Martha & Mary Board of Directors September 6, 2017 Mission: - - PowerPoint PPT Presentation

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Martha & Mary Board of Directors September 6, 2017 Mission: - - PowerPoint PPT Presentation

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Martha & Mary Board of Directors September 6, 2017 Mission: Advocating for its members in the advancement of innovation, quality and social responsibility in aging services. Overview LTSS Spending Drives Policy Slide 3 Disruptors

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Martha & Mary Board of Directors September 6, 2017

Mission: Advocating for its members in the advancement of innovation, quality and social responsibility in aging services.

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Overview

  • LTSS Spending Drives Policy – Slide 3
  • Disruptors – Slide 13

 Survey  SNF Payment  AL Payment  Workforce  New Federal SNF Rules

  • Innovations? ~ State & Federal – Slide 30
  • LeadingAge Washington ~ Creating Solutions – Slide 47
  • Martha & Mary Board Member Engagement – Slide 55
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AARP ranks Washington state 1st in the nation for services to older adults, people with disabilities, and family caregivers. Nationally, our long-term care spending is 35th.

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DSHS Budget

T

  • tal = $14.2 Billion

Washington State Operating Budget

T

  • tal = $79.6 Billion

Mental Health

16.5%

Children and Family Services

8.3%

Long Term Care

31.7%

Economic Services

15.0%

Developmental Disabilities

18.3%

Alcohol and Substance Abuse

5.1%

Payments to Other Agencies

1.5%

Juvenile Rehabilitation

1.5%

Vocational Rehabilitation

0.9%

Administration and Supporting Services

0.8%

Special Commitment Center

0.6%

All Other Agencies

82.2%

DSHS CentralBudgetOffice, January2017

DOLLARS IN MILLIONS

DSHS TOTAL

$14,184.6

Children and Family Services

1,183.3

Juvenile Rehabilitation

191.7

Mental Health

2,339.1

Developmental Disabilities

2,595.6

Aging and Adult Services

4,496.0

Economic Services

2,134.5

Alcohol and Substance Abuse

720.1

Vocational Rehabilitation

124.7

Admin and Supporting Services

110.5

Special Commitment Center

80.3

Payments to Other Agencies

208.6

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31% Individual Provider Adult Family Home Adult Residential Care Field & HQ Nursing Home Agency Provider Assisted Living All Other 28% 14% 2% 2% 7% 4% 12%

*Includes Enhanced Services Facilities, Family Caregiver Support, Respite, Senior Citizens Services Act, special projects

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Rebalancing in Washington State: Funding

Nursing home $816 82% Residential $16 2% In-home $157 16%

1 9 9 1 -19 93 Biennium 2 0 1 5 –2 017 Biennium

Dollars in Millions

In-Home $2,009 53% Residential $537 14% Nursing Home $1,264 33%

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Rebalancing in Washington State: Caseload

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1 9 9 1 -19 93 Biennium 2 0 1 5 –2 017 Biennium

Nursing Home 17,000 45% Residential 2,000 14% In-Home 19,000 49% Nursing Home 10,000 15% Residential 13,000 20% In-Home 42,000 65%

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Like other states, W A is riding the age wave…for the foreseeable future

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Projection of Alzheimer’s Dementia in Washington 2010-2040

Fewer than half of people with dementia receive a diagnosis The dementia population has more than 3x the number of hospital stays annually Older African Americans are 2x as likely and Latinos 1.5x as likely to have dementia

Data Source: SFY 2016 Data Compendium PDQ Citation Frequency Report

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$0 $50,000,000 $100,000,000

State and Federal Costs Avoided Since FY1999

$350,000,000 $300,000,000 $250,000,000 $200,000,000 $150,000,000 $400,000,000

by increasing home and community options, and actively reducing the need for nursing home care

$2.7 Billion

Cumulative savings over 15 years

Source: David Mancuso, PhD, DSHS Research and Data Analysis, December 2014

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Eating, Dressing, Moving Around, T

  • ileting, etc.

6,000 4,000 2,000 8,000 10,000 12,000

Adult Family Home Clients Assisted Living Facility Clients In-Home Clients with Agency or Individual Provider

GROUP 1. Extremely limitedADLs, often immobile GROUP 2. Very limited ADLs, plus cognitive problems GROUP 3. Moderately limitedADL, plus clinically complex GROUP 4. Moderately limitedADL and/or behavior challenge GROUP 5. Moderately limitedADL

ADL means Activities of Daily Living:

14,000

HIGHER ACUITY HIGHER ACUITY IS TO THE LEFT OF EACH SETTING

Source: CARE data as of June 30, 2015 snapshot, combined clients of ALTSA and DDA.

Number of Clients by CARE Assessment Acuity Group

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Licensed and Certified Settings

by Size and Type of Oversight

Size Statutory Frequency of Inspection/ Setting

(number of residents)

Oversight Certification

Skilled Nursing Facilities Total 225 90 average Federal and State Every 15 months

(12 month average)

Assisted Living Facilities Total 538 60 average State Every 18 months

(15 month average)

ICF/IID

(IntermediateCare Facilities for Individuals with Intellectual Disabilities)

16 maximum Federal and State Every 15 months

(12 month average)

Adult Family Homes Total 2,786 6 maximum State Every 18 months

(15 month average)

Supported Living 2-3 typical State At least every 24 months

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Survey C y Citation

  • n Trend

nds

  • Lead Nation in number of citations written
  • Lead Nation in IJ “Actual Harm” citations
  • Increased civil monetary penalties ~ CMS adjusts

algorithm

  • Top Citations SNF

 Provide Care/Svcs Highest Practicable  Environment Free of Hazards  Unnecessary Drugs

Investigations-Ruling out Abuse and Neglect

Skilled Nursing Facility

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Q1 & Q2 2017

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Q1 & Q2 2017

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Survey C y Citation

  • n Trend

nds ~ ~ Top 3 3

Safety Measures Disaster Preparedness Medication Services Monitoring Resident Well-Being

Assisted Living

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0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% B C D E F G H I J K L

Was ashington Proportio ion o

  • f C

Cit itat atio ions b by Sc Scope & Se Severity

2014 2015 2016

Source: CASPER (11/07/2016) Graph provided by Qualis Health

2014-2016

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Price-Based Payment

*Phased in implementation July 2016 – July 2019

Direct care Indirect Care Capital Quality Enhancement

Direct Care Therapy Care Support Services Operations Property Financing Allowance Requirements:

  • 3.4 hours per patient day
  • 24/7 RN onsite

From cost based to price based *Stabilizer phased out by July 1, 2019.

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  • Assisted Living Chronically Underfunded
  • Payments Are Established Using Flawed Methodology
  • Average Daily Payment = $69
  • Rational & Reasonable Benchmarks Produce a

Funding Shortfall of $36-$50 million GF-S biennial cost

  • Medicaid Access to Assisted Living is Decreasing

While Census in AFHs and In-Home Care is Climbing

Medicaid/Access

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  • Bureau of Labor Statistics estimates an additional

1.1 million direct care workers (NA-C, HH Aide, PC Aide) will be needed by 2024; an increase of 26%

  • ver 2014.
  • Population of those that tend to fill these positions

are women age 25-64; increasing at a slower pace than demand.

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  • Wages for direct care workers have stagnated ~

average national hourly wage is $10.11.

  • WA statewide minimum wage is $11.00 and will

increase to $13.50 by 2020; surpassing Tacoma but not Seattle.

  • Unemployment rate is decreasing from a high of over

10% in 2009/2010 to 4.7% today, in Washington state.

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Members’ Survey Response

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00%

Insufficient number of applicants Competitive Wages Staff Turnover

Top Three Workforce Challenges

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Members’ Survey Response

58% 59% 60% 61% 62% 63% 64%

RN LPN Nursing Assistants

Most Difficult Positions to Fill

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  • The Centers for Medicare & Medicaid

Services (CMS) issued a final rule in October, 2016, making substantial changes to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs.

  • Revisions are the first major rewrite of the

conditions of participation for long-term care facilities since 1991

Overview

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  • Changes include:

 Strengthening the rights of long-term care facility residents,  Ensuring that long-term care facility staff members are properly trained on

caring for residents with dementia and in preventing elder abuse.

 Ensuring that long-term care facilities take into consideration the health of

residents when making decisions on the kinds and levels of staffing a facility needs to properly take care of its residents.

 Ensuring that staff members have the right skill sets and competencies to

provide person-centered care to residents. The care plans developed for residents will take into consideration their goals of care and preferences.

Areas of Change

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 Improve care planning  Competency based training for licensed staff  Giving residents accurate information they need for follow-up after

discharge  Updating the long-term care facility’s infection prevention

and control program

 New requirement of an infection prevention and control

  • fficer

 Antibiotic stewardship program that includes antibiotic

use protocols and a system to monitor antibiotic use.

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  • Effective November, 2017
  • Risk Assessment and Emergency Planning (Include but not limited to):
  • Hazards likely in geographic area
  • Care-related emergencies
  • Equipment and Power failures
  • Interruption in Communications, including cyber attacks
  • Loss of all/portion of facility
  • Loss of all/portion of supplies
  • Plan is to be reviewed and updated at least annually
  • Communication Plan
  • Complies with Federal and State laws
  • System to Contact Staff, including patients’ physicians, other necessary persons
  • Well-coordinated within the facility, across health care providers, and with state and local

public health departments and emergency management agencies.

  • Policies and Procedures
  • Complies with Federal and State laws
  • Training and Testing
  • Complies with Federal and State laws
  • Must complete training with local emergency management authorities
  • Maintain and at a minimum update annually

LeadingAge WA App

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Medica caid T Transformati ation D Demonstr trat ation – August 2 t 2017 7 Im Implementation

  • Leveraging federal funding for implementation of person-

centered options to delay or divert people 55+ from more costly services. 5-year demonstration with $58.9M total funds

  • Medicaid Alternative Care (MAC) -A new choice designed

to support unpaid caregivers in continuing to provide quality care

  • Tailored Supports for Older Adults (TSOA) - A new

eligibility group to support individuals who need Long- term Services and Supports and are at risk of spending down to impoverishment

2017/19 Budget

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Resource D Development, Co Community Ca Capac acity & & Regulat atory y Reform

  • Person-centered care model
  • Secure community options including Enhanced Services Facilities
  • Intensive case management around transitions and service planning
  • Training and consultation to strengthen capacity of current and

additional residential resources

  • Monitoring and oversight of contractors, quality assurance
  • Additional Supportive Housing
  • Enhanced rates that provide for:

 Higher staffing ratios  Increased worker skill set  Additional residential providers with specialty expertise particularly in rural

areas

 24/7 response for clients and providers when behavior escalation occurs

Overview

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Indi dividu dual F Fea eatures S Served ed IN MH Transforma mation

  • Typically, individual not previously served by ALTSA or has extensive history with

behavioral health and history of challenges in ALTSA placement

Indi dividu dual e exper erien ences es b barrier ers to comm mmunity living o g options d due to:

  • Behavioral challenges that would put other ALTSA clients at risk
  • High need for supervision and intervention (often requiring more than one

caregiver), which takes time away from other staff and/or requires a higher level

  • f staffing
  • ALTSA funding does not support higher staffing for supervision only

Care e needs eeds are differen ent from t m typical A ALTSA SA c clien ent:

  • Low personal care needs (CARE classification B Low)
  • Younger than typical ALTSA client
  • May only need medication management or supervision
  • High behavioral and mental health support needs

Client Features

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Post Acute

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Discharge to Home

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Post Acute

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Overview

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National Enrollment

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National Enrollment by Plan

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Enrollment by State

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Washington State

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Enrollee Percent by County

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Conclusion

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  • Leadi

dingA gAge ge Wash shing ngton M n Members Ey Eyeing ng Shifting ng Land ndscape

 Exploring Mission and Viability ~ Right Mission for Tomorrow?  Exploring Market Position ~ Identifying Strengths & Value to Hospitals,

Managed Care and Government Payors

 (Re)Positioning SNF, AL, IL  Growing Traditional Service Lines ~ Can We Expand Beyond Campus Walls,

Should We?

 Expand or Create Opportunities to Serve Dementia, TBI, Mental Health  Other New Services ~ Family Caregiver Support, Respite, CCRC without

Walls ~ Low Capital Cost, Fulfill Need, Attract Market

 Partnership Opportunities ~ Can we Leverage our Strengths through

Partnerships ~ Hospital Systems, Post-Acute Providers, Community Based Services

 Efficiency ~ Reduce Costs Maintain Competitive Edge  Talent Development ~ Clinical Rotation Site, High Schools, Staff Growth  Stay Informed, Be Engaged, Advocate!

Solutions

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  • Advocate for Increased Medicaid SNF Funding

 Rebase Funding for July 1, 2018 payments likely inadequate  Minimum Wage Costs are Unaddressed until 2020 when 2018 Cost Reports

and Payment Rebasing Capture added Wage Cost

 Continue Stabilizer, If Needed

  • Advocate for Improved Assisted Living Payment Model Following

Legislative Success ~ New Funding!

  • Member Support & Education to Understand Implications of

Changes

  • Workforce Solutions Council
  • LeadingCare Network NW ~ Expected Launch October 1st

Solutions

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Overview

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Value to Payors

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Value to SNF ~ Post Acute

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Value to LTSS ~ Long Stay SNF & AL

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Value to Housing

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  • Understand Changing Landscape ~ Where are We Going?
  • What are the Opportunities Ahead?
  • Mission Relevance?
  • Organizational Priorities?
  • Lead, Advocate, Innovate
  • All Hands on Deck!
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www.LeadingAgeWA.org (253) 964-8870 info@LeadingAgeWA.org