Sandra L. Spoelstra, PhD, RN Gerontological Society of America November 16 th, 2012 San Diego, CA Can Nursing Home Transfer Be Delayed If Home and Community- Based Waiver Personal Care Services Are Increased?

Bott Building for Nursing Education and Research

Project Team Sandra L. Spoelstra, PhD, RN (PI) Assistant Professor Michigan State University College of Nursing Charles W. Given, PhD (Co-PI) Professor, Michigan State University College of Human Medicine, Department of Family Medicine Barbara A. Given, PhD, RN, FAAN (Co-PI) University Distinguished Professor and Associate Dean of Research Michigan State University College of Nursing Mei You, MS Statistician, Michigan State University College of Nursing

Collaborators Michael Daeschlein Michigan Department of Community Health Long-Term Care Division State of Michigan Waiver Providers and Recipients 20 Waiver Agencies Across the State of Michigan 356 Registered Nurse and Social Worker / Care Managers 20,000 Clients in the Waiver Programs Across the State of Michigan

Funding Sources “Translating Evidence into Demonstrations” Grant Award: Application # Delaying or Preventing Nursing Home Placement in the Home and Community Based Waiver Program with a Medicaid Match Grant from The State of Michigan Data Source: Minimum Data Set for Home Care & State of Michigan Medicaid Claims Files

Objectives for Presentation 1) To describe how nursing home placement can be delayed by increasing the hours of personal care services in Home and Community Based Waiver programs. 2) To review implications cost savings that can be attained by using more personal care hours and delaying nursing home transfer in a Home and Community Based Waiver program.

Purpose  This research compared the use & cost of personal care services (PCS) & the rate of nursing home placement (NHP).  A secondary analysis of 7302 adults >65 years of age in the home and community-based waiver program in Michigan.

Background & Significance  Adults >65 comprise 15% of the population & are growing exponentially.  Concern is mounting as to how to care for this growing demographic group.  It will be important to find ways to deliver high-quality care tailored to the needs of clients in order to allow these individuals to remain living in the community.

The Present Study  A model was developed to estimate costs of increased PCS to compare savings associated with remaining in the community versus NHP.  The second to last and last Minimum Data Set-Home Care (MDS-HC) assessments and Medicaid claims files were examined.  Median hours of PCS and savings based on average cost were calculated.

Sample & Setting  Federal 1915(c) HCBS waiver program in the State of Michigan  Clients must meet Medicaid-defined nursing facility level-of-care criteria (ADLs/IADLs, <300% of poverty level, & a caregiver).  Age >65  Between 2002—2007

Variables Examined  Age  Personal care services (PCS)  Hours  Cost  Nursing home placement

Assumptions of the Model  Median PCS hours = 34  NHP rate for clients:  >34 PCS hours = 25%  <34 PCS hours = 41%  Adding PCS hours for those with <34 hours, could possibly reduce NPH for dually eligible recipients.

Example  A total of 3777 hours of PCS need to be added in order to bring these patients up to the median (34 hours) to sustain an estimated 25% rate of NHP.  If that assumption is achieved 33 clients could be retained in the waiver.  Cost of adding these PCS hours = $59,186  (3777 hours * $15.67 hourly rate of PCS = $59,186)

Example  Average NHP cost per month = $3,500  33 cases * $3,500 per month = $115,500  Average Waiver cost per month = $934  33 cases * $934 per month = $30,822  A difference of $84,678 for 33 cases/month  NHP 33 cases $115,500 – Waiver 33 cases $30,822 = $84,678  Total of $1,016,136 a year for 33 cases  $84,678 * 12 months = $1,016,136

Implications for Practice  Care Managers need to conduct a focused assessments on clients below the 34 hours of PCS to determine if increasing hours of PCS could delay or prevent NHP.

Implications for Research Future research could focus on testing in a real world setting in a small group of clients, if increasing PCS hours would:  delay or prevent NHP, and  what cost saving are experienced.

Conclusion Adding PCS hours to waiver clients whom are below the median PCS hours could help retain clients in the home setting, where they most want to be, and allow for immense cost savings.