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Medicaid Functional Eligibility Instrument (2014 - Current)

The Kansas Department for Aging and Disability Services (KDADS) has contracted with CRADO to develop a Medicaid Functional Eligibility Instrument (MFEI). The MFEI will be used to determine eligibility and support needs for Medicaid Long-Term Services and Supports (LTSS) for customers who have physical disabilities (PD), traumatic brain injury (TBI), or who are frail elders (FE). The nursing home population will also be included. CRADO is partnering with Research and Training Center on Independent Living (RTC/IL) and staff from the University of Kansas Medical Center (KUMC) to complete this project.

Focus groups were held around the state at the beginning of the project to gather community input and the MFEI Advisory Workgroup provides ongoing feedback and support. A draft MFEI has been developed and is currently being tested in different regions of the state. Revisions are being made as needed. Our team will also provide in-depth training to Aging and Disability Resource Center (ADRC) assessors statewide on the final MFEI. 

This work has recently been expanded to develop an instrument to determine the need for LTSS for people with intellectual and developmental disabilities (I/DD). CRADO is continuing to partner with RTCI/IL and KUMC. The MFEI-I/DD will be used to determine eligibility for I/DD services, including intermediate care facilities (ICF-I/DD) and home and community based services (HCBS-I/DD) programs.

Focus groups will be conducted and an Advisory Workgroup has been convened. Upon selection of a base assessment instrument, the MFEI-I/DD will be developed and tested throughout the state. 

Fact Sheet Available: 

FAQs about the MFEI-LOC

Reports available:

MFEI Expanded Executive Summary (pdf)

MFEI-IDD Expanded Executed Summary (pdf)

MFEI (2014-Current) 

PACE (2012)

Program for All Inclusive Care for the Elderly (PACE) Evaluation: PACE is an innovative program that provides all health and long-term care for older adults under a single capitated payment, and holds promise for containing Medicaid costs while improving quality of care. In this project, we compared Medicaid cost expenditures and selected health outcomes for customers in PACE to matched customers in Home and Community Based Services/Frail Elderly (HCBS/FE) and Nursing Facilities (NFs). Our findings can inform decisions on managing and expanding the PACE program.

Reports Available:

PACE Final Report (pdf)

PACE (2012)

Mental Health Needs in Nursing Facilities (2010)

In FY09 the Center for Research on Aging and Disability Options (CRADO) began a study to examine the mental health status and needs, interventions, and discharge patterns of older adults using Medicaid who reside in Kansas nursing facilities (NFs). For mental health status and needs, this study will analyze the characteristics (e.g., demographics, mood, behaviors) associated with NF residents mental health diagnoses and identify potential barriers to addressing mental health needs. When examining interventions, we will investigate the mental health interventions currently in use as well as identify emerging and evidence-based practices and/or interventions, with a focus on interventions that could assist Medicaid residents with mental health needs in discharging from NFs to community-based settings. In order to examine discharge patterns, the mental health status and need, and interventions will be investigated for their relationship to discharge patterns and NF tenure. The findings from this study will provide background information for the future implementation of mental health interventions in nursing facilities and recommendations for the training of NF staff members and CARE assessors.
Mental Health Needs in Nursing Facilities (2010)

Geriatric Mental Health and Peer Support (2009)

The current multiyear study, Meeting the Mental Health Needs of Older Adults Through Civic Engagement will complete the analysis of the Kansas Community Mental Health Center (CMHC) and the PASRR Level II datasets by comparing characteristics of older adults utilizing community-based services and those considering nursing facility level of care. An additional two years of data from the Universal Assessment Instrument (UAI) dataset will be collected and analyzed, in order to identify trends. In FY 09, Area Agency on Aging (AAA) staff will be interviewed to provide input with regard to findings. Another component of this project is a three year study to develop and pilot a peer support program within Central Plains AAA, in Wichita. At the end of the first year, we will provide initial data on applicability of this model for AAAs in Kansas. At the end of the second year, we will provide an in depth analysis of pilot data and establish protocols for implementation. At the end of the third year, a manual and related materials will be produced that will enable other AAAs and other aging service providers with the tools necessary to implement their own peer support program. This project is funded in part through a contract with the KDOA and SRS.

The study, Meeting the Mental Health Needs of Older Adults in the Community involved continuing to gather data in order to further identify trends about both older adults who used the Kansas Community Mental Health Centers (CMHCs), and older adults with serious mental illness considering nursing facility placement. In addition, data from the KDOA Universal Assessment Instrument (UAI) dataset (an instrument used by the AAAs) was analyzed in order to develop a profile of clients with low and high scores. In addition, in response to a request from the Governor's Mental Health Services Planning Council to modify the mental health training that had been developed for aging service providers so that it could be offered to CMHC case managers, a revised training was provided in both the western and eastern regions of the state. This project was funded in part through a contract with KDOA and SRS (report forthcoming).

The Older Adult Mental Health Service Access project continued the analysis of the Kansas Community Mental Health Center (CMHC) dataset in order to identify trends in utilization by older adults. Another activity was to analyze two years of data from the PASRR Level II dataset in order to provide a profile of older adults with serious mental illness considering nursing facility placement. A third activity was to survey all other states to identify innovative mental health services for older adults and strategies for funding those services. Finally, CRADO built on the Planning for Long Term Care Before the Boom project to determine the impact that Medicaid eligible older adults with mental health problems will have on the mental health system in Kansas (report forthcoming). This project was funded in part through a contract with KDOA and SRS.

The three year project, Connecting Older Kansans with Community Mental Health Resources involved the development, evaluation, and implementation of training and a screening tool to enhance the ability of Kansas service providers to identify older adults who may be experiencing mental health problems and to refer them for appropriate resources. Data was also collected to develop a profile of older adults who accessed Kansas Community Mental Health Centers (CMHCs). This project was funded in part through a contract with KDOA and SRS.

Reports available:

Connecting Older Kansans with Community Mental Health Resources: A Pilot Study. Final Report (2005-2006). (pdf)

Connecting Older Kansans with Community Mental Health Resources: A Pilot Study. Status Report for FY 2004 (2004). (pdf)

Connecting Older Kansans with Community Mental Health Services: A Pilot Study Fiscal Year 2003 Status Report (2003). (pdf)

Recent Presentations:

Reynolds, K. (2007, November). Peer Support Programs for Older Adults. Older Adults and Life Transitions: Addictions. Mental Wellness, Ethics. Wichita, KS.

Reynolds, K., Etzel-Wise, D., Graham, A., Troutt, N., Luber, N., & Holthaus, J. (2006, April). Advanced Training: Case Management with Older Adults. Great Bend, KS.

Reynolds, K., Chapin, R., Rachlin, R., Lopez, A., Roberts, C. (2005, November). Do Older Adults Access Community Mental Health Centers? Paper presented at the 58th annual meeting of the Gerontological Society of America, Orlando, FL.

Trout, N., Reynolds, K. (September, 2004). The Aging SPMI Individual. Kansas Health Care Association Convention. Kansas City, KS.

Geriatric Mental Health and Peer Support (2009)

Hospital Discharge Planning Project (2008)

The purpose of this project was to increase choice in care settings at time of discharge for older adults and adults with disabilities. The goal was to increase understanding of the discharge process; identify choice in care settings after discharge; and identify strategies to increase choice. Outcomes included a description of the hospital discharge planning process and recommendations for systems change.
Hospital Discharge Planning Project (2008)

Impact of the Workforce Enhancement Grants (2008)

The Impact of the Workforce Enhancement Grants project focused on the evaluation of grants provided by the Kansas Department on Aging to fund education programs for unlicensed staff working in nursing homes and long-term units of hospitals. CRADO conducted a research project to profile the facilities who participated in the training programs offered through the grant and to investigate the impact of the education programs on quality of care, quality of life, resident-centered care, and staff retention within nursing homes.

Publications:

The Impact of the Workforce Enhancement Grants on Nursing Home Quality of Care, Quality of Life, Culture Change, and Staff Retention (2008) (pdf) and Executive Summary. (pdf)

Impact of the Workforce Enhancement Grants (2008)

Hospice (2007)

Findings from the Diversion Study indicated that within six months of the CARE assessment, 23% of diverted customers had died and 28% of non-diverted customers had died. CRADO conducted an exploratory study of end of life care, specifically hospice use, in FY 2004 called, Hospice Component of the Longitudinal Diversion Study: Explanation of Hospice Use by Medicaid and Medicare Consumers in Kansas. A survey of CARE assessors was completed and indicated that lack of knowledge of palliative care was a barrier to hospice utilization.

During FY 2005, CRADO focused on barriers to discussing end-of-life concerns. Four focus groups of the CARE assessors were completed that allowed us to explore their depth of knowledge about end of life care and their attitudes towards palliative care. This project was funded in part through a contract with KDOA and SRS.

Reports available:

Hospice Component of the Longitudinal Diversion Study: Exploration of Hospice Use by Medicaid and Medicare Consumers in Kansas (2005). (pdf)

Area Agency on Aging End-of-life Resources Tool Kit for Professionals (pdf)

Presentations:

Gordon, T., Landry, S., Chapin, R., Zimmerman, M., Rachlin, R., Hickey, A. (2005, November). Examining Hospice Utilization Among Older Adults Applying for NF placement. Gerontological Society of America, Orlando, FL.

Gordon, T., Macmillan, K., Chapin, R., & Landry, S. (2005, August). Exploring hospice utilization by Medicaid and Non-Medicaid customers: A secondary analysis of a longitudinal study of frail older Kansans. Paper presented at the 1st National Conference on Access to Hospice And Palliative Care, St. Louis, MO.

Publications:

Chapin, R., Gordon, T., Landry, S., Rachlin, R. (2007). Hospice Use by Older Adults Knocking on the Door of the Nursing Facility: Implications for Social Work Practice. Journal of Social Work in End-of-life and Palliative Care.

Hospice (2007)

Planning for Long Term Care Before Boom (2006)

The Planning for Long Term Care Services Before the Boom project focused on the increasing attention being paid to the aging baby boomers. In 2031, the oldest baby boomers will turn age 85. By 2025 1 in 5 Kansans will be aged 65 and older. The current trends in long-term care services and the specific demographics of the baby boomers will influence the timing and intensity of the impact of these changes on long-term care services in Kansas. According to a report published by AARP (2002), national trends in long-term care are changing. These trends in long-term care and demographics are important factors that will influence future provision of long-term care services to older adults. Through this project CRADO examined the demographic trends identified in the AARP report that will effect the national baby boomer generation and applied them to Kansas in order to determine how conditions in Kansas may differ from what is expected nationally. This project was funded in part through a contract with KDADS and DCF.
Planning for Long Term Care Before Boom (2006)

The Longitudinal Study of Customers Diverted Through the CARE Program (2003)

The Longitudinal Study of Customers Diverted Through the CARE Program*, or Diversion Study, tracked four cohorts of older adults who had applied for nursing facility admission and were living in a community setting thirty days later. The purpose was to measure how long these diverted older adults were able to maintain community tenure, to explore the level at which they use community-based services, and to identify the differences and similarities between diverted and non-diverted older adults. CRADO has continued to track the original cohort of diverted customers for five years (Report forthcoming). Continued tracking allows the CRADO to establish a complete and accurate measure of the average length of community tenure.

The Examination of the Relationship of the Use of Medicare Home Health Services and Informal Caregiving to Successful Community Tenure project built on the analysis of factors related to long-term community tenure. The purpose of this study was to examine the relationship of the use of Medicare home health services and informal caregiving to community tenure of older adults who were diverted from nursing facility placement.

The Expanded Examination of Factors Related to Diversion and Successful Community Tenure for Medicaid Customers: The Role of Diagnoses and Prescription Drug Use* project also builds on the Diversion Study by examining the affect of different diagnoses and medication use on the likelihood of being diverted and on the length of community tenure. This study will also provide a cost-benefit analysis of HCBS/FE compared to nursing facility care (Report forthcoming). These projects were funded in part through a contract with KDOA and SRS. (PDF)

Reports Available:

Longitudinal Study of Customers Diverted through the Care Program Report: Fiscal Year 2000; (pdf)

Longitudinal Study of Customers Diverted through the CARE Program: Fiscal Year 2001 Report (pdf), and Appendices; (pdf)

Longitudinal Study of Customers Diverted through the CARE Program Report: Fiscal Year 2002: Summary of Key Policy Findings, (pdf) Technical Report (pdf), and Appendices (pdf);

Examination of the Use of Medicare Home Health Services and Informal Caregiving and Their Relationship to Successful Community Tenure (pdf) and Appendices (2003); (pdf)

The Diversion Study Update: Community Tenure Status of Diverted CARE Assessment Customers at 36 months (2005). (pdf)

The Community Tenure Study: Community Tenure Status of CARE Assessment Customers 60 Months after Diversion. (pdf)

Presentations:

Macmillan, K., Chapin, R., Rachlin, R., Zimmerman, M., Baca, B. (2005, November). Community Tenure of Older Adults 36 Months After NF Diversion: Challenging Assumptions with Facts. Gerontological Society of America, Orlando, FL.

Macmillan, K., Chapin, R., Rachlin, R., Zimmerman, M. (January 2005). Length of community tenure following application for nursing facility placement: A prospective study. Paper presented at the annual meeting of the Society for Social Work and Research, Miami, FL.

Publication:

Chapin, R., Baca, B., Macmillan, K., Rachlin, R., Zimmerman, M. (in press). Residential outcomes for nursing facility applicants who have been diverted: Where are they five years later? The Gerontologist.

TLSCDT CARE Program (2003)

Older Adult Client Outcome Indicators (2002)

This project was to monitor specific outcomes for adults age 65 and over who are receiving long-term care services and are the mandated responsibility of KDADS, DCF, and KDHE. From 1995-2002, we examined independence and protection indicators at the state, county and Area Agency on Aging Planning and Service Area levels to discern regional variations and longitudinal pattern. Independence indicators relate to rates at which Kansans age 65 and over use nursing facilities and home- and community-based services, discharge from nursing facilities to the community, and are diverted from placement through community-based alternatives. Protection indicators track older Kansans’ rate of abuse, neglect, and exploitation in community and institutional settings. Data for indicators were broke down by age group, allowing more precise tracking for the most vulnerable groups. The annual reports summarized findings, examined trends for previous years, and offered policy strategies for improving home- and community-based service delivery. This project was funded in part through a contract with KDADS and DCF.

Reports available:

Older Adult Client Outcome Indicator Project Report Fiscal Year 2002. (pdf)

Older Adult Client Outcome Indicator Project Report. (pdf)

Older Adult Client Outcome Indicators (2002)

Mental Health Needs and Service Access in AL/RHCs (2002)

In 2002, the Center on Aging and Disability Options (CRADO) conducted a comprehensive statewide survey of AL/RHC administrators for the Meeting the Mental Health Needs of Elders in Assisted Living and Residential Health Care Facilities: Community and Facility Factors project. The purpose of this study was to gain a better understanding of the need for and awareness of mental health services in assisted livings and the characteristics that impede or facilitate access to mental health treatment. In addition, we conducted focus groups of community mental health center directors, assisted living providers, aging mental health specialists, and senior consumers to discuss strategies to increase access to mental health services for residents who reside in AL settings. This study was funded by the Retirement Research Foundation.

During FY 2002, we expanded on our FY 2001 longitudinal study in the Barriers to Accessing Mental Health Services for Residents in Assisted Living and Residential Health Care Facilities from the Perspective of Residents and Community Mental Health Center Staff. In our FY 2001 study of AL/RHC facilities, it was found that 37% of the AL/RHC residents have some mental health diagnosis. In addition, it was suggested that residents in AL/RHCs with mental health needs might have difficulty accessing community mental health services. For the FY 2002 project, we interviewed a sample of residents in AL/RHCs about need, awareness, access and use of mental health services in the facility and community setting. We also interviewed community mental health center directors about these same issues. This project was funded in part through a contract with KDOA and SRS.

Reports available:

Barriers to Accessing Mental Health Services for Residents in Assisted Living and Residential Health Care Facilities from the Perspective of Residents and Community Mental Health Center Staff (2002). (pdf)

Meeting the Mental Health Needs of Older Adults in Assisted Living and Residential Health Care Facilities: Community and Facility Factors (2002). (pdf)

Presentations:

Reynolds, K., McLendon, T., Lopez, A. (August, 2004). Mental Health Issues in Assisted Living Residents. Kansas Adult Care Executives Annual Convention, Wichita, KS.

Chapin, R., Reed, C., Dobbs, D., & Hickey, A. (2003, January). Risk and Protective Factors Related to Depression: A Framework for Understanding the Mental Health Needs of Elders in Assisted Living. Society for Social Work and Research Seventh Annual Conference, Washington, DC, January 16-19, 2003.

Mental Health Needs and Service Access in AL/RHCs (2002)

AL/RHC Resident Length of Stay (2001)

The Statewide Study of Assisted Living and Residential Health Facilities and Resident Capacity to Age in Place study surveyed a random sample of facilities and tracked resident length of stay to determine factors associated with varying lengths of stay. The study examined potential relationships between length-of-stay variables such as staffing patterns, resident payer status (public or self-pay), resident functional and cognitive status, and facility characteristics. CRADO also surveyed states to identify aging-in-place strategies that have worked elsewhere.

Reports available:

Resident and Facility Factors Related to Residents Length of Stay in Assisted Living and Residential Health Care Facilities: A Longitudinal Analysis (2001).(pdf)

AL/RHC Resident Length of Stay (2001)

AL/RHC Facility Characteristics and Participation with the Medicaid HCBS/FE Waiver (2000)

For the Fiscal Year 2000 Profile of Kansas Assisted Living and Residential Health Care Facilities project, CRADO conducted a survey of all licensed assisted living and residential health care facilities (AL/RHCs) in Kansas. The survey collected data regarding the facility characteristics, e.g. profit status, average cost, level of service, professional staffing and whether they accepted Medicaid-HCBS/FE customers. Findings indicated that 70% of the facilities that participated in the survey accepted both private pay and Medicaid HCBS/FE residents, and the percentage of residents in AL/RHCs during the study time period that were Medicaid HCBS/FE recipients was 14.3%.

During FY 2005, CRADO re-surveyed all AL/RHCs in Kansas for the Assisted Living/Residential Health Care Facility Participation with the Medicaid HCBS/FE Waiver: A Five Year Follow-up project. The purpose of this study was to update the information collected in FY 2000 and identify changes in the availability and access of AL/RHCs for low-income older adults. This project was funded in part through a contract with KDOA and SRS.

Reports available:

Fiscal Year 2000 Profile of Kansas Assisted Living and Residential Health Care Facilities (2000). (pdf)

Assisted Living/Residential Health Care Facility Participation in the Medicaid HCBS-FE Waiver: A Five Year Follow-Up (2005).(pdf)

Publication:

Chapin, R. Dobbs-Kepper, D. (2001). Aging in Place in Assisted Living: Philosophy versus Policy. The Gerontologist, 41 (1): 43-50.

Presentation:

Higgins, D., Hickey, A., Rachlin, R., Nelson-Becker, H., Chapin, R. (2005, November). Access to Assisted Living for Low Income Elders: A Five Year Follow-up. Gerontological Society of America, Orlando, FL.

AL/RHC FCPM/FE (2000)

Expedited Service Delivery Pilot Evaluation (1999)

The CRADO developed an ESD process and financial worksheet that allowed Medicaid Home and Community Based Service (HCBS) applicants to receive services within three to five days of being assessed. The pilot documented that ESD was cost-effective and produced positive outcomes for older adults.

Reports available:

Expedited Service Delivery Pilot Evaluation Final Report (pdf)

Expedited Service Delivery Pilot Evaluation (1999)

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