What’s the Status of Long-Term Care Rebalancing?

1. What’s the Status of Long-Term Care Rebalancing? March 9, 2006 videoconference

2. History of Long-Term Care ReformProject 2030 • Two-year project (1997-1998) housed within DHS and in partnership with MBA. • Engaged public and private groups to answer two questions: • What does the aging of the state’s population mean for Minnesotans? • What do we need to do now and in the future to prepare – individually and collectively?

3. History of Long-Term Care ReformLong-Term Care Task Force • Composed of State Legislators and Commissioners of Health, Housing Finance and Human Services Departments. • Met during 2000 to develop recommendations for reform. • Key recommendations were implemented in the following legislative session.

4. History of Long-Term Care ReformLong-Term Care Financing Study • The 2003 MN Legislature called for a study of long-term care financing options. • Looking for a new mix of public and private approaches to financing long-term care. • Recommendations focused on private financing options available to individuals as well as system-wide efforts to meet future challenges in the financing of long-term care.

5. Current EffortTransform 2010 “Hurricane” Alert! • We know the Age Wave is coming. • We know our communities are not prepared. Hurricane Strength Predictions: • Category 3: predicted to hit our state in 5 years • Category 4: predicted to hit our state within 15 years • Category 5: disaster strikes within 25 years without preparation State of emergency has been declared. No emergency communications plan. No alternative plans until disaster is here.

6. Transform 2010 • Intensify the state’s efforts to prepare for the coming age wave in Minnesota. • Special partnership with MDH and MBA • Working with 10 other state agencies too • Identifying key strategies for action at the state, community and individual levels

7. Current EffortTransform 2010 Examples of the Age Wave in Minnesota Counties • Anoka County • Relatively young - 7.1% is age 65+ • In 2030, that percent will increase to 17.1% • Caregiver ratio is 5.8 now, will be 14.6 in 2030 • Traverse County • Smallest county in state by population (4,134) • Already experiencing the Age Wave (26.2% of population is 65+) • In 2030, that percent will increase to 31.6% • Caregiver ratio is 49.1 now, will be 52.2 in 2030

8. Current EffortTransform 2010 Some preparation for the hurricane has occurred. Over the past five years, we have taken steps to control utilization and costs of public programs. However,we must pick up the pace and broaden our efforts to be prepared for the full impact of the hurricane.

9. Current EffortTransform 2010 • Regional Meetings in January 2006. • More than 1,000 people attended and provided their input regarding strategies to prepare for the aging population. • Notes for each meeting are available on the DHS Transformation website: www.dhs.state.mn.us/2010 Then click on “2010 meetings”

10. Transform 2010Next Steps • Focus groups with tribal organizations and ethnic and immigrant communities • Citizen Workgroups • Meetings with state legislators • City-level Transform 2010 meetings • Regional and county data profiles

11. Transform 2010Demographic Data • Older Adult Population Projections • Older Adult Population Estimates by Race and Ethnicity • Elderly Dependency Ratio • Percent of Older Adult Population Living Alone • Family Caregiver Ratio

12. Percentage of 85+ by County 2000

13. Percentage of 85+ by County 2030

14. Elderly Dependency Ratio by County 2000Elderly Dependency Ratio is the ratio of 65+ population to the 15-64 population

15. Elderly Dependency Ratio by County 2030Elderly Dependency Ratio is the ratio of 65+ Population to the 15-64 Population

16. Percent 65+ Living Alone by County 2000

17. Percent 65+ Living Alone by County 2030

18. Transform 2010Benchmarks Total Public Long-Term Care Expenditures on Institutional vs. Home/Community-Based Services for the 65+ Population in Minnesota

19. Transform 2010Benchmarks Percent of Older Adults Served in Elderly Waiver and Alternative Care Programs with Higher Care Needs

20. Transform 2010Benchmarks Nursing Home Beds per 1,000 Older Adults

21. Consumer Focus • Increased effort to get input from consumers on what they want for their long-term care needs • Consumer Experience Survey of recipients of EW services as part of our overall quality effort • Survey of sample of residents in all nursing facilities in the state – on quality of life and satisfaction

22. Consumer Focus Consumer Experience Survey • 363 Elderly Waiver consumers interviewed by DHS staff and ombudsman volunteers in the summer of 2005 • Interviews conducted in consumers’ homes • Provided direct consumer feedback on what types of services they use, who gives them the most help, and if they are satisfied with how things are going in their lives

23. Consumer Experience Survey Results General Results • Seniors living in the community on EW generally are happy with where they live and feel safe in their homes • 1 in 5 consumers cannot get to the places they need to or want to go • 3 in 10 consumers are not as socially active as they want to be

24. Consumer Experience Survey Results Daily Living • Consumers get the most help with laundry and grocery shopping, which seems predictable for people with mobility and transportation challenges • Over half of interviewees have someone set up their pills and medications for them • Over half of consumers get help with taking a bath or shower • Consumers also indicate that they have the most trouble getting a bath or shower when they want to

25. Consumer Experience Survey Results Caregivers • Informal caregivers (family and friends) • More consumers get help from their daughters than anyone else at 27% • Informal caregivers give the most help with transportation and getting groceries or other shopping done

26. Consumer Experience Survey Results Caregivers • Paid staff: Consumers in general are pleased with the service they receive from paid staff • There is room for improvement in terms of scheduling – coming when they are supposed to and spending enough time with the consumer • 1 in 10 consumers report that changes in staff have been a problem for them • Three-quarters of respondents report that they did not help to choose the people who are paid to help them • The most common person to call when an EW consumer wants to change or complain about their services is their county case manager, at over 40%.

27. Consumer Experience Survey Results • 57% of consumers say that their life is better because of the help they receive. An additional 39% say that their life is about the same as it would be without the help they receive

28. Consumer Experience Survey ResultsCase Management

29. Consumer Experience Survey Results Case Management • 92% of interviewees either said that their case manager had solved a problem that they told them about, or would help them if they reported a problem • About 50% have not talked with a case manager about special equipment that could make their life easier • 60% have not experienced a change in case managers. 23% have experienced a change, but it was not a problem for them

30. Consumer Experience Survey Final thoughts • 85% of consumers say that their life is better because of the help they get • About 10% of interviewees said they needed more help or services than they are currently getting

31. Consumer Experience Survey Future plans • DHS plans to do the Consumer Experience Survey every other year as part of an overall quality improvement plan • DHS will work with counties, tribes, and health plans to develop consumer surveys that they can use on their own as well

32. Survey of Nursing Home Residents • First ever survey of NH residents on quality of life and consumer satisfaction in Minnesota • First done in spring and summer of 2005 • All nursing homes in the MA program – 400 • Sample of 13,000 people • Face-to-face interviews – all ages • Excluded only most severely cognitively impaired residents • 55 questions focusing on satisfaction

33. Autonomy Comfort Satisfaction Dignity Environmental adaptation Food enjoyment Individuality Meaningful activity Mood Privacy Relationships Security Spiritual well-being Domains Included in NH Survey

34. Survey of Nursing Home Residents • Used in nursing home report card • www.health.state.mn.us/nhreportcard • Went live on January 20, 2006 • Got 75,000 hits the first day

35. Gaps AnalysisHome and Community-Based Services • Follow-up survey to 2001 and 2003 gaps analyses by counties • 76 counties responded between August and October 2005 • Information will be used to help AAAs, DHS, and counties to develop long-term strategies for planning and development around long-term care services

36. Gaps AnalysisHome and Community-Based Services • Home and Community-Based Services • Generally adequate around the state • Counties expressed concern about the migration and integration of HCBS into managed care • 17 counties reported services in surplus, including in-home respite services, Assisted Living, Adult Day services, Grocery Shopping, and Adult Foster Care • Some communities expressed the need for these services in their communities. This underscores the point that all service development is local, and that the needs of individual communities are different.

37. Gaps AnalysisHome and Community-Based Services

38. Gaps AnalysisHome and Community-Based Services

39. Gaps AnalysisHome and Community-Based Services • The biggest concern amongst counties is having the necessary workforce to meet long-term care needs. This concern is consistent and clear, and spans both facility-based and home-based care. • Counties also expressed concern about their changing roles in regard to managed care and waiver services.

40. Gaps AnalysisHousing Options • 82% of counties responded that there has been new development of senior housing or housing with service arrangements in the last 2 years. • 211 buildings with about 5,100 new units across the state. • CS/SD or other state grants helped in this development.

41. Gaps AnalysisHousing Options

42. Gaps AnalysisHousing Options • Over half of counties think that their overall housing supply is adequate • Two-thirds of counties reported that there are housing options in short supply • Subsidized rental apartments with services and Adult Foster Care in greatest need • Other housing concerns • Lack of sufficient affordable housing • Converting existing homes and buildings into accessible living situations • Changes to Alternative Care funding for assisted living. • Need for providers to house and serve persons with high and complex needs

43. Gaps AnalysisNursing Homes • Three-quarters of counties rate their overall supply of LTC nursing home beds as adequate. • Still a significant need to develop certain types of beds, including dementia care and heavy care/complex medical management. • The major issue in Nursing Homes in the concern over adequate workforce to meet the needs of the population.

44. Consumer Directed Community Supports (CDCS) • Helps older adults needing assistance live independently at home. • Allows the consumer to be in charge of services that help them live at home. • Wraps services around the person instead of fitting the person into the services.

45. Changing Focus • From being system-focused (current paradigm) • Rules prevail • Experts “know best” • Consumer lacks direct control over needed supports • To person-centered (CDCS) • Consumer along with family and friends are “experts” • Consumer gains control over resources • Plan based on personal preferences and priorities

46. CDCS appeals to those who: • Want more control over support and services • Are willing to accept the responsibility for planning and directing their support and services • Want more flexibility • Want consistent, reliable and typically relationship-based help • Want to hire a spouse, parent of a minor, family member, friends, neighbors • Want to use a therapy that is an alternative to those available through Medical Assistance • Have special dietary needs • Need equipment and supplies directly related to their disability/healthand safety that are not fundable through any other waiver service or straight Medical Assistance

47. Research Findings on Consumer Direction • Consumer direction increases satisfaction • More people receive paid care – overcome worker shortages • Fewer total hours of care provided • Works for older adults as well as disabled • No adverse health outcomes • Programs need to help consumers with steps necessary to receive allowance

48. Transform 2010Examples of Suggestions for Action Preparing for Retirement and Old Age • Make saving easier by requiring automatic (not voluntary) “opt-in” to retirement plans at work • Provide tax incentives to employers that offer retirement planning services • Redesign retirement, employment and health benefit policies to align better with dramatic changes underway in retirement patterns, pensions and health care benefits

49. Transform 2010Examples of Suggestions for Action Preparing for Retirement and Old Age • Governor should send a letter to Minnesota households with persons ages 40-70 urging them to start planning for retirement and long-term care • Develop state-sponsored long-term care insurance-like program that includes a large risk pool and provides basic LTC coverage for all participants • Rethink current design of health insurance in order to address needs of those unable to get affordable coverage through traditional sources, e.g., early retirees, those in career change, volunteers, employees of small businesses and nonprofits

50. Transform 2010Examples of Suggestions for Action Leading Healthy Lives • Provide information and education on benefits of healthy living to all age groups. Model after no-smoking campaign. • Increase financial incentives for healthy living, e.g., reduced health premiums, individual health assessments, use of community centers, schools malls for exercise and education.