Missouri Lt. Gov. Kinder criticizes home-care backlog

JEFFERSON CITY, Mo. -- Lt. Gov. Peter Kinder accused Gov. Jay Nixon on Tuesday of risking the lives of seniors and the disabled by acting too slowly to reduce a backlog of residents awaiting state approval for in-home care services.

Kinder's confrontational tone comes as the Republican lieutenant governor is preparing to make an announcement next month about his potential challenge to the Democratic governor in the 2012 election. But Kinder said Tuesday that his criticism is rooted in the lieutenant governor's role as the official advocate for senior citizens.

"This is not about politics. This is not about policy differences," Kinder said at a Capitol news conference. "This is about seniors and disabled Missourians and their families whose very lives, in many cases, are being threatened by this abject failure of our governor."

Nixon's office declined to address Kinder's criticisms, instead referring questions to the Department of Health and Senior Services. The agency has defended its performance in gradually reducing the number of low-income people awaiting approval to receive state aid for daily living tasks such as cooking, cleaning, dressing and bathing.

Earlier this year, the Department of Health and Senior Services hired Indiana-based SynCare LLC to assess the home-care needs of Missouri Medicaid patients. But that contract dissolved more than a month ago after residents complained of delays in getting service and long hold times at customer call centers.

Department director Margaret Donnelly said in mid-September that the agency was hiring up to 130 temporary workers to clear a backlog of about 9,300 cases and handle new requests for evaluations. She estimated it would take 45 days to resolve the backlog.

The department said in a written statement provided Friday and again Tuesday that it has hired 86 workers and plans to hire 19 more. The agency said it has processed 6,800 cases "with faster services and shorter wait times than under the former private contractor." It said call center hold times are now minimal. And the department said it is finalizing about 234 care plans a day, which it said was more than double SynCare's rate of 107 a day.

Yet Kinder stressed Tuesday that 48 days have passed and the department still has a backlog. He described the situation as an "unholy trifecta" in which some seniors aren't getting the care they need, some businesses that provide care are getting stuck with the costs because of the state's delay in approving assessments, and taxpayers are being hit with an $8 million bill for hiring the additional state employees.

To clear the backlog, Kinder suggested the department should temporarily use home-care providers to assess the types and quantities of services needed by residents. The state used a similar system until a 2010 law approved the use of third-party eligibility screeners to avoid potential conflicts of interest in which home-care providers determine the amount of care needed by their own clients.

"There can be a legitimate concern about conflicts of interest," Kinder said Tuesday. But "we can put auditing measures in place that assures that providers aren't gaming the system."

Among those in the audience for Kinder's Capitol news conference was Diane Noah, executive director of Home Care of Mid-Missouri, a Moberly business that provides in-home care for several hundred clients and conducted home-care assessments in the past. Noah said her organization has about 100 clients in need of adjustments to their in-home care plans. Of those, 11 are critical because the clients could otherwise have to be placed in a nursing home or hospital. Although the state was notified of those 11 cases a month ago, just five have been taken care of so far, Noah said.

Kinder held similar news conferences Monday in Springfield, Independence and Lake Ozark and planned another one later Tuesday in Chesterfield.