1. Where Will Boomers Live In Their Later Years? LaRhae Knatterud & Todd Stump Minnesota Department of Human Services

2. 2 Agenda Participants will... Learn about senior housing in Minnesota compared to other states Understand housing with services compared to home care, & discuss these use patterns Discuss MN boomers’ preferences for housing/ service supports in later years, and implications in regards to our current system. Twitter: #mnodyssey

3. 3 Minnesota’s Aging Population By 2030, 1.3 million Minnesotans will be over 65 years of age Boomers’ choices in long-term care will differ from previous generations Will they want to live at home, in customized/assisted living, or in nursing facilities?

4. 4 How do we define Assisted / Customized Living? A Definition from the Attorney General: Housing Transportation Customizable & specified health-related and supportive services Examples: assistance with medication supervised by a registered nurse; two meals daily; weekly housekeeping and laundry services; assistance with 3+ activities of daily living

5. 5 Assisted Living: Minnesota vs Other States Minnesota: more than 104 units per 1000 people 65+, highest rate in the US as of 2007 US average: 22.9 units per 1,000 aged 65+ Minnesota eclipses neighboring states: Wisconsin (24 units per 1,000 aged 65+), North Dakota (27), South Dakota (19), Iowa (29) Stevenson, David G., and David C. Grabowski. "Sizing up the market for assisted living." Health Affairs 29.1 (2010): 35-43.

6. 6 Customized Living and Assisted Living: Trends High growth of AL/CL on Medicaid spending and the pace of spend-down to Medicaid eligibility by private-pay residents with low care needs Medicaid beneficiaries account for 8-12% of AL/CL residents 31% of EW participants live in AL/CL, accounting for 65% of EW spending

7. 7 Customized Living and Assisted Living: Trends (continued) High growth of AL/CL on MA spending and pace of spend-down to MA eligibility by the 60% private-pay residents assessed with low care needs Private-pay with low care needs spend down to Medicaid eligibility levels more quickly, and they could be served at home

8. 8 Comparisons within Recipients of the Elderly Waiver Total: $312 million (2011) for 21,778 individuals 31% reside in AL/CL 46% live in 7-county Twin Cities metro; 54% live in greater Minnesota Assisted Living/Customized Living: 22% of EW in metro; 38% of EW in greater MN

9. 9 Comparisons within Recipients of the Elderly Waiver (continued)

10. 10 Comparisons within Recipients of the Elderly Waiver (continued)

11. 11 Comparisons within Recipients of the Elderly Waiver: Table TotalMetroGreater MN EW21,77810,02211,756 AL/CL6,6452,1664,479 EW$311,817,288$143,501,724$168,315,564 AL/CL$202,681,237$66,074,083$136,607,154

12. 12 2010 Boomer Survey: Own Your Future A majority of boomers (52%) plan to stay in their current home an additional 10 years or more 31 percent indicated that they plan to stay in the same community for 20 or more years 27 percent reported that they plan to remain in their home for an additional 20 years or more

13. 13 Additional Years Boomers Expect to Stay in their Current Home, by Year of Birth (n=3,809)

14. 14 Additional Years Boomers Expect to Stay in their Community, Metro vs. Outstate (n=3,809)

15. 15 Future Living Arrangements for Boomers Considering a Move in the Next 10 Years 1/3 of boomers (32%) may move within next 10 years: Plurality because of home characteristics (41%) 24% to retire to a new place, experience a different climate, or to have more freedom to travel 20% due to the cost of housing or living 15% because of change in the family

16. 16 Discussion 1: What Do We Want? What type of housing, location and services will we want as we grow older? Are there other options for residences that should be made available in communities? (i.e., versions of “Golden Girls”-style group or shared housing, one- level living, cottages) If so, who will build them?, etc

17. 17 Discussion #2: Pros and Cons What are the ramifications of current trends regarding the growth of Customized / Assisted Living for Minnesota? Age segregation or community creation?

18. 18 Discussion #3: Substitutes Are customized and assisted living options serving as a substitute for nursing facilities or for home care? If this is the case, what can be done to make home care a more attractive option, even for a few extra months?

19. 19 Conclusion: Final Thoughts and Questions

20. 20 Thank you! For more information, or digital versions of this presentation, please contact LaRhae Knatterud (larhae.knatterud@state.mn.us) Todd Stump (todd.stump@state.mn.us)