.  Information about the homes includes performance scores on quality measures, staffing information and a three-year history of the home’s health, safety and fire inspection reports.  The Website will be updated with new information quarterly.

          “Today’s action is the next step in our commitment to bring transparency and accountability to the process families must go through to find the care that is best for them and their family member,” Weems said.

Further Actions Planned

          The publication of the SFF list was the first major step in CMS’ latest efforts to improve nursing home care.  A comprehensive, multi-year look at future actions the agency will take was also released today.

          The “2008 Action Plan for Further Improvement of Nursing Home Quality” consists of several inter-related and coordinated approaches:

A copy of the full 2008 nursing home action plan can be found at:  http://www.cms.hhs.gov/CertificationandComplianc/12_NHs.asp#TopOfPage.