Alaska’s Continuum of Care A Skilled Nursing Facility Perspective—Dennis Murray, ASHNHA

1. Alaska’s Continuum of CareA Skilled Nursing Facility Perspective—Dennis Murray, ASHNHA There are 17 skilled nursing facilities in Alaska. Most of them are co-located in a community with a hospital. Only 2 are free-standing

2. New SNF’s and Additions 96 Beds-8 Cottages: Providence Extended Care Center

3. 50 beds: Providence Transitional Care Facility---To open mid-year, 2014

4. 18 Bed SNF-- part of Norton Sound Health Corporation in Nome

5. SNF---18 Beds: Part of Maniilaq in Kotzebue

6. YKHC Elders SNF—18 Beds, Opens in October

9. Hospital Readmissions

10. CMS Initiative: Reducing Off-Label Use of Antipsychotics

11. Federal Legislation

12. What is Gero Prep? • A 10-module learning program that prepares your RNs to pass the gerontological certification exam by the American Nurses Credentialing Center. • An important new member benefit for the challenging road ahead. • WHAT: AHCA/NCAL Gerontological Nurse Certification Prep Course. • WHY: Solving pressing challenges today yields big all-in dividends tomorrow. • HOW: Proven certification training - online, self-paced and on-demand 24/7. • Course Preview. • How Gero Prep began. • Good news spreads fast and far. • Meet your gerontological nursing education provider: UNMC College of Nursing. http://app1.unmc.edu/geronurseprep

14. DHSS Strategic PlanningLTC Recommendations to DHSS from Stakeholder Group • Recommendation 1| Educate the public. • Recommendation 2| Develop additional levels of care along the continuum of long-term services and supports; and, incentivize movement towards the lower end through increased coordination at both the individual and systems level. • Recommendation 3| Reduce costs, diversify payers and increase private investment. • Recommendation 4| Improve quality and encourage innovation. • Recommendation 5| Develop in-state capacity for populations with specific needs. • Recommendation 6| Develop workforce and support caregivers. • Recommendation 7| Determine the appropriate number, type and location of skilled nursing and assisted living beds.

15. DHSS Comprehensive Behavior Collaborative

18. Recent Research on Long Term Services and Supports Users Septembe 22, 2013 Provided by the American Health Care Association (AHCA)

19. Overall Spending in the Community is Roughly the Same as Nursing Center Care for Dual Older Adults Overall Spending in the Community is Roughly the Same as Nursing Center Care for Dual Older Adults Spending is Roughly the Same in Total (e.g., Medicare and Medicaid) Kane, R., Wysocki, A., Parashuram S., Shippee, T., Lum, T. Effective of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries. Medicare & Medicaid Research Review 2013: Volume 3, Number 3.

20. Executive Summary of Research Findings • Recent research indicates that Medicare spending is higher for people using home and community-based services (HCBS)) than nursing center residents • Certain demographic trends could exacerbate medical care challenges for people using HCBS • Such findings have notable implications for state and federal efforts to integrate Medicare and Medicaid for people who are dually eligible • Questions still linger about HCBS cost effectiveness and the new research raises further questions about outcomes for people enrolled in HCBS • Traditional managed care does not appear to be the solution

21. Higher Acute Care Costs in the Community • Some studies point to higher rates of avoidable hospitalization and emergency room use among HCBS participants • Historically, states have focused only on Medicaid outlays • Increased Medicare spending for expanding HCBS programs was not considered or not a primary concern for states • Low Medicaid reimbursement correlates with high Medicare spending R. Tamara Konetzka, Sarita L. Karon, and D.E.B. Potter. Users Of Medicaid Home And Community-Based Services Are Especially Vulnerable To Costly Avoidable Hospital Admissions. Health Affairs, 31, NO. 6 (2012): 1167–1175; Kane, R., Wysocki, A., Parashuram S., Shippee, T., Lum, T. Effective of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries. Medicare & Medicaid Research Review 2013: Volume 3, Number 3.

22. Focus on Duals Could be a Game Changer • Financial Alignment Demonstration • Federal and State motivation to keep Medicaid and Medicare spending down • Memoranda of Understanding have Medicare and Medicaid savings targets • Plan metric to reduce hospitalizations related to quality withhold • Fully Integrated Dual Eligible (FIDE) Special Needs Plans • Plan interest in coordinating both Medicare and Medicaid in hopes of broader control and margin • Plans have a strong incentive to manage down costs in both programs

23. Caregiver Capacity Could Exacerbate Medical Care Challenges Caregiver Support Ratio, United States Boomers turn 45 Boomers turn 65 Boomers turn 80 Redfoot, D., et. al. The Aging of the Baby Boom and Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers. AARP Public Policy Institute. Insight on the Issues 85, August 2013.