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

Elderly Dependency Ratio Highest In Rural Counties Source: 2010 Census County Ratio of People 80 and Up to People Traverse 0.19 Big Stone 0.17 Lac Qui Parle 0.17 Lincoln 0.16 Kittson 0.15 Cottonwood 0.15 Norman 0.14 Pipestone 0.14 Faribault 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 Waiver In 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, 4 th 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%) 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 ProcessNo 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% 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 RegionHWS Units People 80 and Up Ratio of Units per 1K People 80 and Up State62,226206, Twin Cities Metro 31,11089, Northeast5,93315, Northwest2,0787, Southeast8,51232, Southwest4,05619, East Central6,89428, West Central3,64312,

Average Care Center Occupancy Lower Outside of Metro Area in 2011 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,

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 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 8 th 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