2012 Annual Meeting:Session #10: Rural Care

Center Roundtable

The Age Wave

Minnesotans Age 85+ Increases 150% Over next 30 Years

17.4%32.0%

64.9%

Source: Minnesota State Demographer using 2010 Census Data

Source: U.S. Census Bureau, Census 2000 and 2010 Census Redistricting Data Summary File

Minnesota Census: Percent Change in Population by County 2000-2010

Elderly Dependency Ratio Highest In Rural Counties

Source: 2010 Census

CountyRatio of People 80 and Up to

People 18-64

Traverse 0.19Big Stone 0.17

Lac Qui Parle 0.17Lincoln 0.16Kittson 0.15

Cottonwood 0.15Norman 0.14

Pipestone 0.14Faribault 0.14

Murray 0.14

State 0.06

Average Age of Residents In Housing-with-Services

Source: Aging Services of Minnesota Senior Housing Data Survey

Percent of Residents on Elderly WaiverIn Housing-with-Services

Source: Aging Services of Minnesota Senior Housing Data Survey, 2012

Percent of Housing-with-Services Residents Requiring Assistance

With Activities of Daily Living

Source: Aging Services of Minnesota Senior Housing Data Survey, 4th Quarter of 2011

The Marketplace

Source: Minnesota Department of Health, 2012

Care Center Beds Continue to Drop Through Downsizing and Closure

MA-certified beds down to 30,552 in March 2012

11,742 total beds statewide (percent of capacity in parentheses)

Source: Minnesota Department of Health, July 2012

(28.4%)

(34.8%)

(32.7%)

(25.0%)(28.9%)

(24.0%)(27.0%)

25 Percent of Minnesota Care Center Beds Closed or Laid Away Since July 2000

Minnesota’s Average Care Center Size is Dropping

Source: Minnesota Department s of Health and Human Services

(14%)

(26%)

(6%)

(11%)

(3%)(3%)

9 of the 14 care centers with 30 beds or less in 2001 are now closed

A Permanent Change: Fewer Long Stay Residents in Care Centers

Source: Minnesota Department of Health, 2008

Average Length of Medicare Stay in Care Centers Remains Steady

Source: Center for Medicare and Medicaid Services, 2010

Similar data not available for managed care, but anecdotal evidence that LOS may be lower and that expanding similar efforts (ACOs) may drive down LOS in the future.

Care Centers with most Progress on Electronic Health Records are in Systems

Source: Minnesota Department of Health Care Center Technology Survey 2011

HER In Process No EHR

Part of Integrated Health System

Hospital Attached

Part of a small/ medium multi-site

Part of a large organization

Stand alone organization

88%

6% 6%

85%

9%6%

79%

5%

15%

66%

31%

3%

59%

29%

12%

Minnesota Hospital Discharges to Care Centers Remain Steady

Source: Agency for Healthcare Research and Quality (AHRQ), 2011

Source: Minnesota Department of Health, March of each year

More Than Twice As Many Housing-with-Service Units as Care Center Beds

Housing-with-Service units in Minnesota exceed Care Center beds by more than 30,000

Metro and Northeast Have Highest Number of Housing-with-Service Units Relative to

Older Adult Population

Source: Minnesota Department of Health, May 2012 and 2010 Census

Region HWS UnitsPeople 80 and Up

Ratio of Units per 1K People 80 and Up

State 62,226 206,580 301.2Twin Cities

Metro31,110 89,702

346.8

Northeast 5,933 15,992 371.0

Northwest 2,078 7,940 261.7

Southeast 8,512 32,843 259.2

Southwest 4,056 19,075 212.6

East Central 6,894 28,157 244.8

West Central 3,643 12,871 283.0

Average Care Center Occupancy Lower Outside of Metro Area in 2011

90.2% 89.8%

92.1%89.7% 89.6%

91.7% 91.1%

85%

90%

95%

100%

Source: Combined Association Occupancy Surveys

The Workforce

Labor Force Growth About To Slow Sharply

Source: Minnesota State Demographer, 2011

Minnesota To Develop 46% More Healthcare Practitioners To Meet Needs

Source: Minnesota Department of Employment and Economic Development (DEED) Occupation Forecasts, 2002-2012

Wage Gap: Senior Living Workers Underpaid in the Marketplace

Sources: 2010 LTC Imperative Salary Survey and 2010 MN Health Care Cost Information Service Hospital Salary Data

Gap=$2.06 per hour or $4,285 per year

Gap=$5.58 per hour or $11,606 per year

Gap=$17.07 per hour or $35,505 per year

Gap=$17.06 per hour or $35,485 per year

Gap=$1.86 per hour or $3,869 per year

Gap=$5.52 per hour or $11,482 per year

Care Center Vacancies Increase Over Past Two Years

Source: Long-Term Care Imperative 2012 Legislative Survey

Avg. Number of FTEs per Care Center

Direct Care Workers will be Largest Occupation Group in US by 2020

Source: Paraprofessional HealthCare Institute May 2012

The Policy Framework

Care Centers in Minnesota: Trends in Payment

Source: Medicaid Cost Reports, Minnesota Department of Human Services

Care Center Operating Margin Stronger in Metro Area

-4.00%

-3.00%

-2.00%

-1.00%

0.00%

1.00%

2.00%

3.00%

4.00%

Me

dia

n

Region

2007 -2.13% -1.15% -0.05% 1.18% -0.05% -0.31% 0.26% -0.01%

2008 -3.79% -1.39% 0.04% 3.28% -0.91% -1.12% 0.67% -0.23%

2009 3.40% 0.64% 1.52% 3.68% 0.97% 2.23% 3.46% 2.39%

2010 -1.15% 1.14% -1.95% 0.35% 0.70% 1.68% 1.98% 0.99%

2011 2.54% -0.97% -0.69% 1.33% 0.50% 0.73% 1.86% 1.13%

North West

North EastWest

CentralEast

CentralSouth West

South East

Metro Total

LTC Imperative Nursing Facility Survey Prepared by CliftonLarsonAllen LLP

Most Care Centers at Risk of Closure are Outside of Metro Area

Legend<15%=15%-24.9%=25%-34.9%=>35%

East Central 29.4%

Metro 8.2%

Northeast 45.0%Northwest 21.1%

Southeast 32.7%

Southwest 23.7%

West Central 20.8%

Approximately 85 Nursing Facilities in MN are Facing a

Financial Crisis, Placing more than 12,000 Jobs at Risk

LTC Imperative Nursing Facility Survey Prepared by CliftonLarsonAllen LLP

Comparison of Care Center Rates vs. Costs

Source: Data from Report Prepared By Eljay, llc for the American Health Care Association

MN has 8th Highest Gap of 38 States in 2009

Source: Minnesota Department of Human Services, Spending Forecast, February 2012

Elderly Waiver Enrollment Exceeding MA Care Center Recipients

State Spending Shifting to Community Alternatives

Source: Minnesota Department of Human Services, Spending Forecast February 2012

Elderly Waiver/Alternative Care Expenditures as a Percentage of all Elderly LTC Spending

Critical Access

Program Background

• Grew out of pilot project study sponsored by Senator Rosen (R-Fairmont)

• Authorizes DHS, working with stakeholders, to designate care centers as critical access with statutory goals of preserving access in isolated areas, rebalancing LTC and improving quality

• DHS used stakeholder input to develop program criteria

Benefits of Critical Access

• Legislation calls for critical access nursing facilities to be eligible for four benefits:1. 60% of operating rate based on costs (rebasing

formula)

2. 60% payment for MA leave days when over 90% occupancy

3. Joint director of nursing with another CA facility

4. Property project minimum threshold 40% of what it would otherwise be ($110,049)

Selection Process

• 58 Care centers applied for designation (those within ten miles of another home were not eligible)

• DHS hopes to make selections by September 30 with rate increases to start January 1

• Large distance from next facility and small size are strongest factors in formula developed by DHS

Funding of Critical Access

• Funding of $500,000 available one-time which greatly limits the number of facilities that can be designated this year (maybe 3 or 4)

• DHS anticipates current funding will be used to provide benefits to selected care centers from January 1 through September 30

• Next budget cycle additional funding will be needed to continue the program

www.agingservicesmn.org