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

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 – 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  2

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 35 th . 4

Washington State Operating Budget DSHS Budget T otal = $79.6 Billion T otal = $14.2 Billion Economic Services Developmental Disabilities 18.3% 15.0% All Other Agencies 82.2% DOLLARS IN MILLIONS DSHS TOTAL $ 14,184.6 Children and Family Services 1,183.3 Juvenile Rehabilitation 191.7 Long Term Care Mental Health Mental Health 2,339.1 31.7% 16.5% Developmental Disabilities 2,595.6 Aging and Adult Services 4,496.0 Economic Services 2,134.5 Alcohol and Substance 720.1 Abuse Children and Vocational Rehabilitation 124.7 Family Services Admin and Supporting 110.5 8.3% Services Special Commitment Center 80.3 Payments to Other Agencies 208.6 Special Commitment Center Alcohol and Substance Abuse 0.6% 5.1% Administration and Supporting Services Payments to Other Agencies 0.8% 1.5% 5 Vocational Rehabilitation Juvenile Rehabilitation DSHS CentralBudgetOffice, January2017 0.9% 1.5%

12% 4% 28% 2% 2% 7% 14% 31% Individual Provider Nursing Home Adult Family Home Agency Provider Adult Residential Care Assisted Living Field & HQ All Other 6 *Includes Enhanced Services Facilities, Family Caregiver Support, Respite, Senior Citizens Services Act, special projects

Rebalancing in Washington State: Funding 1 9 9 1 -19 93 Biennium 2 0 1 5 –2 017 Biennium Residential $16 2% Nursing home $816 Nursing Home 82% $1,264 In-Home 33% $2,009 In-home 53% $157 16% Residential $537 14% Dollars in Millions 7

Rebalancing in Washington State: Caseload 1 9 9 1 -19 93 Biennium 2 0 1 5 –2 017 Biennium Nursing Home 10,000 15% In-Home Nursing Home In-Home 19,000 Residential 17,000 42,000 49% 13,000 45% 65% 20% Residential 2,000 8 8 14%

Like other states, W A is riding the age wave…for the foreseeable future 9

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 10

State and Federal Costs Avoided Since FY1999 by increasing home and community options, $400,000,000 and actively reducing the need for nursing home care $350,000,000 $300,000,000 $250,000,000 $200,000,000 $150,000,000 $2.7 Billion $100,000,000 $50,000,000 Cumulative savings over 15 years $0 11 Source: David Mancuso, PhD, DSHS Research and Data Analysis, December 2014

Number of Clients by CARE Assessment Acuity Group 14,000 GROUP 1. Extremely limitedADLs, often immobile HIGHER ACUITY GROUP 2. Very limited ADLs, plus cognitive problems 12,000 GROUP 3. Moderately limitedADL, plus clinically complex GROUP 4. Moderately limitedADL and/or behavior challenge GROUP 5. Moderately limitedADL 10,000 ADL means Activities of Daily Living: 8,000 Eating, Dressing, Moving Around, T oileting, etc. 6,000 4,000 2,000 0 Adult Family Home Assisted Living Facility In-Home Clients with Clients Clients Agency or Individual Provider HIGHER ACUITY IS TO THE LEFT OF EACH SETTING Source: CARE data as of June 30, 2015 snapshot, combined clients of ALTSA and DDA. 12

Licensed and Certified Settings by Size and Type of Oversight Size Statutory Frequency of Inspection/ (number of Setting Oversight Certification residents) Skilled Nursing Facilities 90 average Federal Every 15 months (12 month average) Total 225 and State Assisted Living Facilities 60 average State Every 18 months (15 month average) Total 538 ICF/IID 16 maximum Federal Every 15 months (12 month average) (IntermediateCare Facilities for and State Individuals with Intellectual Disabilities) Adult Family Homes 6 maximum State Every 18 months (15 month average) Total 2,786 Supported Living 2-3 typical State At least every 24 months 14

Skilled Nursing Facility Survey C y Citation on 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 15

Q1 & Q2 2017 16

Q1 & Q2 2017 17

Assisted Living Survey C y Citation on Trend nds ~ ~ Top 3 3  Safety Measures Disaster Preparedness  Medication Services  Monitoring Resident Well-Being 18

2014-2016 Was ashington Proportio ion o of C Cit itat atio ions b by Sc Scope & Se Severity 80.0% 70.0% 60.0% 2014 50.0% 2015 40.0% 2016 30.0% 20.0% 10.0% 0.0% B C D E F G H I J K L Source: CASPER (11/07/2016) Graph provided by Qualis Health 19

Price-Based Payment *Phased in implementation July 2016 – July 2019 Direct care Direct Care Therapy Indirect Care From cost based to price Care Support Services Capital based Operations Quality Enhancement Property Financing Allowance Requirements: 3.4 hours per patient day • 24/7 RN onsite • *Stabilizer phased out by July 1, 2019. 20

Medicaid/Access  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 21

 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% over 2014.  Population of those that tend to fill these positions are women age 25-64; increasing at a slower pace than demand. 22

 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. 23

Members’ Survey Response Top Three Workforce Challenges 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Insufficient number of Competitive Wages Staff Turnover applicants 24

Members’ Survey Response Most Difficult Positions to Fill 64% 63% 62% 61% 60% 59% 58% RN LPN Nursing Assistants 25

Overview  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 26

Areas of Change 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. 27

 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 officer  Antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use. 28