Older Adult Client Outcome Indicator Project Report Fiscal ... · The purpose of the Older Adult...

The University of Kansas School of Social Welfare

Office of Aging and Long-Term Care

Older Adult Client Outcome Indicator Project Report

Fiscal Year 2002

Rosemary Chapin, Ph.D. Roxanne Rachlin, MHSA

Tara Swaim, LSCSW

This research was supported in part through a contract with the

Kansas Department on Aging and Kansas Department of Social and Rehabilitation Services

Topeka, Kansas 66612

June 30, 2002

Table of Contents Executive Summary ..........................................................................................................................i Older Adult Outcome Indicator Project ...........................................................................................1 National and Kansas Demographic Trends………………………………………………………...4 Longitudinal Outcome Indicator Trends…………………………………………………………...5 State Level Independence Indicators..............................................................................................10 Independence Indicators 1, 1a, 1b, and 1c: Nursing Facility Utilization Rates for People Age 65 and Over, Age 85 and Over, Age 65-74 and People Age 75-84..............................................................................10 Independence Indicator 2: Percent of Kansans Age 65 and Over Receiving Community Based Long Term Care Services Who Would Otherwise Be at Risk of Nursing Facility Placement ................................................13 Independence Indicator 3: Discharge from Nursing Facilities to the Community for Kansans Age 65 and Over .....................................................16 Independence Indicator 4: Diversion of Kansans Age 65 and Older Seeking Nursing Facility Placement..........................................................................18 State Level Protection Indicators ...................................................................................................19 PSA/AAA and County Level Independence Indicators .................................................................26 Regional Analysis of Integrated Indicator Data .............................................................................46 Recommendations.......................................................................................................................….85 Implications/Recommendations based on the outcome indicator trends .............................85 Recommendations to Enhance Monitoring of the Indicator Data........................................89 Conclusion .....................................................................................................................................91 References .....................................................................................................................................92

Executive Summary FY 2002 Older Adult Client Outcome Indicator Project Report

Project Background and Purpose The purpose of the Older Adult Client Outcome Indicators Project is to improve the overall welfare of frail elders by identifying and monitoring selected outcome indicators over time. Since this is the eighth and final year of the Outcome Indicators Project, this report begins with a look at the implementation of the project and original goals behind it. The Older Adult Client Outcome Indicators Project originated in 1993 as a joint effort between Kansas Department of Social and Rehabilitation Services (SRS), Kansas Department of Health and Environment (KDHE), Kansas Department on Aging (KDOA), and the University of Kansas School of Social Welfare (KU) staff. One of the original goals of the project was to aid Kansas policy makers and human service agencies in their effort to develop a more comprehensive, integrated long term care system. The idea behind it was to develop a few straightforward data elements to monitor and track that could be used for strategic planning by state agencies and to help educate key stakeholders in the aging field. Therefore, policy makers were engaged in identifying and developing key outcome indicators that could help policy makers chart progress in creating an effective community based long-term care system. Another purpose of the project was to highlight areas where data was needed by policy makers to help inform decision-making at the systems level. Over the course of the Outcome Indicators Project, much progress has been made in the development of needed indicator data and the monitoring and tracking of the outcome indicators. It is important to continue measuring indicators such as the ones developed for this project in order to track progress in meeting state agency goals such as improving customer access to services and enhancing consumer autonomy. Since this is the final Outcome Indicator Report, a section on overall indicator data trends is provided to give readers an overview of the progress that Kansas has made. The recommendations section of the report includes a discussion of strides made in the improvement of data sources needed to measure and track indicators. In addition, areas where data are needed by policy makers and state agency staff to monitor outcomes are identified. Current indicator data are provided at the state, Planning and Service Area/Area Agency on Aging (PSA/AAA), and county level. The current indicator data are organized by the level of measurement (state, planning and service areas) rather than the indicator. Major sections are indicated by tabs to allow for quick reference and to provide the indicator data in an accessible, “user-friendly” format. It is hoped that this format will allow the indicator data to be easily accessed for a variety of purposes. Summary of Longitudinal Outcome Data Trends The longitudinal outcome data reflects the progress Kansas has made (please see full report for specific tables and graphs). The nursing facility utilization rate has decreased over time, while the utilization of nursing facility alternatives such as HCBS/FE and AL/RHCs have increased during the same time period. In addition, the increasing discharge and diversion rates indicate the greater proportion of older adults have been able to utilize community based alternatives to permanent nursing facility placement. The data also reflect the importance of available publicly funded in-home services. During the time Kansas experienced a waiting list for HCBS/FE services the nursing facility utilization increased. Overall, however, the longitudinal findings are encouraging, and underscore the importance for policy makers to continue these efforts to support

i

the preference of older adults to have their long-term care needs met in their own homes rather than in a nursing facility.

Independence Indicator Findings Independence Indicator 1 reflects the percent of people age 65 and older residing in nursing facilities1. It is referred to as the “nursing facility utilization rate.” This indicator is also analyzed by subgroups for the 85 and older, 65-74, and 75-84 age segments. The 2000 nursing facility utilization rates were also analyzed by gender. Findings from this indicator are highlighted below. • In 2000, approximately 5.6% of Kansans age 65 and over resided in nursing facilities.

The nursing facility utilization rate had increased slightly between 1998 and 1999. • Between 1999 and 2000 all of the age groups stayed the same or showed small decreases

in their NF utilization rates. • The age 85 and over showed the largest NF utilization rate decrease between 1999 and

2000. • In all age groups, a higher proportion of women than men reside in nursing facilities

(NFs) in both 1999 and 2000. • The percent of women age 85 and older who resided in nursing facilities decreased

between 1999 and 2000. In contrast, the percent of men age 85 and over who resided in NFs increased slightly during the same time period.

1998 - 2000 Nursing Facility Utilization Rates by Age Group.

Age

Group 1998 NF

Utilization Rate 1999 NF


Utilization Rate 65-74 1.2% 1.2% 1.2% 75-84 5.2% 5.3% 5.2% 85+ 22.7% 22.7% 21.6%

Total 65+ 5.7% 5.8% 5.6% Independence Indicator 2 is designed to measure the percent of Kansans age 65 and over receiving community based services that would otherwise be “at risk of nursing facility placement”. This indicator reflects publicly funded community based long-term care services, which include programs sponsored with public money under the jurisdiction of AAAs and KDOA. Some of these services are designed to assist with activities of daily living, while others are intended to provide attendant or limited medical assistance at the client’s residence. Due to the growth in the number of assisted living and residential health care (AL/RHC) beds, these settings are also analyzed as part of Indicator 2. Findings from Indicator 2 are highlighted below.

1 This indicator includes long term care clients age 65 and older who resided in licensed nursing facilities, including hospital based licensed nursing facility beds. Data on the number of older adults utilizing nursing facility services on December 31 of each year are collected by KDHE.

ii

• Between State Fiscal Year 2000 and 2001 there was a 9.6% increase in the number of older Kansans receiving HCBS/FE services. The number rose from 7143 in 2000 to 7828 in 2001. There was a 4.7% increase between SFY1999 (6,822) and SFY2000 (7,143). From FY1998 to FY1999 there was an increase of 21% (these figures are derived from the Medicaid fiscal agent)2.

• During FY2001 there were 3,429 customers who received Income Eligible services,

compared to 3,147 customers in FY20003. During SFY1999, there were 2,467 customers who received Income Eligible services, not including those who received just an assessment. An additional 793 customers received just an assessment, bringing the total for FY1999 to 3,260.

• Approximately 2,913 customers received Senior Care Act Services in FY 2001,

decreasing from 3,061 in FY 20004. Overall, however, the number of SCA and IE customers combined has increased during this time.

• The rate of Kansans age 65 and over residing in AL/RHC facilities increased markedly

over time, from 1.0% in 1998 to 1.3% in 1999 and to 1.5% in 2000. • The age 85 and over group showed the greatest increase in the proportion of older

adults residing in AL/RHC settings. • A greater proportion of women reside in AL/RHCs than men in all of the age sub-

groups. The largest difference is in the age 85 and over group, 4.43% of men age 85 and older resided in AL/RHCs facilities during 2000, compared to 6.35% of women in the same age group.

AL/RHC Utilization Rates by Age Group, 1998 - 2000

Age

Group 1998 AL/RHC

Utilization Rate 1999 AL/RHC

Utilization Rate 2000AL/RHC


Total 65+ 1.0% 1.3% 1.5%

Independence Indicator 3 reflects the number of older adults who move from nursing facilities to more integrated environments in the community. It includes residents of licensed nursing facilities and residents of nursing facility beds in hospitals. The Minimum Data Set (MDS) is used to provide the data needed for this indicator. According to staff from Myers and Stauffer, data collection on the MDS 2.0 has improved between 1999 and 2000, which may account for some of the discharge rate increase. They noted, however, that the discharge rate trend accurately reflects what is taking place. Findings from this indicator include:

2 Data provided by the Program Evaluation Supervisor at KDOA. 3 Please note this figure includes Income Eligible and Senior Care Act Assessments. 4 Data provided from the Program Evaluation Supervisor at KDOA.

iii

• The percent and number of older Kansans who have returned to the community from nursing facility placement has increased steadily between 1998 and 2000.

• During Calendar Year 2000, approximately 35% of nursing facility residents (including

nursing facility hospital residents) returned to the community. It increased from 24.3% in 1999.

• If nursing facility hospital residents are not included, the percentage of nursing facility

residents discharged to the community in 2000 was 26.83%, increasing from 18.5% in 1999. The percent of hospital based nursing facility residents that discharged to the community has continued to increase substantially.

Nursing Facility Level Residents Age 65 and Over Who Were Discharged to the

Community CY1993 – CY2000

Year

Total Number of Residents Returned

Total Number of Nursing Facility Residents

Percent

CY 1993 2,345 22,661 10.3%

CY 1994 3,401 24,739 13.8%

CY 1995 4,403 22,574 19.5%

CY 1996 4,962 20,842 23.8%

CY 1997 3,930 18,281 21.5%

CY 1998 4,179 21,377 19.6%

CY 1999 5,349 22,009 24.3%

CY 2000 7,833 22414 35% Independence indicator 4 is structured to measure the number and percent of people age 65 and older seeking nursing facility care who chose and received community based services as an alternative. Detailed diversion data (from the CARE Program) is not included as part of this report to prevent duplication for state agency staff. However, for the sake of other readers and for the purpose of analyzing the indicators in conjunction with one another, some diversion data are presented below. • The percent of Kansans age 65 and older seeking nursing facility care who chose and

received community based services as an alternative decreased slightly from 17.93% in 1999 to 17.7% in 2000. However, the rate has shown an overall increase from 15.33% in FY 1997.

• Overall, the number of CARE assessments increased by 6.8% from FY 1997 to FY 2000. Protection Indicator Findings The protection indicators are structured to measure the reported incidence of abuse, neglect, and exploitation (A/N/E) of older adults receiving long-term care services either in the community or in institutions. Information needs to be collected uniformly. It is important to be able to monitor

iv

A/N/E across care settings and compare rates between settings. Alternative proxies for these indicators have been identified and tracked over time since an unduplicated count of elders abused and/or neglected in Kansas is not yet available. Protection Indicator 1a, addresses abuse/neglect/exploitation in the community for recipients of long-term care services, while Protection Indicator 1b monitors A/N/E of older adults residing in institutions. Data from SRS investigation reports on the number of A/N/E reports involving older adults in the community has been tracked and analyzed for Protection Indicator 1a. Data from KDHE are used to measure Protection Indicator 1b. Findings from these indicators are highlighted below.

• The number of A/N/E reports increased between FY 1999 and 2001, but at a much

slower rate than in the previous years (see table below).

A/N/E Reports Involving Adults Age 60 and Over in the Community5, FY 1996 - FY 2001

Fiscal Year

A/N/E Reports Involving Adults Age 60 and Over

Percent Increase

FY 1996 840 N/A FY 1997 1,270 51.2% FY 1998 2,224 75.1% FY 1999 2,512 13.0% FY 2000 2,723 8.4% FY 2001 2,795 2.6%

Source: SRS “Abuse/Neglect/Exploitation/Fiduciary Abuse” Report • From FY 2000 to FY 2001 the number of KDHE institutional A/N/E investigations

increased by 10%. Between FY 1999 and FY 2000 the number of institutional A/N/E investigations dropped slightly (2%).

• The proportion of SRS A/N/E reports that involved an older adult who was a publicly

funded service recipient decreased for all services between FY 2000 and 2001. • In FY 2001, 20.3% of the adults age 60 and over involved in an SRS A/N/E report were

recipients of publicly funded in-home services. In FY 2000, the percent was 23.6%, while in FY 1999 it was 19.5%.

• In FY 2001, approximately 16.2% (453) of the age 60 and over adults involved in an

SRS A/N/E report were HCBS/FE service recipients6. In FY 2000, the percent was 17.9% (486), while in FY 1999 it was 11.6% (291).

5 These figures could include nursing facility residents if the occurrence involved a resident to resident or other non-staff to resident incident. Incidents that involve a staff member would be investigated by KDHE. 6 Please note that an adult between the ages of 60 and 64 cannot be an HCBS/FE customer.

v

PSA/AAA and County Level Independence Indicators This section of the report provides an overview of the indicator data at the PSA/AAA and county levels, where available. The findings at the PSA level are also presented in conjunction with other indicator data in the segment of this report entitled “Regional Analysis of Integrated Indicator Data” in order to provide a comprehensive picture of long term care in Kansas. Additional sources of long-term care data are also explored. The supplemental information sources include KDHE assisted living utilization data, KDHE nursing facility occupancy data, and other program or agency reports/data as they apply to outcome indicators. This report segment presents a profile of each PSA based on these data. Recommendations This project provided an opportunity to develop a set of data indicators to monitor and track client outcomes that can help evaluate changes in the long-term care system of Kansas and set policy and program goals. When the Long-term Care Action Committee decided on the original indicator list in 1992, the data to measure many of the indicators were not available. Significant progress has been made in developing the data sources necessary to track the indicators longitudinally. Almost all of the independence indicators have been operationalized. In addition, efforts to create new indicators (i.e. monitoring assisted living rates separate from nursing facilities) to reflect the changing long-term care system were successful. Progress has also been made towards operationalizing the protection indicators. However, additional improvements are needed in some areas in order to provide policy makers with information needed for decision-making.. Despite the data gaps, all of the indicators (or proxies) have been tracked for four or more years, making it possible to identify longitudinal trends. Implications and recommendations are also offered based on the outcome indicator data and findings. This section is organized under the following headings:

• Implications/Recommendations based on the outcome indicator trends; and • Recommendations to enhance aging related data.

Conclusion During times of limited resources and increased pressure on state agencies to provide long-term care options in the most cost effective manner possible, tracking data such as the outcome indicators is crucial in order to assess the impact of system changes on older Kansans. The longitudinal indicator trends reflect the progress Kansas has made in improving outcomes for older adults. In addition, there have been substantial improvements in data sources needed to measure and track the indicators over time. Resource support should continue for data collection for long term care programs and services. This information is essential in order to assess the strengths and weaknesses of the state system as well as to determine if policy goals are being met. Monitoring data such as the indicators regionally over time enables the state to analyze its progress in service delivery on a geographic basis. It is anticipated that the effort to monitor key indicators over time will be continued through the Elder Count Project currently underway. In times of major system change, data collection is especially important to quantify changes in long term care service utilization patterns as a result of changes.

vi

Older Adult Client Outcome Indicator Project Report Project Background and Purpose The purpose of the Older Adult Client Outcome Indicators Project is to improve the overall welfare of frail elders by identifying and monitoring selected outcome indicators over time. Since this is the eighth and final year of the Outcome Indicators Project, this report begins with a look at the implementation of the project and original goals behind it. The Older Adult Client Outcome Indicators Project originated in 1993 as a joint effort between Kansas Department of Social and Rehabilitation Services (SRS), Kansas Department of Health and Environment (KDHE), Kansas Department on Aging (KDOA), and the University of Kansas School of Social Welfare (KU) staff. One of the original goals of the project was to aid Kansas policy makers and human service agencies in their effort to develop a more comprehensive, integrated long term care system. The idea behind it was to develop a few straightforward data elements to monitor and track that could be used for strategic planning by state agencies and to help educate key stakeholders in the aging field. Therefore, policy makers were engaged in identifying and developing key outcome indicators that could help policy makers chart progress in creating an effective community based long-term care system. Another purpose of the project was to highlight areas where data was needed by policy makers to help inform decision-making at the systems level. The scope of the project was to define and monitor client outcomes at the systems level for elderly Kansans receiving long term care services. The Long Term Care Action Committee, comprised of staff from SRS, KDOA, KDHE and KU, worked to develop the indicators useful in monitoring outcomes and distribution of services to older adults in Kansas. The agreed upon indicators reflected the goals of the agencies involved as contained in their mission statements. Indicators were chosen that could help focus future planning efforts and inform development of specific strategies to expand community based long term care choices. For example, indicators reflecting the utilization of both institutional and community based services by elderly Kansans were developed. Reviewing the number of the clients served in these settings can determine if utilization patterns are changing. The original indicators were developed to monitor independence, protection, and quality of life7. The current indicators address the following outcomes:

• Nursing facility utilization rates for adults age 65 and over; • Community based services utilization rates for adults age 65 and over; • Nursing facility discharge rates for adults age 65 and over; • Diversion from nursing facility placement; and • Abuse, neglect and exploitation of older adults in community and institutional settings.

Outcome indicators are measurement tools used to describe improvement in client situations or the curbing of deteriorating client situations. It is important not to focus solely on process or cost outcomes since these measures do not thoroughly reflect the influence of system changes from the client’s perspective. Indicators can serve as “ red flags” to draw attention to detrimental changes in desired client outcomes. However, indicators do not show why a fluctuation has taken place, only that one has occurred. It is important to investigate outcome indicator changes to discern the reasons behind them and possible implications. 7 Due to a lack of data availability the quality of life indicators were not operationalized.

1

Quarterly reports were presented to the Long Term Care Action Committee to monitor client outcomes. The committee established accompanying standards for the indicators. Monitoring of outcome indicators requires the establishment of standards, baselines, and collection of actual numbers of individual clients served. As used in this project, a standard is a numerical definition of adequacy (Lewandowski and Rapp, 1991). A baseline is a measurement that serves as a base for comparison. Standards, baselines, and actual percentages allow policy makers to evaluate strategies and costs involved in achieving goals. Over time, baselines were established for the majority of the indicators. In addition, Kansas has surpassed all of the indicator standards established by the Long Term Care Action Committee in 1994. Over the course of the Outcome Indicators Project, much progress has been made in the development of needed indicator data and the monitoring and tracking of the outcome indicators. It is important to continue measuring indicators such as the ones developed for this project in order to track progress in meeting state agency goals such as improving customer access to services and enhancing consumer autonomy. Overview of Fiscal Year 2001 Outcome Indicator Report As mentioned, since this is the final Outcome Indicator Report, a section on overall indicator data trends is provided to give readers an overview of the progress that Kansas has made. The recommendations section of the report includes a discussion of strides made in the improvement of data sources needed to measure and track indicators. In addition, areas where data are needed by policy makers and state agency staff to monitor outcomes are identified. Current indicator data are provided at the state, Planning and Service Area/Area Agency on Aging (PSA/AAA), and county level. Wherever possible, actual population figures from the 2000 Census are used to measure indicators. The current indicator data are organized by the level of measurement (state, planning and service areas) rather than the indicator. Major sections are indicated by tabs to allow for quick reference and to provide the indicator data in an accessible, “user-friendly” format. It is hoped that this format will allow the indicator data to be easily accessed for a variety of purposes. This report is divided into the following sections: • National and Kansas demographic trends related to the independence indicators; • Longitudinal outcome indicator trends; • State level independence indicator data; • State level protection indicator data; • PSA/AAA and county level independence indicator data; • Regional analysis of integrated indicator data, where indicator data are presented and

organized by PSA along with supplemental long-term care system data; and • Recommendations/implications based on the outcome indicator findings and

recommendations to enhance aging related data sources.

2

National and Kansas Demographic Trends: How Older Kansans Compare Nationally The following section provides a snapshot of the latest national and Kansas demographic data related to the indicators. This information indicates how Kansas compares nationally. It also highlights areas of interest in planning for the future long-term care needs of older Kansans. • In 2000, approximately 13.3% of Kansas’ population was age 65 or older, compared to

12.4% nationally. Kansas ranked 17th on this indicator in comparison with other states (U.S. Bureau of the Census, 2001).

• Approximately 1.9% of Kansas’ population was age 85 or older in 2000, compared to 1.5%

nationally. Kansas has the eighth highest percentage of persons age 85 and over in the United States (U.S. Bureau of the Census, 2001).

• Approximately 7.9% of Kansas seniors were below the poverty level from 1998 to 2000,

compared to 10.1% nationally (U.S. Bureau of the Census, June 2001). • The percent of Medicaid dollars spent on the elderly in Kansas during 2000 was 30.3%, while

the national average was 29.8%. In addition, 50.8% of Medicaid dollars in Kansas were spent on long-term care, compared to 34.8% nationally (Raetzman, Craig, and McDougall, 2001).

• Approximately 32% of noninstitutionalized Kansans age 65 and over lived alone in 2000,

compared to 30% nationally. (U.S. Bureau of the Census, October 2001). • In 2000, the percent of Kansans age 65 and over residing in nursing facilities was 5.57%,

while the national average was 4.5% (U.S. Bureau of the Census, October 2001). • In 1999, 32.5% of Kansans age 65 and over in poverty were Medicaid nursing facility

residents, compared to 29.9% nationally (Nawrocki and Gregory, 2000). • In 1999 Kansas had the highest ratio of certified nursing facilities per 1000 adults age 65 and

over (1.13) than any other state. The ratio of nursing facility beds per 1000 adults age 65 and over was also high, 78.6 compared to 52.3 nationally (Nawrocki and Gregory, 2000).

• The nursing facility occupancy rate in Kansas in 1999 was 81.4%. The national average was

82.7% (Nawrocki and Gregory, 2000). • The ratio of residential care beds per 1000 adults age 65 and over in 1999 was 17 compared

to 25.5 nationally. In addition, the ratio of residential health care facilities per 1000 adults age 65 and over was .56 and ranked 36th out of all of the states (Nawrocki and Gregory, 2000).

The comparison data show that Kansas has a higher proportion of older adults than most states, lower poverty rates among the elderly, slightly higher rates of older adults who live alone, a higher rate of older adults who reside in nursing facilities, an above average supply of nursing facility beds in relation to the size of its older adult population and a below average supply of residential care (i.e. assisted living) beds. In addition, a higher proportion of poor older Kansans were Medicaid nursing facility residents than the national average. These data point to a need for additional community based care alternatives for the most vulnerable of the older adult population. The overall trends highlight the challenges policy makers face in crafting a long-term care system for older Kansans that meets the preferences of elders and is cost-effective.

3

Longitudinal Outcome Indicator Trends This section presents longitudinal trends in the outcome indicator data. The majority of the independence indicators have been measured for at least four time periods. Although there have been some changes in how indicators have been measured over time, the data allows for an analysis of the overall trends. The purpose of this section is to examine the relationship of the indicator trends in conjunction with one another. It provides a “picture” of the changes in the long-term care system in Kansas over the last several years. The data are presented graphically, followed by a discussion of the trends. The first figure displays the percent of older Kansans residing in nursing facilities for calendar years 1997 through 2000.

Figure 1. Percent of Older Kansans Residing in Nursing Facilities, CY 1997-2000

22.73%22.71%24.08%21.55%

5.57%5.79%5.70%6.02%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

1997 1998 1999 2000Calendar Year

Perc

ent 65-74

75-8485 and over65 and over

There was an overall decrease in the nursing facility utilization rate. As Figure 1 shows, however, the rate increased in 1999. During this year there was a waiting list for Medicaid Home and Community Based Services for the Frail Elderly (HCBS/FE), which may have contributed to the increase in the nursing facility utilization rate.

Prior to 1997, Independence Indicator 1 (percent of older adults residing in NF placement) was calculated including both nursing facility and assisted living/residential health care8 (AL/RHC) 8 Assisted Living is defined as any place or facility caring for six or more individuals not related within the third degree of relationship to the administrator, operator or owner by blood or marriage and who, by choice or due to functional impairments, may need personal care and may need supervised nursing care to compensate for activities of daily living limitations and in which the place or facility includes apartments for residents and provides or coordinates a range of services including personal care or supervised nursing care available 24 hours a day, seven days a week for the support of resident independence. The provision of skilled nursing procedures to a resident in an assisted living facility is not prohibited by Kansas law. Residential care units are similar to assisted living center in that they provide an independent living option for the frail elderly. They offer the same services and assistance with the activities of daily living. The main difference between a residential care unit and an assisted living unit is that assisted living units are required to have a kitchenette and a food preparation.

4

residents. Therefore, the following combined nursing facility – AL/RHC utilization rates are presented in order to analyze the longitudinal trend from 1991 through 2000.

Figure 2.

Percent of Older Kansans Residing in Nursing or AL/RHC Facilities by Age Group, CY 1991-2000

31.96% 31.49% 30.50% 29.79% 29.60% 28.46% 28.46%26.78% 27.79% 27.37%

7.36% 7.38% 7.13% 7.19% 7.10% 6.99% 7.06% 6.72% 7.06% 7.04%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Calendar Year

Perc

ent 65-74

75-8485 and Over65 and Over

Figure 2 also shows an overall downward trend. The rate for each age group was the lowest in 1998 and then increased. The growth of AL/RHC settings in the state undoubtedly had an impact on the increase during this time. The number of AL/RHC beds in Kansas increased by 36% from 1997 to 1999 (Chapin et al., 1999). The following figure displays the percent of older Kansans residing in AL/RHCs during 1997 through 2000.

Figure 3. Percent of Kansans Age 65 and Over Residing in AL/RHC Facilities, CY 1997-2000

5

1.47%1.27%

1.03%1.04%

0.00%0.20%0.40%0.60%0.80%1.00%1.20%1.40%1.60%1.80%2.00%

1997 1998 1999 2000

Calendar Year

Perc

ent

Figure 3 shows an increase in the percent of older adults utilizing AL/RHC settings. It appears that many older Kansans who would otherwise have entered a nursing facility utilized AL/RHCs instead. Another long-term care option that may be used as an alternative to nursing facility placement is Medicaid Home and Community Based Services for the Frail Elderly (HCBS/FE). Figure 4 below displays the longitudinal trend of Kansans utilizing HCBS/FE services.

Figure 4.

Percent of Kansans Age 65 And Over Utilizing HCBS/FE Services, FY1998-2001

1.52%

1.93% 2.01%2.20%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

FY 1998 FY 1999 FY 2000 FY 2001

Fiscal Year

Perc

ent

Between fiscal year 1998 and 2001 the percent of older adults receiving HCBS/FE services has increased. Over roughly the same time period, the HCBS/FE utilization rate increased by .68% while the nursing facility utilization rate decreased by .45%. Considering that roughly 55% of nursing facility residents use Medicaid as a payment source, it is likely that the increased spending on HCBS/FE services were more than offset by the savings realized through the avoidance of nursing facility placement. In order for older adults to have their long-term care needs met in the least restrictive setting, community based services and alternative settings such as assisted living need to be available. Proxies for the availability of these long-term care options include the rate that older adults return to the community from nursing facility placement and the rate at which they are diverted from nursing facility placement. The overall trends in these rates are displayed in Figure 5 and 6 below.

6

Figure 5. Nursing Facility Residents Age 65 and Over Who Were Discharged to the Community,

CY1993 – 2000

10.30%13.75%

19.50%23.81% 21.50% 24.30%

19.55%

34.95%

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%

1993 1994 1995 1996 1997 1998 1999 2000Calendar Year

Perc

ent

The percent of nursing facility residents age 65 and over who have returned to the community has increased drastically over time. The sharpest increase occurred between 1999 and 2000. The removal of the HCBS/FE waiting list during this time period may have resulted in a large increase in the number of nursing facility residents who were able to return to the community with the help of in-home services. Other possible factors are changes in Medicare rates or policies. Overall, the increasing discharge rate trend reflects how older Kansans are using nursing facilities in a different manner than previously. Findings from the “Longitudinal Study of Customers Diverted Through The CARE Program” showed that entering a nursing facility does not necessarily result in a permanent stay. Increasingly, older adults are using the nursing facility for short-term rehabilitative care and are able to maintain community tenure following a nursing facility stay. The availability of in-home services and alternative care settings such as assisted living are crucial to older adults being able to return to the community from nursing facility placement or be diverted from nursing facility placement. The diversion rate trend is shown in Figure 6 below.

7

Figure 6. Percent of Kansans Age 65 and Over Diverted From Nursing Facilities, FY 1996-2000

14.64% 15.33% 16.45%17.93% 17.74%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

1996 1997 1998 1999 2000

Fiscal Year

Perc

ent

The diversion rate has steadily increased over time, with a leveling off in fiscal year 2000. The increasing diversion rate indicates that more applicants to nursing facilities are being served in the community or in alternative settings with community based services. An expansion in the availability of community based services and AL/RHCs have likely contributed to the diversion rate increase. The most recent decrease in the diversion rate may be due to an increase in the number of older adults who utilize in-home services prior to applying for nursing facility placement (referred to as ‘early diversion’). Therefore, the older adults are delaying admission until after they have exhausted all community based alternatives and it is truly necessary. In addition, a decline in the availability of some in-home services due to the waiting list for HCBS/FE services may have impacted the diversion rate during this time. Summary of Longitudinal Outcome Data Trends The longitudinal outcome data reflects the progress Kansas has made. The nursing facility utilization rate has decreased over time, while the utilization of nursing facility alternatives such as HCBS/FE and AL/RHCs have increased during the same time period. In addition, the increasing discharge and diversion rates indicate the greater proportion of older adults have been able to utilize community based alternatives to permanent nursing facility placement. The data also reflect the importance of available publicly funded in-home services. During the time Kansas experienced a waiting list for HCBS/FE services the nursing facility utilization increased. Overall, however, the longitudinal findings are encouraging, and underscore the importance for policy makers to continue these efforts to support the preference of older adults to have their long-term care needs met in their own homes rather than in a nursing facility.

8

State Level Independence Indicators The independence indicators track the utilization of nursing facility services and community based care by older Kansans. They are defined as follows: • Independence Indicator 1: The percent of older adults residing in nursing

facility settings; • Independence Indicator 2: The percent of older long-term care (LTC) clients

receiving community-based services, who may otherwise be at risk of nursing facility placement9;

• Independence Indicator 3: The percent of older LTC clients returning to the community from nursing facilities (includes nursing facilities and LTC beds in hospitals); and

• Independence Indicator 4: The percent of nursing facility applicants who select and receive community based services instead of institutional placement.

The year of measurement is indicated on all tables and graphs. Years of measurement for indicators vary due to the availability and format of data. Independence Indicator 1, 1a, 1b and 1c: Nursing Facility Utilization by Age Segment This indicator reflects the percent of people age 65 and older residing in nursing facilities10. It is referred to as the “nursing facility utilization rate.” This indicator is also analyzed by subgroups for the 85 and older, 65-74, and 75-84 age segments. Tables 1 and 2 display the most recent nursing facility utilization rates of older adults in Kansas. These data are also displayed in Chart 1. Findings from this indicator are highlighted below. • In 2000, approximately 5.6% of Kansans age 65 and over resided in nursing facilities.

The nursing facility utilization rate had increased slightly between 1998 and 1999. • Between 1999 and 2000 all of the age groups stayed the same or showed small decreases

in their NF utilization rates. • The age 85 and over showed the largest NF utilization rate decrease between 1999 and

2000. Table 1.

Nursing Facility Utilization Rates by Age Group, 2000*

Age Group

NF Clients 12/31/00

2000 Age Group Population

2000 NF Utilization Rate

65-74 2,046 175,916 1.2% 75-84 6,644 128,543 5.2% 85+ 11,157 51,770 21.6%

Total, 65+ 19,847 356,229 5.6% *Source: KDHE Adult Care Home Statistics and Census 2000 population figures 9 The definition of this indicator is available on page 13. 10 This indicator includes long term care clients age 65 and older who resided in licensed nursing facilities, including hospital based licensed nursing facility beds. Data on the number of older adults utilizing nursing facility services on December 31 of each year are collected by KDHE.

9

Table 2. 1998 - 2000 Nursing Facility Utilization Rates by Age Group.

Age

Group 1998 NF




Total 65+ 5.7% 5.8% 5.6%

Chart 1. Nursing Facility Utilization Rates by Age Group, 1997 through 2000

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

65-74 75-84 85 and over 65 and over

Age Group

Perc

ent 1997

199819992000

The 2000 nursing facility utilization rates were also analyzed by gender (see Table 3). Chart 2 displays the 2000 nursing facility utilization rates broken out by age and gender in comparison to the 1999 rates. • In all age groups, a higher proportion of women than men reside in nursing facilities

(NFs) in both 1999 and 2000. • The percent of women age 85 and older who resided in nursing facilities decreased

between 1999 and 2000. In contrast, the percent of men age 85 and over who resided in NFs increased slightly during the same time period.

10

Table 3. Nursing Facility Utilization Rates by Age Group and Gender, 2000*

Age Group

Male NF

Clients 12/31/00

Male 2000

Population

2000 Male

NF Util. Rate

Female NF

Clients 12/31/00

Female

2000 Population

2000 Female NF Util.

Rate 65-74 835 79,950 1.0% 1,222 95,966 1.3% 75-84 1971 50,953 3.9% 4,673 77,590 6.0% 85+ 2244 14,612 15.4% 8,913 37,158 24%

Total 65+ 5051 145,515 3.5% 14,808 210,714 7.0% *Source: KDHE Adult Care Home Statistics and Census 2000 population figures

Chart 2.

Percent of Older Adults Residing in Nursing Facilities by Age and Gender, 1999 – 2000

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

65-74 75-84 85 and over 65 and over

Age Group

Perc

ent

2000 male

1999 male1999 female

2000 female

During 2000, older women resided in nursing facilities at twice the rate of men. The greatest difference was in the age 85 and over subgroup, 15.4% of men age 85 and over resided in nursing facilities compared to 24% of women in this age group. The reason for the disparity may be due to women not having as much informal support available to help them remain in the community. Further analysis to discern the cause for the differences in nursing facility utilization by gender is needed.

11

Independence Indicator 2: Percent of Kansans Age 65 and Over Receiving Community Based Long-Term Care Services Independence Indicator 2 is designed to measure the percent of Kansans age 65 and over receiving community based services that would otherwise be “at risk of nursing facility placement”. This indicator reflects publicly funded community based long-term care services, which include programs sponsored with public money under the jurisdiction of AAAs and KDOA. Some of these services are designed to assist with activities of daily living, while others are intended to provide attendant or limited medical assistance at the client’s residence. The publicly funded services included under this indicator include the following: • Senior Care Act services, including homemaker and attendant care services;

• Income Eligible Services; • Older Americans Act Title III-B In Home Services, including: • Homemaker; • Personal care; • Respite care; and • Chore services.

• Older Americans Act Title III-C-2 State General Fund Services and Home Delivered Meals Services;

• Older Americans Act Title III-D In-Home Services; • State In-Home Nutrition Services;

• HCBS/FE Waiver services: Health Care Attendant (levels one and two), Sleep Cycle Support, Wellness Monitoring, Adult Day Care, Personal Emergency Response and Respite Care.

Individual program data (i.e. HCBS client counts) are used to analyze this indicator since an unduplicated count of community-based customers between and within state publicly funded services was not available. It is anticipated that this information will be available for use in the ElderCount Project. Individual Community Based Service Program Data Individual program data for the HCBS/FE Waiver, Senior Care Act, Income Eligible programs and Title III-B In-Home, Title III C-2, and Title III D specific service data indicate that the number of older adults having their needs met in the community has increased. • Between State Fiscal Year 2000 and 2001 there was a 9.6% increase in the number of

older Kansans receiving HCBS/FE services. The number rose from 7143 in 2000 to 7828 in 2001. There was a 4.7% increase between SFY1999 (6,822) and SFY2000 (7,143). From FY1998 to FY1999 there was an increase of 21% (these figures are derived from the Medicaid fiscal agent)11.

• During FY2001 there were 3,429 customers who received Income Eligible services,

compared to 3,147 customers in FY200012. During SFY1999, there were 2,467 customers who received Income Eligible services, not including those who received just an assessment.

11 Data provided by the Program Evaluation Supervisor at KDOA. 12 Please note this figure includes Income Eligible and Senior Care Act Assessments.

12

An additional 793 customers received just an assessment, bringing the total for FY1999 to 3,260.

• Approximately 2,913 customers received Senior Care Act Services in FY 2001,

decreasing from 3,061 in FY 200013. Overall, however, the number of SCA and IE customers combined has increased during this time.

Assisted Living/Residential Health Care Facility Utilization Rates Due to the growth in the number of assisted living and residential health care (AL/RHC) beds, these settings are analyzed separately as part of Indicator 2. The number of AL/RHC beds in Kansas increased by 36% from 1997 to 1999 (Chapin et al., 1999). Tables 4 through 6 display the 2000 assisted living/residential health care (AL/RHC) utilization rates broken out by age and gender. • The rate of Kansans age 65 and over residing in AL/RHC facilities increased markedly

over time, from 1.0% in 1998 to 1.3% in 1999 and to 1.5% in 2000. • The age 85 and over group showed the greatest increase in the proportion of older

adults residing in AL/RHC settings. • A greater proportion of women reside in AL/RHCs than men in all of the age sub-

groups. The largest difference is in the age 85 and over group, 4.43% of men age 85 and older resided in AL/RHCs facilities during 2000, compared to 6.35% of women in the same age group.

Table 4.

Percent of Older Kansans Residing in Al/RHCs by Age Group, 2000*

Age Group

AL/RHC Clients 12/31/00

2000 Age Group Population

2000 AL/RHC Utilization Rate

65-74 381 175,916 0.2% 75-84 1,858 128,543 1.5% 85+ 3,013 51,770 5.8%

Total, 65+ 5,252 356,229 1.5% *Source: KDHE Adult Care Home Statistics and Census 2000 figures

Table 5. AL/RHC Utilization Rates by Age Group, 1998 - 2000

Age

Group 1998 AL/RHC

Utilization Rate 1999 AL/RHC

Utilization Rate 2000AL/RHC


Total 65+ 1.0% 1.3% 1.5% 13 Data provided from the Program Evaluation Supervisor at KDOA.

13

Table 6. Percent of Older Kansans Residing in AL/RHCs by Age Group and Gender, 1999-2000*

Age Group

1999 Male AL/RHC Util. Rate

2000 Male AL/RHC Util. Rate

1999 Female AL/RHC Util. Rate

2000 Female AL/RHC Util. Rate

1999 Total AL/RHC Util. Rate

2000 Total AL/RHC Util. Rate

65-74 .15% .17% .28% .26% .22% .22% 75-84 .74% .74% 1.50% 1.75% 1.19% 1.45% 85+ 3.62% 4.43% 5.66% 6.35% 5.06% 5.82% 65+ .72% .80% 1.66% 1.88% 1.27% 1.47%

14

Independence Indicator 3: Discharge from Nursing Facilities to the Community for Kansans Age 65 and Over

Independence Indicator 3 reflects the number of older adults who move from nursing facilities to more integrated environments in the community. It includes residents of licensed nursing facilities and residents of nursing facility beds in hospitals14. These figures do not include residents of assisted living or residential health care facilities. The Minimum Data Set (MDS) is used to provide the data needed for this indicator. It is important to note that the 1998 rate included data from both the MDS+ and the MDS 2.0. The 1999 and 2000 data were derived from the MDS 2.0. According to staff from Myers and Stauffer, data collection on the MDS 2.0 has improved between 1999 and 2000, which may account for some of the discharge rate increase. They noted, however, that the discharge rate trend accurately reflects what is taking place. Table 7 below provides a summary of the number of nursing facility residents who returned to the community from CY1993 to CY2000. These rates are also displayed graphically in Figure 7. Findings from this indicator include: • The percent and number of older Kansans who have returned to the community from

nursing facility placement has increased steadily between 1998 and 2000. • During Calendar Year 2000, approximately 35% of nursing facility residents (including

nursing facility hospital residents) returned to the community. It increased from 24.3% in 1999.

• If nursing facility hospital residents are not included, the percentage of nursing facility

residents discharged to the community in 2000 was 26.83%, increasing from 18.5% in 1999. The percent of hospital based nursing facility residents that discharged to the community has continued to increase substantially.

14 The specific type of hospital beds included are those certified for Medicaid long-term care and licensed for nursing facility (NF) care. Some beds are dually licensed for nursing facility care (NF) and skilled nursing facility (SNF) care. These dually certified beds are also included in the discharge indicator. Therefore, the hospital discharge statistics capture some SNF beds. They represent about 11% of the total number of hospital based beds included in this indicator. The focus of the care provided in these beds is generally short term. Therefore, the inclusion of these SNF beds may have an impact on the hospital discharge figures.

15

Table 7.

Nursing Facility Level Residents Age 65 and Over Who Were Discharged to the Community CY1993 – CY2000

Year Total Number of Residents

Returned Total Number of Nursing

Facility Residents

Percent CY 1993 2,345 22,661 10.3%

CY 1994 3,401 24,739 13.8%

CY 1995 4,403 22,574 19.5%

CY 1996 4,962 20,842 23.8%

CY 1997 3,930 18,281 21.5%

CY 1998 4,179 21,377 19.6%

CY 1999 5,349 22,009 24.3%

CY 2000 7,833 22414 35%

Figure 7. Nursing Facility Residents Age 65 and Over Who Were Discharged to the Community

CY1993 - 2000

0.00%

10.00%

20.00%

30.00%

40.00%

1993 1994 1995 1996 1997 1998 1999 2000

Calendar Year

Perc

ent

16

Independence Indicator 4: Diversion of Kansans Age 65 and Older Seeking Nursing Facility Placement This indicator is structured to measure the number and percent of people age 65 and older seeking nursing facility care who chose and received community based services as an alternative. The Client Assessment Referral and Evaluation (CARE) Program defines diversion as “those persons who were assessed for potential nursing facility placement, but who continued to reside in the community with services, or were living in board and care facilities when the 30-day follow-up contact was made” (CARE Program FY 99 Annual Report). Detailed diversion data (from the CARE Program) is not included as part of this report to prevent duplication for state agency staff. However, for the sake of other readers and for the purpose of analyzing the indicators in conjunction with one another, some diversion data and tables are presented below. Table 8 displays the diversion rates for the last four years. Findings include: • The percent of Kansans age 65 and older seeking nursing facility care who chose and

received community based services as an alternative decreased slightly from 17.93% in 1999 to 17.7% in 2000. However, the rate has shown an overall increase from 15.33% in FY 1997.

• Overall, the number of initial assessments increased by 6.8% from FY 1997 to FY 2000.

Table 8.

Fiscal Year 1997 -2000 Diversion Rates

Year

30 Day Follow Ups

CARE Level I Assessments

Diversions

Percent

FY 1997 12,064 12,107 1,850 15.33%

FY 1998 11,867 12,017 1,952 16.45%

FY 1999 12,303 12,524 2,206 17.93%

FY 2000 12,550 12,936 2,226 17.74%

17

State Level Protection Indicators The protection indicators are structured to measure the reported incidence of abuse, neglect, and exploitation (A/N/E) of older adults receiving long-term care services either in the community or in institutions. Information needs to be collected uniformly. It is important to be able to monitor A/N/E across care settings and compare rates between settings. Alternative proxies for these indicators have been identified and tracked over time since an unduplicated count of elders abused and/or neglected in Kansas is not yet available. The protection indicators are defined as follows:

• Protection Indicator 1a: Confirmed Abuse/Neglect/Exploitation Complaints per 10,000 Long-Term Care Clients Age 65 and Over Residing in the Community

• Protection Indicator 1b: Substantiated Abuse/Neglect/Exploitation Complaints per

10,000 Long-Term Care Clients Age 65 and Over Residing in Institutional Facilities National Trends: Abuse, Neglect and Exploitation (A/N/E) The most recent national data on the incidence of abuse, neglect and exploitation of older adults was collected through the National Elder Abuse Incidence Study (1998) conducted by the National Center on Elder Abuse (NCEA). The study collected data on the national incidence of domestic elder abuse and neglect of older adults age 60 and older. The National Elder Abuse Incidence Study gathered data on domestic A/N/E using a stratified sampling of counties. The data were gathered from two sources: 1)reports from the Adult Protective Services agencies; and 2) “reports from ‘sentinels’-specially trained individuals in a variety of community agencies having frequent contact with the elderly” (NCEA, 1998). It is important to note that the National Elder Abuse Incidence Study statistics represent unduplicated incidents of elder maltreatment. Findings from the NCEA are bulleted below. National Incidence of Elder Abuse • It is estimated that there are almost four new unreported incidents of A/N/E for every

one that is reported and substantiated. • Approximately 2.16 million older adults were victims of domestic A/N/E in 1996,

including self-neglect. • Between 1986 and 1996 NCEA documented a 150% increase in domestic elder abuse

reports. They increased from 117,000 to 295, 000 during this time. • According to the NCEA, 64.2% of the elder abuse reports in 1996 were substantiated.

The majority of the substantiations were self-neglect cases. • The NCEA found the most common form of mistreatment to be neglect. The number of

reports involving neglect rose steadily between 1991 and 1996. Emotional/psychological abuse was the second most common, with physical abuse and financial exploitation being the third and fourth most common forms of mistreatment, respectively.

18

National Victims of A/N/E • The majority of elder abuse victims were women. In 1996, 67.3% of the reports involved

female victims, while 32.4% involved male victims (gender was not reported for .3% of the data).

• In 1996, 66.4% of domestic elder abuse victims were white, 18.7% were African

American, and 10.4% were Hispanic. The national proportion of older adults that were African American was 8%, while the proportion that was of Hispanic origin was 5.1%, respectively (AARP, 1999).

• In 1996, the median age of elder abuse victims (not including self-neglect) was 77.6

years. • Adults age 80 and over were victims of abuse and neglect at a rate of two to three times

their proportion in the older adult population. • The majority of domestic elder abuse reports were made by health care providers

(22.5%) in 1996. Family of victims reported an additional 16.3% of the cases, while service providers accounted for another 15.1% of the reports.

The study found that the majority of perpetrators of A/N/E against older adults are family members, most often an adult child. This puts the abuse in a complex web of family dynamics and can leave the older adult without a trusted confidant. Elder abuse is often not recognized, leading to gross under-reporting of the problem (NCEA, 1998). The national data show A/N/E reports are increasing. These data underscore the importance of monitoring A/N/E and its impact on older Kansans. Protection Indicator 1a: Confirmed Abuse/Neglect/Exploitation Complaints per 10,000 Long-Term Care Clients Age 65 and Over Residing in the Community The first protection indicator, Protection Indicator 1a, addresses abuse/neglect/exploitation in the community for recipients of long-term care services. Although the specific information needed to measure this indicator as originally defined are not available, proxies can be used to give an estimate of the overall trend. Data from SRS investigation reports on the number of A/N/E reports involving older adults in the community has been tracked and analyzed. Table 9 below displays the number of A/N/E reports involving adults age 60 and over.

19

Table 9.

A/N/E Reports Involving Adults Age 60 and Over in the Community15, FY 1996 - FY 2001

Fiscal Year

A/N/E Reports Involving Adults Age 60 and Over

Percent Increase

FY 1996 840 N/A FY 1997 1,270 51.2% FY 1998 2,224 75.1% FY 1999 2,512 13.0% FY 2000 2,723 8.4% FY 2001 2,795 2.6%

Source: SRS “Abuse/Neglect/Exploitation/Fiduciary Abuse” Report The number of reports has increased between FY 1999 and 2001, but at a much slower rate than in the previous years. The overall growth in the number of reports may be due to a larger number of older adults residing in the community and an increase in the number of outside contacts they have (i.e. service providers). As with other populations, it appears that the greater the contact older adults have with outside entities, the greater the likelihood of a report. A number of factors may explain the sharp increase and subsequent leveling off of reports. The large increase between FY 1996 and 1998 may be due to enhanced statewide efforts to increase awareness of A/N/E and how to report it, as well as the increase in the number of mandated reporters of A/N/E. Since A/N/E of older adults is often underreported it is important to discern the reasons behind the trend. The following chart displays data on the number of community based service recipients, broken out by program, involved in A/N/E reports from FY 1999 through FY 2001. Table 10 also displays this information. It is important to keep in mind when reviewing these figures that the most common form of A/N/E among the oldest old is self-neglect. This is also the age group most likely to be receiving the majority of these services. • The proportion of A/N/E reports that involved an older adult who was a publicly funded

service recipient decreased for all services between FY 2000 and 2001. • In FY 2001, 20.3% of the adults age 60 and over involved in an A/N/E report were

recipients of publicly funded in-home services. In FY 2000, the percent was 23.6%, while in FY 1999 it was 19.5%.

• In FY 2001, approximately 16.2% (453) of the age 60 and over adults involved in an

A/N/E report were HCBS/FE service recipients16. In FY 2000, the percent was 17.9% (486), while in FY 1999 it was 11.6% (291).

15 These figures could include nursing facility residents if the occurrence involved a resident to resident or other non-staff to resident incident. Incidents that involve a staff member would be investigated by KDHE. 16 Please note that an adult between the ages of 60 and 64 cannot be an HCBS/FE customer.

20

Chart 3. A/N/E Reports Involving Community Dwelling Adults Age 60 and Over by Service Recipient Type

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

HCBS/FE Income Eligible Senior Care Act Older Americans Act

Service

Perc

ent FY 1999

FY 2000FY 2001

Table 10. A/N/E Reports Involving Community Dwelling Adults Age 60 and Over Who are Service

Recipients, FY 1999 - 2001*

*Source: SRS “Abuse/Neglect/Exploitation/Fiduciary Abuse” Report

Service Type

Service

Recipients

FY 1999 Percent of

60+ Reports

Service

Recipients

FY 2000 Percent of

60+ Reports

Service

Recipients

FY 2001 Percent of

60+ ReportsHCBS/FE 291 11.6% 486 17.9% 453 16.2% Income Eligible 56 2.2% 88 3.2% 62 2.2% Senior Care Act 36 1.4% 58 2.1% 43 1.5% Older Americans Act 107 4.3% 10 .4% 10 .4%

The following table displays data on the relationship of the alleged perpetrator to the victim. The data are based on reports for all ages.

21

Table 11. Relationship of the Alleged Perpetrator to the Victim, FY 1999 - 2001*

Relationship of

Alleged Perpetrator

FY 1999 Percent

of All Reports

FY 2000 Percent

of All Reports

FY 2001 Percent

of All Reports Self 40.8% 49.0% 49.6%

Spouse 2.9% 4.0% 3.7% Family/Relative 16.4% 19.4% 18.1% Neighbor/Friend 3.4% 4.7% 2.76%

Guardian/Conservator 0.7% 1.1% 1.1% Patient/Resident 0.2% 0.0% 1.0%

Facility Staff 8.6% 7.9% 13.5% Medicaid Provider 16.9% 18.4% 15.0%

*Source: SRS “Abuse/Neglect/Exploitation/Fiduciary Abuse” Report As Table 11 shows, “self” was the most common alleged perpetrator in all three years, indicating suspected self-neglect. In FY 2001, 15% of all A/N/E reports involved an alleged perpetrator who was a Medicaid provider. This figure dropped slightly from 18.4% in FY 2000. Since these data are not broken out by age groups, this figure may include customers receiving HCBS/FE or other waivered services such as HCBS/PD. The greatest increase in “alleged perpetrators” was in the facility staff category, 7.9% of alleged perpetrators in FY 2000 were facility staff compared to 13.5% in FY 2001. The increase may be related to the growth in settings such as AL/RHCs. This finding highlights an area that may need special attention. The following chart shows the proportion of A/N/E reports involving age 60 and over victims broken out by age subgroups.

22

Chart 4. A/N/E Reports Involving Adults Age 60 and Over by Age Subgroup, FY 2001*

80 - 89(33%)

70 - 79 (35%)

60 - 69 (23%)

90 and Over(9%)

*Source: SRS “Abuse/Neglect/Exploitation/Fiduciary Abuse” Report The proportion of older adults in each age subgroup who were potential A/N/E victims has remained relatively constant over the last three fiscal years. This chart highlights the vulnerability of the oldest old. These figures show that older adults aged 80 and older represented 42% of Adult Protective Services (APS) reports involving older adults age 60 and over. Their proportion within the age 60 and over population is much lower (around 14%), so this clearly indicates over-representation among the maltreated. It is likely that many of these cases involve self-neglect since that is the most common form of abuse among the oldest old. Previously, A/N/E data from SRS included the number of A/N/E investigations involving adults age 60 and over that are confirmed, potential risks and unconfirmed. However, the current data only provides this information for all ages, it does not separate out the age 60 and over subgroup. It is important that this information become available in order to track the true incidence of reported abuse among Kansas elders. Protection Indicator 1b: Substantiated Abuse/Neglect/Exploitation Complaints per 10,000 Long-Term Care Clients Age 65 and Over Residing in Institutional Facilities Protection Indicator 1b monitors A/N/E of older adults residing in institutions. Current A/N/E figures from KDHE represent cases/reports and are not age specific. In addition, the A/N/E figures contain more than just staff to resident incidences of A/N/E. They also include institutional deficiencies, some resident-to-resident abuse and elopements (“neglect”). At this time there is not a system at KDHE for tracking substantiated reports. In the past substantiations were hand counted by staff (1993 through 1998), but this has not been possible for 1999 or 2000.

23

Therefore, the number of institutional A/N/E investigations is the best proxy for the overall trend in A/N/E of older adults residing in care facilities. These data are presented in Table 12 below. • From FY 2000 to FY 2001 the number of institutional A/N/E investigations increased by

10%. Between FY 1999 and FY 2000 the number of institutional A/N/E investigations dropped slightly (2%).

The number of A/N/E investigations involving residents of nursing facilities showed an increase from 1,776 in FY 2000 to 1,961 in FY 2001. Although KDHE staff could not provide data on the number of these cases that were substantiated, they reported that the substantiation trend likely reflects the trend in the number of investigations. They based this fact on the number of names that were added to the nurse aide registry each year.

Table 12. A/N/E Institutional Investigations, All Ages FY1998 - 2001

FY1998 FY1999 FY2000 FY2001

Investigations 1,772 1,807 1,776 1,961

Similar to the SRS APS data, the KDHE data shows an increase in A/N/E reports between 2000 and 2001, although not as large as the increase in previous years. The leveling off of reports may be due to the efforts to increase awareness of A/N/E. As these efforts began there was an increase of reports as people became more sensitive to the indicators of A/N/E. However, it is important to continue to monitor the reporting rate due to the severe underreporting related to A/N/E cases. In summary, the number of reports involving older adults as victims of A/N/E in both the community and institutional settings underscores the importance of continued monitoring of data pertaining to abuse, neglect and exploitation of older Kansans receiving long-term care services.

24

PSA/AAA and County Level Independence Indicators This section of the report provides an overview of the indicator data at the PSA/AAA and county levels, where available. Please note that findings at the PSA level are also presented in conjunction with other indicator data in the segment of this report entitled “Regional Analysis of Integrated Indicator Data” beginning on page 46. The “Regional Analysis” section is organized by PSA and also includes additional data such as NF occupancy rates for each PSA. These data were separated out by region at the request of AAA directors and staff. Independence Indicator 1, 1a, 1b and 1c: Nursing Facility Utilization by Age Calendar Year 2000 nursing facility utilization rates of older adults age 65 and over were calculated on a PSA basis. Map 1 on the next page displays the PSA level rates. The 2000 rates are displayed in comparison to the 1998 and 1999 rates in the table and chart below. Findings related to the PSA level nursing facility utilization include the following: • The 2000 PSA level nursing facility utilization rates ranged from 3.65% to 7.21%. • During all three time periods, PSA 1 (Wyandotte-Leavenworth) and PSA 2 (Central

Plains) had the lowest rates. • PSAs 9 (Northeast Area) and 10 (South Central Area) had among the highest rates for

all three time periods. • PSA 5 (Southeast) had the largest decrease (.53%) between 1999 and 2000.

Table 13. PSA Level Nursing Facility Utilization Rates From Lowest to Highest, 1998-2000

PSA 1998 PSA 1999 PSA 2000 01 Wyandotte-Leavenworth

3.92%

01 Wyandotte-Leavenworth

3.91%


3.65%

02 Central Plains 4.32% 02 Central Plains 4.59% 02 Central Plains 4.47%07 East Central 4.82% 11 Johnson 4.72% 11 Johnson 4.75%11 Johnson 4.85% 04 Jayhawk 5.28% 04 Jayhawk 5.06%04 Jayhawk 5.68% 07 East Central 5.64% 07 East Central 5.25%05 Southeast 5.90% 06 Southwest 6.32% 05 Southeast 5.85%08 North Central 6.45% 05 Southeast 6.38% 06 Southwest 6.28%06 Southwest 6.70% 03 Northwest 6.86% 03 Northwest 6.66%10 South Central 7.39% 08 North Central 7.11% 08 North Central 6.70%09 Northeast 7.39% 09 Northeast 7.20% 10 South Central 7.16%03 Northwest 7.41% 10 South Central 7.52% 09 Northeast 7.21%Statewide Average 5.70% Statewide Average 5.79% Statewide Average 5.57%

25

Click to displays a map showing PSA level rates.

Insert Map 1

26

http://www.oaltc.ku.edu/reports/Map1PSAlevelrates.pdf

Chart 5. Percent of Older Adult Population Residing in Nursing Facilities by PSA, 1997-2000

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

1 2 3 4 5 6 7 8 9 10 11

Planning and Service Area

Perc

ent o

f 65+

Pop

ulat

ion

1997199819992000

County Level Nursing Facility Utilization Rates17 County level nursing facility utilization rates were calculated for 2000. These rates are displayed in Table 14 and Map 2. Findings related to these rates include: • The nursing facility institutionalization rates ranged from 1.90% in Logan County to

11.49% in McPherson County. • The majority of the metropolitan counties (i.e. Wyandotte, Sedgwick, Johnson) had

nursing facility utilization rates below the state average of 5.57%.

17 In previous reports the nursing facility utilization rate by county was adjusted for in and out migration. They are not adjusted for migration in this report because it was not possible to separate assisted living and nursing facility migration figures.

27

Table 14. Nursing Facility Utilization Rates for Kansans Age 65 and Over, 2000

COUNTY 2000 COUNTY 2000 Allen 3.74% Linn 6.63%Anderson 3.38% Logan 1.90%Atchison 6.28% Lyon 6.91%Barber 6.40% Marion 9.67%Barton 6.35% Marshall 6.88%Bourbon 6.06% Mcpherson 11.49%Brown 6.89% Meade 9.03%Butler 7.66% Miami 5.24%Chase 6.69% Mitchell 9.11%Chautauqua 10.37% Montgomery 6.33%Cherokee 3.62% Morris 5.30%Cheyenne 6.18% Morton 9.86%Clark 11.32% Nemaha 11.06%Clay 6.39% Neosho 5.03%Cloud 8.85% Ness 8.12%Coffey 6.25% Norton 6.35%Comanche 10.63% Osage 5.93%Cowley 6.31% Osborne 9.53%Crawford 7.88% Ottawa 8.01%Decatur 10.78% Pawnee 2.91%Dickinson 5.28% Phillips 9.46%Doniphan 5.17% Pottawatomie 9.96%Douglas 4.83% Pratt 3.40%Edwards 5.16% Rawlins 5.28%Elk 8.24% Reno 5.48%Ellis 6.78% Republic 8.54%Ellsworth 8.20% Rice 8.12%Finney 4.88% Riley 6.77%Ford 7.71% Rooks 6.72%Franklin 4.52% Rush 8.01%Geary 4.86% Russell 5.41%Gove 7.76% Saline 5.11%Graham 5.02% Scott 7.69%Grant 5.90% Sedgwick 3.66%Gray 10.55% Seward 3.99%Greeley 9.23% Shawnee 5.07%Greenwood 6.17% Sheridan 11.40%Hamilton 6.94% Sherman 0.00%Harper 5.20% Smith 4.91%Harvey 7.69% Stafford 6.40%Haskell 7.22% Stanton 5.13%Hodgeman 8.08% Stevens 6.88%Jackson 4.08% Sumner 6.30%Jefferson 5.73% Thomas 8.02%Jewell 3.76% Trego 8.67%Johnson 4.75% Wabaunsee 2.24%Kearny 7.74% Wallace 6.96%Kingman 8.66% Washington 9.35%Kiowa 0.00% Wichita 5.68%Labette 6.29% Wilson 5.73%Lane 4.31% Woodson 3.83%Leavenworth 4.46% Wyandotte 3.36%Lincoln 6.18% Statewide Average 5.57%

28

Click here to see a map showing county level nursing facility utilization rates.

Insert Map 2

29

http://www.oaltc.ku.edu/reports/Map2CounttUseRates

Independence Indicator 2: Percent of Kansans Age 65 and Over Receiving Community Based Long-Term Care Services HCBS/FE plans of care data by PSA for Fiscal Years 1999 through 2001 were analyzed. These data were used to develop an “HCBS/FE utilization rate” based on the age 65 and over population of the area. They are displayed in Table 15 and Map 3 below. • The FY2001 HCBS/FE utilization rates ranged from .82% in PSA 11 (Johnson County)

to 4.80% in PSA 5 (Southeast). • For all three time periods, the highest HCBS/FE utilization rates were found in PSA 5

(Southeast), PSA 7 (East Central) and PSA 9 (Northeast). • All of the PSAs, except PSA 9 (Northeast), experienced an increase in their HCBS/FE

utilization rates between SFY 2000 and 2001. • PSA 5 (Southeast) experienced the largest increase (.23%) between SFY2000 and 2001. • The lowest HCBS/FE utilization rates were found in PSA 11 (Johnson County) and PSA

3 (Northwest) in all three time periods.

Table 15. HCBS/FE Utilization Rates, Fiscal Year 1999 - 2001

PSA 1999

Plans of Care

1999 Rate

2000 Plans of

Care

2000 Rate

2001 Plans of

Care

2001 Rate

01 Wyandotte-Leavenworth 549 2.14% 569 2.26% 604 2.39% 02 Central Plains 1059 1.62% 1153 1.76% 1197 1.85% 03 Northwest 263 1.31% 269 1.28% 269 1.32% 04 Jayhawk 569 1.75% 627 1.85% 682 2.03% 05 Southeast 1,334 4.19% 1,434 4.57% 1,502 4.80% 06 Southwest 570 1.87% 579 1.85% 604 1.97% 07 East Central 418 2.93% 443 3.15% 473 3.30% 08 North Central/Flint Hills 665 1.56% 657 1.57% 712 1.68% 09 Northeast 369 2.61% 404 2.90% 393 2.72% 10 South Central 819 2.39% 831 2.44% 873 2.55% 11 Johnson County 332 0.78% 332 0.76% 370 0.82%

30

Chart 6. Percent of Older Adult Population Utilizing HCBS/FE Services by PSA, FY 1999-2001

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

1 2 3 4 5 6 7 8 9 10 11


Perc

ent o

f 65+

Pop

ulat

ion

199920002001

The most recent HCBS/FE utilization rates were also analyzed in conjunction with the NF utilization rates in order to identify patterns. The PSAs with the highest HCBS/FE utilization rates, PSA 5 (Southeast) and PSA 7 (East Central), had slightly below average NF utilization rates. PSAs 3 (Northwest) and 8 (North Central) had among the lowest HCBS/FE utilization rates and highest NF utilization. Although there were not definitive patterns, the data suggest that for rural areas HCBS/FE services, as well as AL/RHCs, help to reduce NF utilization. Since the HCBS/FE program serves older, low-income adults, these rates may be a reflection of the poverty level of the area. Overall, these rates highlight how HCBS/FE services have increased across the state. Therefore, a low HCBS/FE utilization rate does not necessarily indicate a lack of community-based services in an area. Additional data on publicly funded community based service utilization at the PSA level is needed to provide a more comprehensive picture of each area.

31

Click here to see a map showing the “HCBS/FE utilization rate” based on the age 65 and over population of the area.

Insert Map 3

32

http://www.oaltc.ku.edu/reports/Map3Population65.pdf

http://www.oaltc.ku.edu/reports/Map3Population65.pdf

Assisted Living/Residential Health Care Facility Utilization Rates The PSA level AL/RHC utilization rates for 1998 through 2000 are displayed in Table 16 and Chart 7 below. The 2000 AL/RHC utilization rates are also displayed on Map 4. Findings related to the PSA level AL/RHC rates are bulleted below. • The majority of the PSAs experienced an increase in their AL/RHC utilization rate

between 1999 and 2000, only four experienced a decrease. • PSAs 1 (Wyandotte-Leavenworth) and 3 (Northwest) had the lowest AL/RHC facility

utilization rates for all three time periods. • PSA 5 (Southeast) had among the highest AL/RHC facility utilization rate for all three

time periods. • Between 1999 and 2000, the largest PSA AL/RHC facility utilization rate increase

occurred in PSA 11 (Johnson). The rate increased by .61%.

Table 16.

AL/RHC Utilization Rates, by PSA from Lowest to Highest 1998 - 2000

PSA 1998 PSA 1999 PSA 2000 01 Wyandotte-Leavenworth

0.26%


0.35%


0.32%

03 Northwest 0.58% 03 Northwest 0.74% 03 Northwest 0.71% 06 Southwest 0.68% 06 Southwest 1.04% 06 Southwest 1.09% 11 Johnson 0.76% 11 Johnson 1.11% 09 Northeast 1.23% 09 Northeast 1.06% 08 North Central 1.20% 08 North Central 1.38% 08 North Central 1.10% 09 Northeast 1.24% 02 Central Plains 1.45% 02 Central Plains 1.17% 10 South Central 1.32% 10 South Central 1.56% 10 South Central 1.19% 02 Central Plains 1.46% 04 Jayhawk 1.69% 07 East Central 1.33% 04 Jayhawk 1.55% 11 Johnson 1.72% 04 Jayhawk 1.43% 07 East Central 1.77% 05 Southeast 2.08% 05 Southeast 1.50% 05 Southeast 1.95% 07 East Central 2.36% Statewide Average 1.03% Statewide Average 1.27% Statewide Average 1.47%

33

Click here to see a map showing 2000 AL/RHC utilization rates.

Insert Map 4

34

http://www.oaltc.ku.edu/reports/Map4AL-RHC2KUseRates.pdf

Chart 7. Percent of Older Adult Population Residing in AL/RHCs by PSA, 1997-2000

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

1 2 3 4 5 6 7 8 9 10 11


Perc

ent o

f 65+

Pop

ulat

ion

1997199819992000

County Level Assisted Living/Residential Health Care Facility Utilization Rates County level assisted living/residential health care utilization rates were calculated for 2000. These rates are displayed in Table 17. Findings related to the assisted living/residential health care utilization rates include: • The majority of counties experienced an increase in their AL/RHC utilization rate

between 1999 and 2000. • The highest assisted living/residential health care utilization rates for 2000 were found

in Allen County (3.86%), Kiowa County (3.72%), Cherokee County (3.33%), and Osage County (3.06%). Allen County also had the highest rate in 1998 and 1999.

• The lowest AL/RHC rates (of counties with AL/RHC facilities) for 2000 were found in

Wyandotte County (.11%), and Jefferson County (.21%). Wyandotte County and Jefferson County also had among the lowest rates for 1999.

• The largest rate increases between 1999 and 2000 occurred in Kiowa County, Linn

County and Cherokee County. Their rates increased 2.02%, 1.66%, and 1.46% respectively.

• The greatest AL/RHC rate decreases between 1999 and 2000 were found in Marion

County, Pratt County, and Neosho County. Their rates dropped 0.50%, 0.41%, and 0.37%, respectively.

Both the HCBS/FE and AL/RHC utilization data indicate that a growing number of older adults are having their long-term care needs met in the community. The majority of areas showed increases in these rates, although the rates are somewhat uneven across the state.

35

Table 17. AL/RHC Utilization Rates 1998-2000

COUNTY 1998 1999 2000 COUNTY 1998 1999 2000Allen 3.30% 3.51% 3.86% Linn 0.91% ---- 1.66%Anderson 1.55% 1.60% 1.48% Logan ---- ---- ----Atchison 0.89% 0.95% 0.84% Lyon 1.38% 1.33% 1.34%Barber ---- ---- ---- Marion 0.73% 1.04% 0.53%Barton 1.03% 1.85% 1.80% Marshall 2.00% 2.57% 2.44%Bourbon 1.59% 2.76% 2.67% Mcpherson 0.80% 1.18% 1.61%Brown 1.07% 1.48% 1.72% Meade ---- ---- ----Butler 1.06% 1.31% 1.43% Miami 0.59% 1.62% 2.49%Chase ---- ---- ---- Mitchell ---- ---- ----Chautauqua ---- ---- ---- Montgomery 1.28% 1.65% 1.51%Cherokee 1.96% 1.87% 3.33% Morris ---- ---- ----Cheyenne ---- ---- 1.07% Morton ---- ---- ----Clark ---- ---- ---- Nemaha 1.32% 1.48% 1.40%Clay 1.17% 1.79% 1.47% Neosho 2.07% 1.65% 1.28%Cloud 2.04% 2.50% 2.89% Ness ---- ---- ----Coffey 2.09% 2.45% 2.92% Norton ---- ---- ----Comanche 1.43% 1.25% 1.57% Osage 2.15% 2.28% 3.06%Cowley 1.47% 1.65% 2.37% Osborne ---- ---- ----Crawford 0.82% 1.31% 1.49% Ottawa 1.75% 1.75% 1.66%Decatur ---- ---- ---- Pawnee 0.59% 1.22% 0.90%Dickinson 1.82% 2.12% 2.81% Phillips 0.66% 0.66% 0.69%Doniphan 0.38% 0.45% 0.45% Pottawatomie 0.90% 0.70% 1.59%Douglas 0.79% 0.80% 1.25% Pratt ---- 2.46% 2.05%Edwards ---- ---- 0.28% Rawlins ---- ---- ----Elk ---- ---- ---- Reno 2.01% 2.14% 2.26%Ellis 2.28% 2.31% 2.01% Republic ---- ---- ----Ellsworth ---- ---- ---- Rice ---- 0.21% 0.31%Finney ---- 1.13% 1.20% Riley 1.17% 1.33% 2.14%Ford 1.61% 1.45% 1.57% Rooks ---- ---- ----Franklin 1.18% 2.21% 2.24% Rush ---- ---- ----Geary 0.94% 1.00% 0.99% Russell ---- 1.61% 1.75%Gove 0.00% ---- ---- Saline 1.53% 1.59% 1.50%Graham 1.19% 1.33% 1.29% Scott ---- ---- ----Grant ---- ---- ---- Sedgwick 1.08% 1.39% 1.31%Gray ---- ---- ---- Seward 2.38% 1.88% 2.04%Greeley ---- ---- ---- Shawnee 1.77% 1.95% 2.00%Greenwood 1.39% 1.33% 1.66% Sheridan ---- ---- ----Hamilton ---- ---- ---- Sherman ---- ---- 0.52%Harper ---- ---- ---- Smith ---- ---- 0.08%Harvey 2.20% 2.26% 2.79% Stafford 2.71% 2.71% 2.66%Haskell ---- ---- ---- Stanton ---- ---- ----Hodgeman ---- ---- ---- Stevens ---- ---- ----Jackson 1.17% 1.06% 1.11% Sumner 0.68% 0.56% 0.60%Jefferson 0.33% 0.29% 0.21% Thomas 1.15% ---- ----Jewell ---- ---- ---- Trego ---- ---- ----Johnson 0.76% 1.11% 1.72% Wabaunsee 0.97% 0.74% 0.84%Kearny 2.12% ---- ---- Wallace ---- ---- ----Kingman 1.17% 1.30% 1.06% Washington ---- ---- ----Kiowa ---- 1.70% 3.72% Wichita ---- ---- ----Labette 1.40% 2.30% 2.22% Wilson 1.07% 2.54% 2.28%Lane ---- ---- ---- Woodson ---- ---- ----Leavenworth 0.53% 0.87% 0.90% Wyandotte 0.17% 0.17% 0.11%Lincoln 0.73% Statewide Average 1.04% 1.27% 1.47%

36

Independence Indicator 3: Discharge from Nursing Facilities to the Community for Kansans Age 65 and Over

Data on the number of Kansans age 65 and over discharged from nursing facilities to the community were collected on a PSA and county level. The nursing facility discharge rates by PSA for calendar years 1998 through 2000 are displayed in Table 18. They are also presented graphically in Chart 8 and in Map 5. Please note that these rates include residents of licensed nursing facilities and residents of nursing facility beds in hospitals. As mentioned previously, data collection on the MDS 2.0 has improved between 1999 and 2000, which may account for some of the discharge rate increase, however, according to Myers and Stauffer staff, the discharge rate trend accurately reflects what is taking place. Additional analysis to discern the reasons behind the increases may be helpful. Highlights from the PSA level analysis are presented below. • PSA 5 (Southeast) had the highest discharge rates for 1998, 1999 and 2000.

• For all three time periods, PSAs 10 (South Central), 1 (Wyandotte-Leavenworth) and 2 (Central Plains) had the lowest discharge rates.

• All eleven PSAs experienced an increase in their discharge rates between 1999 and 2000,

continuing the upward trend from 1998.

• PSA 11 (Johnson) had the largest discharge rate increase between 1999 and 2000. It’s rate increased by 16.2%.

Table 18.

PSA

Nursing Facility Level Discharge Rates, by PSA from Lowest to Highest 1997 - 2000

1998 PSA 1999 PSA 2000 10 South Central 10.1% 10 South Central 13.2% 18.7% 01 Wyandotte-Leavenworth


13.9%

02 Central Plains

02 Central Plains 11.9% 02 Central Plains 01 Wyandotte-Leavenworth

21.8%

07 East Central 07 East Central 14.7% 07 East Central

10 South Central 20.0%

10.3% 14.1%

12.7% 22.3% 03 Northwest 16.1% 08 North Central 19.5% 08 North Central 26.3% 08 North Central 17.0% 09 Northeast 23.9% 09 Northeast 29.9% 11 Johnson 19.3% 03 Northwest 24.7% 03 Northwest 36.9% 09 Northeast 20.5% 04 Jayhawk 30.1% 04 Jayhawk 42.2%

25.8% 11 Johnson 31.4% 11 Johnson 52.0% 04 Jayhawk 29.0% 06 Southwest 36.8% 06 Southwest 53.0% 05 Southeast 37.5% 05 Southeast 41.0% 05 Southeast 55.1% Statewide Average 19.6% Statewide Average 24.3% Statewide Average 34.95%

06 Southwest

37

38

Click here to see a map showing the nursing facility discharge rates by PSA for calendar years 1998 through 2000.

Insert map 5

39

http://www.oaltc.ku.edu/reports/Map5DischargeRates.pdf

http://www.oaltc.ku.edu/reports/Map5DischargeRates.pdf

Chart 8. Nursing Facility Level Discharge Rates, by PSA 1997 - 2000

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

1 2 3 4 5 6 7 8 9 10 11

PSA

Perc

ent o

f NF

Res

iden

ts

1997199819992000

The 2000 PSA discharge rates were compared to the 2000 NF utilization rates in order to identify patterns. The most notable finding was the PSAs with the highest discharge rates, PSAs 5 (Southeast), 6 (Southwest), 11 (Johnson) and 4 (Jayhawk) all had average or below nursing facility utilization rates. County Level Nursing Facility Discharge Rates The 1999 and 2000 county level discharge rates are displayed in Table 19. The county level data show a relatively wide range in discharge rates between counties. The majority of the metropolitan/midsize counties had higher than average discharge rates.

40

Table 19. Nursing Facility Discharge Rates 1999-2000

COUNTY 1999 2000 COUNTY 1999 2000Allen 33.10% 39.33% Linn 0.95% 4.05%Anderson 21.52% 18.52% Logan 0.00% 75.00%Atchison 57.35% 31.85% Lyon 16.89% 25.35%Barber 10.94% 12.24% Marion 9.89% 17.56%Barton 92.03% 25.91% Marshall 25.71% 24.60%Bourbon 72.10% 13.58% Mcpherson 9.91% 14.53%Brown 10.42% 16.20% Meade 5.88% 10.00%Butler 10.62% 15.78% Miami 15.25% 26.11%Chase 36.59% 42.22% Mitchell 18.49% 36.84%Chautauqua 22.61% 26.79% Montgomery 39.71% 47.60%Cherokee 24.74% 32.80% Morris 12.66% 23.29%Cheyenne 7.84% 17.31% Morton 21.57% 31.91%Clark 17.65% 33.33% Nemaha 13.00% 20.66%Clay 18.27% 29.17% Neosho 12.36% 24.29%Cloud 13.45% 20.00% Ness 4.11% 7.25%Coffey 10.23% 21.31% Norton 0.00% 1.35%Comanche 11.54% 9.26% Osage 21.72% 29.95%Cowley 17.87% 23.10% Osborne 29.46% 31.67%Crawford 60.03% 17.64% Ottawa 10.10% 20.00%Decatur 17.82% 9.68% Pawnee 8.70% 19.05%Dickinson 25.63% 10.24% Phillips 14.62% 22.58%Doniphan 32.61% 44.44% Pottawatomie 19.02% 26.28%Douglas 22.03% 37.29% Pratt 97.79% 30.16%Edwards 17.65% 28.57% Rawlins 13.95% 25.00%Elk 14.81% 26.09% Reno 14.49% 22.94%Ellis 58.66% 10.73% Republic 13.64% 25.25%Ellsworth 16.80% 18.18% Rice 13.86% 15.34%Finney 39.62% 54.02% Riley 39.56% 46.58%Ford 9.81% 15.91% Rooks 12.00% 16.00%Franklin 13.17% 19.31% Rush 6.25% 7.84%Geary 22.60% 35.17% Russell 11.34% 15.73%Gove 15.56% 14.06% Saline 18.85% 21.57%Graham 5.13% 22.22% Scott 13.24% 13.85%Grant 12.73% 28.26% Sedgwick 14.44% 20.33%Gray 7.59% 16.67% Seward 8.57% 9.59%Greeley 16.67% 30.77% Shawnee 34.07% 45.42%Greenwood 21.77% 28.32% Sheridan 13.51% 10.81%Hamilton 8.57% 18.92% Sherman 5.26% 3.64%Harper 8.79% 12.05% Smith 17.82% 28.57%Harvey 17.23% 24.94% Stafford 20.90% 18.31%Haskell 13.33% 14.71% Stanton 5.00% 13.33%Hodgeman 6.06% 6.25% Stevens 2.00% 6.52%Jackson 13.25% 15.79% Sumner 6.73% 11.56%Jefferson 17.86% 28.91% Thomas 34.69% 41.67%Jewell 32.26% 32.50% Trego 14.08% 21.88%Johnson 31.39% 45.31% Wabaunsee 11.11% 13.46%Kearny 0.00% 2.56% Wallace 8.33% 18.18%Kingman 10.83% 11.61% Washington 9.82% 17.73%Kiowa 0.00% 0.00% Wichita 8.70% 4.17%Labette 15.88% 24.00% Wilson 18.18% 20.71%Lane 0.00% 10.53% Woodson 40.00% 47.37%Leavenworth 11.89% 14.04% Wyandotte 14.70% 24.97%Lincoln 14.52% 7.55% Statewide 24.30% 34.95%

41

Independence Indicator 4: Diversion18 of Kansans Age 65 and Older Seeking Nursing Facility Placement The following table and chart display the PSA level diversion rates from FY 1997 through FY 2000. The PSA level actual diversion rates for Fiscal Year 2000 are displayed on Map 6 on the following page. The following are highlights from this analysis: • PSA 8 (North Central) had the highest diversion rate in FY 2000, and among the highest

in 1999. • PSA 1 (Wyandotte Leavenworth) and PSA 5 (Southeast) had among the lowest

diversion rates for all of the time periods. • Six PSAs experienced an increase in their diversion rates between 1999 and 2000. The

largest increase (4.6%) occurred in PSA 7 (East Central). • PSA 6 (Southwest) had the largest decrease in diversion rate between 1999 and 2000, its

rate decreased by 12.9%.

Table 20. Fiscal Year 1997 -2000 Diversion Rates, by PSA

PSA 1997 1998 1999 2000 01 Wyandotte-Leavenworth Area 4.8% 12.3% 13.7% 12.1% 02 Central Plains Area 15.5% 16.5% 17.3% 16.3% 03 Northwest Area 15.9% 17.6% 14.7% 18.9% 04 Jayhawk Area 12.4% 14.9% 17.9% 18.4% 05 Southeast Area 13.4% 11.4% 11.9% 14.3% 06 Southwest Area 15.7% 23.2% 25.7% 12.8% 07 East Central Area 15.4% 13.8% 12.8% 17.4% 08 North Central/Flint Hills 22.6% 15.3% 21.1% 24.7% 09 Northeast Area 14.6% 22.9% 21.2% 16.6% 10 South Central Area 15.2% 19.5% 21.0% 20.8% 11 Johnson County Area 18.1% 16.4% 17.1% 18.7% Statewide Average 15.3% 16.5% 17.9% 17.7%

18 The CARE Program’s definition of diversion is used for this report: “… individuals who have been assessed for potential nursing facility placement, and who were residing in community settings with services or were living in board and care facilities when the 30 day follow-up contact was made.” (CARE Annual Report, December 30, 1998, page 5)

42

Click here to see a map showing the PSA level actual diversion rates for Fiscal Year 2000.

Insert map 6

43

http://www.oaltc.ku.edu/reports/Map6DiversionRates2K.pdf

Chart 9. Diversion Rate by PSA, Fiscal Year 1997 through 2000

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%

1 2 3 4 5 6 7 8 9 10 11


Perc

ent

FY 1997FY 1998FY 1999FY 2000

Chart 9 shows that there has been an uneven trend in the diversion rates by PSA. In most areas they appear to be “leveling off.” This may be due to an increase in the number of older adults who utilize community-based services prior to seeking nursing facility placement. They may not apply for nursing facility admission until after all community based alternatives have been exhausted. Research from the “Longitudinal Study of Customers Diverted Through the CARE Program” found that approximately 25% of older adults who received the CARE Assessment utilized state publicly funded services prior to applying for nursing facility placement. In summary, monitoring additional indicators such as the average long-term care threshold score at the time of nursing facility admission in conjunction with diversion rates will help to discern the causes behind any diversion rate trends.

44

Regional Analysis of Integrated Indicator Data

In this section, outcome indicator and other long-term care data at the PSA level are presented together to provide a “picture” of the long-term care system in each area across the state. It also draws attention to the relationship between the indicators and uncovers potential “red flags” where attention and extra efforts may be needed. In addition to the PSA level data, county level data are presented where possible. In order to provide the data in a “user friendly” format, the indicator data are presented in a table format for each PSA. Additional findings related to each area are also presented.

45

Wyandotte-Leavenworth AAA (PSA 1) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 1 was 3.65%.

This rate decreased from the 1999 rate (3.91%). The percent of adults age 85 and over in PSA 1 who resided in nursing facilities during 2000 was 14.82%. PSA 1 continues to have the lowest nursing facility utilization rates in the state.

• The 2000 nursing facility occupancy rate in PSA 1 was 87.19%, dropping from 89.41%

in 1999. The 2000 rate is average compared to the other PSAs. • Based on 2000 data, PSA 1 has approximately 44.45 nursing facility beds per 1000

adults age 65 and over, and 370.22 beds per 1000 adults age 85 and over. These rates were the lowest rates among all of the PSAs.

Table 21. Nursing Facility Utilization, PSA 1, by Gender and Age, 2000

Age Group 2000 Male

NF Utilization Rate 2000 Female

NF Utilization Rate 2000 Total

NF Utilization Rate 65-74 1.05% 0.97% 1.01% 75-84 2.99% 3.98% 3.60%

85 and above 9.39% 16.83% 14.82% 65 and above 2.41% 4.50% 3.65%

Table 22. Nursing Facility Utilization by County, 2000

County Age 65 and Over

NF Utilization Rate Age 85 and Over

NF Utilization Rate Leavenworth 4.46% 17.78% Wyandotte 3.17% 13.12%

Table 23. Nursing Facility Occupancy Rates and Beds per 1000 by County, 2000

County NF

Occupancy Rate NF beds per 1000 adults

age 65 and over NF beds per 1000

adults age 85 and overLeavenworth 84.70% 60.9 508.6 Wyandotte 88.54% 38.4 319.9

Community Based Service Utilization: PSA and County Level Highlights • During 2000 in PSA 1, approximately .32% of adults age 65 and over resided in

AL/RHC facilities. This rate decreased slightly from .35% in 1999. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 1 during 2000 was 1.65%. PSA 1 continues to have the lowest AL/RHC utilization rates in the state.

• In 2000, PSA 1 had an assisted living/residential health care occupancy rate of 79.31%,

increasing from 68.60% in 1999. The 2000 occupancy rate is the highest among PSAs.

46

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering

• Based on 2000 data, PSA 1 has approximately 4.43 AL/RHC beds per 1000 adults age 65 and over, and 36.89 beds per 1000 adults age 85 and over. These rates are substantially lower than in other PSAs. The availability of AL/RHC settings in proportion to the older adult population of PSA 1 continues to be the lowest of all the PSAs.

• Approximately, 2.39% of adults age 65 and over in PSA 1 received HCBS/FE services

during State Fiscal Year (SFY) 2001, increasing from 2.26% in SFY 2000. For both time periods, PSA 1 had the fifth highest utilization of HCBS/FE services in proportion to the older adult population of the area out of all 11 PSAs.

Table 24. AL/RHC Utilization, PSA 1, by Gender and Age, 2000

Age Group 2000 Male

AL/RHC Utilization Rate 2000 Female

AL/RHC Utilization Rate 2000 Total

AL/RHC Utilization Rate 65-74 0.02% 0.01% 0.01% 75-84 0.09% 0.48% 0.33%


Table 25. AL/RHC Utilization by County, 2000

County

Age 65 and Over AL/RHC Utilization Rate


Leavenworth 0.90% 4.69% Wyandotte 0.11% 0.54%

Table 26. AL/RHC Occupancy Rates and Beds per 1000 by County, 2000

County AL/RHC

Occupancy Rate AL/RHC beds per 1000 adults age 65 and over

AL/RHC beds per 1000 adults age 85 and over

Leavenworth 79.30% 11.2 93.8 Wyandotte 79.31% 1.9 16.2

Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 1 was the third lowest among the PSAs.

Table 27. Percent of Kansans Age 65 and Over in PSA 1 Discharged to the Community, 1999-2000

1999 2000

Discharge Rate 13.91% 21.82% Diversion From Nursing Facility Placement: PSA Level Highlights • The diversion rate in PSA 1 decreased from 13.73% in FY1999 to 12.10%. The FY2000

rate was the lowest among the PSAs.

47

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering

Wyandotte-Leavenworth AAA (PSA 1) Trend Data

INDICATOR

1998

Rank (lowest

to highest)

1999

Rank (lowest

to highest)

2000

Rank (lowest

to highest)

NF Util. Rate 3.92% 1st 3.91% 1st 3.65% 1st AL/RHC Util. Rate .26% 1st 0.35% 1st 0.32% 1st Discharge Rate 10.25% 2nd 13.91% 3rd 21.82% 3rd Diversion Rate (Fiscal Years)

12.34%

2nd

13.73%

3rd

12.1%

1st

NF Occupancy Rate* 90.79% 10th 89.41% 8th 87.19% 6th

AL/RHC Occupancy Rate

78.01%

10th

68.60%

4th

79.31%

11th

2000 2001 HCBS/FE Utilization Rate** (State Fiscal Year)

N/A

N/A

2.14%

7th 2.26% 2.39%

7th

* The NF occupancy rate does not include hospital long-term care units. The source for occupancy data is the Adult Care Home Semi-Annual Survey. ** The HCBS/FE utilization rate measures the use of HCBS/FE services in proportion to the older adult population of the area. The rate reflects the percent of older adults who used HCBS/FE services in relation to the number of adults age 65 and over.

48

Central Plains AAA (PSA 2) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 2 was 4.47%.

This rate decreased from the 1999 rate (4.59%). Of the 11 PSAs, PSA 2 had the second lowest nursing facility utilization rate by adults age 65 and over in the state.

• The percent of adults age 85 and over in PSA 2 who resided in nursing facilities during

2000 was 19.32%. Among the PSAs, this was the fourth lowest rate. • The 2000 nursing facility occupancy rate in PSA 2 was 90.05%, dropping slightly from

90.39% in 1999. The 2000 nursing facility occupancy rate was the highest of the PSAs. • Based on 2000 data, PSA 2 has approximately 56.48 nursing facility beds per 1000

adults age 65 and over, and 454.97 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 2 was the second lowest among the PSAs, while the 85 and over ratio was the fourth lowest.


Age Group 2000 Male






County

Age 65 and Over NF Utilization Rate


Butler 7.75% 30.37% Harvey 7.66% 26.85%

Sedgwick 3.56% 15.89%


County

NF Occupancy Rate

NF beds per 1000 adults age 65 and over


Butler 89.51% 92.7 648.6 Harvey 91.73% 93.1 527.8

Sedgwick 89.77% 47.3 408.4 Community Based Service Utilization: PSA and County Level Highlights • During 2000 in PSA 2, approximately, 1.45% of adults age 65 and over resided in

AL/RHC facilities. This rate is almost the same as in 1999, 1.46%. The percent of adults

49

Roxanne Rachlin

numbering

age 85 and over that resided in AL/RHC facilities in PSA 2 during 2000 was 6.56%. Out of the PSAs, PSA 2 had the state average AL/RHC utilization rate of adults age 65 and over, while the 85 and over rate was the fourth highest.

• In 2000, PSA 2 had an assisted living/residential health care occupancy rate of 67%,

increasing from 66.47% in 1999. PSA 2 had the third lowest occupancy rate in 2000. • Based on 2000 data, PSA 2 has approximately 21.40 AL/RHC beds per 1000 adults age

65 and over, and 172.41 beds per 1000 adults age 85 and over. The availability of AL/RHC settings in proportion to the older adult population of PSA 2 is average compared to the other eleven PSAs.


during State Fiscal Year (SFY) 2001, increasing slightly from 1.76% in SFY 1999. For both time periods, PSA 2 had the fourth lowest utilization of HCBS/FE services in proportion to the older adult population of the area out of all 11 PSAs.


Age Group 2000 Male






County



Butler 1.43% 6.17% Harvey 2.79% 10.29%

Sedgwick 1.31% 6.03%


County




Butler 84.10% 17.5 122.4 Harvey 62.49% 39.2 222.2

Sedgwick 66.61% 20.1 173.3 Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 2 was the second lowest among the PSAs.

50


1999 2000 Discharge Rate 14.07% 20.03%

Diversion From Nursing Facility Placement: PSA Level Highlights • The diversion rate in PSA 2 decreased from 17.26% in FY1999 to 16.30% in FY2000.

The FY2000 rate was the fourth lowest among the eleven PSAs. Central Plains AAA (PSA 2) Trend Data

INDICATOR

1998

Rank (lowest

to highest)

1999

Rank (lowest

to highest)

2000

Rank (lowest

to highest)

NF Util. Rate 4.32% 2nd 4.59% 2nd 4.47% 2nd AL/RHC Util. 1.17% 7th 1.46% 8th 1.45% 6th Discharge Rate 11.89% 3rd 14.07% 3rd 20.03% 2nd Diversion Rate (Fiscal Years)

16.50%

7th

17.26%

6th

16.30%

4th

NF Occupancy Rate*

90.11%

9th

90.39%

11th

90.05%

11th


76.06%

7th

66.47%

3rd

67.00%

3rd


N/A

N/A

1.62%

4th 1.76% 1.85%

4th


51

Roxanne Rachlin

numbering

Northwest Area (PSA 3) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 3 was 6.66%.

This 0.20% decrease from 1999. The 2000 rate is the eighth highest among the PSAs. • The percent of adults age 85 and over in PSA 3 who resided in nursing facilities during

2000 was 24.58%. Out of the eleven PSAs, PSA 3 had the eighth highest nursing facility utilization rate of adults age 85 and over.

• The 2000 nursing facility occupancy rate in PSA 3 was 87.23%, increasing slightly from

86.53% in 1999. The 1999 occupancy rate was the fifth highest among the PSAs. • Based on 2000 data, PSA 3 has approximately 85.46 nursing facility beds per 1000

adults age 65 and over, and 511 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 3 was the third highest among the PSAs, while the 85 and over ratio was the fourth lowest.


Age Group 2000 Male






County

Age 65+ NF Utilization

Rate


Rate

County


Rate


Rate Cheyenne 6.18% 17.09% Rawlins 5.28% 23.58% Decatur 10.78% 38.41% Rooks 6.07% 23.96%

Ellis 6.75% 24.54% Russell 5.24% 17.75% Gove 7.04% 24.24% Sheridan 16.32% 72.62%

Graham 5.02% 16.00% Sherman ------- ------- Logan 1.42% 8.99% Smith 7.04% 22.18% Norton 6.35% 21.94% Thomas 8.27% 31.79%

Osborne 9.53% 30.64% Trego 9.17% 32.39% Phillips 9.38% 31.47% Wallace 6.96% 24.49%

52


County

NF

Occupancy Rate*

NF beds Per 1000 Adults

Age 65+


Age 85+

County

NF

Occupancy Rate*


Age 65+


Age 85+ Cheyenne 93.03% 64.1 461.5 Rawlins 92.25% 66.0 406.5 Decatur 93.86% 115.5 695.4 Rooks 84.84% 78.7 442.4

Ellis 97.96% 78.7 521.0 Russell 65.00% 68.2 413.0 Gove ------- 84.8 447.0 Sheridan ------- 91.2 619.0

Graham 90.40% 66.0 368.0 Sherman 97.52% 52.0 405.4 Logan ------- 113.9 809.0 Smith 68.67% 99.7 508.1 Norton 89.66% 73.8 362.9 Thomas 79.57% 115.3 797.7

Osborne 90.20% 109.3 531.9 Trego 87.68% 99.2 556.3 Phillips 86.69% 103.0 537.8 Wallace 89.90% 88.6 571.4

*These figures do not include hospital based long term care beds. Community Based Service Utilization: PSA and County Level Highlights • During 2000 in PSA 3, approximately, .71% of adults age 65 and over resided in

AL/RHC facilities. This rate is almost the same as in 1999, .74%. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 3 during 2000 was 2.35%. PSA 3 had the second lowest AL/RHC utilization rates in the state.


decreasing substantially from 80.89% in 1999. The 2000 occupancy rate was the lowest among PSAs.

• Based on 2000 data, PSA 3 has approximately 11.04 AL/RHC beds per 1000 adults age

65 and over, and 66 beds per 1000 adults age 85 and over. These rates are the second lowest of all of the PSAs.


during State Fiscal Year (SFY) 2001, increasing slightly from 1.28% in SFY 2000. For both time periods, PSA 3 had the second lowest utilization of HCBS/FE services in proportion to the older adult population of the area out of all 11 PSAs.


Age Group 2000 Male





53

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering

Table 39. AL/RHC Utilization by County, 2000, 2000

County

Age 65+ AL/RHC

Utilization Rate

Age 85+ AL/RHC

Utilization Rate

County

Age 65+ AL/RHC

Utilization Rate

Age 85+ AL/RHC

Utilization Rate

Cheyenne 1.07% ------- Rawlins ------- -------- Decatur ------- ------- Rooks ------- --------

Ellis 2.01% 6.89% Russell 1.75% 7.85% Gove ------- ------- Sheridan -------- -------

Graham 1.29% 6.40% Sherman 0.52% 2.03% Logan ------- ------- Smith 0.08% ------- Norton -------- ------- Thomas ------- -------

Osborne -------- ------- Trego -------- ------- Phillips 0.69% 1.99% Wallace ------- -------


County

AL/RHC Occupancy

Rate*

AL/RHC Beds

Per 1000 Adults

Age 65+ *

AL/RHC Beds

Per 1000 Adults

Age 85+ *

County

AL/RHC Occupancy

Rate*

AL/RHC Beds

Per 1000 Adults

Age 65+ *

AL/RHC Beds

Per 1000 Adults

Age 85+ *Cheyenne ------- 0.0 0.0 Rawlins ------- 0.0 0.0 Decatur ------- 8.8 53.0 Rooks ------- 0.0 0.0

Ellis 77.94% 30.5 201.7 Russell 83.12% 19.7 119.5 Gove ------- 0.0 0.0 Sheridan ------- 0.0 0.0

Graham 79.13% 14.3 80.0 Sherman 3.04% 34.7 270.3 Logan ------- 0.0 0.0 Smith 9.02% 0.0 0.0 Norton ------- 0.0 0.0 Thomas ------- 0.0 0.0

Osborne ------- 0.0 0.0 Trego ------- 0.0 0.0 Phillips 77.03% 9.2 47.8 Wallace ------- 0.0 0.0

*Please note that the occupancy rate data was collected from a time period prior to the bed data. Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 3 was the fifth highest among the PSAs.


1999 2000

Discharge Rate 24.65% 36.94%

54

Roxanne Rachlin

numbering

Diversion From Nursing Facility Placement: PSA Level Highlights • The diversion rate in PSA 3 increased from 14.74% in FY1999 to 18.90% in FY2000.

The FY2000 rate was the third highest among the eleven PSAs.

Northwest Area (PSA 3) Trend Data

INDICATOR

1998

Rank (lowest

to highest)

1999

Rank (lowest

to highest)

2000

Rank (lowest

to highest)

NF Util. Rate 7.41% 11th 6.86% 8th 6.66% 8th AL/RHC Util. Rate .58% 2nd 0.74% 2nd 0.71% 2nd Discharge Rate 16.06% 5th 24.65% 7th 36.94% 7th Diversion Rate (Fiscal Years)

17.64%

8th

14.74%

4th

18.90%

9th

NF Occupancy Rate* 86.08% 7th 86.53% 3rd 87.23% 7th


72.83%

5th

80.89%

11th

61.63%

1st


N/A

N/A

1.31%

2nd 1.28% 1.32%

2nd


55

Jayhawk AAA (PSA 4) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 4 was 5.06%.

This rate decreased from the 1999 rate (5.68%). Of the 11 PSAs, PSA 4 had the fourth lowest nursing facility utilization rate by adults age 65 and over in the state.


2000 was 20.40%. Compared to the other PSAs, this rate was average. • The 2000 nursing facility occupancy rate in PSA 4 was 84.89%, decreasing from 86.56%

in 1999. The 2000 nursing facility occupancy rate was the second lowest of the PSAs. • Based on 2000 data, PSA 4 has approximately 67.34 nursing facility beds per 1000

adults age 65 and over, and 515.71 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 4 was the fifth lowest among the PSAs, while the 85 and over ratio was the third highest.


Age Group 2000 Male







NF Utilization Rate Age 85 and Over

NF Utilization Rate Douglas 4.88% 22.08% Jefferson 5.89% 20.74% Shawnee 5.07% 19.93%


County NF

Occupancy Rate NF beds per 1000 adults

age 65 and over NF beds per 1000

adults age 85 and overDouglas 87.76% 65.8 507.8 Jefferson 80.61% 72.1 526.3 Shawnee 84.59% 67.4 517.3

Community Based Service Utilization: PSA and County Level Highlights • During 2000 in PSA 4, approximately, 1.69% of adults age 65 and over resided in

AL/RHC facilities. This rate increased from the 1999 rate, 1.55%. The percent of adults

56

Roxanne Rachlin

numbering

age 85 and over that resided in AL/RHC facilities in PSA 4 during 2000 was 7.88%. Out of the PSAs, PSA 4 had the fourth highest AL/RHC utilization rate of adults age 65 and over, while the 85 and over rate was the third highest.


increasing slightly from 64.33% in 1999. PSA 4 had the second lowest AL/RHC occupancy rate in 2000.


65 and over, and 224.95 beds per 1000 adults age 85 and over. These ratios were the third highest and highest, respectively, among the eleven PSAs.


during State Fiscal Year (SFY) 2001, increasing from 1.85% in SFY 2000. For both time periods, PSA 4 had average utilization of HCBS/FE services in proportion to the older adult population of the area compared to all 11 PSAs.


Age Group 2000 Male





Table 46. AL/RHC Utilization by County, 2000, 2000


AL/RHC Utilization Rate Age 85 and Over

AL/RHC Utilization Rate Douglas 1.25% 6.52% Jefferson 0.21% 0.31% Shawnee 2.00% 9.14%


County




Douglas 70.34% 18.8 144.9 Jefferson 84.21% 15.7 114.6 Shawnee 64.31% 34.4 263.7

Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 4 was the fourth highest among the PSAs.

57

Roxanne Rachlin

numbering


1999 2000

Discharge Rate 30.08% 42.21% Diversion From Nursing Facility Placement: PSA Level Highlights • The diversion rate in PSA 4 increased slightly from 17.86% in FY1999 to 18.40% in

FY2000. The FY2000 rate was the fifth highest among the eleven PSAs. Jayhawk AAA (PSA 4) Trend Data

INDICATOR

1998

Rank (lowest to highest)

1999


2000


NF Util. Rate 5.68% 5th 5.28% 4th 5.06% 4th AL/RHC Util. Rate 1.43% 10th 1.55% 9th 1.69% 8th Discharge Rate 28.99% 10th 30.08% 8th 42.21% 8th Diversion Rate (Fiscal Year)

14.88% 4th 17.86% 7th 18.40% 7th

NF Occupancy Rate* 84.58% 3rd 86.56% 4th 84.89% 2nd


67.57% 3rd 64.33% 2nd 65.70% 2nd


N/A

N/A

1.75%

5th 1.85% 2.03%

6th


58

Roxanne Rachlin

numbering

Southeast AAA (PSA 5) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 5 was 5.85%.

This rate decreased from the 1999 rate (6.38%). Compared to the other PSAs, this rate was average.


2000 was 19.80%. Among the PSAs, this was the sixth lowest rate. • The 2000 nursing facility occupancy rate in PSA 5 was 88.46%, increasing from 87.27%

in 1999. The 2000 nursing facility occupancy rate was the second highest of the PSAs. • Based on 2000 data, PSA 5 has approximately 71.43 nursing facility beds per 1000

adults age 65 and over, and 439.21 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 5 was average compared to the PSAs, while the 85 and over ratio was the third lowest.


Age Group 2000 Male






County



Allen 3.74% 13.32% Bourbon 5.67% 18.61% Cherokee 3.62% 12.15% Crawford 7.83% 23.19% Labette 6.41% 19.05%

Montgomery 6.54% 23.05% Neosho 5.03% 21.51% Wilson 5.73% 20.92%

Woodson 3.83% 15.89%

59


County

NF Occupancy Rate



Allen 83.89% 62.9 394.7 Bourbon 81.47% 69.9 424.2 Cherokee 93.02% 59.3 404.4 Crawford 91.60% 91.2 500.0 Labette 84.96% 76.8 452.4

Montgomery 90.26% 75.7 484.1 Neosho 90.04% 46.0 303.8 Wilson 86.61% 67.4 427.7

Woodson 82.38% 56.4 351.0 Community Based Service Utilization: PSA and County Level Highlights • During 2000 in PSA 5, approximately 2.08% of adults age 65 and over resided in

AL/RHC facilities. This rate increased from the 1999 rate, 1.95%. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 5 during 2000 was 7.94%. Out of the PSAs, PSA 5 had the second highest AL/RHC utilization rate of adults age 65 and over.


decreasing from 73.97% in 1999. PSA 5 had the median AL/RHC occupancy rate of the PSAs in 2000.


65 and over, and 168.73 beds per 1000 adults age 85 and over. The availability of AL/RHC settings in proportion to the older adult population of PSA 5 is average compared to the other eleven PSAs.


during State Fiscal Year (SFY) 2001, increasing from 4.57% in SFY 2000. For both time periods, PSA 5 had the highest utilization of HCBS/FE services out of all 11 PSAs in proportion to the older adult population of the area.


Age Group 2000 Male





60

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering


Age 65 and Over Age 85 and Over County AL/RHC Utilization Rate AL/RHC Utilization Rate Allen 3.86% 13.56%

Bourbon 2.67% 11.69% 3.33% 11.55%

Crawford 6.68% Labette 2.22%

Montgomery 1.51% 6.27% Neosho 1.28% 4.43%

Cherokee 1.49%

6.70%

2.28% 10.46% Wilson Woodson ------- -------


County

AL/RHC AL/RHC beds per 1000 adults age 65 and over


66.10% 59.0 370.5 Bourbon ------- 33.5 Cherokee 60.03% 189.2 Crawford 20.1 110.4

75.12% 30.6 180.1 Montgomery 78.32% 21.3

Occupancy Rate Allen

203.5 27.7

70.77% Labette

136.0 Neosho 54.70% 27.5 181.8 Wilson 77.25% 26.2 166.2

Woodson ------- 0.0 0.0

Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate of 55.11% in PSA 5 was the highest among the PSAs. It was

also the highest in 1998 and 1999.


1999 2000



The FY2000 rate was the third lowest among the eleven PSAs.

61

Roxanne Rachlin

numbering

Southeast AAA (PSA 5) Trend Data

INDICATOR

1998

Rank (lowest - highest)

1999


2000


NF Util. Rate 5.90% 6th 6.38% 7th 5.85% 6th AL/RHC Util. 1.50% 11th 1.95% 11th 2.08% 10th Discharge Rate 37.47% 11th 40.97% 11th 55.11% 11th Diversion Rate (Fiscal Years)

11.41%

1st

11.89%

1st

14.30%

3rd

NF Occupancy Rate*

85.33%

4th

87.27%

5th

88.46%

10th


76.97%

9th

73.97%

9th

68.73%

6th


N/A

N/A

4.19%

11th 4.57%

4.80%

11th


62

Southwest AAA (PSA 6) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 6 was 6.28%.

This rate decreased from the 1999 rate (6.32%). The 2000 rate is the sixth highest among the eleven PSAs.


2000 was 23.09%. Out of the eleven PSAs, PSA 6 had the fifth highest nursing facility utilization rate of adults age 85 and over.

• The 2000 nursing facility occupancy rate in PSA 6 was 84.86%, decreasing from 89% in

1999. The 2000 occupancy rate was the lowest among the PSAs. • Based on 2000 data, PSA 6 has approximately 83 nursing facility beds per 1000 adults

age 65 and over, and 542.89 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 6 was the fourth highest among the PSAs, while the 85 and over ratio was the second highest.


Age Group 2000 Male






County


Rate


Rate

County


Rate


Rate Barber 4.29% 18.98% Kiowa ------- ------- Barton 6.15% 25.00% Lane 4.31% 11.90% Clark 9.98% 22.12% Meade 9.03% 33.78%

Comanche 10.63% 31.91% Morton 11.09% 56.36% Edwards 5.16% 11.11% Ness 8.84% 31.10% Finney 4.88% 19.30% Pawnee 2.91% 8.04% Ford 7.68% 23.46% Pratt 5.94% 19.66% Grant 5.90% 25.30% Rush 8.12% 35.66% Gray 10.55% 34.87% Scott 7.69% 27.45%

Greeley 9.59% 35.90% Seward 3.99% 11.36% Hamilton 7.76% 27.71% Stafford 6.40% 27.54% Haskell ------- ------- Stanton 6.09% 34.21%

Hodgeman 8.84% 29.73% Stevens 6.88% 28.28% Kearny ------- ------- Wichita 5.68% 21.79%

63


County

NF

Occupancy Rate*


Age 65+


Age 85+

County

NF

Occupancy Rate*


Age 65+


Age 85+ Barber 72.16% 74.5 620.4 Kiowa ------- 0.0 0.0 Barton 87.00% 78.1 515.7 Lane ------- 47.6 250.0 Clark 61.10% 147.8 740.4 Meade 89.42% 99.9 560.8

Comanche 87.54% 139.8 755.3 Morton -------- 123.2 1090.9 Edwards 92.86% 82.3 546.3 Ness ------- 95.6 487.8 Finney 87.24% 61.9 511.7 Pawnee 68.49% 51.5 308.0 Ford 88.41% 94.5 627.6 Pratt 86.61% 72.4 454.2 Grant 89.64% 91.7 843.4 Rush 90.81% 95.7 601.4 Gray 93.50% 120.2 592.1 Scott 94.23% 94.7 522.9

Greeley ------- 118.1 820.5 Seward 78.82% 76.8 485.8 Hamilton ------- 98.0 578.3 Stafford 69.90% 90.6 550.9 Haskell ------- 76.6 625.0 Stanton ------- 80.1 657.9

Hodgeman ------- 90.9 486.5 Stevens 84.23% 82.5 606.1 Kearny ------- 129.0 1354.2 Wichita ------- 64.2 333.3

*These figures do not include hospital based long term care beds. Community Based Service Utilization: PSA and County Level Highlights • During 2000 in PSA 6, approximately, 1.09% of adults age 65 and over resided in

AL/RHC facilities. This rate increased slightly from the 1999 rate, 1.04%. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 6 during 2000 was 4.52%. Out of the PSAs, PSA 6 had the third lowest AL/RHC utilization rate of adults age 65 and over, while the 85 and over rate was the fourth lowest.


decreasing from 73.32% in 1999. The 2000 occupancy rate was the fifth highest among PSAs.


65 and over, and 102.65 beds per 1000 adults age 85 and over. These rates are the fourth lowest of the PSAs.


during State Fiscal Year (SFY) 2001, decreasing slightly from 1.85% in SFY 2000. For both time periods, PSA 6 had average utilization of HCBS/FE services in proportion to the older adult population of the area compared to all 11 PSAs.

64

Roxanne Rachlin

numbering


Age Group

2000 Male AL/RHC Utilization Rate

2000 Female AL/RHC Utilization Rate

2000 Total AL/RHC Utilization Rate

65-74 0.09% 0.11% 0.10% 75-84 0.98% 1.27% 0.98%



County

Age 65+ AL/RHC Utilization

Rate


Rate

County


Rate


Rate Barber ------- ------- Kiowa 3.72% 20.00% Barton 1.80% 6.94% Lane ------- ------- Clark -------- ------- Meade ------- --------

Comanche 1.57% 5.32% Morton ------- --------- Edwards 0.28% 1.85% Ness ------- -------- Finney 1.20% 2.63% Pawnee 0.90% 4.46% Ford 1.57% 6.52% Pratt 2.05% 9.49% Grant ------- ------- Rush -------- ------- Gray ------- ------- Scott -------- -------

Greeley ------- -------- Seward 2.04% 9.78% Hamilton ------- ------- Stafford 2.66% 11.38% Haskell ------- ------- Stanton ------- -------

Hodgeman ------- ------- Stevens ------- --------- Kearny ------- ------- Wichita -------- ---------


County

AL/RHC Occupancy

Rate*

AL/RHC Beds

Per 1000 Adults

Age 65+

AL/RHC Beds

Per 1000 Adults

Age 85+

County

AL/RHC Occupancy

Rate*

AL/RHC Beds

Per 1000 Adults

Age 65+

AL/RHC Beds

Per 1000 Adults

Age 85+ Barber ----- 0.0 0.0 320.0 Kiowa 56.69% 45.8 Barton 86.61% 22.8 150.5 Lane ----- 0.0 0.0 Clark ----- 0.0 0.0 Meade ----- 6.0 33.8

Comanche 72.64% 27.6 148.9 Morton ----- 0.0 0.0 Edwards ----- 0.0 0.0 Ness ----- 0.0 0.0 Finney 57.66% 27.6 228.1 Pawnee 62.24% 10.4 62.5 Ford 80.99% 20.2 134.1 Pratt 76.30% 30.3 189.8 Grant ----- 0.0 0.0 0.0 Rush ----- 0.0 Gray ----- 0.0 0.0 Scott ---- 0.0 0.0

Greeley ----- 0.0 0.0 Seward 73.37% 27.9 176.7 Hamilton ----- 0.0 0.0 Stafford ------ 38.4 233.5 Haskell ----- 0.0 0.0 Stanton ------ 0.0 0.0

Hodgeman ----- 0.0 0.0 Stevens ------ 0.0 0.0 Kearny ----- 0.0 0.0 Wichita ------ 0.0 0.0

*Please note that the occupancy rate data was collected from a time period prior to the bed data.

65

Roxanne Rachlin

numbering

Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 6 was the second highest among the PSAs.


1999 2000


Diversion From Nursing Facility Placement: PSA Level Highlights • The diversion rate in PSA 6 decreased substantially from 25.66% in FY1999 to 12.80%

in FY2000. The FY2000 rate was the second lowest among the eleven PSAs.

Southwest AAA (PSA 6) Trend Data

INDICATOR


1999


2000

Rank (lowest -highest)

NF Util. Rate 6.70% 8th 6.32% 6th 6.28% 7th AL/RHC Util. .68% 3rd 3rd 1.04% 3rd 1.09% Discharge Rate 25.78% 9th 36.83% 10th 53.00% 10th

(Fiscal Years)

23.22%

25.66%

11th 12.80%

2nd

85.49%

5th 89.00

%

6th

84.86%

1st


76.40%

8th 73.32% 7th

69.36% 7th

2000 2001HCBS/FE Utilization Rate** (State Fiscal Year)

N/A

N/A

1.87%

6th 1.85% 1.97%

5th

1998

Diversion Rate 11th

NF Occupancy Rate*


66

Roxanne Rachlin

numbering

East Central AAA (PSA 7) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 7 was 5.25%.

This rate increased slightly from the 1999 rate (5.64%). Of the 11 PSAs, PSA 7 had the fifth lowest nursing facility utilization rate by adults age 65 and over in the state.


1999 was 19.18%. Among the PSAs, this was the third lowest rate. • The 2000 nursing facility occupancy rate in PSA 7 was 84.94%, increasing from 83.43%

in 1999. The 2000 nursing facility occupancy rate was the third lowest of the PSAs.

2000 Male 2000 Total

• Based on 2000 data, PSA 7 has approximately 66.21 nursing facility beds per 1000

adults age 65 and over, and 420.03 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 7 was the fourth lowest among the PSAs, while the 85 and over ratio was the second lowest.


Age Group NF Utilization Rate 2000 Female

NF Utilization Rate NF Utilization Rate 65-74 1.09% 1.51% 1.31% 75-84 4.28% 5.20% 4.82%


County NF Utilization Rate NF Utilization Rate


Age 65 and Over Age 85 and Over

5.10% 19.01%

Franklin 4.52% 17.49% Linn 6.63% 27.71%

Miami 5.24% 18.05% Osage 5.93% 21.13%

Anderson 22.26% Coffey 6.67%


County

NF Occupancy Rate



Anderson 87.52% 55.4 328.5 Coffey 95.62% 74.4 376.8

Franklin 85.78% 56.1 355.2 Linn 84.68% 59.4 450.2

Miami 82.42% 69.9 478.7 83.40% 81.6 507.0 Osage

67

Roxanne Rachlin

numbering


AL/RHC facilities. This rate increased from the 1999 rate, 1.77%. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 7 during 2000 was 9.61%. Out of the PSAs, PSA 7 had the highest AL/RHC utilization rates.


decreasing from 73.71% in 1999. Out of the eleven PSAs, PSA 7 had the fourth highest AL/RHC occupancy rate in 2000.

Table 66. AL/RHC Utilization PSA 7, by Gender and Age, 2000

AL/RHC Utilization Rate

• Based on 2000 data, PSA 7 has approximately 32.46 AL/RHC beds per 1000 adults age 65 and over, and 187.04 beds per 1000 adults age 85 and over. These ratios were the second and fourth highest, respectively, among the eleven PSAs.


during State Fiscal Year (SFY) 2001, increasing from 3.15% in SFY 2000. For both time periods, PSA 7 had the second highest utilization of HCBS/FE services out of all 11 PSAs in proportion to the older adult population of the area.

Age Group

2000 Male 2000 Female AL/RHC Utilization Rate


65-74 0.21% 0.46% 0.34% 75-84 0.94% 2.65% 1.96%

85 and above 8.60% 10.04% 9.61% 1.37% 3.09% 2.36% 65 and above


County



Anderson 1.48% 5.11% 2.92% 10.92%

Linn 1.66% 7.79% Miami 2.49% 12.17% Osage 3.06% 11.97%

Coffey Franklin 2.24% 7.83%


County




Anderson 95.77% 16.6 98.5 Coffey 72.51% 34.7 176.1

Franklin 80.44% 30.2 191.3 Linn 43.50% 29.1 220.8

Miami 72.34% 29.0 198.8 Osage 61.90% 47.2 293.4

68

Roxanne Rachlin

numbering

Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 7 was the fourth lowest among the PSAs.


1999 2000

Discharge Rate 14.65% 22.34% Diversion From Nursing Facility Placement: PSA Level Highlights

• The diversion rate in PSA 7 increased substantially from 12.82% in FY1999 to 17.40% in FY2000. The FY2000 rate was the median among the eleven PSAs.

East Central AAA (PSA 7) Trend Data

INDICATOR

1998


1999

Rank

2000

Rank (lowest-highest)

NF Util. Rate 4.82% 5.64% 5th 5.25% 5th 3rd AL/RHC Util. Rate 1.33% 1.77% 2.36% 9th 10th 11th Discharge Rate 12.68% 14.65% 22.34% 4th 4th 4th Diversion Rate (Fiscal Years)

13.83%

3rd

12.82%

2nd

17.40%

6th

NF Occupancy Rate* 81.48% 1st 83.43% 1st 84.94% 3rd


68.22%

4th

73.71%

8th

69.80%

8th


N/A

N/A

2.93%

10th 3.15% 3.30%

10th

(lowest to highest)


69

Roxanne Rachlin

numbering

North Central/ Flint Hills AAA (PSA 8) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 8 was 6.70%.

This rate decreased from the 1999 rate (7.11%). The 2000 rate is the third highest among the PSAs.


2000 was 24.92%. Out of the eleven PSAs, PSA 8 had the third highest nursing facility utilization rate of adults age 85 and over.

• The 2000 nursing facility occupancy rate in PSA 8 was 86.74%, decreasing from 89.82%

in 1999. The 1999 occupancy rate was the fifth lowest of PSAs. • Based on 2000 data, PSA 8 has approximately 81.21 nursing facility beds per 1000

adults age 65 and over, and 497.75 beds per 1000 adults age 85 and over. Both of these ratios were the fifth highest among the PSAs.


Age Group 2000 Male




17.85% 27.78% 24.92% 65 and above 4.12% 8.50% 85 and above

6.70%

Rate County


County



Rate

Age 65+ NF

Utilization Rate


Rate

Chase 6.69% 20.22% Marion 9.88% 32.69% Clay 6.39% 24.42% Mitchell 9.18% 31.03%

Cloud 8.72% 24.58% Morris 5.30% 19.25% Dickinson 5.67% 23.18% Ottawa 8.01% 27.06% Ellsworth 8.20% 23.22% Pottawatomie 6.53% 27.18%

Geary 4.86% 17.22% Republic 8.54% 32.95% Jewell 3.05% 17.28% Riley 6.77% 27.26%

8.43% 31.17% Saline 5.12% 19.88% Lyon 6.96% 24.15% Wabaunsee 2.24% 11.94%

Lincoln

70


Age 65+

County

NF

Occupancy Rate*


Age 65+


Age 85+

County

NF

Occupancy Rate*



Age 85+ Chase 84.76% 93.3 595.5 Marion 90.78% 122.2 609.5

87.67% 69.9 422.4 Mitchell 91.30% 108.0 551.7 Cloud 87.31% 109.5 482.4 Morris 89.15% 68.6 413.2

Dickinson 77.99% 93.6 570.2 Ottawa 83.29% 99.4 495.4 Ellsworth 95.68% 102.3 509.4 Pottawatomie 88.36% 75.9 490.8

Geary 87.93% 53.2 463.6 Republic 89.57% 102.4 597.7 ------ 41.7 253.1 Riley 85.07% 76.5 495.9

Lincoln 92.43% 90.3 493.5 Saline 85.09% 63.6 492.8 Lyon 97.76% 82.7 472.0 Wabaunsee 81.64% 32.6 261.2

Clay

Jewell

*These figures do not include hospital based long term care beds. Community Based Service Utilization: PSA and County Level Highlights • During 2000 in PSA 8, approximately, 1.38% of adults age 65 and over resided in

AL/RHC facilities. This rate increased from the 1999 rate, 1.20%. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 8 during 2000 was 5.68%. Out of the PSAs, PSA 8 had the fifth lowest AL/RHC utilization rate of adults age 65 and over, while the 85 and over rate was the average.


increasing from 70.86% in 1999. The 2000 occupancy rate was the third highest among the PSAs.


65 and over, and 116.25 beds per 1000 adults age 85 and over. These rates are the fifth lowest of all of the PSAs.


during State Fiscal Year (SFY) 2001, increasing from 1.57% in SFY 2000. For both time periods, PSA 8 had the third lowest utilization of HCBS/FE services out of all 11 PSAs in proportion to the older adult population of the area.


Age Group 2000 Male




85 and above 3.97% 6.37% 5.68% 0.75% 1.81% 1.38% 65 and above

71

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering


County

Age 65+ AL/RHC

Utilization Rate

Age 85+ AL/RHC

Utilization Rate

County

Age 65+ AL/RHC

Utilization Rate

Age 85+ AL/RHC

Utilization Rate

Chase ------- ------- Marion 0.53% 1.59% Clay 1.47% 8.91% Mitchell ------- -------

Cloud 2.89% 7.76% Morris ------- ------- Dickinson 2.81% 11.17% Ottawa 1.66% 8.26% Ellsworth ------- ------- Pottawatomie 1.59% 5.28%

Geary 0.99% 5.63% Republic ------- ------- Jewell ------- ------- Riley 2.14% 9.59%

Lincoln 1.07% 5.19% Saline 1.50% 7.56% Lyon 1.34% 5.46% Wabaunsee 0.84% 1.49%


County

AL/RHC Occupancy

Rate

AL/RHC Beds

Per 1000 Adults

Age 65+

AL/RHC Beds

Per 1000 Adults

Age 85+

County

AL/RHC Occupancy

Rate

AL/RHC Beds

Per 1000 Adults

Age 65+

AL/RHC Beds

Per 1000 Adults

Age 85+ Chase ------- 0.0 0.0 Marion 58.18% 19.1 95.4 Clay 68.08% 26.2 158.4 Mitchell ------- 0.0 0.0

Cloud 82.55% 31.9 140.5 Morris ------- 0.0 0.0 Dickinson 75.15% 36.1 220.0 Ottawa 86.10% 20.3 100.9 Ellsworth ------- 0.0 0.0 Pottawatomie 77.70% 30.2 195.3

83.23% 12.9 112.6 ------- 0.0 0.0 Jewell ------- 0.0 0.0 Riley 67.17% 22.8 148.0

Lincoln 63.56% 15.4 84.4 Saline 86.05% 18.4 142.9 Lyon 66.86% 17.7 101.0 Wabaunsee 61.30% 28.9 231.3

Geary Republic

Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 8 was the fifth lowest among the PSAs.


1999 2000



The FY2000 rate was the highest among the eleven PSAs.

72

Roxanne Rachlin

numbering

North Central/Flint Hills AAA (PSA 8) Trend Data

INDICATOR

1998


1999


2000



15.34%

5th

11th 21.10%

9th

24.7%

NF Occupancy Rate*

84.26% 2nd 89.82% 10th 86.74% 5th


77.43%

6th

70.86%

5th

73.50%

9th


N/A

N/A

1.56%

3rd 1.57% 1.68%

3rd


73

Northeast AAA (PSA 9) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 9 was 7.21%.

This rate increased slightly from the 1999 rate (7.20%). Of the 11 PSAs, PSA 9 had the highest nursing facility utilization rate by adults age 65 and over in the state.


2000 was 25.24%. Among the PSAs, this was the second highest rate. • The 2000 nursing facility occupancy rate in PSA 9 was 86.45%, increasing slightly from

85.57% in 1999. The 2000 nursing facility occupancy rate was the fourth lowest of the PSAs. • Based on 2000 data, PSA 9 has approximately 88.06 nursing facility beds per 1000

adults age 65 and over, and 491.30 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 9 was the highest among the PSAs, while the 85 and over ratio was average.


Age Group

2000 Male NF Utilization Rate

2000 Female NF Utilization Rate

2000 Total NF Utilization Rate

65-74 1.78% 1.15% 1.44% 75-84 4.76% 5.34% 5.11%



County



Atchison 6.43% 26.92% Brown 6.89% 21.84%

Doniphan 5.17% 21.36% Jackson 4.08% 16.78% Marshall 5.10% 18.12% Nemaha 11.02% 31.09%

Washington 7.32% 21.74%


County

NF Occupancy Rate



Atchison 82.94% 82.6 540.9 Brown 86.05% 80.9 444.7

Doniphan 81.07% 72.0 466.0 Jackson 85.27% 49.2 305.9 Marshall 82.75% 78.7 447.1 Nemaha 89.45% 134.0 591.8

Washington 94.04% 112.0 565.2

74

Roxanne Rachlin

numbering


AL/RHC facilities. This rate is almost the same as in 1999, 1.24%. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 9 during 2000 was 3.83%. Out of the PSAs, PSA 9 had the fourth lowest AL/RHC utilization rate of adults age 65 and over, while the 85 and over rate was the third lowest.


increasing from 72.83% in 1999. PSA 9 had the second highest AL/RHC occupancy rate in 2000.


65 and over, and 83.88 beds per 1000 adults age 85 and over. These ratios were the third lowest among the eleven PSAs.


during State Fiscal Year (SFY) 2001, decreasing from 2.90% in SFY 2000. For both time periods, PSA 9 had the third highest utilization of HCBS/FE services out of all 11 PSAs in proportion to the older adult population of the area.


Age Group




65-74 0.19% 0.11% 0.15% 75-84 0.61% 1.78% 1.31%



County



Atchison 0.84% 1.92% Brown 1.72% 5..00%

Doniphan 0.45% 0.97% Jackson 1.11% 4.61% Marshall 2.44% 8.24% Nemaha 1.40% 3.93%

Washington ------- -------

75

Roxanne Rachlin

numbering


County




Atchison 92.51% 9.2 60.1 Brown 61.24% 27.8 152.6

Doniphan 91.44% 4.5 29.1 Jackson 90.26% 12.2 75.7

82.43% 28.6 162.4 Nemaha ---------- 15.3 67.4

Washington ---------- 0.0 0.0

Marshall

Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 9 was the median among the PSAs.


1999 2000


•

Diversion From Nursing Facility Placement: PSA Level Highlights

The diversion rate in PSA 9 decreased noticeably from 21.16% in FY1999 to 16.60% in FY2000. The FY2000 rate was the fifth lowest among the eleven PSAs.

76

Roxanne Rachlin

numbering

Northeast AAA (PSA 9) Trend Data

INDICATOR

1998


1999


2000



22.86%

10th

21.16%

10th

16.60%

5th

*

85.52%

6th

85.57%

2nd

86.45%

4th AL/RHC Occupancy Rate

88.40%

11th

72.83%

6th

78.21%

10th

2000 2001 HCBS/FE Utilization Rate** (State Fiscal

N/A

N/A

2.61%

9th 2.90% 2.72%

9th

NF Occupancy Rate


77

South Central AAA (PSA 10) Nursing Facility Utilization: PSA and County Level Highlights: • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 10 was

7.16%. This rate decreased from the 1999 rate (7.52%). Of the 11 PSAs, PSA 10 had the second highest nursing facility utilization rate by adults age 65 and over in the state.


2000 was 26.17%. Among the PSAs, this was the highest rate. • The 2000 nursing facility occupancy rate in PSA 10 was 87.96%, decreasing from

89.50% in 1999. The 2000 nursing facility occupancy rate was the third highest of the PSAs. • Based on 2000 data, PSA 10 has approximately 87.82 nursing facility beds per 1000

adults age 65 and over, and 547.44 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 10 was the second highest among the PSAs, while the 85 and over ratio was the highest.


Age Group




65-74 1.22% 1.41% 1.31% 75-84 4.82% 7.30% 6.25%

17.74% 29.63% 26.17% 65 and above 4.38% 9.09% 85 and above

7.16%


County



Chautauqua 10.37% 29.12% Cowley 6.31% 23.26%

Elk 8.24% 30..95% Greenwood 5.89% 24.40%

Harper 5.20% 16.61% Kingman 8.66% 25.00%

McPherson 11.49% 37.70% Reno 5.49% 21.21% Rice 8.12% 33.67%

Sumner 6.25% 22.51%

78


County

NF Occupancy Rate



Chautauqua 94.85% 127.2 741.8 Cowley 78.89% 88.2 563.7

83.63% 110.3 541.7 Greenwood 89.57% 74.9 450.2

Harper 83.01% 67.1 352.9 Kingman 92.55% 97.2 565.1

McPherson 94.61% 123.1 675.6 Reno 87.15% 69.0 467.8

602.7 Sumner 83.66% 84.2 580.8

Elk

Rice 94.31% 92.6


AL/RHC facilities. This rate increased from the 1999 rate, 1.32%. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 10 during 2000 was 5.27%. Out of the PSAs, PSA 10 had the fifth highest AL/RHC utilization rate of adults age 65 and over, while the 85 and over rate was the fifth lowest.


increasing from 61.59% in 1999. PSA 10 had the fourth lowest AL/RHC occupancy rate in 2000.


65 and over, and 217.01 beds per 1000 adults age 85 and over. The 65 and over ratio was the highest among the PSAs, while the 85 and over ratio was the third highest.


during State Fiscal Year (SFY) 2001, increasing from 2.44% in SFY 2000. For both time periods, PSA 10 had the fourth highest utilization of HCBS/FE services out of all 11 PSAs in proportion to the older adult population of the area.


Age Group




65-74 0.33% 0.32% 0.33% 75-84 1.13% 1.79% 1.53%


79

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering


County



Chautauqua ------- ------- Cowley 2.37% 6.76%

Elk ------- ------- Greenwood 1.66% 8.93%

Harper ------- ------- Kingman 1.06% 4.11%

McPherson 1.61% 4.94% Reno 2.26% 8.04% Rice 0.31% 1.68%

Sumner 0.60% 2.41%


County

AL/RHC Occupancy Rate*

AL/RHC beds per 1000 adults age 65 and over*

AL/RHC beds per 1000 adults age 85 and over*

Chautauqua ---------- 0.0 0.0 Cowley 51.51% 45.9 293.5

Elk ---------- 0.0 0.0 Greenwood 73.42% 19.4 116.8

Harper ---------- 0.0 0.0 Kingman 82.47% 14.1 82.2

McPherson 64.37% 80.4 441.5 Reno 77.69% 37.4 253.4 Rice 46.36% 6.2 40.4

Sumner 76.98% 12.7 87.6 *Please note that the occupancy rate data was collected from a time period prior to the bed data. Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 10 was the lowest among the PSAs.


1999 2000


•

Diversion From Nursing Facility Placement: PSA Level Highlights

The diversion rate in PSA 10 decreased slightly from 20.96% in FY1999 to 20.80% in FY2000. The FY2000 rate was the second highest among the eleven PSAs

80

Roxanne Rachlin

numbering

South Central AAA (PSA 10) Trend Data

INDICATOR

1998


1999


2000


NF Util. Rate 7.39% 10th 7.52% 11th 7.16% 10th AL/RHC Util. Rate 1.19% 8th 1.32% 7th 1.56% 7th Discharge Rate 10.09% 1st 13.20% 1st 18.66% 1st Diversion Rate (Fiscal Years)

19.49%

9th

20.96%

8th

20.80%

10th



51.30%

1st

61.59%

1st

67.02%

4th


N/A

N/A

2.39%

4th 2.44% 2.55%

8th


81

Johnson County AAA (PSA 11) Nursing Facility Utilization: PSA Level Highlights • The 2000 nursing facility utilization rate of adults age 65 and over in PSA 11 was

4.75%, increasing slightly from 4.72% in 1999. Of the 11 PSAs, PSA 11 had the third lowest nursing facility utilization rate by adults age 65 and over in the state.


2000 was 18.47%. Among the PSAs, this was the second lowest rate. • The 2000 nursing facility occupancy rate in PSA 11 was 87.85%, decreasing from

89.39% in 1999. PSA 11 had the fourth highest NF occupancy rate among the PSAs. • Based on 2000 data, PSA 11 has approximately 60 nursing facility beds per 1000 adults

age 65 and over, and 458.69 beds per 1000 adults age 85 and over. The ratio of nursing facility beds per 1000 adults age 65 and over in PSA 11 was the third lowest among the PSAs, while the 85 and over ratio was the fifth lowest.


Age Group




65-74 0.73% 1.11% 0.94% 75-84 3.09% 6.42% 5.12%


Community Based Service Utilization: PSA Level Highlights • During 2000 in PSA 11, approximately, 1.72% of adults age 65 and over resided in

AL/RHC facilities. This rate increased from the 1999 rate, 1.11%. The percent of adults age 85 and over that resided in AL/RHC facilities in PSA 11 during 2000 was 6.6%. Out of the PSAs, PSA 11 had the third highest AL/RHC utilization rate of adults age 65 and over, while the 85 and over rate was the fourth highest.


decreasing from 76.19% in 1999. The 2000 occupancy rate is the fifth lowest among the PSAs.


65 and over, and 219.17 beds per 1000 adults age 85 and over. The 65 and over ratio was the fourth highest of the PSAs, while the 85 and over ratio was the second highest.

• Approximately, .82% of adults age 65 and over in PSA 11 received HCBS/FE services

during State Fiscal Year (SFY) 2001, increasing slightly from .76% in SFY 2000. For both time periods, PSA 11 had the lowest utilization of HCBS/FE services in proportion to the older adult population of the area in comparison to the other PSAs.

82


Age Group




65-74 .48% .23% .37% 75-84 2.48% .87% 1.85%

85 and above 6.84% 5.94% 6.60% 65 and above 2.24% .95% 1.72% Discharge From Nursing Facility Placement: PSA Level Highlights • The 2000 discharge rate in PSA 11 was the third highest among the PSAs. It also

showed the greatest increase from 1999 to 2000 of any of the PSAs.


1999 2000 Discharge Rate 31.39% 51.98%


The FY2000 rate was the fourth highest among the PSAs.

Johnson County AAA (PSA 11) Trend Data

INDICATOR

1998


1999


2000


NF Util. Rate 4.85% 4th 4.72% 3rd 4.75% 3rd AL/RHC Util. Rate .76% 4th 1.11% 4th 1.72% 9th Discharge Rate 19.26% 7th 31.39% 9th 51.98% 9th Diversion Rate (Fiscal Years)

16.38%

6th

17.14%

5th

18.7%

8th



65.39%

2nd

76.19%

10th

68.01%

5th


N/A

N/A

0.78%

1st .76% .82%

1st


83

Roxanne Rachlin

numbering

Roxanne Rachlin

numbering

Recommendations This project provided an opportunity to develop a set of data indicators to monitor and track client outcomes that can help evaluate changes in the long-term care system of Kansas and set policy and program goals. When the Long-term Care Action Committee decided on the original indicator list in 1992, the data to measure many of the indicators were not available. Significant progress has been made in developing the data sources necessary to track the indicators longitudinally. Almost all of the independence indicators have been operationalized. In addition, efforts to create new indicators (i.e. monitoring assisted living rates separate from nursing facilities) to reflect the changing long-term care system were successful. Progress has also been made towards operationalizing the protection indicators. However, additional improvements are needed in some areas in order to provide policy makers with information needed for decision-making. Recommendations to enhance the data are offered below. Despite the data gaps, all of the indicators (or proxies) have been tracked for four or more years, making it possible to identify longitudinal trends. Implications and recommendations are also offered based on the outcome indicator data and findings. This section is organized under the following headings:

• Implications/Recommendations based on the outcome indicator trends; and • Recommendations to enhance aging related data.

Recommendations/Implications Based On The Outcome Indicator Trends Nursing Facility Utilization

Kansas has made progress in reducing the percent of older adults who reside in nursing facilities over the last eight years. The biggest decreases have been shown in age 85 and over subgroup. Kansas, however, continues to have nursing facility utilization rates that are much higher than the national average. Table 94 below displays Kansas’ rates in comparison to the national rates.

Table 94. Percent of Adults Age 65 and Over Who Resided in Nursing Facilities in Kansas and

Nationally, 2000

Age Group 2000 Kansas Rates 2000 National Rates* 65-74 1.2% 1.1% 75-84 5.2% 4.7% 85 and above 21.6% 18.2% 65 and above 5.6% 4.5%

*(US Census Bureau, 2001) An area of concern related to these rates is the supply of nursing facility beds. Although the number of beds has been decreasing over time, in 1999 Kansas had the highest ratio of certified nursing facilities per 1000 adults age 65 and over (1.13) of all states. The ratio of nursing facility beds per 1000 adults age 65 and over was also high, 78.6 compared to 52.3 nationally (Nawrocki and Gregory, 2000). A study by Greene et al. (1993) found that the risk of NF admission is higher in areas with high bed density, even with controlling for disability levels. Continued efforts to evaluate bed supply by specific areas of the state and incentives to reduce any over supply of beds are needed to help reduce unnecessary institutionalization rates.

84

An important longitudinal indicator finding is that nursing facility utilization showed an increase in 1999, after a long trend of decreasing. The increase may be due to a lack of availability of some in-home services during 1999 due to a waiting list for services. In fact, the rate showed a subsequent decrease in 2000 after the waiting list was no longer in effect. This finding highlights the importance of the availability of community-based services in reducing unnecessary nursing facility utilization. It also directly points to the cost-effectiveness of community-based services as a nursing facility alternative. Another noteworthy data finding is that older women reside in nursing facility rates at a much higher rate than men. There was a wide disparity between the rates at which older women resided in nursing facilities compared to men in relation to their proportion in the population. Fewer older women than men have a spouse available to help care for them. Efforts may be needed to develop specific supportive services that could help older women remain in the community. Community Based Service Utilization

Kansas has made progress in creating a more balanced long-term care system. The data clearly indicate that a growing number of older adults are having their long-term care needs met in the community through services and settings such as assisted living. The most recent AL/RHC utilization rates showed a relatively large increase. The HCBS/FE utilization rates showed an increase as well. Additional research on assisted living indicates that a relatively small proportion of low-income older adults reside in assisted living. Assisted living is typically the second most costly care setting so it is important to make sure services in the elder’s original home are available so that they do not prematurely move to assisted living. However, policy makers may want to explore strategies to increase the availability of these settings for low-income customers, and in rural areas where no AL services are yet available. There has been tremendous pressure on state agencies to trim their budgets and reduce spending. Agencies are faced with the task of providing services that meet the customer’s needs and are cost effective. Given the increasing scarcity of resources relative to demand, information on the effectiveness of community-based services in extending community tenure is needed. This information can be used to target limited public resources. Research from the “Longitudinal Study of Customers Diverted Through the CARE Project” indicates that many older adults are able to maintain community tenure if community based supports are mobilized in a timely fashion. The overall indicator data trends show that as use of community based alternatives increased, the nursing facility utilization rate decreased. As the State faces a shortage in resources, program and planning efforts will be needed to continue the progress Kansas has made. Nursing Facility Discharge Rates

Overall, the nursing facility discharge rates have increased since 1993. However, the last few years of data show a large increase. During the most recent year of measurement, from 1999 to 2000, the rate increased from 24.3% to 35%. Part of the increase may be explained by the increase in community-based options as a result of the waiting list for community-based services ending during 1999. The recent discharge rate increase in conjunction with the nursing facility utilization rate decrease indicates that older adults are more able to return to the community from nursing facility placement. Findings from the “Longitudinal Study of Customers Diverted Through The CARE Program” showed that entering a nursing facility does not necessarily result in a permanent stay. Increasingly, older adults are using the nursing facility for short-term rehabilitative care and are able to maintain community tenure following a nursing facility stay. The availability of in-home services and alternative care settings such as assisted living is crucial to older adults being able to return to the community from nursing facility placement or be

85

diverted from nursing facility placement. Given these trends, it is important to continue to monitor changes and to examine possible causes in more depth. Nursing Facility Diversion Rates

The diversion rates steadily increased between Fiscal Years 1996 and 1999, and then showed a slight decrease in 2000. The most recent decrease in the diversion rate may be due to an increase in the number of older adults who utilize in-home services prior to applying for nursing facility placement (referred to as ‘early diversion’). Therefore, older adults are delaying admission until after they have exhausted all community based alternatives and it is truly necessary. In order to validate this explanation, policy makers need to examine other sources of data such as the proportion of initial CARE assessments being conducted and the acuity level of older adults admitted to nursing facilities to see if it has increased. People who are private pay may choose to enter nursing facilities even if they do not require this level of care. Because of concerns about impoverishment, strategies are needed to reduce the number of private pay individuals who enter nursing or assisted living/residential health care facilities before level of care need indicates that level of care is required. These individuals may represent potential cost savings for the state if an unnecessary nursing facility stay and spend-down is avoided. It is crucial to continue to educate the public (including health care providers) about the capabilities of older persons and the availability of community services and programs to help older adults remain in the community. Public education could assist in altering perceptions of both elders and their families regarding who is able to live in the community and may help decrease the institutionalization rate. It is important to address the possible attitudinal barriers of families, friends, and professionals who may think that once a person needs help, they should enter a nursing facility. These efforts may help to reduce future reliance on public dollars to pay for long-term care. Urban and Rural Differences in Outcome Indicator Findings

Through this project, indicators at the PSA level have been tracked for four years. Some important findings with policy implications have emerged. In general, the urban areas (PSAs 1, 2, 4 and 11) have had the lowest nursing facility utilization rates over time. One possible explanation for this finding may be that older adults in urban areas are more likely to have informal support available in the community. Older adults in the rural areas of the state often do not have family nearby since younger residents have moved away. Strategies need to be developed that address the loss of informal support of older adults in these areas and reduce unnecessary nursing facility utilization. It is important in areas of limited resources, particularly rural ones, to develop ways to foster alternative approaches to serving older adults. One possibility is to create or enhance informal support networks by building relationships with community members including beauticians, pharmacists, librarians, and shop owners. This network can help case managers stay informed regarding the status of older adults in the community and alert them when problems arise. Although these approaches have been developed with some success in other states, research into how to develop and maintain these alternatives is needed. In addition, further research is needed into the role informal support plays in helping older adults remain in the community. The indicator data also showed that the development of assisted living was uneven throughout the state. PSAs 1 (Wyandotte-Leavenworth) and 3 (Northwest) have had the lowest assisted living utilization rates over time. Assisted living can be an appropriate setting for elders with light-care needs that cannot be met in their own homes. Assuring Medicaid customers continued access to

86

assisted living will not only support customer choice but also the state’s goal of maintaining frail elders in the most appropriate care setting. We now have baseline information on assisted living utilization rates. The state could use this information to consider policy standards regarding assisted living utilization. It is particularly important to develop solutions for counties/areas that need improvement on more than one indicator, for example high institutionalization and low community re-entry rates. These areas need immediate attention because they present the greatest potential risk of not meeting clients’ needs in the least restrictive or most appropriate environment. It is important to determine the reasons behind the indicator trends in these areas. Certain PSAs appear to be providing older adults with needed community based services and have institutionalization rates below the average (i.e. PSA 7, East Central). These areas could be studied as a source of strategies for success and lessons learned for other areas and the state as a whole. Areas that are economically or demographically similar could benefit from a comparison analysis. Therefore, venues for sharing successful indicator strategies and innovative ideas between AAAs should be developed. The indicator differences between PSAs could be explored with local AAA staff to determine underlying reasons for differences. It is helpful to understand the causes for one area’s success with a particular indicator and another area’s struggle. Addressing these differences will help Kansas provide effective and comprehensive long-term services to clients in all parts of the state. Abuse, Neglect and Exploitation Findings

Proxies for the protection indicators have been tracked over time. They provide information on the number of reports of A/N/E of older adults who reside in the community or in facilities. SRS and KDHE data indicate that reports of A/N/E of older adults in the community and in nursing facility settings are still increasing, but at a much lower rate. A recent finding that highlights the importance of monitoring A/N/E in Kansas is that even when other risk factors are controlled, elders who are victims of A/N/E (including self-neglect) are more likely to die of non-abuse related causes than are elders who are not maltreated or self-neglected. (Lachs and Pilmer, 1998 in NCEA, 1998). This finding also indicates that A/N/E investigations may result in a reduced likelihood of abuse-related deaths. Another noteworthy finding related to A/N/E is that national data show that the oldest old are at a greater risk of maltreatment (NCEA, 1998). Since Kansas has a relatively high proportion of the oldest old, this finding is of concern. The data from SRS Adult Protective Services (APS) indicates that the oldest old are potential victims more often than other age groups. Further exploration into the risk factors present in this group is needed to illuminate this issue. Specific strategies can then be targeted towards recognizing and reducing A/N/E among the oldest old. Financial exploitation of the elderly accounts for 30.2% of all reports of maltreatment. In light of the fact that older people are particularly vulnerable to this type of mistreatment and it accounts for one-third of all abuse reports, it would appear as if this might be an area for further study and more clearly delineated interventions. The Adult Protective Services Division of the Office of Social and Rehabilitation Services in Lawrence has recently implemented a Financial Abuse Specialist Team (FAST), which facilitates the education of the elderly and pertinent community members to prevention, indications, and interventions regarding financial exploitation of the elderly. This model has proven effective in reducing rates of financial exploitation of the elderly in the state of Oregon and, upon further study, may be an intervention which could be considered for statewide implementation in Kansas. (Mary Transue, APS Supervisor, Personal Communication, April 3, 2002).

87

Massachusetts’ lawmakers have also devised a collaborative effort to prevent, combat, and create awareness of elder financial exploitation which increased reporting rates by over 400% (Price & Fox, 1997).

The goal of the Massachusetts Bank Reporting Project, “a public/private partnership between state government and the banking industry, is to prevent elder financial exploitation through educating bank employees and consumers; increasing voluntary cooperation among the financial industry, elder protective services, and law enforcement; and encouraging the banking industry to develop and promote methods of protecting customers and their assets.” (Price & Fox, 1997, p.59).

The Massachusetts project involved the training of approximately 1000 bank employees to recognize indicators of suspect behavior and banking activity, as well as to develop new product lines for banks, which served as preventative techniques for the financial exploitation of older customers. Some of these product lines included accounts which required two signatures for withdrawals over a specified amount, daily or weekly withdrawal limits, advance notice of withdrawals, specified prohibitions on account withdrawals, or a flag on the account to notify the elder of unusual banking activity (Price & Fox, 1997, p.65). This project might also serve as a model for implementation in Kansas. As more customers are having their long-term care needs met in the community, the rates of A/N/E should be carefully monitored for any increases in rates of abuse, neglect and exploitation. In FY 2001, 20% of the adults age 60 and over involved in an A/N/E report were recipients of publicly funded in-home services. In addition, 15% of all community based A/N/E reports involved an alleged perpetrator who was a Medicaid provider. In 1997, Medicaid Fraud Control Units (MFCU) were nationally created to “investigate and prosecute, on a statewide basis, instances of health care provider fraud and patient abuse in health care facilities that receive Medicaid funds” (Hodge, 1998, p.24). Using this same approach, it may be possible that a similar measure could be created to prevent, identify, and address elder abuse, which occurs in the homes of people who receive publicly funded services. At this time, however, the most immediate issue is to improve the state data collection systems related to A/N/E in order to provide policy makers with accurate A/N/E data related to older adults in Kansas. Recommendations To Enhance Aging Related Data Overall Improvements Needed to Existing Data Sources

To facilitate data collection for outcome tracking and cross-program analysis, standardization of terms and time periods are needed across all programs and services. For example, having program data available by quarters (January-March, etc.) would make it possible to create calendar years, state fiscal years or federal fiscal years with the data and facilitate cross-program comparisons. The majority of indicator data is available at the PSA level except for the protection indicators. The availability of county level indicator data is less complete. It has been difficult to obtain some of the data such as diversion rates or unduplicated community based service recipients at the county level. Efforts to provide data on an AAA/county basis should continue in order to highlight regional strengths and weaknesses. AAA directors have expressed the need for county level data for use with County Commissions. Aggregation of data by county would also facilitate comparisons on an AAA/county area basis.

88

The long-term care data sources of the state should be updated to reflect changing trends in the system. One example is the growth of assisted living facilities. At the start of the Outcome Indicators Project, assisted living had not yet experienced large growth and was not an adult care home licensure category. During the course of this project, these settings gained popularity and showed substantial growth in Kansas. Based on the efforts of this project, changes to the Annual Adult Care Home Survey were made so that assisted living utilization could be tracked separately from nursing facility utilization. At this time, there are additional elements on the Annual Adult Care Home Survey that are not broken out between assisted living and nursing facilities, such as the migration statistics. This information is important in order to analyze the effect of older adults moving from one county to another to receive long-term care services. Efforts should be made to distinguish these settings from each other on all state survey forms. Because of the special needs of elders age 85 and over, and the desirability of targeting resources where they can be most effective, it is important to be able to identify customers by age group. Dates of birth should be included on all agency records. Information on the 85+ group should be available due to the special needs associated with old-old age. It is important to develop the ability to track recipients of long term care services as they move between and within the long term care service network. Social Security numbers or other unique client identifiers should also be collected on all long term care forms. Encryption techniques can be employed to safeguard the confidentiality of clients while still yielding useful data for policy makers, providers, program administrators, and researchers. A common client identification number should be assigned to all long term care clients, whether they are nursing facility, community based service, or adult protective service recipients. Databases could be linked in order to facilitate tracking of clients through the continuum of care and to allow for cost analysis at various stages of care. This sort of longitudinal information could lay the groundwork for the development of more sophisticated indicators, e.g., average length of community tenure after entering the HCBS system. A/N/E Data Enhancements

Currently A/N/E data in Kansas are not broken out by age subgroups. The absence of data broken out by age for institutionalized and community dwelling long term care clients complicates attempts to measure the A/N/E rate among older Kansans. Although age information is collected for APS long term care clients age 60 and older, it is not possible to track A/N/E trends among the age 65 and over population separate from the whole population. In order to effectively monitor A/N/E among older adults in Kansas, SRS and KDHE A/N/E data (such as confirmations) should be available by age subgroups. In particular, data are needed on the age 85 and older subgroup due to their increased risk of maltreatment. It would also be useful to be able to identify whether publicly funded in-home service recipients are at a greater risk of maltreatment. Currently, the Adult Protective Services data show how many reports involved service recipients as potential victims, but it does not show the percent of these reports that were confirmed or if the alleged perpetrator was a service provider. The management information system for tracking reports of A/N/E in nursing facilities needs to be refined in order to supply information on the number of confirmed or substantiated cases involving older adults as victims. Currently, these figures are not available from existing data sources. An area of interest noted by AAA directors is that they would like to receive A/N/E data on an area (PSA/county) basis. Local AAAs and SRS offices could work together to identify needed information and ways to provide it. For example, the addition of a county code on the

89

A/N/E data that are entered into the APS database would enable reports to be generated on a PSA basis as needed. To obtain a more accurate picture of the incidence of abuse, neglect, and exploitation of elders, and to protect individuals who move between community and institutional settings, investigation reports from both SRS and KDHE could be integrated. A single system, with codes used to identify the investigating agency, is one possible method. Systems in states that have solved similar problems might be a fertile source of ideas. Although progress has been made over time in enhancing the A/N/E data, overall improvements are still needed to allow policy makers and state agency staff to monitor and track confirmed/substantiated cases of A/N/E of older Kansans. This is an area that needs attention at both the state and national level. Long-term Care Data Oversight

A long-term care information system oversight committee could be established to address strategic issues and improve information systems for all state long-term care programs. It is important to have reliable and accurate data for policy, program and research needs and for effective program monitoring. The committee should be composed of a broad cross-section of systems personnel and data users. Tasks of such a group could include assuring that new systems contain information needed by key users in a format that meets their needs. The current ElderCount work group has addressed some of these issues. A sub-group of these members could comprise a long-term care data steering committee. Conclusion During times of limited resources and increased pressure on state agencies to provide long-term care options in the most cost effective manner possible, tracking data such as the outcome indicators is crucial in order to assess the impact of system changes on older Kansans. The longitudinal indicator trends reflect the progress Kansas has made in improving outcomes for older adults. In addition, there have been substantial improvements in data sources needed to measure and track the indicators over time. Resource support should continue for data collection for long term care programs and services. This information is essential in order to assess the strengths and weaknesses of the state system as well as to determine if policy goals are being met. Monitoring data such as the indicators regionally over time enables the state to analyze its progress in service delivery on a geographic basis. It is anticipated that the effort to monitor key indicators over time will be continued through the Elder Count Project currently underway. In times of major system change, data collection is especially important to quantify changes in long term care service utilization patterns as a result of changes.

90

References Administration on Aging. (July, 1998). 1998 Census Estimates of the Older Population, for

States. Available from: http://www.aoa.gov/aoa/stats/98pop/ Administration on Aging. (April, 2000). 2000 Census Figures for the Older Population, for States

(number of persons). Available from: http://www.aoa.dhhs.gov/aoa/stats/2000pop/numberxstate.html

Administration on Aging. (April, 2000). 2000 Census Figures for the Older Population, for States

(percent distribution). Available from: http://www.aoa.dhhs.gov/aoa/stats/2000pop/percentxxstate.html

Administration on Aging. (April, 2000). 2000 Census Figures for the Older Population, for States

(rank based on percent). Available from: http://www.aoa.dhhs.gov/aoa/stats/2000pop/rankxpercent.html

Administration on Aging. (2001). A Profile of Older Americans. Available from:

http://www.aoa.gov/aoa/stats/profile/2001/ Administration on Aging. (1999). Elder Abuse Prevention. Available from: http://www.aoa.gov/Factsheets/abuse.html Administration on Aging. (1997). Projected Health Conditions Among the Elderly. Available

from: http://www.aoa.dhhs.gov/aoa/stats/aging21/health.html

Administration on Aging. (2000). Summary Table of Age Characteristics of the Older Population for the United States and for States: 2000. Available from: http://www.aoa.dhhs.go…tateprofiles/ageprofile-states.html

American Association of Retired Persons and the Administration on Aging. (1999). A Profile of

Older Americans: 1999, by Fowles, D. G., Duncker A., Greenberg, S., Evans, E. & Madrid F. Washington, D.C.

American Association of Retired Persons. (1999). Across the States: Profiles of Long-term Care

Systems 1998. Washington, D.C: American Association of Retired Persons. American Association of Retired Persons. (2000). Across the States: Profiles of Long-term Care

Systems 2000. Washington, D.C: American Association of Retired Persons. American Association of Retired Persons. (1998). Medicaid and Long-term Care for Older

People. Available from: http://research.aarp.org/health/fs18r medicaid.html

American Association of Retired Persons. (1998). On the Issues: Long-term Care. Available from: http://www.aarp.org/ontheissues/issueltc.html

American Association of Retired Persons. (2001). Reforming the Health Care System: State

Profiles 2001. Washington, D.C: American Association of Retired Persons.

91

http://www.aoa.gov/aoa/stats/98pop/popx5.html

http://www.aoa.dhhs.gov/aoa/stats/2000pop/percentxxstate.html

American Association of Retired Persons. (1998). Taking Care of their Own: State-funded home and community-based care programs for older persons. Available from:

http://research.aarp.org/health/9704_funded.html American Association of Retired Persons. (1998). Trends in Medicaid Long-term Care Spending. Available: http://research.aarp.org/health/dd38_trends.html

American Public Human Services Association. (1999). National Elder Abuse Incidence Study Fact Sheet. Available from: http://www.aphsa.org/hotnews/neais.html

CARE Program Annual Report - Fiscal Year 1999. KDOA. Campbell, P. R. (1996). Population Projections for States, by Age, Sex, Race and Hispanic

Origin: 1995 to 2050. Washington, DC: U.S. Bureau of the Census. Chapin, R., Dobbs, D., Moore, J, & Waltner, M. (1999) A Study of Kansas Assisted Living and

Residential Health Care Facilities. Lawrence, KS: University of Kansas School of Social Welfare.

Coleman, B. (1998). New Directions for State Long-term Care Services. Washington, DC:

AARP Public Policy Institute. Compiled from Internet releases by the U.S. Department of the Census. Available from: Profile

of Older Americans: 1999. Available from: http://www.aoa.gov/aoa/stats/profile/default.htm

Compiled from the National Center of Health Statistics. Available from: Profile of Older

Americans: 1999. Available from: http://www.aoa.gov/aoa/stats/profile/default.htm Congressional Budget Office. (March 1999). Projections of Expenditures for Long-term Care

Services for the Elderly. Available from: http://www.cbo.gov/showdoc.cfm?index=1123&sequence=0-&from=1.

Floerchinger, T. (1992). Kansas Population Projections 1995-2030. Topeka, KS: Kansas Division of the Budget. Gabrel, C. S. (2000). An Overview of Nursing Home Facilities: Data From the 1997 National

Nursing Home Survey. Hyattsville, Maryland: National Center for Health Statistics. Greene, V.L, Lovely, M.E., Ondrich, J.I. (1993). The Cost-effectiveness of Community Services

in a Frail Elderly Population. The Gerontologist 33, (2), 117-129. Kane, K. (1993). Kansas Seniors and Their Families: Estimating the Senior Population and

Impairment Levels - 1990-2005. Topeka, KS: Aging Research Institute. Kansas Department of Health and Environment. (October, 2000). Long Term Care Program Fact

Sheet. Topeka, KS: State of Kansas. Kansas Department of Health and Environment. (January, 2001). Long Term Care Program Fact

Sheet. Topeka, KS: State of Kansas.

92

Kansas Department of Health and Environment. (April, 2001). Long Term Care Program Fact Sheet. Topeka, KS: State of Kansas.

Kansas Department of Health and Environment. (June, 2001). Long Term Care Program Fact

Sheet. Topeka, KS: State of Kansas. Kansas Department of Health and Environment. (October, 2001). Long Term Care Program Fact

Sheet. Topeka, KS: State of Kansas. Kansas Department of Health and Environment. (January, 2002). Long Term Care Program Fact

Sheet. Topeka, KS: State of Kansas. Kansas Department on Aging. (1998, May). Report on the 1997 Survey of Kansas Seniors.

Topeka, KS: State of Kansas. Kansas Department of Social and Rehabilitation Services (June 1998).

Abuse/Neglect/Exploitation/Fiduciary Abuse Report Statewide. Topeka, KS: Adult and Medical Services Commission.

Kansas Department of Social and Rehabilitation Services (June 1999).

Abuse/Neglect/Exploitation/Fiduciary Abuse Report Statewide. Topeka, KS: Adult and Medical Services Commission.

Ladd and Kane. (April 1999). State LTC Profiles Report. School of Public Health University of Minnesota.

Ladd, R., Kane, R. L., Kane, R. A., and Nielsen, W. (1995, November). State Long Term Care

Profiles Report. Minneapolis, MN: University of Minnesota, Institute for Health Services Research.

Lewandowski, C.A., and Rapp, C. A., (1991). Children and Youth Client Outcome Indicator

Project Status Report, Unpublished paper. Mollica, R. L., Reinardy, J., Kane, R. A., Fralich, J., Potthoff, S., Nyman, J., & Leone, A. (1994).

Findings and recommendations concerning the Kansas long term care system. Portland, Maine: National Academy for State Health Policy, National Long Term Care Resource Center.

National Center on Elder Abuse. (1997). “Elder Abuse in Domestic Settings” Available from: http://www.gwjapan.com/NCEA/Statistics/index.html National Center on Elder Abuse. (October, 1998). Abuse Victims Die Sooner Researchers Say. in

Newsletter, 1(1). National Center on Elder Abuse. (1998). The National Elder Abuse Incidence Study. Washington,

D.C. Available from: http://www.aoa.gov/abuse/report

Rapp, C. and Poertner, J. (1992). Social Administration: A Client-Centered Approach. New York: Longman.

93

Siegel, J. (1996, May). Aging Into The 21st Century. Bethesda, Maryland: National Aging Information Center.

Strahan, G. W. (1997). An Overview of Nursing Homes and Their Current Residents: Data From

the 1995 National Nursing Home Survey. Hyattsville, Maryland: National Center for Health Statistics.

Tatara, T. (1993). National Aging Resource Center on Elder Abuse. Summary of the Statistical

Data on Elder Abuse in Domestic Settings for FY90 and FY91: A Final Report. Tatara, T., and Kuzmeskus, L. M. (1999). Types of Elder Abuse in Domestic Settings

Washington, D.C.: National Center on Elder Abuse Tatara, T., and Kuzmeskus, L. M. (1997). Summaries of Statistical Data on Elder Abuse in

Domestic Settings for FY95 and FY96 Washington, D.C.: National Center on Elder Abuse

Tatara, T., and Kuzmeskus, L. M. (1997). Types of Elder Abuse in Domestic Settings

Washington, D.C.: National Center on Elder Abuse Tatara, T., Kuzmeskus, L. M. and Duckhorn, E. (1997). Reporting of Elder Abuse in Domestic

Settings Washington, D.C.: National Center on Elder Abuse Tatara, T., Kuzmeskus, L. M.. and Duckhorn, E. (1997). Trends in Elder Abuse in Domestic

Settings Washington, D.C.: National Center on Elder Abuse U.S. Bureau of the Census. (April, 1999). 65+ in the United States. Available from:

http://www.census.gov/prod/1/pop/p23-190/p23-190.html

U.S. Bureau of the Census. (June 15, 1999) Population Projections of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050. Washington, DC: U.S. Government Printing Office.

U.S. Bureau of the Census. (September 30, 1999). About Population Projections. Available from: http://www.census.gov/population/www/projections/aboutproj.htm

l

U.S. Bureau of the Census. (June, 2001). America’s Families and Living Arrangements; Population Characteristics. Current Population Reports, p.20-537. Available from: http://www.aoa.gov/aoa/stats/profile/2001/4.htm

U.S. Bureau of the Census. (2000). Profile of General Demographic Characteristics:2000.

Available from: http://factfinder.census.gov/servle…4000US20&qr_name=DEC_2000_SF1_U_DP1

U.S. Bureau of the Census. (September 30, 1999). Kansas and county population estimates by

age and gender. Available from: http://www.census.gov/population/county/cas/cas20.txt

U.S. Bureau of the Census. (September 30, 1999). Overall Population Growth. Available from: http://www.census.gov/population/projections/state/stpjpop.txt

94

http://www.aoa.gov/aoa/stats/profile/2001/4.htm

U.S. Bureau of the Census. (2000). Population in Households. Available from: http://factfinder.census.gov/servlet/DTTable?_ts=37944135170

U.S. Bureau of the Census. (June 30, 1999). Population projections for Kansas, by single year

2001 through 2025. Available from: http://www.census.gov/population/projections/state/yr01to05/ks0105.zip

U.S. Bureau of the Census. (June, 15, 1999). Population Projections for Kansas, by single year

2001-2025. Available from: http://www.census.gov/population/projections/state/yr06to10/ks0610.zip

U.S. Bureau of the Census. (June 15, 1999). Population Projections for Kansas, by single year






U.S. Bureau of the Census. (2000). Relationship by Household Type (Including Living Alone) for

the Population 65 Years and Over. Available from: http://factfinder.census.gov/servlet/DTTable?_ts=38073168967

U.S. Bureau of the Census. (June 15, 1999). State Population Rankings Summary. Available

from: http://www.census.gov/population/projections/state/9525rank/ksprsrel.txt U.S. Bureau of the Census. (June 15, 1999). Statewide Population Estimates. Available from: http://www.census.gov/population/estimates/state/5age9890.txt

U.S Bureau of the Census. (October, 2001). The 65 Years and Over Population: 2000. Census 2000 Brief. Available from: http://www.aoa.gov/aoa/stats/profile/2001/4.html.

U.S. Bureau of the Census. (September 30, 1999). 1990 to 1998 Annual Time Series of County Population Estimates By Selected Age Groups. Available from: http://www.census.gov/population/estimates/county/ca/caks98.txt

95

http://www.census.gov/population/projections/state/yr21to25/ks2125.zip

Date post:	27-Jul-2020
Category:	Documents
Upload:	others
View:	5 times
Download:	0 times

Older Adult Client Outcome Indicator Project Report Fiscal ... · The purpose of the Older Adult...

Documents