What’s the Status of Long-Term Care Rebalancing? March 9, 2006 videoconference.

What’s the Status of Long-Term Care

Rebalancing?

March 9, 2006

videoconference

History of Long-Term Care ReformProject 2030

Two-year project (1997-1998) housed within DHS and in partnership with MBA.

Engaged public and private groups to answer two questions: What does the aging of the state’s population

mean for Minnesotans? What do we need to do now and in the future to

prepare – individually and collectively?

History of Long-Term Care ReformLong-Term Care Task Force

Composed of State Legislators and Commissioners of Health, Housing Finance and Human Services Departments.

Met during 2000 to develop recommendations for reform.

Key recommendations were implemented in the following legislative session.

History of Long-Term Care ReformLong-Term Care Financing Study

The 2003 MN Legislature called for a study of long-term care financing options.

Looking for a new mix of public and private approaches to financing long-term care.

Recommendations focused on private financing options available to individuals as well as system-wide efforts to meet future challenges in the financing of long-term care.

Current EffortTransform 2010

“Hurricane” Alert! We know the Age Wave is coming. We know our communities are not prepared.

Hurricane Strength Predictions: Category 3: predicted to hit our state in 5 years Category 4: predicted to hit our state within 15 years Category 5: disaster strikes within 25 years without preparation

State of emergency has been declared.No emergency communications plan.No alternative plans until disaster is here.

Transform 2010

Intensify the state’s efforts to prepare for the coming age wave in Minnesota.

Special partnership with MDH and MBAWorking with 10 other state agencies too Identifying key strategies for action at the

state, community and individual levels


Examples of the Age Wave in Minnesota Counties Anoka County

Relatively young - 7.1% is age 65+ In 2030, that percent will increase to 17.1% Caregiver ratio is 5.8 now, will be 14.6 in 2030

Traverse County Smallest county in state by population (4,134) Already experiencing the Age Wave

(26.2% of population is 65+) In 2030, that percent will increase to 31.6% Caregiver ratio is 49.1 now, will be 52.2 in 2030


Some preparation for the hurricane has occurred.

Over the past five years, we have taken steps to control utilization and costs of public programs.

However, we must

pick up the pace and

broaden our efforts to be prepared

for the full impact of the hurricane.


Regional Meetings in January 2006. More than 1,000 people attended and

provided their input regarding strategies to prepare for the aging population.

Notes for each meeting are available on the DHS Transformation website:

www.dhs.state.mn.us/2010

Then click on “2010 meetings”

Transform 2010Next Steps

Focus groups with tribal organizations and ethnic and immigrant communities

Citizen Workgroups

Meetings with state legislators

City-level Transform 2010 meetings

Regional and county data profiles

Transform 2010Demographic Data

Older Adult Population Projections Older Adult Population Estimates by Race

and Ethnicity Elderly Dependency Ratio Percent of Older Adult Population Living

Alone Family Caregiver Ratio

Percentage of 85+ by County 2000

Percentage of 85+ by County 2030

Elderly Dependency Ratio by County 2000Elderly Dependency Ratio is the ratio of 65+ population to the 15-64 population

Elderly Dependency Ratio by County 2030Elderly Dependency Ratio is the ratio of 65+ Population to the 15-64 Population

Percent 65+ Living Alone by County 2000

Percent 65+ Living Alone by County 2030

Transform 2010Benchmarks

Total Public Long-Term Care Expenditures on Institutional vs. Home/Community-Based Services for the 65+

Population in MinnesotaFiscal Year Percent Nursing Home/

Percent HCBS

2000 88 / 12

2001 86 / 14

2002 84 / 16

2003 80 / 20

2004 79 / 21


Percent of Older Adults Served in Elderly Waiver and Alternative Care Programs with Higher Care Needs

Fiscal Year Total AC/EW Clients

Total Non-

Case Mix A

Percent Non-Case Mix A

2000 22,392 7,985 35.7%

2001 22,991 8,125 35.3%

2002 24,350 9,049 37.2%

2003 25,435 10,099 39.7%

2004 25,566 10,820 42.3%


Nursing Home Beds per 1,000 Older Adults

Calendar Year State Beds Per 1,000 65+

State Beds Per 1,000 85+

2001 69.69 483.8

2003 65.7 431.4

2005 60.4 378.6

Consumer Focus

Increased effort to get input from consumers on what they want for their long-term care needs Consumer Experience Survey of recipients of EW

services as part of our overall quality effort Survey of sample of residents in all nursing

facilities in the state – on quality of life and satisfaction

Consumer Focus

Consumer Experience Survey 363 Elderly Waiver consumers interviewed by DHS

staff and ombudsman volunteers in the summer of 2005

Interviews conducted in consumers’ homes Provided direct consumer feedback on what types of

services they use, who gives them the most help, and if they are satisfied with how things are going in their lives

Consumer Experience Survey Results

General Results Seniors living in the community on EW

generally are happy with where they live and feel safe in their homes

1 in 5 consumers cannot get to the places they need to or want to go

3 in 10 consumers are not as socially active as they want to be


Daily Living Consumers get the most help with laundry and

grocery shopping, which seems predictable for people with mobility and transportation challenges

Over half of interviewees have someone set up their pills and medications for them

Over half of consumers get help with taking a bath or shower Consumers also indicate that they have the most trouble

getting a bath or shower when they want to


Caregivers Informal caregivers

(family and friends) More consumers get help

from their daughters than anyone else at 27%

Informal caregivers give the most help with transportation and getting groceries or other shopping done

Quality of Care from Informal Caregivers (n=194)

Excellent, 147, 75%

Fair, 3, 2%

Good, 44, 23%


Caregivers Paid staff: Consumers in general are pleased with

the service they receive from paid staff There is room for improvement in terms of scheduling –

coming when they are supposed to and spending enough time with the consumer

1 in 10 consumers report that changes in staff have been a problem for them

Three-quarters of respondents report that they did not help to choose the people who are paid to help them

The most common person to call when an EW consumer wants to change or complain about their services is their county case manager, at over 40%.


Excellent61%

Fair3%

Good36%

Overall quality of paid help, n=310

• 57% of consumers say that their life is better because of the help they receive. An additional 39% say that their life is about the same as it would be without the help they receive

Consumer Experience Survey ResultsCase Management

In the last year, how often has a case manager contacted you?

Don't Know, 39

About once a month, 44

About once a year, 66

Every few months, 147

More than once a month,

31

0 50 100 150 200

Number of respondents


Case Management 92% of interviewees either said that their case

manager had solved a problem that they told them about, or would help them if they reported a problem

About 50% have not talked with a case manager about special equipment that could make their life easier

60% have not experienced a change in case managers. 23% have experienced a change, but it was not a problem for them

Consumer Experience Survey

Final thoughts 85% of consumers say that their life is better

because of the help they get About 10% of interviewees said they needed

more help or services than they are currently getting

Consumer Experience Survey

Future plans DHS plans to do the Consumer Experience

Survey every other year as part of an overall quality improvement plan

DHS will work with counties, tribes, and health plans to develop consumer surveys that they can use on their own as well

Survey of Nursing Home Residents

First ever survey of NH residents on quality of life and consumer satisfaction in Minnesota

First done in spring and summer of 2005 All nursing homes in the MA program – 400 Sample of 13,000 people Face-to-face interviews – all ages Excluded only most severely cognitively impaired

residents 55 questions focusing on satisfaction

Domains Included in NH Survey

Autonomy Comfort Satisfaction Dignity Environmental

adaptation Food enjoyment Individuality

Meaningful activity Mood Privacy Relationships Security Spiritual well-being

Survey of Nursing Home Residents

Used in nursing home report card www.health.state.mn.us/nhreportcard

Went live on January 20, 2006 Got 75,000 hits the first day

Gaps AnalysisHome and Community-Based Services

Follow-up survey to 2001 and 2003 gaps analyses by counties

76 counties responded between August and October 2005

Information will be used to help AAAs, DHS, and counties to develop long-term strategies for planning and development around long-term care services


Home and Community-Based Services Generally adequate around the state Counties expressed concern about the migration

and integration of HCBS into managed care 17 counties reported services in surplus, including

in-home respite services, Assisted Living, Adult Day services, Grocery Shopping, and Adult Foster Care

Some communities expressed the need for these services in their communities. This underscores the point that all service development is local, and that the needs of individual communities are different.


Inadequate or Unavailable HCBS

3532

3027

2519

1412

11111111

10

0 5 10 15 20 25 30 35 40

Transporation

Chore

Companion

Guardianship

Home Delivered Meals

Home Mods

Homemaking

Ser

vice

Number of Counties


Adequate Inadequate Unavailable

Sufficient service/program flexibility to meet changing consumer expectations for more choice and personal direction 61 18 1

76% 23% 1%

Capacity for quality assurance and consumer protection in private homes and apartments56 15 9

70% 19% 11%

Cultural competence in health and support service systems to adequately meet needs of minority elderly and disabled 52 25 3

65% 31% 4%

Access to information and assistance for all persons (regardless of income) to make informed choices about long-term care 68 12 -

85% 15% -

Communication patterns and referral protocols between health care and long-term care providers to maximize care coordination 64 16 -

80% 20% -

Workforce necessary to meet local health/LTC industry and market needs25 55 -

31% 69% -


The biggest concern amongst counties is having the necessary workforce to meet long-term care needs. This concern is consistent and clear, and spans both facility-based and home-based care.

Counties also expressed concern about their changing roles in regard to managed care and waiver services.

Gaps AnalysisHousing Options

82% of counties responded that there has been new development of senior housing or housing with service arrangements in the last 2 years. 211 buildings with about 5,100 new units across

the state. CS/SD or other state grants helped in this

development.


Inadequate32.5%

Adequate57.5%

Surplus/underutilized10.0%

Overall Housing Supply


Over half of counties think that their overall housing supply is adequate

Two-thirds of counties reported that there are housing options in short supply Subsidized rental apartments with services and Adult

Foster Care in greatest need Other housing concerns

Lack of sufficient affordable housing Converting existing homes and buildings into accessible

living situations Changes to Alternative Care funding for assisted living. Need for providers to house and serve persons with high

and complex needs

Gaps AnalysisNursing Homes

Three-quarters of counties rate their overall supply of LTC nursing home beds as adequate. Still a significant need to develop certain types of

beds, including dementia care and heavy care/complex medical management.

The major issue in Nursing Homes in the concern over adequate workforce to meet the needs of the population.

Consumer Directed Community Supports (CDCS)

Helps older adults needing assistance live independently at home.

Allows the consumer to be in charge of services that help them live at home.

Wraps services around the person instead of fitting the person into the services.

Changing FocusFrom being system-focused (current

paradigm) Rules prevail Experts “know best” Consumer lacks direct control over needed

supportsTo person-centered (CDCS)

Consumer along with family and friends are “experts”

Consumer gains control over resources Plan based on personal preferences and priorities

CDCS appeals to those who: Want more control over support and services Are willing to accept the responsibility for planning and

directing their support and services Want more flexibility Want consistent, reliable and typically relationship-based help Want to hire a spouse, parent of a minor, family member,

friends, neighbors Want to use a therapy that is an alternative to those available

through Medical Assistance Have special dietary needs Need equipment and supplies directly related to their

disability/health and safety that are not fundable through any other waiver service or straight Medical Assistance

Research Findings on Consumer Direction

Consumer direction increases satisfaction More people receive paid care – overcome

worker shortages Fewer total hours of care provided Works for older adults as well as disabled No adverse health outcomes Programs need to help consumers with steps

necessary to receive allowance

Transform 2010 Examples of Suggestions for Action

Preparing for Retirement and Old Age

Make saving easier by requiring automatic (not voluntary) “opt-in” to retirement plans at work

Provide tax incentives to employers that offer retirement planning services

Redesign retirement, employment and health benefit policies to align better with dramatic changes underway in retirement patterns, pensions and health care benefits

Transform 2010 Examples of Suggestions for Action

Preparing for Retirement and Old Age Governor should send a letter to Minnesota households

with persons ages 40-70 urging them to start planning for retirement and long-term care

Develop state-sponsored long-term care insurance-like program that includes a large risk pool and provides basic LTC coverage for all participants

Rethink current design of health insurance in order to address needs of those unable to get affordable coverage through traditional sources, e.g., early retirees, those in career change, volunteers, employees of small businesses and nonprofits

Transform 2010Examples of Suggestions for Action

Leading Healthy Lives Provide information and education on benefits of

healthy living to all age groups. Model after no-smoking campaign.

Increase financial incentives for healthy living, e.g., reduced health premiums, individual health assessments, use of community centers, schools malls for exercise and education.


Supporting Family Caregivers Provide information in a variety of ways, including

establishing local caregiver resource centers in every community

Provide financial incentives to family caregivers Increase number of elderly-friendly employers Increase use of technology by family caregivers Beef up state’s adult protection system at all levels


Supporting LTC Workforce Recruit older workers retiring from career jobs into health

and long-term care positions Increase use of technology to change nature of work Create more opportunities for contact between young and

old Make LTC jobs a more viable career choice


Creating Healthy and Livable Communities Set goal that by 2015, 50% of all Minnesota

communities will include essential components of a livable community

Create state imitative focused on providing incentives to communities to become livable

Re-establish MN Board of Innovation and Cooperation to provide grants or cut red tape on projects that build livable communities


Improving and Integrating Health and LTC Maximize use of technology to improve continuity of

care, e.g., electronic health records Change reimbursement to support integration of

health and LTC in both Medicare and Medicaid Allow longer appointments for physicians caring for

elderly with multiple conditions Integrate geriatric training into the training

curriculum of all health professionals

Discussion of State and Local Strategies

Pick a theme and discuss barriers to action on this theme in your community and identify most creative solutions to address them (state and local)

OR Within a theme, what needs to happen at the

local level to successfully implement the strategies?

Resources for Systems Change CMS Promising Practices

www.cms.hhs.gov/PromisingPractices Administration on Aging

www.aoa.gov Visiting Nurse Service of New York

Center for Homecare Policy & Research

www.vnsny.org/research Community Partnerships for Older Adults (RWJF)

www.partnershipsforolderadults.org

What’s the Status of Long-Term Care Rebalancing? March 9, 2006 videoconference.

Documents

Transcript of What’s the Status of Long-Term Care Rebalancing? March 9, 2006 videoconference.