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The Long-Term Care Imperative: Insights into Admission Policies in Minnesota

Survey results from November 8, 2022, highlight the impact of the pandemic on long-term care facilities in Minnesota. The data reveals historically low census levels, holds on admissions, and increased rejections of hospital referrals. Assisted living facilities also face challenges with occupancy rates and turning away hospital admissions. A significant number of residents are enrolled in Medicaid waivers, and many facilities are declining admission referrals. Overall, the report sheds light on the critical issues faced by nursing and assisted living facilities in the state.

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The Long-Term Care Imperative: Insights into Admission Policies in Minnesota

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  1. Survey on Admission Policies November 8, 2022 11/8/2022 The Long-Term Care Imperative 1

  2. Background • Survey emailed on October 31, 2022 • Survey closed on November 7, 2022 • Respondents Region East Central Northeast Northwest Southeast Southwest Twin Cities Metro West Central State Assisted Living 35 13 12 38 24 116 24 262 Nursing Facility 20 18 13 36 19 43 14 163 11/8/2022 The Long-Term Care Imperative 2

  3. Nursing Facility Census Remains Historically Low Nursing Facility Census Remains Historically Low 4 of 5 Nursing Facilities Have Placed Hold on Admissions during the Pandemic 100% 91.7% 84.6% 84.2% 83.3% 90% 79.1% 78.6% 75.0% 80% 65.1% 70% 60% 50% 40% 30% 20% 10% 76.6% 75.9% 83.3% 73.6% 74.5% 84.2% 83.8% 79.2% 0% East Central Northeast Northwest Southeast Southwest Twin Cities Metro West Central Statewide Occupancy on 10-31-22 Setting has placed a hold on all new admissions at some point during the pandemic 11/8/2022 The Long-Term Care Imperative 3

  4. Nearly All Nursing Facilities that Have Placed Hold on Admissions Report Nearly All Nursing Facilities that Have Placed Hold on Admissions Report Turning Away More Hospital Admissions than Before the Pandemic Turning Away More Hospital Admissions than Before the Pandemic Statewide 93.5% West Central 90.0% Twin Cities Metro 92.9% Southwest 93.8% Southeast 93.8% Northwest 88.9% Northeast 93.3% East Central 100.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 11/8/2022 The Long-Term Care Imperative 4

  5. Assisted Living Census Remains Historically Low Assisted Living Census Remains Historically Low More than 50% of Assisted Living Facilities in East Central and West Central Have Placed Hold on Admissions during the Pandemic 100% 90% 80% 70% 58.3% 60% 51.4% 46.2% 50% 36.6% 33.3% 40% 31.0% 29.2% 28.9% 30% 20% 10% 72.2% 79.7% 78.0% 82.8% 75.6% 79.8% 83.4% 79.0% 0% East Central Northeast Northwest Southeast Southwest Twin Cities Metro West Central Statewide Occupancy on 10-31-22 Setting has placed a hold on all new admissions at some point during the pandemic 11/8/2022 The Long-Term Care Imperative 5

  6. Nearly 70% of Assisted Living Facilities that Have Placed Hold on Nearly 70% of Assisted Living Facilities that Have Placed Hold on Admissions Report Turning Away More Hospital Admissions than Before Admissions Report Turning Away More Hospital Admissions than Before the Pandemic the Pandemic Statewide 69.3% West Central 61.5% Twin Cities Metro 62.9% Southwest 100.0% Southeast 81.8% Northwest 66.7% Northeast 100.0% East Central 60.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Setting has held admissions and turned away more hospital admissions when compared to pre-COVID-19 pandemic 11/8/2022 The Long-Term Care Imperative 6

  7. One-Third of Assisted Living Residents are Enrolled in Medicaid Waiver 100% 90% 80% 70% 60% 52.6% 50% 40.4% 38.8% 36.6% 36.2% 40% 33.4% 29.9% 28.9% 30% 20% 10% 0% East Central Northeast Northwest Southeast Southwest Twin Cities Metro West Central Statewide Percent of Residents on EW, CADI, BI 11/8/2022 The Long-Term Care Imperative 7

  8. Typical Nursing Facility Decline Nearly 15 Admission Referrals during October 2022 Average Number of Declined Admission Referrals Decline by Facility for October 2022 Estimated Number of Declined Admission Referrals for Minnesota in October 2022 16 14.6 14 7,000 6,460 12 6,000 5,096 10 5,000 8 4,000 6 3,000 4 2,000 3.1 2 1,000 0 - Nursing Facility Assisted Living Facility Nursing Facility Assisted Living Facility 11/8/2022 The Long-Term Care Imperative 8

  9. Miniscule Number of Nursing Facilities Report Not Turning Down Any Any Admission Referrals in October 100% 90% 80% 70% 60% 50% 40% 30% 20% 7.7% 10% 5.9% 5.4% 2.7% 0.0% 0.0% 0.0% 0.0% 0% East Central Northeast Northwest Southeast Southwest Twin Cities Metro West Central Statewide 11/8/2022 The Long-Term Care Imperative 9

  10. More than a Third of Nursing Facilities in Minnesota Report Turning Down 21 or More Admission Referrals in October 34.5% Statewide 20.9% 19.6% 22.3% West Central 23.1% 38.5% 30.8% Twin Cities Metro 16.2% 8.1% 27.0% 43.2% Southwest 43.8% 18.8% 12.5% 25.0% Southeast 18.2% 27.3% 18.2% 36.4% Northwest 38.5% 30.8% 15.4% 15.4% Northeast 29.4% 11.8% 23.5% 29.4% East Central 10.5% 26.3% 21.1% 42.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 to 5 6 to 10 11 to 20 21 or more 11/8/2022 The Long-Term Care Imperative 10

  11. Assisted Living Facilities More Likely to Report Not Turning Down Any Any Admission Referrals During Month of October 2022 100% 90% 80% 70% 60% 50% 41.7% 37.5% 40% 30% 25.2% 23.8% 23.1% 18.2% 16.7% 20% 13.0% 10% 0% East Central Northeast Northwest Southeast Southwest Twin Cities Metro West Central Statewide 11/8/2022 The Long-Term Care Imperative 11

  12. More than 60% of Assisted Living Facilities in Minnesota Report Turning Down 1 to 5 Admission Referrals During Month of October 2022 Statewide 61.3% 12.9% West Central 8.7% Twin Cities Metro 61.7% 10.3% Southwest 45.8% 16.7% Southeast 66.7% 13.9% Northwest 50.0% 8.3% Northeast 61.5% 15.4% East Central 57.6% 21.2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 to 5 6 to 10 11 to 20 21 or more 11/8/2022 The Long-Term Care Imperative 12

  13. Nursing Facilities and Assisted Living Facilities Differ in Approach to Admissions Nursing Facility Assisted Living 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Facility is admitting residents if admissions criteria is met. Facility does not have the staffing and resources to increase census but will admit a new resident when a different resident is discharged. Facility has a hold on all new admissions. Facility is admitting residents from the community but not the hospital (if admissions criteria is met). Facility is admitting residents from the hospital but not the community (if admissions criteria is met). 11/8/2022 The Long-Term Care Imperative 13

  14. Insufficient Staffing, Ability to Meet Specific Needs, and Insufficient Staffing, Ability to Meet Specific Needs, and Weekends Used Most Frequently when Deciding to Admit Weekends Used Most Frequently when Deciding to Admit Criteria used to presently inform decision to accept or not accept an admission 100% 90% 84.0% 80% 74.0% 71.2% 70% 60% 54.0% 50% 40.8% 38.5% 40% 30% 20% 11.5% 11.1% 4.9% 10% 3.7% 3.1% 0.6% 0% Insufficient staffing Ability to meet the specific needs of the new admission. Admissions over the weekend are very difficult to process and staff to. Other Potential admission must be reviewed by corporate staff Supply and re-supply of personal protective equipment (PPE) Assisted Living Nursing Facility 11/8/2022 The Long-Term Care Imperative 14

  15. Waiting Lists for Admission Vary by Region and Provider Type Waiting Lists for Admission Vary by Region and Provider Type Maintain a Waiting List for New Admissions 100% 92.3% 90% 82.9% 80.0% 78.6% 77.8% 80% 70.8% 70.8% 68.4% 70% 65.2% 60.0% 58.3% 57.9% 56.5% 60% 47.6% 50% 46.2% 39.7% 40% 30% 20% 10% 0% East Central Northeast Northwest Southeast Southwest Twin Cities Metro West Central Statewide Assisted Living Nursing Facility 11/8/2022 The Long-Term Care Imperative 15

  16. An estimated 727 unregistered staff are working as nursing assistants who will need to complete training and/or testing for certification before the nurse aide training waiver expires. 8/17/2020, the estimate was nearly 1,200. 11/8/2022 The Long-Term Care Imperative 16

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