2013-2018 Nursing home Bed Projections - PowerPoint Presentation

2013-2018 Nursing home Bed Projections July 25th, 2013 1

Nursing Home Bed Projections: Summary IntervalLicensed Supply Projected Need Net Shortage / Surplus Detailed Shortage / Surplus2009-20155,2005,309-109NC: +35Kent: +38Sussex: -1822010-20155,2105,830-620NC: -314Kent: -82Sussex: -2242011-20165,1485,494-346NC: -178Kent: +28Sussex: -1962012-20175,1054,973+132NC: +169Kent: -121Sussex: +842013-20185,0815,520-438NC: -217Kent: +55Sussex: -276 2

Bed Shortage / Surplus Stats: Trends Over Time 3

Variability in Projections: Why So Much Fluctuation? Data In Analysis Methods (HRMP) Data Out (NH Bed Projections)4

Variability in Projections: Why So Much Fluctuation? Data In Analysis Methods (HRMP) Data Out (NH Bed Projections)Population EstimatesCurrent Patient Day DataCurrent NH Bed CountsAllocation of Public NH Billable Pt Days5

P r i v ate FacilitiesPublicFacilitiesYearNew CastleCounty K e n t C oun t y S uss e x C oun t y T o t al P r i v a t e All FacilitiesHomesBedsHomesBedsHomesBedsHomesBedsHomesBedsHomesBeds2002262,4255530101,161414,1164655454,7712003262,4275530101,144414,1014655454,7562004262,4005521101,133414,0544653454,7072005272,5165521101,133424,1704652464,8222006262,4275530101,144414,1014655454,7562007272,5236642101,143434,3084626474,9342008262,4986642121,323444,4634626485,0892009262,5196642111,234434,3954626475,0212010262,5196642111,234434,3953591464,9862011262,5196642111,234434,3953591464,9862012272,5696672111,264444,5053576475,081 Variability in Projections: Why So Much Fluctuation? Number of NH Beds by Year 6

Number of Billable Patient Days Utilized by Year P r i vate FacilitiesPublicFacilitiesYearNew CastleCounty K e n t C oun t y S uss e x C oun t y T o t al P r i v a t e All Facilities2002801,927171,659381,1521,354,738153,4631,508,2012003793,095178,907380,1561,352,158144,0121,496,1702004816,613177,472382,2531,376,338132,6031,508,9412005800,955176,226367,3911,344,572135,6221,480,1942006809,733175,027373,2211,357,981144,3571,502,3382007830,921179,315371,5201,381,756142,8931,524,6492008833,344208,235387,7151,429,294143,6401,572,9342009824,262219,019404,2341,447,515137,5841,585,0992010838,037218,593402,1881,458,818137,8241,596,6422011829,974219,302398,5501,447,826131,6751,579,5012012843,039219,558403,8421,466,439114,1771,580,616Variability in Projections: Why So Much Fluctuation?7

Variability in Projections: Why So Much Fluctuation? 8 The context for LTC is changing Shifting toward a more community-based structure where older individuals age in place with the assistance of expanded services Delaware has implemented more robust, wrap-around, comprehensive care for its seniorsAs a result, less need for NH beds (as illustrated by decreasing utilization rates in DE public NHs)

Variability in Projections: Why So Much Fluctuation?     2013 20142015201620172018New Castle County        <65477,772478,356479,662480,895482,130483,250 65-7440,571 43,053 45,245 47,622 49,735 51,708   75-84 21,930 22,211 22,593 22,855 23,326 24,121   85+ 10,222 10,595 10,908 11,212 11,471 11,604 Kent County               <65144,206144,89614,5716146,618147,550148,368 65-7414,41815,01515,57015,96816,34316,664 75-847,5937,9128,0968,3558,5598,882 85+2,6832,7932,9413,0543,1883,309Sussex County        <65162,911164,960167,335169,868171,041172,128 65-7428,40030,20331,58832,90333,61734,264 75-8414,48915,24616,13516,99217,75518,556 85+5,0435,4975,9026,2946,6306,992Delaware Population Estimates (DPC)9

Variability in Projections: Why So Much Fluctuation? Year Public NH Billable Patient Days (Total)% Admissions to Public NH (by County)Public NH Billable Pt Days (by County)2009137,584NC: 66.7%Kent: 21.1%Sussex: 12.2%NC: 91,769Kent: 29,030Sussex: 16,7852010137,824NC: 63.0%Kent: 21.0%Sussex: 16.0%NC: 86,829Kent: 28,943Sussex: 22,0522011131,675NC: 60.0%Kent: 35.4%Sussex: 3.1%NC: 79,005Kent: 46,613Sussex: 4,0822012114,177NC: 64.5%Kent: 22.6%Sussex: 13.0%NC: 73,644Kent: 25,804Sussex: 14,843 Allocation of Public NH Billable Pt Days 10

Variability in Projections: Why So Much Fluctuation? Data In Analysis Methods (HRMP) Data Out (NH Bed Projections)Population EstimatesCurrent Patient Day DataCurrent NH Bed CountsAllocation of Public NH Billable Pt Days11

Variability in Projections: Why So Much Fluctuation? Data In Analysis Methods (HRMP) Data Out (NH Bed Projections)DE Veterans Home (Kent Co. Only)Calculation of Population Change Factor (PCF)12

PCF = weighted average of projected population changes, from the first to the last year of the projected period2013-2018 projection period:2013 = first year 2018 = last year PCFs are usually greater than 1.0When PCF > 1.0, the population is expected to increase from the first to the last year Example: a PCF of 1.17 calculated for the 2013-2018 projection period means that from 2013 to 2018, the weighted population increase is expected to be 17% Analysis Methods (HRMP): Population Change Factor (PCF)13

**Special PCF Rule**If the base year (2012) Average Daily Census is LESS THAN the Average Daily Census in the previous year (2011)AND If the percentage of occupancy in private NHs in the base year (2012) is LESS THAN 95%, A PCF of 1.0 will be used. Analysis Methods (HRMP): Population Change Factor (PCF)14

**Special PCF Rule** -- Why? Rationale:Analysis Methods (HRMP) : Population Change Factor (PCF)If the base year ADC fell from the previous year, and the base year occupancy rate is less than 95%, it is assumed that the current level of NH resources in a particular county are not “maxed out”. And, if the current level of NH resources are not “maxed out”, using a PCF of 1.0 eliminates population growth as a factor in future bed projections.Using a PCF of 1.0 “freezes” the base year Average Daily Census (2012) and holds it constant for the projected year (2018). 15

Analysis Methods (HRMP): Population Change Factor (PCF) Example: Kent County   Prior YearBase Year (2011)(2012)Private (Kent)219,302219,558Public (Kent) 46,613 25,804 Total (Kent) 265,915 245,362   Prior Year Base Year   (2011) (2012) Private (Kent) 600.8 601.5 Public (Kent) 127.7 70.7 Total (Kent) 728.5 672.2 ÷ 365… Billable Patient Days Average Daily Census (ADC) (2012 ADC) / (2011 ADC) Total (Kent) 92.3% 16

Analysis Methods (HRMP): Population Change Factor (PCF) Example: Kent County For Kent County, base year ADC (2012; 672.2) is LESS THAN the prior year ADC (2011; 728.5 ) AND the percentage occupancy for private NHs in Kent Co. in the base year (2012) is LESS THAN 95%. So, a PCF of 1.0 will be used to calculate NH bed needs for 2013-2018.17

Analysis Methods (HRMP): Population Change Factor (PCF) Example: Kent County Kent County Age GroupDE Pt Days (N) DE Pt Days (%)Kent Pop ChangeWeights (2012)(2012) (2018/2013)   <65 1664 14.2 1.03 14.59 65-74 2287 19.5 1.16 22.6 75-84 3937 33.5 1.17 39.24 85+ 3850 32.8 1.23 40.34 Total 11738 Weighted Avg. of Projected Pop Changes: 117      Calculated PCF:1.17Calculated Projected ADC: 786.5Calculated Future Bed Need: 874  FINAL PCF1.0FINAL Projected ADC:672.2FINAL Calculated Future Bed Need: 74718

**Special PCF Rule** -- Why? Effect: There is fairly strong year-to-year variability in counties’ allocation of public NH beds.Also, based on the shifting context of LTC in Delaware, a larger proportion of Delawareans are choosing to “age in place” (with the assistance of community-based services), which reduces the need for public NH beds. Thus, it is more likely that counties’ public NH billable patient days will continue to decline (which, in turn, lowers the base year ADC). If a county has fewer public NH admissions in a given year (like Kent County in 2012 or Sussex County in 2011), the base year ADC will likely be lower than the previous year ADC. Analysis Methods (HRMP): Population Change Factor (PCF)19

The current NH bed projection methodology relies heavily on population growth and county of admission as factors for calculating future bed need. Given the shifting context of LTC, a change in projection methodology – one in which home- and community-based services are factored into the equation – might serve to smooth out some of the variability in future projections, while also providing a more accurate picture of LTC needs in Delaware. Analysis Methods (HRMP) : Population Change Factor (PCF) 20

Variability in Projections: Why So Much Fluctuation? Data In Analysis Methods (HRMP) Data Out (NH Bed Projections)DE Veterans Home (Kent Co. Only)Calculation of Population Change Factor (PCF)21

In 2012, the Delaware Veterans Home (officially located in Kent County), operated 150 licensed bedsUnlike other private NHs in Kent County, the DE Veterans Home operated at a lower occupancy rate Analysis Methods (HRMP): Delaware Veterans Home (Kent Co. Only) Nursing HomeBillable Patient Days 2012Number of Licensed Beds (2012)Weighted Occupancy Rate (2012)Kent County (Private)   Capitol Healthcare41,926 120 95.7% Courtland Manor 21,685 70 84.9% Delaware Veterans Home 41,874 150 76.5% Pinnacle Rehab 51,808 151 94.0% Silver Lake Center 41,531 120 94.8% Westminster Village 20,734 61 93.1% Kent County (Private) 219,558 672 89.5% 22

The DE Veterans Home also had fewer 2012 admissions compared to other private NHs of similar bed size Analysis Methods (HRMP) : Delaware Veterans Home (Kent Co. Only)Similarly-Sized Private NHsCounty# Licensed Beds# 2012 AdmissionsDE Veterans HomeKent15033ParkviewNew Castle 150 270 ManorCare Wilmington New Castle 139 576 Pinnacle Kent 151 474 Harrison House Sussex 139 277 23

And, unlike other private NHs in Kent County, the majority of 2012 admissions to the DE Veterans Home were not Kent County residentsIn 2012, 36.4% of admissions to the DE Veterans Home were among Kent County residents Analysis Methods (HRMP): Delaware Veterans Home (Kent Co. Only) Nursing HomeNCCKentSussexMDNJPAOtherKent County (Private)              Capitol Healthcare 0.0% 99.7% 0.3% 0.0% 0.0% 0.0% 0.0% Courtland Manor 10.6% 84.8% 2.3% 0.8% 0.8% 0.0% 0.8% Delaware Veterans Home 24.2% 36.4% 36.4% 0.0% 3.0% 0.0%0.0%Pinnacle Rehab11.6%82.5%1.7%1.5%0.6%1.9%0.2%Silver Lake Center1.2%95.4%2.2%0.6%0.2%0.2%0.2%Westminster Village4.4%89.9%4.4%0.0%0.0%1.3%0.0%Kent County Total5.3%90.3%2.5%0.6%0.4%0.7%0.2%Percentage of Admissions by County and State of Residence, 201224

In summary, based on the current NH bed projection methods, the DE Veterans Home is categorized as a private NH in Kent CountyYet, it represents an “outlier” in terms of other Kent Co. private NHs Despite differences in number of admissions, occupancy rates, and the proportion of Kent County residents admitted, all 150 beds from the DE Veterans Home are assigned to Kent County as available private NH bedsThis inflates the picture of total private NH beds available to the general Kent County public and works to create a surplus bed scenario for the county Analysis Methods (HRMP) : Delaware Veterans Home (Kent Co. Only)25

Variability in Projections: Why So Much Fluctuation? Data In Analysis Methods (HRMP) Data Out (NH Bed Projections)DE Veterans Home (Kent Co. Only)Calculation of Population Change Factor (PCF)26Population EstimatesCurrent Patient Day DataCurrent NH Bed CountsAllocation of Public NH Billable Pt Days

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