1. Policy Does Matter
Testimony to Aging and Long-Term Care Committee Ohio House of Representatives
Bob Applebaum
October 2017

2. An Aging Ohio to 2040
Year Total Pop (millions) 60 plus 1.9 (17%) 3.0 (25%) 3.4 (29%) 65 plus 1.5 (13%) 2.1 (18%) 2.8 (24%) 85 plus .177 (1.6%) .270 (2.3%) .553 (4.6%)

6. 2010

7. Aging in Ohio: Health Conditions and Behaviors, 65 plus
Health conditions % Ohio U.S. Ranking Diabetes Arthritis Hip fractures per Mult chronic conditions Skill NF Admits per Health behaviors % Smoking Obesity No leisure physical act

8. Are Individuals Prepared for Long-Term Disability?
What is disability? Moderate shopping, getting to the doctor without help– Severe help with dressing or bathing
Will it effect me?
65 and older with some long-term disability 28.4% % %
85 plus 42.4%
Women higher rates than men
U.S. low Savings rate
Almost half of retirees rely on Social Security for majority of income (Avg. $1400 per month, maximum $2700)
Less than 4% of Ohioans over age 45 with LTC insurance

9. Proportion of Ohio's Population Age 60 and Older with Severe Disability by Care Setting, 2015 (N=164,250)

10. Ohio’s Nursing Facility Characteristics, 2015
All Nursing Facilities
County Homes
Hospital Based Long-Term Care Unit
Number of Facilities (as of 12/31/2015)
958 15 20
Licensed/certified nursing facility beds 12/31/15
Average number of beds available daily
Average number of licensed beds
92,157
91,503 95
1628
1756
103
998
1017 50
Location (percent)
Urban
Rural
76.2
23.8
46.7
53.3 80
Ownership (percent)
Proprietary
Not for profit
Government
79.7
18.1
2.3 —
100.0
36.4
54.6
9.0
Separate Memory Care Unit (percent)
51-100
100 or more 34 41 55

11. Ohio Nursing Facility Admissions, Discharges, and Occupancy Rates, 1992 – 2015
1992
1999
2001
2005
2009
2011
2013
2015
NF Beds in Service (000) 92 96 94 91 93 95
Number of
Admissions (000)
Total 71
150
190
197
207
219
211
Medicaid resident 18 28 24 34 27 31 37 35
Medicare resident 30 79
117
109
148
145
147
Occupancy Rate (%)
91.9
83.5
83.2
86.4
84.7
83.9

12. Time Period (Percentage Remaining)
Newly Admitted Nursing Home Residents and Changes in Their Stay Patterns Over a Three Year Period ( )
Time Period (Percentage Remaining)
Admissions
0-3 months
At 6
months
At 9
Months At
12 months
At 24 months
At 36
5803
56.7
41.1
35.2
32.2
24.0 NA
15,250
43.1
32.5
20.7
16.1
9.0
5.7
23,475
16.3
12.5
11.1
10.4
8.8
8.2
Medicaid*
4844
26.5
20.4
17.8
16.2
13.4
12.0

13. Demographic Characteristics of Ohio’s Certified Nursing Facility Residents Over Time,
1996, 2006 – 2016
1996
(Percent)
2006
2012
2014
2016
Age
45 under
2.6
2.7
2.3
2.1
46–59
3.8
9.1
10.4
9.9
60–64
4.5
6.4
6.5
7.1
65–69
4.4
5.9
7.9
8.3
9.6
70–74
8.1
9.5
9.7
75–79
13.1
13.2
12.0
12.1
12.3
80–84
18.7
19.2
16.4
15.3
14.5
85–89
21.2
19.4
18.2
17.6
16.7
90+
25.5
17.9
16.9
18.0
Avg Age
80.7
78.4
77.3
77.5
77.2
Female
73.5
68.5
65.5
65.1
63.8
Race Wht
88.3
86.3
86.0
85.5
85.3
Marital
Never
13.8
15.1
16.1
Wid/div
70.7
63.7
58.7
59.9
57.9
Married
15.5
25.2
23.4
24.2

14. Private Pay Nursing Home Residents Who "Spent-Down" to Medicaid, Over a Three Year Period

16. Ohio’s Residential Care Facility Characteristics, 2015
All RCFs
RCF Only
Assisted Living*
Number of Facilities
655 73
582
Total licensed RCF beds
50,431
4229
46,202
Total number of units
35,979
3312
32,667
Average number of beds 77 58 79
Average number of units 55 45 56
Average Monthly Rate (Private Non Memory)
Location (Percent)
$4044
$3921
$4056
Urban
78.8
79.5
Rural
21.2
20.6
Ownership (percent)
Proprietary
71.6
80.0
70.5
Not for profit
28.4
20.0
29.5

17. Occupancy and Length of Stay in Ohio’s Residential Care Facilities,
2013 – 2015
Overall
(Percentages)
RCF Only
Assisted Living
2013
2015
Unit Occupancy
87.8
88.9
84.2
85.3
88.5
89.3
Bed Occupancy
67.3
70.6
70.8
72.1
66.5
70.4
Average Length of Stay (Days)
867
823
877
872
865
821

19. 31.1
31.8
32.0
35.6
34.1
35.0
35.5
33.4
33.0
31.4

20. Policy and the Future
Even with changes the current system is simply not sustainable.
Short-term window where “boomer growth” remains small, before the major increase.
The current system was never designed-- it just happened– Meaningful change is very slow.
We often have policy changes with unplanned consequences. Hospital reform meant a new nursing home. Very low Medicaid rates for AL have resulted in high rate of terminations to NF (PASSPORT 28% AL 52%).

21. Recommendations for Ohio
Heavy pressure driven by Medicaid budget concerns– but most older people not on Medicaid (90%), Nationally and in Ohio-- Medicaid about 25% of state budget– Ohio -- 36% allocated to LTSS
Today 164,000 older people with severe disability– Almost half, about 81,000 on Medicaid.
In 2040, 310,000 older people with severe disability– if 50%-- 155,000 on Medicaid– not easily sustainable
Strategy needs to be to lower Medicaid use through prevention, individual planning, technology development, environmental adaptation.

22. Recommendations for Ohio
Lowering Medicaid spend-downs by leveraging the Senior Service Levies and use of support services.
Enhancing family support through programs and policies.
Workforce will always be critical. Ohio NF’s have a 66% retention rate– varies– how can we improve?
Dramatic increase in short stay residents. Pre-Admission Review process designed 25 years ago needs to be changed. (16% continue after 3 months)
Short-term stays-- implications for LTC Consumer Guide and Quality & Inspection Process

23. Recommendations for Ohio
One in four NF residents under age 65– 45% stay less than 3 months and are being used for rehab. But a large group have a behavioral health diagnosis– 28% 0,1 ADL impairments. MFP has made progress, but– problem continues.
Ohio has reduced supply and use of NF beds– in 2011, 29% of severely impaired elders in NF in 2015 dropped to 25%. (Oregon’s rate about 10%).
LTC system must be innovative and efficient-- It will need to use technology, public-private partnerships, and new ideas such as aging friendly communities to meet our future challenges.

24. Contact info
Bob Applebaum
Scrippsaging.org (Scripps web site)