nursing facility rates & policy division status of ltc in minnesota - 2005 mdh ltc ad hoc...

Nursing Facility Rates Nursing Facility Rates

& Policy Division& Policy Division

STATUS OF LTC IN MINNESOTA - 2005

MDH LTC AD HOC COMMITTEE

July 13, 2006



Demographics

• More and more elderly

Number of Minnesotans Aged 85+ by Decade 2000 - 2050

0

50,000

100,000

150,000

200,000

250,000

300,000

2000 2010 2020 2030 2040 2050



HCBS

• Gaps

• New services

• CS/SD Grants

• Funding increases



Nursing Homes

• Quality

• Cost

• Industry size



NH Quality

• Report card

• Pay for performance

• Staffing



Estimated Total Nursing Home Costs in Minnesota (2005) by Source of Payment

SourceAmount

(in millions)

MA payments$868

Federal share 434

State share 425

County share9

Payments by MA recipients217

Private pay 475

Medicare291

Other57

Estimated revenues of non-MA nursing homes38

Estimated Total Nursing Home Revenues $1,946



NH Costs

Total Annual MA Nursing Facility Payments 1995-2005

800

820

840

860

880

900

920

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Pay

men

ts in

Mill

ion

$



Nursing Home Days

Annual MA Paid NF Days

1995-2005

6.0

7.0

8.0

9.0

10.0

11.0

12.0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Day

s in

Mill

ions



Nursing Home Payments

Average MA Payment Per Day

1995-2005

60

70

80

90

100

110

120

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Av

era

ge

Pa

ym

en

t $



Average Nursing Home Beds per Thousand Persons Age 65+ and 85+ (and Range) -- Minnesota 2005

VARIABLE AGE 65+ AGE 85+

Statewide beds per 1000 60.4 378.6

County median beds per 1000

65.9 373.7

County mean beds per 1000

67.8 395.0

County standard deviation of beds per 1000

22.1 119.9

County range of beds per 1000

Low is 20.7 in AnokaHigh is 127.2 in Norman

Low is 180.2 in HubbardHigh is 775.9 in Norman

Contiguous county groups median beds per 1000

62.8 377.8

Contiguous county groups mean beds per 1000

64.6 380.3

Contiguous county groups standard deviation of beds per 1000

11.3 43.0

Contiguous county groups range of beds per 1000

Low is 32.4 in ChisagoHigh is 89.4 in Traverse

Low is 282.1 in ChisagoHigh is 549.4 in Cook



NH Beds in Minnesota

Nursing Home Beds

37000380003900040000410004200043000440004500046000470004800049000

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

year

no

. o

f b

ed

s



Comparison of Minnesota and U.S. Data on Nursing Home Supply

Minnesota U.S. MN as % of U.S.

Historic number of beds1987 – 48,307

1995 – 47,181 1995 – 1,751,302 2.69%

Current number of beds

2003 – 39,530 2003 – 1,756,699 2.25%

2005 – 37,182

Average annual % change in number of beds, 1995 to 2003 -1.37% 0.03%

Peak beds per 1000 age 65+1987 – 91.2

1995 – 82.0 1995 – 51.9 158%

Current beds per 1000 age 65+

2003 – 64.2 2003 – 48.9 131%

2005 – 59.3

Average annual % change in beds per 1000 age 65+, 1995 to 2003 -2.24% -0.66%

Peak beds per 1000 age 85+1987 – 745.3

1995 – 611.4 1995 – 475.8 128%

Current beds per 1000 age 85+

2003 – 407.7 2003 – 372.3 110%

2005 – 365.4

Average annual % change in beds per 1000 age 85+, 1995 to 2003 -3.68% -2.69%



Trend in Number of NH Beds

Projected NH Beds Available

15000

20000

25000

30000

35000

40000

2005 2010 2015 2020 2025

year

nu

mb

er

of

bed

s

10 year

5 year



Nursing Home Utilization Rates in Selected Years from 1984 - 2002for Persons 65+ and 85+ in Minnesota

(Restated)* (Restated)*

Year 65+ Utilization Annual Rate of Change

65+ Utilization

Annual Rate of Change

85+Utilization


85+ Utilization


1984 8.4% 36.4%

1987 8.1% -1.2% 35.1% -1.2%

1989 7.8% -1.9% 33.4% -2.4%

1993 7.6% -0.6% 30.8% -1.9%

1994 7.1% -6.6% 28.7% -6.8%

1996 6.9% -1.4% 28.2% -0.9%

1998 6.1% -5.8% 24.3% -6.9%

2000 6.1% 0.0% 5.84% 22.3% -4.1% 22.8%

2001 5.8% -2.5% 5.59% -2.2% 22.0% -0.6% 21.3% -3.3%

2002 5.52% -0.6% 20.6% -1.6%

2005 4.92% -2.8% 17.4% -4.2%

Source: Residents – MDH and DHS; Population – US Census Bureau*Beginning in 2002, it was necessary to restate the utilization rate because the data source used to compute this rate was no longer available when the Minnesota case mix system was replaced with the RUGS system.



Trend in Needfor NH Beds

Projected NH Beds Needed

17,00019,00021,00023,00025,00027,00029,00031,00033,00035,00037,000

2005 2010 2015 2020 2025

year

nu

mb

er

of

bed

s

10 year 85+

5-year 85+

10 year 65+

5-year 65+

Average



Projected NH Bed Need & Availability

20,000

22,000

24,000

26,000

28,000

30,000

32,000

34,000

36,000

38,000

40,000

2005 2010 2015 2020 2025

year

nu

mb

er

of

be

ds need - 10 yr (65+)

beds - 5 yr

beds - 10 yr

need - 5 yr (65+)

need - 5 yr (85+)

need - 10 yr (85+)

average need

Projected Need and Availability



Benchmark 1

Percent of Public Long-Term Care Dollars Spent on Institutional

vs. Community Care

for Elderly in Minnesota

87.7 85.9 83.6 80.2 79.1 79.5

19.8 20.9 20.516.414.112.3

0%

20%

40%

60%

80%

100%

2000 2001 2002 2003 2004 2005

Community

Institutional



Benchmark 2

Percent of NF Residents 65+ that is Low Acuity

(PA-1 or 2)

17.01 16.87 16.09

19.86

0

5

10

15

20

25

2000 2001 2002 (old) 2002 (new)



Benchmark 3

Percent of EW/AC Recipients who are High

Acuity (Case Mix B-K)

35.7 35.337.2

39.742.3 42

3032343638404244

2000 2001 2002 2003 2004 2005



Benchmark 4

Ratio of Nursing Home Beds Per 1,000 Persons

65+ in Minnesota

60.4

83.9 80.1 77.469.4 65.7

0

20

40

60

80

100

1993 1996 1998 2000 2002 2005



RecommendationsRegarding Nursing Homes

• Permit the Commissioner to suspend one or more of the bed closure incentive programs on a regional or statewide basis, if and when the supply of beds approaches the projected need for nursing home beds, and to re-activate those incentive programs in the event that the surplus of beds begins to grow.

• Revise the hardship county exception to the moratorium to allow construction of new beds in counties with the lowest beds/1,000 persons age 65+ ratios.



Recommendations (cont.)

• Develop refinements to the Minnesota Nursing Home Report Card to include an environmental assessment or a measure of family satisfaction.

• Extend the quality add-on payment.

• Implement the Performance Incentive Payment Program.



•Questions?

nursing facility rates & policy division status of ltc in minnesota - 2005 mdh ltc ad hoc...

Documents

nursing home supply

minnesota slide

current beds

statewide beds

supply of beds

peak beds

surplus of beds

county range of beds