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Minnesota’s Seniors Public Policy Issues. Crisis in Long Term Care. Toby Pearson, Vice President of Advocacy, Care Providers of Minnesota Heidi Holste, Director of Government Affairs, Care Providers of Minnesota Kari Thurlow, Vice President of Advocacy, Aging Services of Minnesota. - PowerPoint PPT Presentation

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  • Minnesotas Seniors Public Policy IssuesToby Pearson, Vice President of Advocacy, Care Providers of MinnesotaHeidi Holste, Director of Government Affairs, Care Providers of MinnesotaKari Thurlow, Vice President of Advocacy, Aging Services of Minnesota

    Crisis in Long Term Care

  • WHO WE AREThe Long-Term Care Imperative is a collaboration of Aging Services of Minnesota and Care Providers of Minnesota, two of the states largest long-term care associations.

    The Long-Term Care Imperative is committed to advancing a shared vision and future for older adult housing, health care and supportive services.

  • Supporting the EconomyEconomic Impact of Long Term Care Facilities for Minnesota Prepared by the Lewin Group for AHCA-NCALLTC Supports $6.7 billion in Economic Activity

    Chart1

    3.9

    1

    1.8

    Output (in Billions)

    Sheet1

    DirectIndirectInduced

    Output (in Billions)$3.90$1.00$1.80

    2nd Qtr3.2

    3rd Qtr1.4

    4th Qtr1.2

    To resize chart data range, drag lower right corner of range.

  • Powering the WorkforceEconomic Impact of Long Term Care Facilities for Minnesota Prepared by the Lewin Group for AHCA-NCAL.LTC Contribute to Approximately 112,600 Jobs

    Chart1

    89700

    7300

    12600

    Employment

    Sheet1

    DirectIndirectInduced

    Employment89,7007,30012,600

    2nd Qtr3.2

    3rd Qtr1.4

    4th Qtr1.2

    To resize chart data range, drag lower right corner of range.

  • The Payment GapInformation and data on Shortfalls in Medicaid funding based on Report Prepared by ELJAY, LLC FOR THE AMERICAN HEALTH CARE ASSOCIATIONProjected 2012 Nursing Facility Shortfall Between Medicaid Reimbursement and Allowable Medicaid Costs (Per Patient Day)Minnesota vs. North DakotaThe annual cost of eliminating the shortfall to the State would be $78.5 million.

    Chart1

    -27.7

    2.86

    -22.34

    Projected 2009 Shortfall

    Sheet1

    MinnesotaNorth DakotaU.S. Average

    Projected 2009 Shortfall($27.70)$2.86($22.34)

    Category 22.54.42

    Category 33.51.83

    Category 44.52.85

    To resize chart data range, drag lower right corner of range.

  • Nursing Facility Rebasing Unallottments, Suspensions, and Repeal (State Savings)Source: Long Term Care Imperative 2013

    Chart1

    -3420000

    -5872000

    -14477000

    -27507000

    -61000000

    -72000000

    Rebasing Unallottments, Suspensions, and Repeal (State Savings)

    Sheet1

    Estimated Funding Reductions to Nursing Facilities (State Share)FY2010FY2011FY2012FY2013FY2014FY2015

    Rebasing Unallottments, Suspensions, and Repeal (State Savings)-$3,420,000-$5,872,000-$14,477,000-$27,507,000-$61,000,000-$72,000,000

    Category 22.54.42$0$0$0

    Category 33.51.83$0$0$0

    Category 44.52.85$0$0$0

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  • % of Nursing Facilities at Risk of Closure(Operating Margins of -5% or Worse)Legend=25%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 2011 Nursing Facility Financial Survey Prepared by CliftonLarsonAllen LLP

  • The Wage GapSources: 2011 LTC Imperative Salary Survey and 2011 MN Health Care Cost Information Service Hospital Salary DataGap=$2.07 per hour or $4,306 per yearGap=$5.79 per hour or $12,043 per yearGap=$17.39 per hour or $36,171 per yearGap=$15.77 per hour or $32,802 per yearGap=$1.81 per hour or $3,765 per yearGap=$6.13 per hour or $12,750 per yearSenior Living Workers Underpaid in the Marketplace

    Chart1

    11.6917.8212.03

    18.4920.318.23

    26.1941.9624.57

    Home Care

    Hospital

    Care Center

    Sheet1

    NARLPNRN

    Home Care$11.69$18.49$26.19

    Hospital$17.82$20.30$41.96

    Care Center$12.03$18.23$24.57

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  • The Worker GapSource: Long Term Care Imperative 2013 Legislative SurveyEstimated Number of Selected Vacant FTE Positions in Minnesotas Nursing Homes

    Chart1

    258.2218.4970.9110.98213.7215.31

    463.72362.65138.46214.32248.68273.79

    1123.82958.82538.35823.02925.161147.52

    117.99106.8266.3984.7984.9473

    1963.731646.78814.11233.111472.481709.62

    2007

    2008

    2009

    2010

    2011

    2012

    Sheet1

    R.N.L.P.N.C.N.A.Dietary AideTotal

    2007258.2463.721,123.82117.991963.73

    2008218.49362.65958.82106.821646.78

    200970.9138.46538.3566.39814.1

    2010110.98214.32823.0284.791,233.11

    2011213.7248.68925.1684.941472.48

    2012215.31273.791,147.52731709.62

  • The Worker GapSource: Long Term Care Imperative 2013 Legislative SurveyVacant FTE Positions as a Percent of Budgeted Positions in Minnesotas Nursing Homes

    Chart1

    0.09790.08260.02350.0360.06940.0657

    0.10460.0810.03260.0530.06210.0721

    0.08570.07170.04120.06680.07530.0993

    0.040.03590.02230.03110.02910.0278

    2007

    2008

    2009

    2010

    2011

    2012

    Sheet1

    R.N.L.P.N.C.N.A.Dietary Aide

    20079.79%10.46%8.57%4.00%

    20088.26%8.10%7.17%3.59%

    20092.35%3.26%4.12%2.23%

    20103.60%5.30%6.68%3.11%

    20116.94%6.21%7.53%2.91%

    20126.57%7.21%9.93%2.78%

  • Losing WorkersSource: DHS Nursing Home Cost Reports (2011)Employee Retention Percentage Declined in Care Centers

    Chart1

    72.675.967

    73.475.766.7

    73.175.966.7

    78.878.470.2

    76.777.569.9

    70.477.468.1

    RNs

    LPNs

    NARs

    Sheet1

    200620072008200920102011

    RNs72.673.473.178.876.770.4

    LPNs75.975.775.978.477.577.4

    NARs67.066.766.770.269.968.1

  • Staff TurnoverSource: American Health Care Association, LTC Trend Tracker

    Chart1

    0.3040.4080.565

    0.3070.3630.385

    0.4490.3920.499

    2009

    2010

    2011

    Sheet1

    Turnover Rate200920102011

    Staff RNs Turnover30.4%40.8%56.5%

    LPNs/LVNs Turnover30.7%36.3%38.5%

    CNAs Turnover44.9%39.2%49.9%

    Category 44.55

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  • Nursing Home Costs Without the Elderly Waiver ProgramDecrease due to increased Federal Match Source: DHS Spending Forecast November 2010Elderly Waiver Program Saved State Up To $275 Million in 2010

    Chart1

    191287410.09842105598.34537484886.50607399

    215082988.553162807981.487367201535.1180373

    248134448.763543353576.818149845213.95912245

    278194225.170963418324.2140416527086.9986834

    296280337.505224013526.1252522722703.436483

    294553423.290245000925.272414432360511.1756439

    362347837.9779497201840.666211139918283.4160576

    349306235.3757839689438.776723245542431.6752193

    357621375.2771529952455.628807251998877.1925071

    360744662.01896512437715.857981456405638.6239817

    366713875.32677514841799.778671262528243.2444889

    370079218.29795818687245.318349380683952.848974

    383729830.74007225792278.51751298789920.8469341

    442966629.834338607727.07176131161562.772759

    447743074.3948383383.135156399880.53753

    427736571.17311556267060.931095178610050.900139

    424898104.45569700705.185191798821.0151

    411407743.3986810939.86211985449.727819

    401636447.385112485598.045249759894.99557

    397184408.095128104096.95279921487.794405

    347634304.869972120195283.985827278342246.94137

    310424102.714118115483461.025744275273682.455224

    328582129.19712129843450.708691311355520.106643

    394683580.292262163106179.507866373962135.74583

    379954988.922389170181762.108497357103242.832187

    Nursing Home State Share

    EW State Share

    Net Additional Expenditures if Elderly Waiver Clients Resided in Nursing Homes

    Sheet1

    YearNursing Home State ShareEW State ShareNet Additional Expenditures if Elderly Waiver Clients Resided in Nursing Homes

    1989$191,287,410$2,105,598$7,484,887

    1990$215,082,989$2,807,981$7,201,535

    1991$248,134,449$3,353,577$9,845,214

    1992$278,194,225$3,418,324$16,527,087

    1993$296,280,338$4,013,526$22,722,703

    1994$294,553,423$5,000,925$32,360,511

    1995$362,347,838$7,201,841$39,918,283

    1996$349,306,235$9,689,439$45,542,432

    1997$357,621,375$9,952,456$51,998,877

    1998$360,744,662$12,437,716$56,405,639

    1999$366,713,875$14,841,800$62,528,243

    2000$370,079,218$18,687,245$80,683,953

    2001$383,729,831$25,792,279$98,789,921

    2002$442,966,630$38,607,727$131,161,563

    2003$447,743,074$48,383,383$156,399,881

    2004$427,736,571$56,267,061$178,610,051

    2005$424,898,104$69,700,705$191,798,821

    2006$411,407,743$86,810,940$211,985,450

    2007$401,636,447$112,485,598$249,759,895

    2008$397,184,408$128,104,097$279,921,488

    2009$347,634,305$120,195,284$278,342,247

    2010$310,424,103$115,483,461$275,273,682

    2011 -Projected$328,582,129$129,843,451$311,355,520

    2012 - Projected$394,683,580$163,106,180$373,962,136

    2013 - Projected$379,954,989$170,181,762$357,103,243

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  • Rate ChangesAssisted Living (Elderly Waiver Customized Living)Nursing FacilitySource: LTC Imperative 2012Nursing Facility and Elderly Waiver/Customized Living No base increase in last four years In 2011, 70 low rate homes received increases of up to 2.45% In 2012, 7 homes were designated critical access and received rate increases

    Chart1

    -0.0258

    -0.05

    -0.0527

    -0.05

    0

    -0.0167

    Reduction

    Sheet1

    July 1, 2009 ReductionJuly 1, 2010 ReductionEstimated 2010 Decrease Due to New