Bob Applebaum October 2017 Year 2000 2020 2040 Total Pop 114 117 117 millions 60 plus 19 17 30 25 34 29 ID: 700522
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Slide1
Policy Does MatterTestimony to Aging and Long-Term Care Committee Ohio House of Representatives
Bob Applebaum
October 2017Slide2
Year 2000 2020 2040
Total Pop 11.4 11.7 11.7
(millions)60 plus 1.9 (17%) 3.0 (25%) 3.4 (29%)65 plus 1.5 (13%) 2.1 (18%) 2.8 (24%)85 plus .177 (1.6%) .270 (2.3%) .553 (4.6%)
An Aging Ohio-- 2000 to 2040Slide3Slide4Slide5Slide6
2010Slide7
Health conditions % Ohio U.S. Ranking
Diabetes 24 22 38
Arthritis 57 52 44Hip fractures per 1000 6.2 5.9 33Mult chronic conditions 40 37 39Skill NF Admits per 1000 93 63
Health behaviors %
Smoking 10.2 8.8 38
Obesity 33 28 50
No leisure physical act. 36 31 42
Aging in Ohio: Health Conditions and Behaviors, 65 plusSlide8
Are Individuals Prepared for Long-Term Disability?
What is disability? Moderate shopping, getting to the doctor without help– Severe help with dressing or bathing
Will it effect me? 65 and older with some long-term disability 28.4%65-74 20.2%75-84 26.9%
85 plus 42.4%
Women higher rates than men
U.S. low Savings rate
Almost half of retirees rely on Social Security for majority of income (Avg. $1400 per month, maximum $2700)
Less than 4% of Ohioans over age 45 with LTC insuranceSlide9
Proportion of Ohio's Population Age 60 and Older with Severe Disability by Care Setting, 2015 (N=164,250)Slide10
Ohio’s
Nursing Facility Characteristics, 2015
All Nursing Facilities
County Homes
Hospital Based Long-Term Care Unit
Number of Facilities (as of 12/31/2015)
958
15
20
Licensed/certified nursing facility beds 12/31/15
Average number of beds available daily
Average number of licensed beds
92,157
91,503
95
1628
1756
103
998
1017
50
Location (percent)
Urban
Rural
76.2
23.8
46.7
53.3
80
20
Ownership (percent)
Proprietary
Not for profit
Government
79.7
18.1
2.3
—
—
100.0
36.4
54.6
9.0
Separate
Memory Care Unit (percent)
51-100
100 or more
34
41
55Slide11
Ohio Nursing Facility Admissions, Discharges, and Occupancy Rates, 1992 – 2015
1992
1999
2001
2005
2009
2011
2013
2015
NF
Beds in Service (000)
92
96
94
91
93
95
93
92
Number
of
Admissions (000)
Total
71
150
150
190
197
207
219
211
Medicaid resident
18
28
24
34
27
31
37
35
Medicare resident
30
79
91
117
109
148
145
147
Occupancy Rate (%)
91.9
83.5
83.2
86.4
84.7
83.2
83.9
84.7Slide12
Newly
Admitted Nursing Home Residents and Changes in Their Stay
Patterns
Over a Three Year Period (1994-2014)
Time Period (Percentage Remaining)
Admissions
0-3 months
At 6
months
At 9
Months
At
12 months
At 24 months
At 36
months
1994-1996
5803
56.7
41.1
35.2
32.2
24.0
NA
2001-2004
15,250
43.1
32.5
20.7
16.1
9.0
5.7
2011-2014
23,475
16.3
12.5
11.1
10.4
8.8
8.2
Medicaid* 2011-2014
4844
26.5
20.4
17.8
16.2
13.4
12.0Slide13
Demographic
Characteristics of Ohio’s
Certified Nursing Facility Residents Over Time,
1996, 2006 – 2016
1996
(
Percent)
2006
(
Percent)
2012
(
Percent)
2014
(
Percent)
2016
(
Percent)
Age
45
under
2.6
2.7
2.3
2.1
2.1
46–59
3.8
9.1
10.4
10.4
9.9
60–64
2.6
4.5
6.4
6.5
7.1
65–69
4.4
5.9
7.9
8.3
9.6
70–74
8.1
8.1
9.5
9.7
9.9
75–79
13.1
13.2
12.0
12.1
12.3
80–84
18.7
19.2
16.4
15.3
14.5
85–89
21.2
19.4
18.2
17.6
16.7
90+
25.5
17.9
16.9
18.0
17.9
Avg
Age
80.7
78.4
77.3
77.5
77.2
Female
73.5
68.5
65.5
65.1
63.8
Race
Wht
88.3
86.3
86.0
85.5
85.3
Marital
Never
13.8
15.1
16.1
16.7
17.9
Wid
/div
70.7
63.7
58.7
59.9
57.9
Married
15.5
21.2
25.2
23.4
24.2Slide14
Private Pay Nursing Home Residents Who "Spent-Down" to Medicaid, Over a Three Year Period Slide15Slide16
Ohio’s
Residential Care Facility Characteristics, 2015
All RCFs
RCF Only
Assisted Living*
Number of Facilities
655
73
582
Total licensed RCF beds
50,431
4229
46,202
Total number of units
35,979
3312
32,667
Average number of beds
77
58
79
Average number of units
55
45
56
Average Monthly Rate
(Private Non Memory)
Location (Percent)
$4044
$3921
$4056
Urban
78.8
79.5
78.8
Rural
21.2
20.6
21.2
Ownership (percent)
Proprietary
71.6
80.0
70.5
Not for profit
28.4
20.0
29.5Slide17
Occupancy and Length of Stay in Ohio’s Residential Care Facilities,
2013
– 2015
Overall
(Percentages)
RCF Only
(Percentages)
Assisted Living
(Percentages)
2013
2015
2013
2015
2013
2015
Unit Occupancy
87.8
88.9
84.2
85.3
88.5
89.3
Bed Occupancy
67.3
70.6
70.8
72.1
66.5
70.4
Average Length of Stay (Days)
867
823
877
872
865
821Slide18Slide19
31.1
31.8
31.8
32.0
35.6
34.1
35.0
35.5
33.4
33.0
31.4Slide20
Policy and the Future
Even with changes the current system is simply not
sustainable.
Short-term window where “boomer growth” remains small, before the major
increase.
The current system was never designed-- it just happened–
Meaningful
change is very
slow.
We often have policy changes with unplanned consequences. Hospital reform meant a new nursing
home. Very low Medicaid rates for AL have resulted in high rate of terminations to NF (PASSPORT 28% AL 52%).Slide21
Heavy pressure driven by Medicaid budget concerns– but most older people not on Medicaid (90%), Nationally
and in
Ohio-- Medicaid about 25% of state budget– Ohio -- 36% allocated to LTSSToday 164,000 older people with severe disability– Almost half,
about
81,000
on
Medicaid.
In
2040, 310,000
older people with severe disability– if 50%-- 155,000 on
Medicaid– not easily sustainable
Strategy needs to be to lower Medicaid use through prevention, individual planning, technology development, environmental adaptation.
Recommendations for OhioSlide22
Lowering Medicaid spend-downs by leveraging the Senior Service Levies and use of support services.
Enhancing family support through programs and policies.
Workforce will always be critical. Ohio NF’s have a 66% retention rate– varies– how can we improve?Dramatic increase in short stay residents. Pre-Admission Review process designed 25 years ago needs to be changed. (16% continue after 3 months)
Short-term stays-- implications for LTC Consumer Guide and Quality & Inspection Process
Recommendations for OhioSlide23
One in four NF residents under age 65– 45% stay less than 3 months and are being used for rehab. But a large group have a behavioral health diagnosis– 28% 0,1 ADL
impairments. MFP has made progress, but– problem continues.
Ohio has reduced supply and use of NF beds– in 2011, 29% of severely impaired elders in NF in 2015 dropped to 25%. (Oregon’s rate about 10%).LTC system must be innovative and efficient-- It will need to use technology, public-private partnerships, and new ideas such as aging friendly communities to meet our future challenges.
Recommendations for OhioSlide24
Contact info
24
Bob Applebaum Applebra@Miamioh.edu
Scrippsaging.org (Scripps web site)