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Long-Term Care in Minnesota:  Past, Present, and Future Trends for Senior Services in Minnesota

Long-Term Care in Minnesota:  Past, Present, and Future Trends for Senior Services in Minnesota. Todd Bergstrom Care Providers of Minnesota. Topics. Past (a review of trends) Present (a look at the Gaps Summary Analysis Future (Where do present trends may take us). The Past. Length of Stay

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Long-Term Care in Minnesota:  Past, Present, and Future Trends for Senior Services in Minnesota

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  1. Long-Term Care in Minnesota: Past, Present, and Future Trends for Senior Services in Minnesota Todd Bergstrom Care Providers of Minnesota

  2. Topics • Past (a review of trends) • Present (a look at the Gaps Summary Analysis • Future (Where do present trends may take us)

  3. The Past • Length of Stay • Number of providers • Demographics

  4. Declining Length of Stay in Minnesota Nursing Facilities Source: Minnesota Department of Health

  5. Minnesota Nursing Facility Resident Days

  6. Care Providers of Minnesota

  7. Monthly Average Medicaid Nursing Facility Residents Source: February 2006 DHS Forecast

  8. Monthly Average Medicaid EW Service Recipients Source: February 2006 DHS Forecast

  9. Monthly Average Medicaid LTC Waivers & Home Care* * Payments for MA home and community-based waivers, home health agency services, personal care and private duty nursing services. Source: February 2006 DHS Forecast

  10. Total Annual Payments – State Share Source: February 2006 DHS Forecast

  11. Operating Margin Imperative Nursing Facility SurveyPrepared by Larson, Allen, Weishair & Co., LLP

  12. Percent Days by Payor Imperative Nursing Facility SurveyPrepared by Larson, Allen, Weishair & Co., LLP

  13. Percent Revenues by Payor Imperative Nursing Facility SurveyPrepared by Larson, Allen, Weishair & Co., LLP

  14. Average Age of Facility Imperative Nursing Facility SurveyPrepared by Larson, Allen, Weishair & Co., LLP

  15. MinnesotaPopulation 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  16. CPM Region 1 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  17. CPM Region 2 Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  18. CPM Region 3Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  19. CPM Region 4Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  20. CPM Region 5Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  21. CPM Region 6Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  22. CPM Region 7Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  23. CPM Region 8Population 65 to 84 and 85 Plus Source: Population Projections from the State of Minnesota Demographer

  24. Minnesota: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  25. CPM Region 1: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  26. CPM Region 2: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  27. CPM Region 3: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  28. CPM Region 4: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  29. CPM Region 5: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  30. CPM Region 6: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  31. CPM Region 7: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  32. CPM Region 8: Aging Population as a Percent of 20 to 64 Population Source: Population Projections from the State of Minnesota Demographer

  33. The Present: Long-Term Care Gaps Analysis 2005 Update Survey • Minnesota’s counties were asked to complete the following survey in order to re-assess the gaps that exist in long-term care and home and community-based services in their communities. Counties were asked to submit their responses through a web-based survey tool called SnapSurvey. The invitation was initially sent out through a bulletin. Reminders were sent to Long Term Care Consultation administrative contacts at counties. • Seventy-six counties and/or county collaborations responded to this survey between August 12, 2005, and October 27, 2005. Although Minnesota has 87 counties, the maximum number of possible responses for this survey was 84, due to collaborations • http://www.dhs.state.mn.us/main/groups/aging/documents/pub/DHS_id_054450.hcsp • The following summarizes statewide findings Minnesota Department of Human Services

  34. General Findings • HCBS. Generally speaking, counties believe that home and community-based services around the state are adequate. • However, there is still need for service development in particular counties and in particular services, including transportation, evening and weekend care and respite services, chore services, and adult day services. • Counties are also concerned about how the migration of HCBS into managed care will affect access and quality of services. • Housing. Housing needs for average income and high-functioning persons with disabilities and elderly are adequate around the state. • There is still a great need to address affordable housing for people around the state, and to develop housing options for persons with complex needs. • In addition, there is a need for home and apartment modifications, so people can continue to live in their own communities with limited mobility. • Nursing facilities. The number of nursing home beds around the state is generally adequate. • Although some communities have concerns about the distance that people must travel to get to them. • There is still a need to develop nursing home beds for special needs populations. • The most pressing concern for nursing home care is the lack of adequate workforce to serve the population. Minnesota Department of Human Services

  35. Home and Community Based LTC Services • 71 of 80 responding counties (88%) responded that there have been new long-term care home and community-base services developed in the last 2 years. • 35 counties (43%) responded that services had been decreased or eliminated in the last 2 years. • 69 of 80 responding counties (86%) rated their county’s general capacity of HCBS as adequate. 11 of 80 rated their county’s general capacity of HCBS as inadequate. • 64 counties responded that there are currently some services that are inadequate or unavailable. • the biggest concern for the ability to meet HCBS needs of communities is having the necessary workforce to meet local needs. • Lack of adequate workforce is the most pressing issue facing counties in terms of providing home and community-based services • The highest priority for counties in addressing HCBS needs of their communities is managing their changing roles and expectations with the development of waiver services in managed care. Minnesota Department of Human Services

  36. Home and Community Based LTC Services Minnesota Department of Human Services

  37. Overall Housing Supply Surplus/underutilized 10.0% Inadequate 32.5% Adequate 57.5% Housing Options • 66 of 80 (82%) responded that there has been new development of senior housing or housing with services arrangements in the last 2 years. • Two-thirds reported that there are housing options in their county that they would rate inadequate or unavailable Minnesota Department of Human Services

  38. Housing Options Minnesota Department of Human Services

  39. Housing Options - Challenges • Roughly 25% of counties responded that there are housing options that are in surplus or are underutilized. Market rate rental apartments for seniors, with services, was most commonly cited as being in surplus. • Lack of affordable housing • Need to convert existing homes and apartment buildings • Changes to Alternative Care funding that eliminated Assisted Living as a funded option for people • Need for providers willing to house persons with high and complex needs, such as behavioral problems, dementia, and mental illness. Minnesota Department of Human Services

  40. Long-Term Care Beds – Nursing Facilities • Three-quarters of counties rate their overall supply of LTC nursing home beds as adequate. • However 32 counties responded that there are types of nursing home services or specialty beds that are inadequate or unavailable in their communities. • While the number of nursing home beds around the state generally appears to be adequate, there is still a need for nursing home beds for special populations, including people with dementia, people with mental illness, and people with behavioral problems. • Almost all counties expressed explicit concern over workforce issues in long-term care, especially in nursing homes. • This was the most consistent and serious gap expressed throughout this entire analysis. Minnesota Department of Human Services

  41. Long-Term Care Beds – Nursing Facilities Minnesota Department of Human Services

  42. Source of DHS Information on Regions • 2005 Transformation Survey • Advocacy groups • Community health and long-term care providers • Housing providers • Hospitals • Nursing facilities • Volunteer programs • 2005 County Gaps Analysis • County staff who administer aging programs Minnesota Department of Human Services

  43. Counties Dakota County Ramsey County Washington County Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is VERY LOW compared to the rest of the state. Workforce: The number of workers age 15-64 to support the 65+ population is VERY HIGH for the region overall, although Ramsey County has significantly fewer. Caregivers: The availability of potential family caregivers for the 85+ population is VERY HIGH for the region overall, although Ramsey County has significantly fewer. Living Alone: The percent of persons 65+ living alone is LOW in Dakota and Washington counties and HIGH in Ramsey County. East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

  44. East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

  45. East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

  46. East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

  47. East Metro Twin CitiesCapacity to Meet Needs in 2010Transformation and County Gaps Surveys • Biggest barriers: Dollars for service subsidies and unwillingness of consumers to pay true cost of aging services • Systems gaps: Cultural competence, workforce supply, care coordination between health and long-term care • Other issues: Quality assurance, consumer protection, program flexibility to ensure choice and personal direction • Nursing home bed supply: Adequate Transform 2010: Minnesota Department of Human Services January 2006

  48. East Metro Twin Cities • County Gaps Survey: Subsidized rental apartments for seniors (no services) were deemed inadequate by all three counties. Transform 2010: Minnesota Department of Human Services January 2006

  49. East Metro Twin Cities Transform 2010: Minnesota Department of Human Services January 2006

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