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Historical Information

Historical Information. “Long Term Care & Medicaid” has been a priority of the South Dakota Health Care Commission Bill passed and signed by Governor Rounds in 2006 to authorize long-term care study Long Term Care Study conducted by Abt Associates; completed November 2007.

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Historical Information

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  1. Historical Information • “Long Term Care & Medicaid” has been a priority of the South Dakota Health Care Commission • Bill passed and signed by Governor Rounds in 2006 to authorize long-term care study • Long Term Care Study conducted by Abt Associates; completed November 2007

  2. Long Term Care Study- Challenges • Key challenges identified in the study include: • A rapidly aging population • Number of elders will double by 2025 and increase by 92,000-105,000 • Number of disabled elders will increase by 42,000-50,000

  3. Long Term Care Study- Challenges • Counties where the elderly population is expected to more than double by 2025

  4. Long Term Care Study- Challenges • Geographic mismatch between the places where services exist today and the places where the elderly population is expected to grow over the next 20 years • Slow growing East River counties averaged 7.2 nursing home beds per 100 elders in 2005. • Rapidly growing West River counties had 3.8 nursing home beds per 100 elders in 2005.

  5. Long Term Care Study- Challenges • Historically low rates of use of home and community-based services (HCBS) • South Dakota ranks second lowest in the U.S in terms of utilization of skilled home health episodes • Rural and Frontier areas face particularly low availability of HCBS: • 34 counties have no adult day service facilities • 28 counties have no, or one, senior center per 1,000 elders • 18 counties have no, or one, nutrition program per 1,000 elders • Every county in South Dakota is served by a homemaker agency, but 40 counties have no homemaker agencies located in their borders

  6. Long Term Care Study- Challenges • Aging skilled nursing facilities

  7. Long Term Care Study- Challenges • Shortages of front-line health care workers • Sharply rising costs of care coupled with tightening of Federal dollars for program support and provider reimbursement • Inadequate individual planning and financing of long-term care costs, and limited use of long-term care insurance

  8. Long Term Care Study • In summary, there are both short and long term issues • Shorter-run: Right-sizing aging facilities, excess capacity, assuring access critical services • Longer-run: Sharp growth in demand in parts of the state • Elders increasingly want to remain at home as long as possible; and this must be at the forefront of any policy recommendations

  9. Long Term Care Study • Need to address rate of utilization of expensive nursing home care • SD has10th highest rate of nursing home use in the U.S. • National average is 4.8 beds per 100 elderly; SD use is 6 bedsper 100 elderly • Study provided 3 options: • Scenario 1: Status Quo – NH utilization rates are fixed at recent levels • 2003-2005 avg NH utilization in SD as % of elderly = 5.9% • Scenario 2: NH Utilization declines over time, at national rates • 0.17% annual decline, reach 5 bed per 100 utilization by 2025 • Scenario 3: SD will move to national norms in NH utilization • NH utilization is declining 0.04% annually in the US and will reach 4% by 2025

  10. Long Term Care Study • South Dakota is pursuing nursing home utilization rate in Scenario 3 • Will require major expansion of Home and Community-Based Services • Large financial ramifications for future system

  11. Task Force Development • Meeting the Continuum of Care Needs of the Elderly in South Dakota Task Force convened by Department of Social Services in March 2008 based on study results • 100+ members, including legislators, providers, advocacy groups and state agencies • Subcommittees • Right-Sizing Long-Term Care • Financing • Expansion of Home and Community-Based Services

  12. Task Force Recommendations • 1. Develop a Single Point of Entry system for long-term care services • Network to provide public with information and referrals to variety of services, including transportation, nutrition, assisted living, etc. • Help individuals plan for long-term care needs • Method to assess needs for services and provide connections to services • Assist public in determining funding options from self-support to public assistance

  13. Task Force Recommendations • Develop a Single Point of Entry system for long-term care services (cont.) • DSS should develop regional centers within existing field office structure • Develop hospital discharge planning process that includes DSS staff

  14. Task Force Recommendations • 2. Expand existing home and community-based services so people can stay in their own homes and communities as long as possible • Identify and define critical core services that need to be available at least regionally • Work with entities such as the Board of Nursing and Medical Association to increase use of home and community based services • Use technology to increase service options

  15. Task Force Recommendations • 2. Expand existing home and community-based services so people can stay in their own homes and communities as long as possible (cont.) • Provide information to the medical community and the public about the need for home and community based services • Advocate for changes on the federal level to better support home and community-based services

  16. Task Force Recommendations • 3. Enhance existing home and community-based services to ensure services are comprehensive and meet the needs of the elderly • Strengthen and create better access to services such as chore services, drop-in visitor services, and transportation services • Work with community leaders and organizations

  17. Task Force Recommendations • 4. Implement an access critical nursing facility model to ensure people have access to care within a reasonable distance to their communities • No other nursing home within 20 miles • Facility located in largest town within 35 miles • Must provide skilled facility services • Must be integrated with other health care services • Projected county demand for nursing homes is less than 60 beds in 2015 • Must relinquish excess moratorium beds

  18. Task Force Recommendations • Locations where facilities meet access critical criteria: • -Philip -Miller • -Lemmon -Hot Springs • -Chamberlain -Eureka • -Martin -White River • -Britton • Recommendation to increase reimbursement for access critical facilities • Increase overall rate growth cap from 8%-10%, also provide up to a 2% adjustment to rates

  19. Task Force Recommendations • 5. Right-size the nursing facility industry by realigning moratorium bed levels to reflect projected demand for nursing facility services • Moratorium on new nursing home beds in state statute • Facilities adjust the number of beds they license according to their occupancy rates for Medicaid reimbursement purposes • Recommendation to change reimbursement methodology so moratorium beds, not licensed beds, are used • Allow facilities to voluntarily close the gap between moratorium beds and occupancy

  20. Task Force Recommendations • Expand nursing facilities through a Request for Proposals (RFP) process developed by state agencies for areas in the state that will need additional nursing facility services • Not a Certificate of Need process • Only certain parts of the state will need more nursing facility beds in the future • State agencies would allow expansion in certain areas based on population-based projections for need, occupancy of existing facilities • Would need to change moratorium statute and develop administrative rules

  21. Task Force Recommendations • RFP will request: business plan with payor source info and evidence of community contributions, plan to meet workforce needs • Consideration of providers for expansion include factors such as: • Facilities that give up existing moratorium beds if there is future service need in the area • Providers who demonstrate integration with full continuum of care • Providers must accept people eligible for Medicaid • Special consideration for providers serving specialized populations

  22. Task Force Recommendations • 7. Maintain a sustainable financial infrastructure for the current and future system of care • Help nursing facilities access funding to replace or renovate aging facilities • Provide financial incentives to long term care providers that serve a higher percentage of people on Medicaid • No consensus on how to get additional funding for services

  23. Task Force Recommendations • 8. Collect data and analyze the need for additional assisted living facilities • DSS has started to collect data needed to project the need and costs for additional assisted living facilities in the state

  24. For More Information • Final Report Online: • www.dss.sd.gov/ltctaskforce.asp • Abt Study Online: • http://www.dss.sd.gov/news/2007/LTCStudy.asp

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