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CALIFORNIA - SCORECARD

CALIFORNIA - SCORECARD. 3/2/2012. The 1999 Olmstead Supreme Court Decision. Unnecessary institutionalization is discrimination under the ADA. People with disabilities should NOT have to enter an institution to receive the same services they can receive in the community.

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CALIFORNIA - SCORECARD

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  1. CALIFORNIA - SCORECARD 3/2/2012

  2. The 1999 Olmstead Supreme Court Decision • Unnecessary institutionalization is discrimination under the ADA. • People with disabilities should NOT have to enter an institution to receive the same services they can receive in the community. • People with disabilities should NOT be institutionalized because a State refuses to provide services in the community.

  3. Measuring Compliance with the Olmstead Decision • There are two basic ways to determine if California complies with the Olmstead decision. • One - show me the money! Where does Indiana spend its money – in the institution versus in the community? How do its expenditures compare to other States. • Second - how does Indiana compare with other States on non-monetary issues?

  4. This session and power point will review only the non-money criteria.

  5. Some Background Data for California [as of 2010] – and Why is Data Important. • 57.0% of the 97,474 people in NH were on MA. [54.6% nationally] • 63.3% women [68.1% nationally] • 21.7% still married [20.4% nationally] • 26.8% want to return to community [23.2%] • 25.6% had support person who was positive about return. [19.7%]

  6. More California Data • 7.5% admitted to NH from home/apt WITHOUT receiving any home health services. [10.3% nationally] • 2.1% receiving some home health. [4.3%] • 69.3 % directly from acute care hospital [60.8%] • 17.5% lived alone prior to admission [27.2%]

  7. MA per person payments for California’s NH • FY 2005 $132.83 per diem • FY 2010 $164.65 per diem • FY 2005 $48,482.95 per year • FY 2010 $60,097.25 per year • Between 2005 and 2010, a 24% increase in NH’s MA reimbursements.

  8. Macro MA $ to NH • 2005 - $3.099b to NH • 2010 - $4.122b to NH • A 33% increase.

  9. # NH Residents • 2005 -- total NH residents 101,045 of whom 55.5% on MA = 56,080. • 2010 -- total NH residents 97,474 of whom 57.0% on MA = 55,560.

  10. NH Occupancy Rates • FY 2005 - 85.80% of NH beds occupied. [84.40% nationally] • FY 2008 – 85.10% of NH beds occupied. [84.9% nationally]

  11. Community • 2005 - PCO $3.296b,HH $160m &$103 waivers = $3.559b • 2010 - PCO $4.549b,HH $179m &$134 waivers = $4.862b • A 36.6% increase.

  12. Managed Care • The BIG $ went to Managed Care Premiums: 2005 - $4.9b and 2010 - $6.1b.

  13. 2005 – a baseline and national comparisons. • FY 2005 - 47% of LTSS for Aged and Physically Disabled to NH [72.9% nationally]; and 53% to Com-Based services [28.4% nationally]. • FY 2010 - 46% of LLTS for Aged and Physically Disabled to NH. [64.3% nationally]; 54% to Com.-Based services [35.7%nationally].

  14. Comparison • California stayed almost the same between 2005 and 2010 re HCBS. • California still ahead of national average.

  15. How does California compare with other States on Non-Monetary [i.e., non-MA] issues? • The AARP’s “Raising Expectations” [9/2011], ranked California overall 15th BEST/WORST state in nation. • If California had improved ONLY to equal the best state, then – trumpets, please, • 11,309 new MA LTSS users would have FIRST received MA services in home/apt – NOT NH. • 9,824 NH residents with “low care needs” would instead receive LTSS in community. • 7,796 unnecessary hospitalizations of NH residents would be avoided.

  16. ENORMOUS MA $$ COULD BE SAVED!!!!! WHILE COMPLYING WITH OLMSTEAD • Since MA paid $60,097 per year for each person in NH…, then • The 11,309 people who went directly from home or directly from acute care hospitals w/o being offered home-based services cost CA $ 660 m in MA. • The 9,824 people in NH with very few ADLs, i.e., “low care,” cost CA $600m in MA. They may be married and no one has offered HCBS. Why are they in the NH? Silly us, PWDs are the cash-cows. • The 7,796 unnecessarily hospitalized are from NH neglect, and the great myth “nursing” and “home.” If hospitalized with bed sores for 30 days @$2,000 a day, cost $480 m in MA.

  17. AARP’s Four Criteria • First, “affordability and access,” California ranked 7th best. • Does poorly [42th worst state] in ability to access LTSS system through ADRC or other single point of entry.

  18. Second, “CHOICE” of setting and provider. • 9h best/worst. • 19th worst re % nursing home residents with “low care needs”. • Ranked 5th re new MA LTSS users first receiving services in the community. • Does great [#1] re number of people with disabilities in community directing own services.

  19. Third, “Quality of Life & of Care” • California ranked 39th worst re: • % of high risk NH residents with pressure sores [ranked 40]. • % of long-stay NH residents physically restrained [ranked 49th]. • % of long-stay NH residents with hospital admission[ranked 29th worst].

  20. Fourth, Support for family caregivers • 30th worst/best. • Low % of caregivers who usually or always get needed support [ranked 46th]. • Re number of health maintenance tasks able to be delegated to LTSS workers [ranked 32].

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