Long-Term Care in Minnesota: Past, Present, and Future Trends for Senior Services in Minnesota Todd Bergstrom Care Providers of Minnesota

Topics Past (a review of trends) Present (a look at the Gaps Summary Analysis Future (Where do present trends may take us)

The Past Length of Stay Number of providers Demographics

Declining Length of Stay in Minnesota Nursing Facilities Source: Minnesota Department of Health

Minnesota Nursing Facility Resident Days

Care Providers of Minnesota

Monthly Average Medicaid Nursing Facility Residents Source: February 2006 DHS Forecast

Monthly Average Medicaid EW Service Recipients Source: February 2006 DHS Forecast

Monthly Average Medicaid LTC Waivers & Home Care* Source: February 2006 DHS Forecast * Payments for MA home and community-based waivers, home health agency services, personal care and private duty nursing services.

Total Annual Payments – State Share Source: February 2006 DHS Forecast

Operating Margin Imperative Nursing Facility Survey Prepared by Larson, Allen, Weishair & Co., LLP

Percent Days by Payor Imperative Nursing Facility Survey Prepared by Larson, Allen, Weishair & Co., LLP

Percent Revenues by Payor Imperative Nursing Facility Survey Prepared by Larson, Allen, Weishair & Co., LLP

Average Age of Facility Imperative Nursing Facility Survey Prepared by Larson, Allen, Weishair & Co., LLP

Minnesota Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

CPM Region 1 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

CPM Region 2 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

CPM Region 3 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

CPM Region 4 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

CPM Region 5 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

CPM Region 6 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

CPM Region 7 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

CPM Region 8 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

Minnesota: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

CPM Region 1: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

CPM Region 2: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

CPM Region 3: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

CPM Region 4: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

CPM Region 5: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

CPM Region 6: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

CPM Region 7: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

CPM Region 8: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

The Present: Long-Term Care Gaps Analysis 2005 Update Survey Minnesota’s counties were asked to complete the following survey in order to re-assess the gaps that exist in long-term care and home and community-based services in their communities. Counties were asked to submit their responses through a web-based survey tool called SnapSurvey. The invitation was initially sent out through a bulletin. Reminders were sent to Long Term Care Consultation administrative contacts at counties. Seventy-six counties and/or county collaborations responded to this survey between August 12, 2005, and October 27, Although Minnesota has 87 counties, the maximum number of possible responses for this survey was 84, due to collaborations The following summarizes statewide findings Minnesota Department of Human Services

General Findings HCBS. Generally speaking, counties believe that home and community-based services around the state are adequate.  However, there is still need for service development in particular counties and in particular services, including transportation, evening and weekend care and respite services, chore services, and adult day services.  Counties are also concerned about how the migration of HCBS into managed care will affect access and quality of services. Housing. Housing needs for average income and high-functioning persons with disabilities and elderly are adequate around the state.  There is still a great need to address affordable housing for people around the state, and to develop housing options for persons with complex needs.  In addition, there is a need for home and apartment modifications, so people can continue to live in their own communities with limited mobility. Nursing facilities. The number of nursing home beds around the state is generally adequate.  Although some communities have concerns about the distance that people must travel to get to them.  There is still a need to develop nursing home beds for special needs populations.  The most pressing concern for nursing home care is the lack of adequate workforce to serve the population. Minnesota Department of Human Services

Home and Community Based LTC Services 71 of 80 responding counties (88%) responded that there have been new long-term care home and community-base services developed in the last 2 years. 35 counties (43%) responded that services had been decreased or eliminated in the last 2 years. 69 of 80 responding counties (86%) rated their county’s general capacity of HCBS as adequate. 11 of 80 rated their county’s general capacity of HCBS as inadequate. 64 counties responded that there are currently some services that are inadequate or unavailable. the biggest concern for the ability to meet HCBS needs of communities is having the necessary workforce to meet local needs. Lack of adequate workforce is the most pressing issue facing counties in terms of providing home and community-based services The highest priority for counties in addressing HCBS needs of their communities is managing their changing roles and expectations with the development of waiver services in managed care. Minnesota Department of Human Services

Home and Community Based LTC Services Minnesota Department of Human Services

Housing Options Inadequate 32.5% Adequate 57.5% Surplus/underutilized 10.0% Overall Housing Supply 66 of 80 (82%) responded that there has been new development of senior housing or housing with services arrangements in the last 2 years. Two-thirds reported that there are housing options in their county that they would rate inadequate or unavailable Minnesota Department of Human Services

Housing Options Minnesota Department of Human Services

Housing Options - Challenges Roughly 25% of counties responded that there are housing options that are in surplus or are underutilized. Market rate rental apartments for seniors, with services, was most commonly cited as being in surplus. Lack of affordable housing Need to convert existing homes and apartment buildings Changes to Alternative Care funding that eliminated Assisted Living as a funded option for people Need for providers willing to house persons with high and complex needs, such as behavioral problems, dementia, and mental illness. Minnesota Department of Human Services

Long-Term Care Beds – Nursing Facilities Three-quarters of counties rate their overall supply of LTC nursing home beds as adequate.  However 32 counties responded that there are types of nursing home services or specialty beds that are inadequate or unavailable in their communities. While the number of nursing home beds around the state generally appears to be adequate, there is still a need for nursing home beds for special populations, including people with dementia, people with mental illness, and people with behavioral problems. Almost all counties expressed explicit concern over workforce issues in long-term care, especially in nursing homes. This was the most consistent and serious gap expressed throughout this entire analysis. Minnesota Department of Human Services

Long-Term Care Beds – Nursing Facilities Minnesota Department of Human Services

Source of DHS Information on Regions 2005 Transformation Survey  Advocacy groups  Community health and long-term care providers  Housing providers  Hospitals  Nursing facilities  Volunteer programs 2005 County Gaps Analysis  County staff who administer aging programs Minnesota Department of Human Services

East Metro Twin Cities Counties  Dakota County  Ramsey County  Washington County Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is VERY LOW compared to the rest of the state. Workforce: The number of workers age to support the 65+ population is VERY HIGH for the region overall, although Ramsey County has significantly fewer. Caregivers: The availability of potential family caregivers for the 85+ population is VERY HIGH for the region overall, although Ramsey County has significantly fewer. Living Alone: The percent of persons 65+ living alone is LOW in Dakota and Washington counties and HIGH in Ramsey County. Transform 2010: Minnesota Department of Human Services January 2006

East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

East Metro Twin Cities Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: Dollars for service subsidies and unwillingness of consumers to pay true cost of aging services Systems gaps: Cultural competence, workforce supply, care coordination between health and long-term care Other issues: Quality assurance, consumer protection, program flexibility to ensure choice and personal direction Nursing home bed supply: Adequate Transform 2010: Minnesota Department of Human Services January 2006

East Metro Twin Cities County Gaps Survey: Subsidized rental apartments for seniors (no services) were deemed inadequate by all three counties. Transform 2010: Minnesota Department of Human Services January 2006

East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

West Metro Twin Cities Counties  Anoka County  Carver County  Hennepin County  Scott County Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is VERY LOW compared to the rest of the state. Workforce: The number of workers age to support the 65+ population is consistently VERY HIGH. Caregivers: The availability of potential family caregivers for the 85+ population is consistently VERY HIGH, but decreases slightly over the next twenty years. Living Alone: The percent of persons 65+ living alone is VERY LOW in Scott & Carver, SOMEWHAT LOW in Anoka & Hennepin. Transform 2010: Minnesota Department of Human Services January 2006

West Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

West Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

West Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

West Metro Twin Cities Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: Dollars for service subsidies and workforce shortage Systems gaps: Cultural competence and program flexibility to allow for more choice and personal direction Other issues: Access to information and assistance, care coordination between health and long-term care and workforce supply Nursing home bed supply: Adequate Transform 2010: Minnesota Department of Human Services January 2006

West Metro Twin Cities County Gaps Survey: subsidized rental apartments for seniors (no services) and adult foster care homes identified as inadequate or unavailable. Transform 2010: Minnesota Department of Human Services January 2006

West Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

Rochester Area Counties  Dodge  Olmsted  Fillmore  Rice  Freeborn  Steele  Goodhue  Wabasha  Houston  Winona  Mower Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is LOW in central/northern counties, SOMEWHAT HIGH in southern counties. Workforce: The number of workers age to support the 65+ population is HIGH in central/northern counties, CLOSE TO AVERAGE in southern counties. Caregivers: The availability of potential family caregivers for the 85+ population is SOMEWHAT HIGH in central/northern counties, until 2030 when it is SOMEWHAT LOW. The availability for southern counties is consistently SOMEWHAT LOW. Living Alone: The percent of persons 65+ living alone is SOMEWHAT LOW, until 2030 when it increases slightly. The percent living alone in southern counties is CLOSE TO AVERAGE, until 2030 when it increases slightly. Transform 2010: Minnesota Department of Human Services January 2006

Rochester Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

Rochester Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

Rochester Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Rochester Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: Dollars for service subsidies and unwillingness of consumers to pay true cost of aging services Systems gaps: workforce and cultural competence Other issues: service and program flexibility to ensure choice and personal direction, quality and consumer protection system for private homes and other settings Nursing home bed supply: adequate Transform 2010: Minnesota Department of Human Services January 2006

Rochester Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: subsidized rental apartments (with services) were deemed most inadequate. Transform 2010: Minnesota Department of Human Services January 2006

Rochester Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Willmar Area Counties  Big Stone  Meeker  Chippewa  Renville  Kandiyohi  Swift  Lac qui Parle  Yellow Medicine  McLeod Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is HIGH in the western counties and SOMEWHAT LOW in the eastern counties. Workforce: The number of workers age to support the 65+ population is LOW in the western counties and CLOSE TO STATE AVERAGE in the eastern counties. Caregivers: The availability of potential family caregivers for the 85+ population is LOW in the western counties, until 2030 when it becomes even lower. The availability in the eastern counties is consistently SOMEWHAT LOW. Living Alone: The percent of persons 65+ living alone is HIGH in the western counties but decreases slightly by The percent is LOW in the eastern counties but increases by Transform 2010: Minnesota Department of Human Services January 2006

Willmar Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

Willmar Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

Willmar Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Willmar Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: Dollars for service subsidies and unwillingness of consumers to pay true cost of aging services Systems gaps: service and program flexibility to ensure choice and personal direction, cultural competence and workforce supply Other issues: quality and consumer protection system for private homes and other settings, and access to information and assistance for all persons Nursing home bed supply: adequate Transform 2010: Minnesota Department of Human Services January 2006

Willmar Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: adult foster care and board & lodging were deemed inadequate by two counties. Adult foster care was also deemed in surplus or underutilized by two counties. Transform 2010: Minnesota Department of Human Services January 2006

Willmar Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Marshall Area Counties  Cottonwood  Nobles  Jackson  Pipestone  Lincoln  Redwood  Lyon  Rock  Murray Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is consistently HIGH in most counties in the area. Jackson, Lyon and Nobles will have LOW percentages of older adults, until 2030 when the proportion will increase slightly. Workforce: The number of workers age to support the 65+ population is LOW in most counties in the area and SOMEWHAT HIGH in Jackson, Lyon and Nobles. Caregivers: The availability of potential family caregivers for the 85+ population is LOW in all counties into In 2030, most counties will experience an increase in availability. Living Alone: The percent of persons 65+ living alone decreases over time for most counties, however Pipestone, Lyon and Nobles start with HIGH percents in Murray will experience an increase. Transform 2010: Minnesota Department of Human Services January 2006

Marshall Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

Marshall Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

Marshall Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Marshall Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: Dollars for service subsidies and unwillingness of consumers to pay true cost of aging services Systems gaps: cultural competence and workforce supply Other issues: program flexibility to ensure personal choice and direction, and quality and consumer protection system for private homes and other settings Nursing home bed supply: half of the counties reported supply as adequate, half as surplus Transform 2010: Minnesota Department of Human Services January 2006

Marshall Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: adult foster care and board & lodging were deemed inadequate by two counties. Adult foster care was also deemed in surplus or underutilized by two counties. Transform 2010: Minnesota Department of Human Services January 2006

Marshall Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Mankato Area Counties  Blue Earth  Nicollet  Brown  Sibley  Faribault  Waseca  Le Sueur  Watonwan  Martin Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is HIGH in the two southern counties, CLOSE TO STATE AVERAGE in the mid-region counties, and LOW in the northern counties. Workforce: The number of workers age to support the 65+ population is VERY LOW in the southern counties, CLOSE TO STATE AVERAGE in the mid-region counties, and HIGH in the northern counties. Caregivers: The availability of potential family caregivers for the 85+ population is LOW in 2000 and decreases even further in 2030 for the southern and mid-region counties. The availability is LOW in 2000 for the northern counties but increases in Living Alone: The percent of persons 65+ living alone is consistently HIGH in the southern and mid-range counties, except for Waseca which is consistently VERY LOW. The northern counties are CLOSE TO STATE AVERAGE. Transform 2010: Minnesota Department of Human Services January 2006

Mankato Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

Mankato Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

Mankato Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Mankato Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: workforce supply and cultural competence Systems gaps: service and program flexibility to ensure choice and personal direction, and quality and consumer protection system for private homes and other settings Nursing home bed supply: adequate Transform 2010: Minnesota Department of Human Services January 2006

Mankato Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: adult foster care was identified as inadequate. Transform 2010: Minnesota Department of Human Services January 2006

Mankato Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

St. Cloud Area Counties  Benton  Morrison  Cass  Pine  Chisago  Sherburne  Crow Wing  Stearns  Isanti  Todd  Kanabec  Wadena  Mille Lacs  Wright Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is CLOSE TO STATE AVERAGE in the counties outside the St. Cloud metro area and LOW in the St. Cloud metro area counties. Workforce: The number of workers age to support the 65+ population is CLOSE TO THE STATE AVERAGE in the counties outside the St. Cloud metro area and HIGH in the St. Cloud metro area counties. Caregivers: The availability of potential family caregivers for the 85+ population is CLOSE TO THE STATE AVERAGE in the counties outside the St. Cloud metro area, and HIGH within the St. Cloud metro area counties. Living Alone: The percent of persons 65+ living alone is CLOSE TO THE STATE AVERAGE in the counties outside the St. Cloud metro area, and LOW in counties within the St. Cloud metro area in The percent increases in all counties by Transform 2010: Minnesota Department of Human Services January 2006

St. Cloud Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

St. Cloud Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

St. Cloud Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

St. Cloud Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: subsidies for services, unwillingness of consumers to pay true cost of aging services. Systems gaps: workforce supply, service and program flexibility to ensure choice and personal direction Other issues: quality and consumer protection system for private homes and other settings Nursing home bed supply: adequate Transform 2010: Minnesota Department of Human Services January 2006

St. Cloud Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: subsidized rental (with and without services) was identified as inadequate. Transform 2010: Minnesota Department of Human Services January 2006

St. Cloud Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Fergus Falls Area Counties  Becker  OtterTail  Clay  Pope  Douglas  Stevens  Grant  Traverse  Wilkin Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is LOW to CLOSE TO STATE AVERAGE in Becker, Clay, Douglas, Stevens and Wilkin Counties, and HIGH in Grant, OtterTail, Pope and Traverse Counties. Workforce: The number of workers age to support the 65+ population is VERY LOW in Grant, OtterTail, Pope and Traverse Counties and CLOSE TO STATE AVERAGE to HIGH in Becker, Clay, Douglas, Stevens and Wilkin Counties. Caregivers: The availability of potential family caregivers for the 85+ population is LOW in 2010 and decreases even further in 2030 for Grant, OtterTail, Pope and Traverse Counties. The availability is relatively HIGH in 2010 in Becker, Clay, Douglas, Stevens and Wilkin Counties but decreases somewhat by Living Alone: The percent of persons 65+ living alone in 2010 and 2030 is consistently HIGH in Stevens, Traverse and Wilkin Counties, and CLOSE TO THE STATE AVERAGE in the remaining counties. Transform 2010: Minnesota Department of Human Services January 2006

Fergus Falls Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

Fergus Falls Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

Fergus Falls Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Fergus Falls Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: subsidies for services, unwillingness of consumers to pay true cost of aging services. Systems gaps: workforce supply, service and program flexibility to ensure choice and personal direction Other issues: quality and consumer protection system for private homes and other settings, and cultural competence Nursing home bed supply: adequate Transform 2010: Minnesota Department of Human Services January 2006

Fergus Falls Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: subsidized rental apartments (with services) was identified as inadequate Transform 2010: Minnesota Department of Human Services January 2006

Fergus Falls Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Thief River Falls Area Counties  Kittson  Polk  Marshall  Red Lake  Norman  Roseau  Pennington Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is CLOSE TO STATE AVERAGE in Pennington, Polk and Roseau Counties and HIGH in Kittson, Marshall, Norman and Red Lake Counties. Workforce: The number of workers age to support the 65+ population is LOWER THAN THE STATE AVERAGE in all area counties except Roseau County. Caregivers: The availability of potential family caregivers for the 85+ population is LOWER THAN THE STATE AVERAGE in all counties except Roseau County where it is HIGH. Living Alone: The percent of persons 65+ living alone is HIGHER THAN THE STATE AVERAGE in all the counties except Roseau County where it is LOW. The percent increases in all counties by Transform 2010: Minnesota Department of Human Services January 2006

Thief River Falls Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

Thief River Falls Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

Thief River Falls Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Thief River Falls Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: subsidies for services, lack of products and service models to meet changing expectations of older population Systems gaps: workforce supply, service and program flexibility to ensure choice and personal direction, and access to information and assistance for all persons Other issues: quality and consumer protection system for private homes and other settings, cultural competence, care coordination between health and long-term care Nursing home bed supply: adequate Transform 2010: Minnesota Department of Human Services January 2006

Thief River Falls Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: adult foster care and board and lodging (with services) were identified as inadequate. Transform 2010: Minnesota Department of Human Services January 2006

Thief River Falls Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Bemidji Area Counties  Beltrami  Clearwater  Hubbard  Lake of the Woods  Mahnomen Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is HIGHER THAN THE STATE AVERAGE in Clearwater, Hubbard, Lake of the Woods, and Mahnomen Counties, and LOWER THAN THE STATE AVERAGE in Beltrami County. Workforce: The number of workers age to support the 65+ population is LOWER THAN THE STATE AVERAGE in all area counties except Beltrami County. Caregivers: The availability of potential family caregivers for the 85+ population is LOWER THAN THE STATE AVERAGE in all counties except Beltrami County where it is HIGH. Living Alone: The percent of persons 65+ living alone is HIGHER THAN THE STATE AVERAGE in all the counties except Beltrami County where it is LOW. The percent increases in all counties by Transform 2010: Minnesota Department of Human Services January 2006

Bemidji Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

Bemidji Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

Bemidji Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Bemidji Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: subsidies for services and workforce supply Systems gaps: service and program flexibility to ensure choice and personal direction, and quality and consumer protection system for private homes and other settings Other issues: cultural competence Nursing home bed supply: adequate Transform 2010: Minnesota Department of Human Services January 2006

Bemidji Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: subsidized rental apartments for seniors (with and without services) were identified as inadequate. Transform 2010: Minnesota Department of Human Services January 2006

Bemidji Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Duluth Area Counties  Aitkin  Koochiching  Carlton  Lake  Cook  St. Louis  Itasca Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is MUCH HIGHER THAN THE STATE AVERAGE in Aitkin, Itasca, Koochiching, Lake and St. Louis counties, and CLOSE TO THE STATE AVERAGE in Carlton and Cook Counties. Workforce: The number of workers age to support the 65+ population is MUCH LOWER THAN THE STATE AVERAGE in all area counties except Carlton, Cook and St. Louis County. Caregivers: The availability of potential family caregivers for the 85+ population is MUCH LOWER THAN THE STATE AVERAGE in all counties except Cook County where it is CLOSE TO THE STATE AVERAGE. Living Alone: The percent of persons 65+ living alone is CLOSE TO THE STATE AVERAGE in all the area counties except Koochiching and St. Louis Counties where it is LOWER THAN THE STATE AVERAGE. Transform 2010: Minnesota Department of Human Services January 2006

Duluth Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs Transform 2010: Minnesota Department of Human Services January 2006

Duluth Area Number of Nursing Home Beds per 1, , 2001 and 2005 Transform 2010: Minnesota Department of Human Services January 2006

Duluth Area What You Told Us About Current Supply of HCBS Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

Duluth Area Capacity to Meet Needs in 2010 Transformation and County Gaps Surveys Biggest barriers: subsidies for services and unwillingness of consumers to pay true cost of aging services Systems gaps: workforce supply, and service and program flexibility to ensure choice and personal direction Other issues: cultural competence, and quality and consumer protection system for private homes and other settings Nursing home bed supply: adequate Transform 2010: Minnesota Department of Human Services January 2006

Duluth Area What You Told Us About Current Housing Supply Transformation Survey County Gaps Survey: subsidized rental apartments (with services) and market rate rental apartments (no services) were identified as inadequate. Transform 2010: Minnesota Department of Human Services January 2006

Duluth Area What You Told Us About Current Supply of Health and Medical Services Transformation Survey Results Transform 2010: Minnesota Department of Human Services January 2006

The Future Where the present trends may take us  Informal Care  Utilization  Labor

When family caregiving decreases, public costs increase For every 1% decline in family caregiving, it costs the public sector $30 million ? Source: DHS 2010 Initiative

Nursing Facility Projections: Scenario 1

Housing With Services Projections

Estimated and Annualized Resident Demand

Projected Supply and Demand of RN’s (Minnesota) Source: US Department of Health and Human Services, July 2002