Table of Contents - AARP · Table of Contents INTRODUCTIO N ... Francisco, CA, for his publication...

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Table of ContentsINTRODUCTION.............................................................................................................................................................. 5

STATE PROFILES.......................................................................................................................................................... 11

TERRITORY PROFILES ............................................................................................................................................. 217

SELECTED DATA RANKINGS................................................................................................................................... 225

THEMATIC MAPPING................................................................................................................................................ 231

DATA DOCUMENTATION ......................................................................................................................................... 243

The Public Policy Institute, formed in 1985, is part of the Research Group in the American Association of Retired Persons.One of the missions of the Institute is to foster research and analysis on public policy issues of interest to older Americans.This publication represents part of that effort.

Any views expressed in this publication are for information, debate, and discussion, and do not necessarily represent formalpolicies of the Association.

4

AcknowledgmentsThe editors are grateful to the many individuals who assisted with this project and provided helpful comments. Theeditors would like to thank the staff of the Public Policy Institute (PPI) for their comments and assistance on thepublication, particularly Jane Tilly, Associate Director PPI, Barbara Coleman, Senior Analyst, Jeremy Citro,Research Assistant, Normandy Brangan, Research Assistant, and Kristine Thurston, Research Technician. Theauthors would also like to thank the Creative Services Department for the cover design.

Special thanks go to Barbara Bedney, Helen Carrilo, Susan Keo de Wit, Michael Curtis, James Swan, andCharlene Harrington, at the Department of Social and Behavioral Sciences, University of California, SanFrancisco, CA, and the Department of Health Services Organization and Policy, College of Health Professions,Wichita State University, Wichita, KS, for their publication 1995 State Data Book on Long-Term Care Programand Market Characteristics, November 1996; and C. McKeen Cowles of the Cowles Research Group, Inc., SanFrancisco, CA, for his publication Nursing Home Statistical Yearbook, 1996. Both of these documents serve assources for provider data used in this publication.

IntroductionLong-term care comprises a broad range of services needed by persons of all ages with physical ormental impairments, who have lost or never acquired the ability to function independently. Long-term care services include personal care, nursing and home health care, habilitation andrehabilitation, adult day care, case management, social services, and assistive technology. Theseservices are provided in a variety of settings from homes to residential housing to nursingfacilities. Long-term care services may be needed on a regular or respite basis over a period ofseveral months, several years, or a lifetime.

States bear substantial responsibility for long-term care. They administer federal and state funds,and regulate nursing homes and home health agencies. Spending for long-term care services hasplaced a great demand on state budgets.

Across the States 1998: Profiles of Long-Term Care Systems, 3rd Edition, features recentstatistics for long-term care on a state-by-state basis under four major headings demographics,recipients, providers, and expenditures for long-term care.

I. Demographics

The demographic data in this chartbook establish the framework for understanding howpopulation aging will lead to a greater demand for formal long-term care by providing thepercentage of the older population in each state and the proportion of those 65 and over who livealone. Currently, there are at least 265 million people in the United States. Of this population,12.8 percent is age 65 and over. Florida has the highest percentage (18.5 percent) of persons age65 and over, while Alaska has the lowest (5.6 percent). Between 1996 and 2025, the U.S. Bureauof the Census projects there will be an 83 percent increase among the 65 and over population. By2030, nearly 20 percent of the population will be age 65 and over.

The older a person is the higher the probability that he or she will have disabilities. Nearly 6percent of the U.S. population is age 75 and older and 1.4 percent is 85 and older. Iowa has thehighest percentage of persons aged 85 and over (2.1 percent) while Alaska has the lowest (0.3percent).

In 1990, 28 percent of those over age 65 were living alone. The percentage ranged from 35percent in the District of Columbia to 16.7 in Hawaii. Living alone increases the probability thatpeople do not receive informal long-term care, as is commonly provided by spouses. Women, thetraditional primary caretakers of older persons, have increased their participation in the workforce and may not be as available as in the past to provide informal long-term care. Althougholder people comprise the majority of those with difficulties in mobility or self-care, people underthe age of 65 also have such difficulties.

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II. Recipients of Long-Term Care

Many older people have functional limitations or cognitive impairments and need ongoingassistance, yet they are not so disabled as to require nursing home care. Since most informal careis undocumented, this chartbook features information only on the recipients of formal long-termcare delivered in institutions, the community, or the home. Institutional care includes servicesprovided in nursing homes, which may offer 24-hour skilled nursing care and personal and socialservices. Community-based and in-home services generally include assistance with activities ofdaily living (ADLs) such as bathing, dressing, toileting, transferring, and eating, as well as withinstrumental ADLs including shopping, chores, meal preparation, and laundry.

Across the States breaks down the recipient data by funding source (i.e., Medicaid and Medicare).For Medicaid, this chartbook features data on recipients of home health care, personal care,Medicaid waiver services, and nursing home care. In 1996, there were 45 Medicaid home healthrecipients per 1,000 beneficiaries. The numbers of Medicaid home health care recipients per1,000 beneficiaries range from 234.1 in Minnesota to 0.0 in Florida and Montana. The Medicaidaged and disabled waivers served 290,776 clients across the country.

This report also presents data on Medicare home health beneficiaries. Medicare coverage forlong-term care is much more limited than that offered under Medicaid. Medicare beneficiaries arecovered for home health care and skilled nursing home care following an acute care episode, ifprescribed by a physician. Medicare covers home health care only if provided by a Medicare-certified home health agency. In 1995, 94 out of every 1,000 Medicare beneficiaries receivedhome health care and, in the same year, there were 47 Medicare skilled nursing facility (SNF)admissions per 1,000 beneficiaries in the United States. Vermont had the highest number of homehealth beneficiaries at 151 per 1,000 beneficiaries, and Hawaii had the lowest at 31. Minnesotahad the highest number of SNF admissions at 72 per 1,000 beneficiaries, and Hawaii had thelowest at 17.

Across the States also includes data on the age of United States nursing home residents and theirlimitation levels. In 1996, there were 43.7 nursing home residents per 1,000 persons age 65 andover. The rate ranged from 72.9 in North Dakota to 19.2 in Nevada. In 1996, about 70 percentof U.S. nursing home residents had four to five limitations in ADLs. In 1990, persons over theage of 65 represented the overwhelming majority of the nursing home population (90 percent).

III. Providers of Long-Term Care

Across the States presents data only on formal providers of long-term care because, as notedabove, informal caregiving is not well documented. In 1996, certified nursing homes totaled16,706 with over 1.78 million beds. There were 49.1 nursing home beds per 1,000 persons age 65and over. The rate ranged from 80.9 in Kansas to 21.6 in Nevada. New York has the highestnursing home occupancy rate at 98 percent; Texas has the lowest at 77 percent. Nationally, fourpercent of the total nursing home beds were dedicated to residents with Alzheimer’s Disease;

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fewer than one percent of total nursing home beds were dedicated to residents with AIDS. In1995, there were 13,140 licensed home health agencies, 2,871 licensed adult day care centers, and44,564 licensed residential care facilities across the nation.

IV. Expenditures for Long-Term Care

Long-term care is a major expense for persons with disabilities and their families as well as forlocal, state, and federal governments. Across the States features expenditure data from the fourmajor public sources of long-term care funding Medicaid, Medicare, the Older Americans Act,and the Social Services Block Grant. Out-of-pocket expenditures are not included because of lackof data on a state-by-state basis.

Medicaid, a joint federal/state program, is the largest source of funding for institutional care and amajor source for home and community-based long-term care. For these reasons, this sectionfocuses on state-level Medicaid expenditures and provides limited data on the other programs. In1996, total current expenditures for Medicaid exceeded $154 billion. Medicaid expenditures forlong-term care reached $51.3 billion. Of this amount, only $10.5 billion was spent for home andcommunity-based care, amounting to approximately 20 percent of all Medicaid long-term careexpenditures and 7 percent of total Medicaid expenditures. The percentage of Medicaid’s long-term care funds devoted to home and community-based care range from 50 percent in Oregon to4.4 percent in Mississippi. Medicaid expenditures for institutional care were $40.8 billion, orabout 80 percent of total Medicaid spending on long-term care and 26 percent of total Medicaidexpenditures. In 1995, the data also show that the average Medicaid per diem reimbursement forintermediate care facilities/mentally retarded (ICFs/MR) was $229; it was $84 a day for nursinghomes.

Medicare plays a much smaller role in funding long-term care because of strict eligibility andcoverage limits. For example, Medicare will cover only 100 days of SNF care per benefit period,and beneficiaries must pay high coinsurance ($95 per day in 1997) from days 21-100. For homehealth care, the Medicare benefit covers skilled services and some home health aide care.However, to be eligible to receive these services, beneficiaries must be homebound and meetother restrictive eligibility requirements. Across the States presents information on Medicarereimbursement for SNFs and for home health care. In 1995, Medicare on average reimbursedSNFs $187 per day, and home health care agencies $62 per visit. SNF reimbursements rangedfrom $294 in California to $104 in New York. California had the highest home health careagency cost per visit at $88, and Vermont the lowest at $45.

Title III Older Americans Act (OAA) programs play a limited role in providing home andcommunity-based services, such as congregate and home-delivered meals and some in-homeassistance, because the program’s funding is capped. Approximately $800 million wasappropriated for Title III programs in fiscal year 1997. This section of the chartbook providesdata on Title III appropriations by state. Unlike Medicaid, OAA may serve persons of any incomelevel, although the funds must be targeted to persons with the "greatest social or economic need."These funds also provide for supportive and preventive services, ombudsman programs, and elderabuse programs.

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The Social Services Block Grant (SSBG) is a federal block grant based on the state's population.For the fiscal year 1997, $2.5 billion was appropriated for social services under Title XX of theSocial Security Act. This section of the chartbook provides data on SSBG appropriations bystate. The state may allocate the funds for a variety of social services, including community-basedlong-term care. The SSBG supports a limited amount of home and community-based services forolder persons. In FY 1995, 38 states intended to use SSBG funds to provide homemaker/homehealth services; 32 planned to provide case management or access services (e.g., pre-admissionscreening, information, and referral, etc.); 28 intended to provide transportation; and 25 plannedto provide nutritional assistance. The SSBG does not require that services be restricted only topersons with low incomes but, in practice, most states direct these funds to low-incomepopulations.

Across the States presents available information on five U.S. Territories (American Samoa, Guam,Northern Marianas, Puerto Rico, and the Virgin Islands). Each territory profile presents, in alimited form, information on demographics, Medicaid expenditures, and other long-term carefunding sources including OAA and SSBG funding.

Selected Data Rankings and Thematic Maps

Across the States ranks the performance of states and provides thematic maps exhibiting ninedifferent indicators. The rankings and maps provide an easily comprehensible comparison of dataon the states long-term care systems. The indicators exhibited are: 1) percent of total populationaged 65 and over, 1996 estimated; 2) percent change in population age 65 and over, 1990-2025projected; 3) number of nursing home residents per 1,000 persons age 65 and over, 1996estimated; 4) number of nursing home beds, 1996; 5) total current expenditures for Medicaid, percapita, 1996; 6) nursing home Medicaid expenditures per capita, 1996; 7) ICFs/MR Medicaidexpenditures per capita, 1996; 8) home and community-based Medicaid expenditures per capita,1996; and 9) occupancy rates in nursing homes, 1996. Users should be aware, however, that someindicators are not as well-suited to being displayed in these fashions as are others.

Data Documentation

The Data Documentation section is an integral component of this chartbook and one to which thereader should refer frequently. It provides both the source and a general explanation for eachindicator and identifies the limitations of specific data. Reference to the Data Documentationsection is particularly important in confirming the data’s appropriateness for a specific applicationand in understanding its specific population of reference. This section also highlights which datahave been obtained from sources that differ from those included in previous editions of Across theStates. An (†) denotes an indicator that has been updated by an individual state’s Medicaid office.An (*) denotes an indicator that has been obtained from a source that differs from previouseditions of Across the States.

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Conclusion

AARP’s Public Policy Institute has compiled and published Across the States, Profiles of Long-Term Care Systems biannually since 1992 to make available the most current data on manydimensions of state long-term care systems to policymakers, AARP members and volunteers, andother interested individuals. Direct written requests for additional copies or earlier editions of thispublication to the Research Group’s Public Policy Institute, AARP 601 E Street, NW,Washington, DC 20049. Copies may also be obtained by calling (202) 434-3860.

Although this edition incorporates some indicators pertaining to state health care systems, pleaserefer to the Public Policy Institute’s annual publication Reforming the Health Care System: StateProfiles 1996 for a comprehensive presentation of state-level health care and reform data. Acomplete listing of Public Policy Institute publications can be obtained by calling (202) 434-3840.

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SState tate PProfilesrofiles

11

ALABAMA

I. Demographics

Persons per Thousand with Difficulty in Mobility or Self-Care, by Age, 1990

State

61.8

264.7

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age


Home and Community-Based CareState United States

Medicaid home health recipients per 1,000 recipients (1996) 83.1 45

Medicaid personal care recipients per 1,000 recipients (1992) 0 5.7

Medicaid aged and disabled waiver client caseload (FY 1996) 6,678 290,776

Medicare home health beneficiaries per 1,000 beneficiaries (1995) 127 94

State United StatesTotal population, in thousands (1996 est.) 4,273 265,284

Percent of persons age 65+ (1996 est.) 13.0 12.8



Percent of persons age 85+ (2025 proj.) 2.0 2.3

Percent of persons age 65+ living alone (1990) 29.5 28.2

Percent change in population age 65+ (1990-2025 proj.) 105.6 99.3

13

ALABAMA

Institutional CareState United States

Total nursing home residents (1996) * 22,167 1,479,653

Percent change in nursing home residents (1995-1996) 2.2 -0.2

Percent of nursing home population age 65+ (1990) 91.4 89.8

Nursing home residents per 1,000 65+ population (1996)* 39.8 43.7

Average Medicaid days per recipient per year (1994) 271 245

Total Medicaid nursing home recipients (1996)* 16,270 1,009,640

Medicaid nursing facility recipients per 1,000 recipients (1996)* 29.8 28.6

Medicare SNF admissions per 1,000 beneficiaries (1995) 34 47

Percentage of Nursing Home Residents with Multiple Dependencies, 1996

State

5 ADLs49.3%

0 ADLs7.6%

1 ADLs6.9%

2 ADLs11.0%

3 ADLs3.6%

4 ADLs21.4%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%



Licensed home health care agencies (1995) n/l 13,140

Licensed adult day care centers (1995) n/l 2,871

Licensed residential care facilities (1995) 208 44,564

Licensed residential care beds (‘95) per 1,000 65+ population (‘95) 9 21

*= Source for this indicator has changed from previous editionsn/l = Not licensed, n/a = Not available

14

15*HCBC = Home & Community-Based Care

ALABAMA


Certified nursing facilities (1996) 223 16,706

Number of beds in certified nursing facilities (1996) 24,083 1,780,772

Number of nursing facility beds dedicated to Alzheimer’s (1996) 355 64,466

Number of nursing facility beds dedicated to AIDS (1996) 0 3,005

Percent change in certified nursing facility beds (1995-1996) 3.1 -5.4

Nursing home beds (‘96) per 1,000 65+ population (‘96) 42.7 49.1

Occupancy rates in nursing homes (1996) 97.0 89.9


Medicaid (1996)(in thousands of dollars)

Percent of Long-Term CareMedicaid

Expenditures

State U.S. State U.S.Total current expenditures for Medicaid 2,038,419 154,157,003

Long-term care Medicaid expenditures 621,731 51,327,309

Nursing home expenditures 446,193 31,084,050 71.8 60.6

Intermediate care facility / mentally retarded 68,011 9,714,031 10.9 18.9

Home & community-based care expenditures 107,527 10,529,227 17.3 20.5

Personal care 0 2,849,138

Home health 21,553 2,051,746

Home & community-based services waivers 85,974 5,628,344

Federal Medicaid matching percent (FY 1996) 69.9 --

State5.3%

21.9%

3.3%

69.5%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%

Medicaid Long-Term Care Expenditures as a Percent ofTotal Medicaid Expenditures, 1996

16

ALABAMA

Average Medicaid Per Diem Reimbursement forNursing Homes and ICFs\MR, 1995

Nursing Home

$83 $84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$213 $229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare

Average Medicare Reimbursement by Service Type, 1995

SNF (per day)

$149

$187

$0

$50

$100

$150

$200

$250

$300

State U.S.

Home Health (per visit)

$47$62

$0

$50

$100

$150

$200

$250

$300

State U.S.

Other Funding Sources

Older Americans Act Total FY97 ($000s) $ 12,839The Title III Allotments are based on the age 60 and over population in the state.

Social Services Block Grant Total FY97 ($000s) $ 40,288This federal block grant allocation is based on the state’s population. The state may allocate the funds for a varietyof social services, including community-based long-term care.

17

ALASKA

I. Demographics


State

25.0

156.9

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age




Medicaid personal care recipients per 1,000 recipients (1992) 13.9 5.7

Medicaid aged and disabled waiver client caseload (FY 1996) 280 290,776


State United StatesTotal population, in thousands (1996 est.) 607 265,284







18

ALASKA


Total nursing home residents (1996) * 626 1,479,653

Percent change in nursing home residents (1995-1996) -1.3 -0.2




Total Medicaid nursing home recipients (1996)* 542 1,009,640




State

5 ADLs46.3%

0 ADLs7.3%

1 ADLs7.8%

2 ADLs7.3%

3 ADLs4.8%

4 ADLs26.4%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%



Licensed home health care agencies (1995) 26 13,140






ALASKA



Number of beds in certified nursing facilities (1996) 829 1,780,772









Expenditures

State U.S. State U.S.Total current expenditures for Medicaid 331,304 154,157,003





Personal care 3,818 2,849,138

Home health 925 2,051,746



State4.4%

14.6%

2.1%

78.9%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


20

ALASKA


Nursing Home

$215

$84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$385

$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$228

$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$62

$0

$50

$100

$150

$200

$250

$300

State U.S.

Data not available




21

ARIZONA

I. Demographics


State

41.2

165.0

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age





Medicaid aged and disabled waiver client caseload (FY 1996) n/a 290,776









n/l = Not licensed, n/a = Not available

22

ARIZONA






Average Medicaid days per recipient per year (1994) n/a 245





State

5 ADLs46.3%

0 ADLs6.2%

1 ADLs8.7%

2 ADLs7.9%

3 ADLs4.7%

4 ADLs26.2%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%




Licensed adult day care centers (1995) 26 2,871





ARIZONA




Number of nursing facility beds dedicated to Alzheimer’s (1996) 1,453 64,466








Expenditures




Intermediate care facility / mentally retarded 0 9,714,031 0.0 18.9

Home & community-based care expenditures 638 10,529,227 5.2 20.5


Home health 556 2,051,746

Home & community-based services waivers 0 5,628,344


State

99.3%

0.7%HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


24

ARIZONA


Nursing Home

$82 $84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$253$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$257

$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$73 $62

$0

$50

$100

$150

$200

$250

$300

State U.S.




25

ARKANSAS

I. Demographics


State

54.6

240.6

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age














26

ARKANSAS











State

5 ADLs47.3%

0 ADLs8.6%

1 ADLs10.2%

2 ADLs13.1%

3 ADLs3.7%

4 ADLs17.2%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%







*= Source for this indicator has changed from previous editions


ARKANSAS












Expenditures







Home health 13,425 2,051,746



State

8.5%

23.7%

8.4%

59.4%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


28

ARKANSAS


Nursing Home

$60$84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$162

$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$162$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$48 $62

$0

$50

$100

$150

$200

$250

$300

State U.S.




29

CALIFORNIA

I. Demographics


State

48.7

190.0

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age




Medicaid personal care recipients per 1,000 recipients (1992) n/a 5.7










30

CALIFORNIA











State

5 ADLs49.6%

0 ADLs6.7% 1 ADLs

5.1%

2 ADLs7.1%

3 ADLs3.2%

4 ADLs28.3%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%





Licensed residential care facilities (1995) 9,572 44,564



31*HCBC = Home & Community-Based Care†= State level data has been updated from state Medicaid office. HCFA -64 data is used for U.S. aggregate figures.

CALIFORNIA


Certified nursing facilities (1996) 1,398 16,706




Percent change in certified nursing facility beds (1995-1996) -1.0 -5.4






Expenditures†

State U.S. State U.S.Total current expenditures for Medicaid† 16,395,083 154,157,003

Long-term care Medicaid expenditures† 3,680,470 51,327,309

Nursing home expenditures 2,059,057 31,084,050 56.9 60.6

Intermediate care facility / mentally retarded† 557,758 9,714,031 15.2 18.9

Home & community-based care expenditures† 1,027,381 10,529,227 11.9 20.5

Personal care† 535,180 2,849,138

Home health† 33,310 2,051,746

Home & community-based services waivers† 458,891 5,628,344


State6.3%

12.8%

3.4%

77.6%

HCBC*†

Nursing Home†

ICF/MR†

Other Medicaid†

United States6.8%

20.2%

66.7% 6.3%


32

CALIFORNIA


Nursing Home

$80 $84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$86

$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$187

$294

$0

$50

$100

$150

$200

$250

$300

State U.S.


$88$62

$0

$50

$100

$150

$200

$250

$300

State U.S.




33

COLORADO

I. Demographics


State

31.6

171.0

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age














34

COLORADO











State

5 ADLs41.7%

0 ADLs5.6%

1 ADLs14.5%

2 ADLs9.0%

3 ADLs7.3%

4 ADLs21.9%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%









COLORADO












Expenditures







Home health 20,588 2,051,746



State

13.6%

22.2%

1.8%

62.4%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


36

COLORADO


Nursing Home

$76 $84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$196$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)$277

$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$69 $62

$0

$50

$100

$150

$200

$250

$300

State U.S.




37

CONNECTICUT

I. Demographics


State

37.3

187.3

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age














38

CONNECTICUT











State

5 ADLs40.4%

0 ADLs12.3%

1 ADLs6.3%

2 ADLs12.9%

3 ADLs3.8%

4 ADLs24.3%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%








39*HCBC = Home & Community-Based Caren/l = Not licensed, n/a = Not available

CONNECTICUT








Occupancy rates in nursing homes (1996) n/a 89.9




Expenditures


Long-term care Medicaid expenditures 1,320,858 51,327,309





Home health 85,175 2,051,746



State

11.0%

30.6%

6.6%

51.9%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


40

CONNECTICUT


Nursing Home

$125$84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$324

$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$145

$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$60 $62

$0

$50

$100

$150

$200

$250

$300

State U.S.




41

DELAWARE

I. Demographics


State

43.3

185.5

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age














42

DELAWARE











State

5 ADLs48.1%

0 ADLs9.8%

1 ADLs6.9%

2 ADLs8.6%

3 ADLs5.3%

4 ADLs21.4%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%









DELAWARE












Expenditures







Home health 12,155 2,051,746



State7.6%

17.8%

7.5%67.0%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


44

DELAWARE


Nursing Home

$94 $84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$153

$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

169 $163

0

50

100

150

200

250

300

State U.S.


$60 $62

$0

$50

$100

$150

$200

$250

$300

State U.S.




45

DISTRICT OF COLUMBIA

I. Demographics


State

70.8

228.6

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age





Medicaid aged and disabled waiver client caseload (FY 1996) n/a 290,776









46












State

5 ADLs53.6%

0 ADLs6.9% 1 ADLs

4.4%

2 ADLs8.8%

3 ADLs4.8%

4 ADLs21.5%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%





















Expenditures







Home health 11,698 2,051,746

Home & community-based services waivers 0 5,628,344


State2.3%

18.6%

8.7%

70.4%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


48



Nursing Home

$155

$84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$252 $229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$192 $187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$81$62

$0

$50

$100

$150

$200

$250

$300

State U.S.




49

FLORIDA

I. Demographics


State

50.2

181.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age














50

FLORIDA











State

5 ADLs47.7%

0 ADLs8.0%

1 ADLs6.4%

2 ADLs8.9%

3 ADLs4.2%

4 ADLs24.9%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%



Licensed home health care agencies (1995) 1,912 13,140






FLORIDA












Expenditures


Long-term care Medicaid expenditures 1,690,828 51,327,309

Nursing home expenditures 1,138,309 31,084,050 67.3 60.6




Home health 142,675 2,051,746



State5.5%

19.2%

3.8%

71.5%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


52

FLORIDA


Nursing Home

$88 $84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$203$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$155$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$63 $62

$0

$50

$100

$150

$200

$250

$300

State U.S.




53

GEORGIA

I. Demographics


State

53.0

246.8

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age




Medicaid personal care recipients per 1,000 recipients (1992) n/a 5.7










n/l = Not licensed, n/a = Not available

54

GEORGIA











State

5 ADLs46.5%

0 ADLs8.5%

1 ADLs7.9%

2 ADLs10.4%

3 ADLs4.2%

4 ADLs22.5%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%









GEORGIA












Expenditures







Home health 48,947 2,051,746



State4.0%

18.0%

3.5%

74.5%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


56

GEORGIA


Nursing Home

$73 $84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$202$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$155$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$52 $62

$0

$50

$100

$150

$200

$250

$300

State U.S.



Social Services Block Grant Total FY97 ($000s) $ 67,369This federal block grant allocation is based on the state’s population. The state may allocate the funds for a variety

of social services, including community-based long-term care.

57

HAWAII

I. Demographics


State

40.2

175.7

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age














58

HAWAII











State

5 ADLs60.5%

0 ADLs3.6%

1 ADLs2.6%

2 ADLs4.3%

3 ADLs2.0%

4 ADLs26.9%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%









HAWAII












Expenditures







Home health 1,702 2,051,746



State3.5%

21.2%

1.8%

73.5%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


60

HAWAII


Nursing Home

$124$84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$274$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$147

$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$81$62

$0

$50

$100

$150

$200

$250

$300

State U.S.




61

IDAHO

I. Demographics


State

26.7

148.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age




Medicaid personal care recipients per 1,000 recipients (1992) 6.9 5.7










62

IDAHO











State

5 ADLs44.2%

0 ADLs5.8%

1 ADLs11.3%

2 ADLs8.4%

3 ADLs0.6%

4 ADLs29.7%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%








63*HCBC = Home & Community-Based Caren/l = Not licensed, n/a = Not available

IDAHO








Occupancy rates in nursing homes (1996) n/a 89.9




Expenditures







Home health 8,435 2,051,746



State

9.9%

23.1%

10.5%

56.5%

HCBC*

Nursing Home

ICF/MR

Other Medicaid

United States6.8%

20.2%

66.7% 6.3%


64

IDAHO


Nursing Home

$81 $84

$0

$100

$200

$300

$400

$500

State U.S.

ICFs\MR

$177$229

$0

$100

$200

$300

$400

$500

State U.S.

Medicare


SNF (per day)

$208$187

$0

$50

$100

$150

$200

$250

$300

State U.S.


$64 $62

$0

$50

$100

$150

$200

$250

$300

State U.S.




65

ILLINOIS

I. Demographics


State

45.5

201.4

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age

United States

45.9

201.1

0.0

50.0

100.0

150.0

200.0

250.0

300.0

16-64 65+Age














66

ILLINOIS




Percent of nursing home population age 65+ (1990) 88 89.8







State

5 ADLs34.7%

0 ADLs18.6%

1 ADLs9.1%

2 ADLs9.8%

3 ADLs4.1%

4 ADLs23.6%

United States

4 ADLs23.7%

3 ADLs4.5%

2 ADLs9.8%

1 ADLs8.0%

0 ADLs7.6%

5 ADLs46.5%








67*HCBC = Home & Community-Based Care†=State level data has been updated from state Medicaid office. HCFA -64 data is used for U.S. aggregate figures.

ILLINOIS








Occupancy rates in nursing home

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