Long-Term Care in Minnesota: Past, Present, and Future Trends for Senior Services in Minnesota Todd Bergstrom Care Providers of Minnesota

Long-Term Care in Minnesota:

Past, Present, and Future Trends for

Senior Services in Minnesota

Todd Bergstrom

Care Providers of Minnesota

Topics

Past (a review of trends)

Present (a look at the Gaps Summary Analysis

Future (Where do present trends may take us)

The Past

Length of Stay Number of providers Demographics

Declining Length of Stay in Minnesota Nursing Facilities

Source: Minnesota Department of Health

405

658

4099

0

100

200

300

400

500

600

700

1990 1992 1994 1996 1998 2000 2002 2004

Mean Median

Minnesota Nursing Facility Resident Days

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1991 1994 1997 2000 2003

Medicare Days Other Days

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

1991 1994 1997 2000 2003

Private Days Medicaid Days

Number of Housing with Services Establishments vs. Number of Nursing Facilities in Minnesota

148

316

383

445

559

686

741

871

926

1,000

10491,028440 440

438435

432

420417

413

409

401398

396

0

200

400

600

800

1000

1200

1996 1997 1998 1999 2000 2001 2002 2003 Mid 2004 5-Jun 5-Nov Apr-06

370

380

390

400

410

420

430

440

450

Number Sites Registered for Housing with Services Number of Nursing Homes

Care Providers of Minnesota

Monthly Average Medicaid Nursing Facility Residents

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Est.2006

Est.2007

Est.2008

Est.2009

Monthly Average MA Nursing Facility Residents

Source: February 2006 DHS Forecast

Monthly Average Medicaid EW Service Recipients

0

5,000

10,000

15,000

20,000

25,000

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Est.2006

Est.2007

Est.2008

Est.2009

EW - Fee for Service EW - Managed Care


Monthly Average Medicaid LTC Waivers & Home Care*

0

10,000

20,000

30,000

40,000

50,000

60,000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Est.2006

Est.2007

Est.2008

Est.2009

Monthly Average


* Payments for MA home and community-based waivers, home health agency services, personal care and private duty nursing services.

Age Distribution ofElderly Waiver Recipients

96

596

2,101

3,2013,094

2,533

1,935

1

3,671

100+95-9990-9485-8980-8475-7970-7465-6960-64

FY 2005

Total Annual Payments – State Share

$0

$100,000,000

$200,000,000

$300,000,000

$400,000,000

$500,000,000

$600,000,000

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Est.2006

Est.2007

Est.2008

Est.2009

Nursing Facility EW - Fee for Service EW - Managed Care


Operating Margin

-3.00%

-2.00%

-1.00%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

Me

dia

n

Region

2001 3.20% 3.60% 5.90% 2.20% 4.70% 1.00% -1.70% 2.30%

2002 1.32% 3.51% 3.93% 1.50% 3.74% 1.06% -0.82% 1.31%

2003 1.32% -0.20% 2.53% 1.58% 2.33% 0.15% -0.84% 0.38%

2004 3.58% 1.41% 0.52% 1.67% -0.76% -0.05% -0.38% 0.46%

2005 0.98% -0.04% 2.63% 0.01% -2.48% -1.01% 0.60% 0.14%

North West

North EastWest

CentralEast

CentralSouth West

South East

Metro Total

Imperative Nursing Facility SurveyPrepared by Larson, Allen, Weishair & Co., LLP

Percent Days by Payor

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Me

dia

n

Region

MA 72.8% 69.1% 68.0% 62.9% 52.9% 59.7% 60.1% 61.3%

MC A 5.7% 13.2% 8.3% 10.2% 10.0% 10.3% 8.9% 9.4%

OTHER 20.9% 19.2% 23.1% 29.2% 37.3% 30.2% 29.9% 28.7%

North West

North East

West Central

East Central

South West

South East

Metro Total


Percent Revenues by Payor

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%M

ed

ian

Region

MA 68.7% 59.1% 60.0% 50.6% 46.9% 49.4% 50.5% 51.3%

MC A 11.5% 24.5% 16.0% 20.4% 19.9% 20.9% 16.1% 18.4%

MC B 1.2% 2.3% 2.2% 1.9% 1.5% 2.1% 1.3% 1.6%

OTHER 19.1% 19.0% 22.7% 26.0% 34.0% 28.3% 27.3% 26.6%

North West

North East

West Central

East Central

South West

South East

Metro Total


Average Age of Facility


0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Me

dia

n

Region

2001 11.2 5.4 12.0 13.5 12.5 9.7 11.3 11.9

2002 11.1 6.7 12.6 14.4 12.8 9.9 11.6 11.8

2003 12.7 9.4 13.2 14.5 13.9 11.3 12.2 12.6

2004 14.0 8.7 14.5 14.5 14.4 11.8 12.5 13.0

2005 17.2 6.1 14.7 11.6 14.7 10.4 13.5 13.2

North West

North East

West Central

East Central

South West

South East

Metro Total

MinnesotaPopulation 65 to 84 and 85 Plus

0

500,000

1,000,000

1,500,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+

Source: Population Projections from the State of Minnesota Demographer

CPM Region 1 Population 65 to 84 and 85 Plus

0

20,000

40,000

60,000

80,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+


CPM Region 2 Population 65 to 84 and 85 Plus

0

20,000

40,000

60,000

80,000

100,000

120,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+


CPM Region 3Population 65 to 84 and 85 Plus

0

20,000

40,000

60,000

80,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+



0

50,000

100,000

150,000

200,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+



0

20,000

40,000

60,000

80,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+



0

200,000

400,000

600,000

800,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+



0

20,000

40,000

60,000

80,000

100,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+



0

20,000

40,000

60,000

80,000

2000 2005 2010 2015 2020 2025 2030

65 to 84 85+


Minnesota: Aging Population as a Percent of 20 to 64 Population

0.00%

10.00%

20.00%

30.00%

40.00%

2000 2005 2010 2015 2020 2025 2030

Percent 65 Plus to Population 20 to 64



CPM Region 1: Aging Population as a Percent of 20 to 64 Population

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2000 2005 2010 2015 2020 2025 2030





0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2000 2005 2010 2015 2020 2025 2030





0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2000 2005 2010 2015 2020 2025 2030





0.00%

10.00%

20.00%

30.00%

40.00%

2000 2005 2010 2015 2020 2025 2030





0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

2000 2005 2010 2015 2020 2025 2030





0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%

2000 2005 2010 2015 2020 2025 2030





0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

2000 2005 2010 2015 2020 2025 2030





0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

2000 2005 2010 2015 2020 2025 2030




The Present: Long-Term Care Gaps Analysis 2005 Update Survey

Minnesota’s counties were asked to complete the following survey in order to re-assess the gaps that exist in long-term care and home and community-based services in their communities. Counties were asked to submit their responses through a web-based survey tool called SnapSurvey. The invitation was initially sent out through a bulletin. Reminders were sent to Long Term Care Consultation administrative contacts at counties.

Seventy-six counties and/or county collaborations responded to this survey between August 12, 2005, and October 27, 2005. Although Minnesota has 87 counties, the maximum number of possible responses for this survey was 84, due to collaborations

http://www.dhs.state.mn.us/main/groups/aging/documents/pub/DHS_id_054450.hcsp The following summarizes statewide findings

Minnesota Department of Human Services

General Findings HCBS. Generally speaking, counties believe that home and community-based

services around the state are adequate. However, there is still need for service development in particular counties and

in particular services, including transportation, evening and weekend care and respite services, chore services, and adult day services.

Counties are also concerned about how the migration of HCBS into managed care will affect access and quality of services.

Housing. Housing needs for average income and high-functioning persons with disabilities and elderly are adequate around the state. There is still a great need to address affordable housing for people around the

state, and to develop housing options for persons with complex needs. In addition, there is a need for home and apartment modifications, so people

can continue to live in their own communities with limited mobility. Nursing facilities. The number of nursing home beds around the state is generally

adequate. Although some communities have concerns about the distance that people

must travel to get to them. There is still a need to develop nursing home beds for special needs

populations. The most pressing concern for nursing home care is the lack of adequate

workforce to serve the population.


Home and Community Based LTC Services 71 of 80 responding counties (88%) responded that there have been

new long-term care home and community-base services developed in the last 2 years.

35 counties (43%) responded that services had been decreased or eliminated in the last 2 years.

69 of 80 responding counties (86%) rated their county’s general capacity of HCBS as adequate. 11 of 80 rated their county’s general capacity of HCBS as inadequate.

64 counties responded that there are currently some services that are inadequate or unavailable.

the biggest concern for the ability to meet HCBS needs of communities is having the necessary workforce to meet local needs.

Lack of adequate workforce is the most pressing issue facing counties in terms of providing home and community-based services

The highest priority for counties in addressing HCBS needs of their communities is managing their changing roles and expectations with the development of waiver services in managed care.


Home and Community Based LTC Services

0 5 10 15 20 25 30 35

Long-Term Care Consultation / Relocation 1

Long-Term Care Consultation / Community Assessment1

Adult Protection2

Non-County Information/Referral and Assistance3

Case Management (provided by county)3

Fiscal Intermediary5

End-of-life, hospice, palliative care6

Home Health Aide6

Non-County Case Management7

Skilled Nursing7

Insurance Counseling / Forms Assistance9

Homemaking10

Assisted Living11

Home Modification11

Personal Care11

Home Delivered Meals11

Grocery Shopping12

Guardianship / Conservatorship14

In-Home Respite and Caregiver Support19

Companion Services25

Adult Day Services27

Chore Services30

Evening and Weekend Care32

Transportation35

HCBS Inadequate or Unavailable Services


Housing Options

Inadequate

32.5%

Adequate

57.5%

Surplus/underutilized

10.0%

Overall Housing Supply

66 of 80 (82%) responded that there has been new development of senior housing or housing with services arrangements in the last 2 years.

Two-thirds reported that there are housing options in their county that they would rate inadequate or unavailable


Housing Options

0 5 10 15 20 25 30 35

Board and Lodging (with services)27

Adult Foster Care33

Market rate rental apartments for seniors (with services), e.g. Assisted Living14

Market rate rental apartments for seniors (no services)13

Subsidized rental apartments for seniors (with services), e.g. Assisted Living35

Subsidized rental apartments for seniors (no services)33

Number of Counties Reporting Inadequate or Unavailable Housing,by type of housing


Housing Options - Challenges Roughly 25% of counties responded that there are

housing options that are in surplus or are underutilized. Market rate rental apartments for seniors, with services, was most commonly cited as being in surplus.

Lack of affordable housing Need to convert existing homes and apartment buildings Changes to Alternative Care funding that eliminated

Assisted Living as a funded option for people Need for providers willing to house persons with high

and complex needs, such as behavioral problems, dementia, and mental illness.


Long-Term Care Beds – Nursing Facilities Three-quarters of counties rate their overall supply of

LTC nursing home beds as adequate. However 32 counties responded that there are types of nursing

home services or specialty beds that are inadequate or unavailable in their communities.

While the number of nursing home beds around the state generally appears to be adequate, there is still a need for nursing home beds for special populations, including people with dementia, people with mental illness, and people with behavioral problems.

Almost all counties expressed explicit concern over workforce issues in long-term care, especially in nursing homes.

This was the most consistent and serious gap expressed throughout this entire analysis.


Long-Term Care Beds – Nursing Facilities

0

5

10

15

20

25

30

Number of counties responding

17

26

3

Post-acute / rehabilitation

Dementia care

Heavy care, complex medical management

Unavailable Nursing Home/Specialty Services


Source of DHS Information on Regions 2005 Transformation Survey

Advocacy groups Community health and long-term care providers Housing providers Hospitals Nursing facilities Volunteer programs

2005 County Gaps Analysis County staff who administer aging programs


East Metro Twin Cities

Counties Dakota County Ramsey County Washington County

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is VERY LOW compared to the rest of the state.

Workforce: The number of workers age 15-64 to support the 65+ population is VERY HIGH for the region overall, although Ramsey County has significantly fewer.

Caregivers: The availability of potential family caregivers for the 85+ population is VERY HIGH for the region overall, although Ramsey County has significantly fewer.

Living Alone: The percent of persons 65+ living alone is LOW in Dakota and Washington counties and HIGH in Ramsey County.

Transform 2010: Minnesota Department of Human Services January 2006







East Metro Twin CitiesCapacity to Meet Needs in 2010Transformation and County Gaps Surveys

Biggest barriers: Dollars for service subsidies and unwillingness of consumers to pay true cost of aging services

Systems gaps: Cultural competence, workforce supply, care coordination between health and long-term care

Other issues: Quality assurance, consumer protection, program flexibility to ensure choice and personal direction

Nursing home bed supply: Adequate



County Gaps Survey: Subsidized rental apartments for seniors (no services) were deemed inadequate by all three counties.




West Metro Twin Cities

Counties Anoka County Carver County Hennepin County Scott County

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is VERY LOW compared to the rest of the state.

Workforce: The number of workers age 15-64 to support the 65+ population is consistently VERY HIGH.

Caregivers: The availability of potential family caregivers for the 85+ population is consistently VERY HIGH, but decreases slightly over the next twenty years.

Living Alone: The percent of persons 65+ living alone is VERY LOW in Scott & Carver, SOMEWHAT LOW in Anoka & Hennepin.








West Metro Twin CitiesCapacity to Meet Needs in 2010Transformation and County Gaps Surveys

Biggest barriers: Dollars for service subsidies and workforce shortage

Systems gaps: Cultural competence and program flexibility to allow for more choice and personal direction

Other issues: Access to information and assistance, care coordination between health and long-term care and workforce supply

Nursing home bed supply: Adequate



County Gaps Survey: subsidized rental apartments for seniors (no services) and adult foster care homes identified as inadequate or unavailable.




Rochester Area

Counties Dodge Olmsted Fillmore Rice Freeborn Steele Goodhue Wabasha Houston Winona Mower

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is LOW in central/northern counties, SOMEWHAT HIGH in southern counties.

Workforce: The number of workers age 15-64 to support the 65+ population is HIGH in central/northern counties, CLOSE TO AVERAGE in southern counties.

Caregivers: The availability of potential family caregivers for the 85+ population is SOMEWHAT HIGH in central/northern counties, until 2030 when it is SOMEWHAT LOW. The availability for southern counties is consistently SOMEWHAT LOW.

Living Alone: The percent of persons 65+ living alone is SOMEWHAT LOW, until 2030 when it increases slightly. The percent living alone in southern counties is CLOSE TO AVERAGE, until 2030 when it increases slightly.


Rochester AreaPercent of Older Adults Served in AC & EW Programs with Higher Care Needs


0

10

20

30

40

50

60

70

Minn

esot

a

Dodge

Fillmore

Freeb

orn

Goodh

ue

Housto

n

Mow

er

Olmste

dRice

Steele

Waba

sha

Wino

na

FY 2000

FY 2004

Rochester AreaNumber of Nursing Home Beds per 1,000 85+, 2001 and 2005


0

100

200

300

400

500

600

700

Minn

esot

a

Dodge

Fillmore

Freeb

orn

Goodh

ue

Housto

n

Mow

er

Olmste

dRice

Steele

Waba

sha

Wino

na

Rochester AreaWhat You Told Us About Current Supply of HCBSTransformation Survey Results


0 10 20 30 40 50 60 70 80 90

Transportation

Chore

In-Home Respite

Evg & Wknd Care

LTCC/Comm Assmt

LTCC/Reloc

Home Mods

Grdnship/Consrvtrship

Adult Prot

Info, Refer & Asst

Percent of Respondents

Unavailable

Inadequate

Adequate

Surplus

Rochester Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys


Systems gaps: workforce and cultural competence

Other issues: service and program flexibility to ensure choice and personal direction, quality and consumer protection system for private homes and other settings

Nursing home bed supply: adequate


Rochester AreaWhat You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: subsidized rental apartments (with services) were deemed most inadequate.


0 20 40 60 80

Mkt Rate Rental - No Svs

Subsidized Rental - No Svs

Mkt Rate Rental - w/ Svs

Subsidized Rental - w/ Svs

Small Service Settings


Unavailable

Inadequate

Adequate

Surplus

Rochester AreaWhat You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 20 40 60 80 100

Primary Health Care

Geriatric Specialty Care

Other Specialty Care

Hospital Care

Pharmacy

Fac-based End-of-Life

Fac-based Post-acute Rehab


Unavailable

Inadequate

Adequate

Surplus

Willmar Area

Counties Big Stone Meeker Chippewa Renville Kandiyohi Swift Lac qui Parle Yellow Medicine McLeod

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is HIGH in the western counties and SOMEWHAT LOW in the eastern counties.

Workforce: The number of workers age 15-64 to support the 65+ population is LOW in the western counties and CLOSE TO STATE AVERAGE in the eastern counties.

Caregivers: The availability of potential family caregivers for the 85+ population is LOW in the western counties, until 2030 when it becomes even lower. The availability in the eastern counties is consistently SOMEWHAT LOW.

Living Alone: The percent of persons 65+ living alone is HIGH in the western counties but decreases slightly by 2030. The percent is LOW in the eastern counties but increases by 2030.


Willmar AreaPercent of Older Adults Served in AC & EW Programs with Higher Care Needs


0102030405060708090

Minn

esot

a

Big Sto

ne

Chippew

a

Kandiy

ohi

Lac q

ui Parle

McL

eod

Mee

ker

Renville

Swift

Yellow

Med

icine

FY 2000

FY 2004

Willmar AreaNumber of Nursing Home Beds per 1,000 85+, 2001 and 2005


0100200300400500600700800

Minn

esot

a

Big Sto

ne

Chippew

a

Kandiy

ohi

Lac q

ui Parle

McL

eod

Mee

ker

Renville

Swift

Yellow

Med

icine

Willmar AreaWhat You Told Us About Current Supply of HCBSTransformation Survey Results


0 20 40 60 80 100

Transportation

Skilled Nursing

Home Delivered Meals

Evening & Weekend Care

Congregate Meals

Companion Services

Adult Protection


Unavailable

Inadequate

Adequate

Surplus

Willmar Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys


Systems gaps: service and program flexibility to ensure choice and personal direction, cultural competence and workforce supply

Other issues: quality and consumer protection system for private homes and other settings, and access to information and assistance for all persons



Willmar AreaWhat You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: adult foster care and board & lodging were deemed inadequate by two counties. Adult foster care was also deemed in surplus or underutilized by two counties.


0 20 40 60 80 100






Home Mods


Unavailable

Inadequate

Adequate

Surplus

Willmar AreaWhat You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 20 40 60 80 100

Primary Health Care

Pharmacy

Hospital Care


Fac-based End-of-Life

Fac-based Rehab


Unavailable

Inadequate

Adequate

Surplus

Marshall Area

Counties Cottonwood Nobles Jackson Pipestone Lincoln Redwood Lyon Rock Murray

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is consistently HIGH in most counties in the area. Jackson, Lyon and Nobles will have LOW percentages of older adults, until 2030 when the proportion will increase slightly.

Workforce: The number of workers age 15-64 to support the 65+ population is LOW in most counties in the area and SOMEWHAT HIGH in Jackson, Lyon and Nobles.

Caregivers: The availability of potential family caregivers for the 85+ population is LOW in all counties into 2010. In 2030, most counties will experience an increase in availability.

Living Alone: The percent of persons 65+ living alone decreases over time for most counties, however Pipestone, Lyon and Nobles start with HIGH percents in 2000. Murray will experience an increase.


Marshall Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs


05

1015202530354045

Minn

esot

a

Cottonw

ood

Jack

son

Linco

lnLy

on

Mur

ray

Nobles

Pipesto

ne

Redwood

Rock

FY 2000

FY 2004

Marshall Area Number of Nursing Home Beds per 1,000 85+, 2001 and 2005


0

100

200

300

400

500

600

700

Marshall AreaWhat You Told Us About Current Supply of HCBSTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100

Transportation

Congregate Meals

Skilled Nursing

Companion Services

Evening and Weekend Care

Home Modification


Unavailable

Inadequate

Adequate

Surplus

Marshall Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys


Systems gaps: cultural competence and workforce supply

Other issues: program flexibility to ensure personal choice and direction, and quality and consumer protection system for private homes and other settings

Nursing home bed supply: half of the counties reported supply as adequate, half as surplus


Marshall Area What You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: adult foster care and board & lodging were deemed inadequate by two counties. Adult foster care was also deemed in surplus or underutilized by two counties.


0 10 20 30 40 50 60 70 80






Home Mods


Unavailable

Inadequate

Adequate

Surplus

Marshall Area What You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100

General Primary Care


Hospital Care

Pharmacy

Fac-based End-of-Life Care


Unavailable

Inadequate

Adequate

Surplus

Mankato Area

Counties Blue Earth Nicollet Brown Sibley Faribault Waseca Le Sueur Watonwan Martin

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is HIGH in the two southern counties, CLOSE TO STATE AVERAGE in the mid-region counties, and LOW in the northern counties.

Workforce: The number of workers age 15-64 to support the 65+ population is VERY LOW in the southern counties, CLOSE TO STATE AVERAGE in the mid-region counties, and HIGH in the northern counties.

Caregivers: The availability of potential family caregivers for the 85+ population is LOW in 2000 and decreases even further in 2030 for the southern and mid-region counties. The availability is LOW in 2000 for the northern counties but increases in 2030.

Living Alone: The percent of persons 65+ living alone is consistently HIGH in the southern and mid-range counties, except for Waseca which is consistently VERY LOW. The northern counties are CLOSE TO STATE AVERAGE.


Mankato Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs


05

1015202530354045

Minn

esot

a

Blue E

arth

Brown

Faribau

lt

Le S

ueur

Mar

tin

Nicolle

t

Sibley

Wase

ca

Waton

wan

FY 2000

FY 2004

Mankato Area Number of Nursing Home Beds per 1,000 85+, 2001 and 2005


0

100

200

300

400

500

600

Minn

esot

a

Blue E

arth

Brown

Faribau

lt

Le S

ueur

Mar

tin

Nicolle

t

Sibley

Wase

ca

Waton

wan

Mankato Area What You Told Us About Current Supply of HCBSTransformation Survey Results


0 10 20 30 40 50 60 70 80 90

Transportation

Home Del Meals

Congregate Meals

Skilled Nursing


Home Modification

Adult Protection

Info, Referral & Assistance


Unavailable

Inadequate

Adequate

Surplus

Mankato Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys

Biggest barriers: workforce supply and cultural competence

Systems gaps: service and program flexibility to ensure choice and personal direction, and quality and consumer protection system for private homes and other settings



Mankato Area What You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: adult foster care was identified as inadequate.


0 10 20 30 40 50 60 70 80







Unavailable

Inadequate

Adequate

Surplus

Mankato Area What You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100



Hospital Care

Pharmacy

Facility Based Dementia Care


Unavailable

Inadequate

Adequate

Surplus

St. Cloud Area

Counties Benton Morrison Cass Pine Chisago Sherburne Crow Wing Stearns Isanti Todd Kanabec Wadena Mille Lacs Wright

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is CLOSE TO STATE AVERAGE in the counties outside the St. Cloud metro area and LOW in the St. Cloud metro area counties.

Workforce: The number of workers age 15-64 to support the 65+ population is CLOSE TO THE STATE AVERAGE in the counties outside the St. Cloud metro area and HIGH in the St. Cloud metro area counties.

Caregivers: The availability of potential family caregivers for the 85+ population is CLOSE TO THE STATE AVERAGE in the counties outside the St. Cloud metro area, and HIGH within the St. Cloud metro area counties.

Living Alone: The percent of persons 65+ living alone is CLOSE TO THE STATE AVERAGE in the counties outside the St. Cloud metro area, and LOW in counties within the St. Cloud metro area in 2010. The percent increases in all counties by 2030.


St. Cloud Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs


0

10

20

30

40

50

60

70

Min

neso

ta

Ben

ton

Cas

s

Chi

sago

Cro

w W

ing

Isan

ti

Kan

abec

Mill

e La

cs

Mor

rison

Pin

e

She

rbur

ne

Ste

arns

Tod

d

Wad

ena

Wrig

ht

FY 2000

FY 2004

St. Cloud Area Number of Nursing Home Beds per 1,000 85+, 2001 and 2005


0100200300400500600700800900

10001100

Minn

esot

a

Bento

nCass

Chisago

Crow W

ingIsa

nti

Kanab

ec

Mille

Lac

s

Mor

rison

Pine

Sherb

urne

Stear

nsTod

d

Wade

na

Wrig

ht

St. Cloud Area What You Told Us About Current Supply of HCBSTransformation Survey Results


0 10 20 30 40 50 60 70 80 90

Transportation

Chore

In-Home Respite

Caregiver Support

Grocery Shopping

Companion Services



Unavailable

Inadequate

Adequate

Surplus

St. Cloud Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys

Biggest barriers: subsidies for services, unwillingness of consumers to pay true cost of aging services.

Systems gaps: workforce supply, service and program flexibility to ensure choice and personal direction

Other issues: quality and consumer protection system for private homes and other settings



St. Cloud Area What You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: subsidized rental (with and without services) was identified as inadequate.


0 10 20 30 40 50 60 70 80 90






Home Modifications


Unavailable

Inadequate

Adequate

Surplus

St. Cloud Area What You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100

Primary Care



Hospital Care

Pharmacy

Facility-based Dementia Care

Facility-based Complex Medical Mgmt


Unavailable

Inadequate

Adequate

Surplus

Fergus Falls Area

Counties Becker OtterTail Clay Pope Douglas Stevens Grant Traverse Wilkin

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is LOW to CLOSE TO STATE AVERAGE in Becker, Clay, Douglas, Stevens and Wilkin Counties, and HIGH in Grant, OtterTail, Pope and Traverse Counties.

Workforce: The number of workers age 15-64 to support the 65+ population is VERY LOW in Grant, OtterTail, Pope and Traverse Counties and CLOSE TO STATE AVERAGE to HIGH in Becker, Clay, Douglas, Stevens and Wilkin Counties.

Caregivers: The availability of potential family caregivers for the 85+ population is LOW in 2010 and decreases even further in 2030 for Grant, OtterTail, Pope and Traverse Counties. The availability is relatively HIGH in 2010 in Becker, Clay, Douglas, Stevens and Wilkin Counties but decreases somewhat by 2030.

Living Alone: The percent of persons 65+ living alone in 2010 and 2030 is consistently HIGH in Stevens, Traverse and Wilkin Counties, and CLOSE TO THE STATE AVERAGE in the remaining counties.


Fergus Falls Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs


0

5

10

15

20

25

30

35

40

45

Minn

esot

a

Becke

rCla

y

Douglas

Grant

Otter T

ail

Pope

Steve

ns

Trave

rse

Wilk

in

FY 2000

FY 2004

Fergus Falls Area Number of Nursing Home Beds per 1,000 85+, 2001 and 2005


0

100

200

300

400

500

600

700

800

Minn

esot

a

Becke

rCla

y

Douglas

Grant

Otter T

ail

Pope

Steve

ns

Trave

rse

Wilk

in

Fergus Falls Area What You Told Us About Current Supply of HCBSTransformation Survey Results


0 10 20 30 40 50 60 70 80 90

Transportation

Grocery Shopping

Congregate Meals

Companion Services

Adult Protection


Unavailable

Inadequate

Adequate

Surplus

Fergus Falls Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys

Biggest barriers: subsidies for services, unwillingness of consumers to pay true cost of aging services.

Systems gaps: workforce supply, service and program flexibility to ensure choice and personal direction

Other issues: quality and consumer protection system for private homes and other settings, and cultural competence



Fergus Falls Area What You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: subsidized rental apartments (with services) was identified as inadequate


0 10 20 30 40 50 60 70 80 90






Home Modifications


Unavailable

Inadequate

Adequate

Surplus

Fergus Falls Area What You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100

Hospital Care

Pharmacy







Unavailable

Inadequate

Adequate

Surplus

Thief River Falls Area Counties

Kittson Polk Marshall Red Lake Norman Roseau Pennington

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is CLOSE TO STATE AVERAGE in Pennington, Polk and Roseau Counties and HIGH in Kittson, Marshall, Norman and Red Lake Counties.

Workforce: The number of workers age 15-64 to support the 65+ population is LOWER THAN THE STATE AVERAGE in all area counties except Roseau County.

Caregivers: The availability of potential family caregivers for the 85+ population is LOWER THAN THE STATE AVERAGE in all counties except Roseau County where it is HIGH.

Living Alone: The percent of persons 65+ living alone is HIGHER THAN THE STATE AVERAGE in all the counties except Roseau County where it is LOW. The percent increases in all counties by 2030.


Thief River Falls Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs


05

1015202530354045

Minn

esot

a

Kittson

Mar

shall

Norman

Pennin

gton

Polk

Red La

ke

Roseau

FY 2000

FY 2004

Thief River Falls Area Number of Nursing Home Beds per 1,000 85+, 2001 and 2005


0

200

400

600

800

1000

1200

Minn

esot

a

Kittson

Mar

shall

Norman

Pennin

gton

Polk

Red La

ke

Roseau

Thief River Falls Area What You Told Us About Current Supply of HCBSTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100

Transportation

In-Home Respite


Congregate Meals

Skilled Nursing



Unavailable

Inadequate

Adequate

Surplus

Thief River Falls Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys Biggest barriers: subsidies for services, lack of

products and service models to meet changing expectations of older population

Systems gaps: workforce supply, service and program flexibility to ensure choice and personal direction, and access to information and assistance for all persons

Other issues: quality and consumer protection system for private homes and other settings, cultural competence, care coordination between health and long-term care



Thief River Falls Area What You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: adult foster care and board and lodging (with services) were identified as inadequate.


0 10 20 30 40 50 60 70 80 90







Unavailable

Inadequate

Adequate

Surplus

Thief River Falls Area What You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100




Hospital Care

Pharmacy




Unavailable

Inadequate

Adequate

Surplus

Bemidji Area

Counties Beltrami Clearwater Hubbard Lake of the Woods Mahnomen

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is HIGHER THAN THE STATE AVERAGE in Clearwater, Hubbard, Lake of the Woods, and Mahnomen Counties, and LOWER THAN THE STATE AVERAGE in Beltrami County.

Workforce: The number of workers age 15-64 to support the 65+ population is LOWER THAN THE STATE AVERAGE in all area counties except Beltrami County.

Caregivers: The availability of potential family caregivers for the 85+ population is LOWER THAN THE STATE AVERAGE in all counties except Beltrami County where it is HIGH.

Living Alone: The percent of persons 65+ living alone is HIGHER THAN THE STATE AVERAGE in all the counties except Beltrami County where it is LOW. The percent increases in all counties by 2030.


Bemidji Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs


0102030405060

Minn

esot

a

Beltra

mi

Clear

water

Hubbar

d

Lake

of t

he W

oods

Mah

nomen

FY 2000

FY 2004

Bemidji Area Number of Nursing Home Beds per 1,000 85+, 2001 and 2005


0100200300400500600

Minn

esot

a

Beltra

mi

Clear

water

Hubbar

d

Lake

of t

he W

oods

Mah

nomen

Bemidji Area What You Told Us About Current Supply of HCBSTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100

Transportation

In-Home Respite

Grocery Shopping

Skilled Nursing


Info, Referral & Assistance


Unavailable

Inadequate

Adequate

Surplus

Bemidji Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys Biggest barriers: subsidies for services and

workforce supply Systems gaps: service and program

flexibility to ensure choice and personal direction, and quality and consumer protection system for private homes and other settings

Other issues: cultural competence Nursing home bed supply: adequate


Bemidji Area What You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: subsidized rental apartments for seniors (with and without services) were identified as inadequate.


0 10 20 30 40 50 60 70 80 90






Home Modifications


Unavailable

Inadequate

Adequate

Surplus

Bemidji Area What You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100



Hospital Care

Pharmacy



Unavailable

Inadequate

Adequate

Surplus

Duluth Area

Counties Aitkin Koochiching Carlton Lake Cook St. Louis Itasca

Percent 65/85+: The percent of the population that is 65+ and 85+ from now until 2030 is MUCH HIGHER THAN THE STATE AVERAGE in Aitkin, Itasca, Koochiching, Lake and St. Louis counties, and CLOSE TO THE STATE AVERAGE in Carlton and Cook Counties.

Workforce: The number of workers age 15-64 to support the 65+ population is MUCH LOWER THAN THE STATE AVERAGE in all area counties except Carlton, Cook and St. Louis County.

Caregivers: The availability of potential family caregivers for the 85+ population is MUCH LOWER THAN THE STATE AVERAGE in all counties except Cook County where it is CLOSE TO THE STATE AVERAGE.

Living Alone: The percent of persons 65+ living alone is CLOSE TO THE STATE AVERAGE in all the area counties except Koochiching and St. Louis Counties where it is LOWER THAN THE STATE AVERAGE.


Duluth Area Percent of Older Adults Served in AC & EW Programs with Higher Care Needs


0

10

20

30

40

50

Minn

esot

a

Aitkin

Carlton

Cook

Itasc

a

Kooch

iching

Lake

St. Lo

uis

FY 2000

FY 2004

Duluth Area Number of Nursing Home Beds per 1,000 85+, 2001 and 2005


0100200300400500600700800

Minn

esot

a

Aitkin

Carlton

Cook

Itasc

a

Kooch

iching

Lake

St. Lo

uis

Duluth Area What You Told Us About Current Supply of HCBSTransformation Survey Results


0 10 20 30 40 50 60 70 80 90

Transportation

Chore

In-Home Respite

Homemaking


Congregate Meals

Companion Services


Adult Protection


Unavailable

Inadequate

Adequate

Surplus

Duluth Area Capacity to Meet Needs in 2010Transformation and County Gaps Surveys Biggest barriers: subsidies for services and

unwillingness of consumers to pay true cost of aging services

Systems gaps: workforce supply, and service and program flexibility to ensure choice and personal direction

Other issues: cultural competence, and quality and consumer protection system for private homes and other settings



Duluth Area What You Told Us About Current Housing SupplyTransformation Survey

County Gaps Survey: subsidized rental apartments (with services) and market rate rental apartments (no services) were identified as inadequate.


0 10 20 30 40 50 60 70 80






Home Modifications


Unavailable

Inadequate

Adequate

Surplus

Duluth Area What You Told Us About Current Supply of Health and Medical ServicesTransformation Survey Results


0 10 20 30 40 50 60 70 80 90 100




Hospital Care

Pharmacy




Unavailable

Inadequate

Adequate

Surplus

The Future

Where the present trends may take us Informal Care Utilization Labor

When family caregiving decreases, public costs increase

Sources of Long-Term Care for Older Minnesotans

97 95 91

50

0%

20%

40%

60%

80%

100%

1988 1995 2001 2030

Agencies

Families

For every 1% decline in family caregiving, it costs the public sector $30 million?

Source: DHS 2010 Initiative

Nursing Facility Projections: Scenario 1

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

2005 2010 2015 2020 2025 2030

Three Year Trend 2002-2004 (Annualized LOS Decreases, Population and Admissions)

Annualized Residents Beds per 95% Occupancy

Housing With Services Projections

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

2000 2005 2010 2015 2020 2025 2030

Growth of HWS Need Based on Population Projections for 65 plus and 2% Increase per Year in Estimated Utilization

Estimated Number of EW Clients Private Population

Estimated and Annualized Resident Demand

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

2000 2005 2010 2015 2020 2025 2030

Hou

sing

wit

h Se

rvic

es

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Nur

sing

Fac

ilit

y

Housing with Services Annualized Number of Nursing Facility Residents

Projected Supply and Demand of RN’s (Minnesota)

30,000

35,000

40,000

45,000

50,000

55,000

60,000

2000 2005 2010 2015 2020

Supply Demand

Source: US Department of Health and Human Services, July 2002

Documents

Long-Term Care in Minnesota: Past, Present, and Future Trends for Senior Services in Minnesota Todd Bergstrom Care Providers of Minnesota