[northwest senior services board] · [northwest senior services board] advance meeting materials...

[Northwest Senior Services Board]

ADVANCE MEETING MATERIALS

OCTOBER 9, 2018

REGULAR MEETING

1:00 – 3:30PM NORTHWEST REGIONAL COUNCIL – SKAGIT OFFICE

301 VALLEY MALL WAY, SUITE 100 MOUNT VERNON, WA 98273

Northwest Regional Council 600 Lakeway Drive

Bellingham, WA 98225 360.676.6749

Map to

Northwest Regional Council Office

301 Valley Mall Way, Suite 100

Mount Vernon WA 98273

Exit 227

Exit 227 R

ive

rsid

e D

rive

E College Way

Bellingham

Take exit 227off I-5. At the end of the exit ramp, head east on E College Way. Continue to Riverside Drive, turn right. First cross street is Roosevelt Street, turn right. There is a traffic light at intersection.

Building will be on your left. NWRC is located in the South end of the building. The North end of the build-ing houses Northsound BHO.

5

Roosevelt Street

Valley Mall Way

Hobby Lobby

Camano

PAGE LEFT INTENTIONALLY BLANK

Date: October 9, 2018

Time: 1:00pm – 3:30pm

Location: Northwest Regional Council 301 Valley Mall Way, Suite 100

Mount Vernon, WA 98273

Agenda Time Topic Pages Action

Required 1:00-1:05 Regular Meeting Call to Order

Barbara Pesola, Chair • Pledge of Allegiance• Introduction of Guests• Roll Call• Review of August Minutes• Announcements• Public Comments• Call for Expense Reimbursement

Forms

3-6 Motion

1:05-1:10 NWSSB Membership Updates Barbara Pesola, Chair

• Certificate of Appreciation for JoanFortune

• Other Changes

7

Verbal

Motion

Information

1:10-2:05 NWRC Contracts Michael Dunckel and Angela Ross

• Four Year Process• Top Drawer Contracts• Risk Assessment Tool• Q&A

9-12

Handout

Discussion

2:05-2:15 Break

2:15-2:45 NWRC Agency Update Dan Murphy

Handout Discussion

NORTHWEST SENIOR SERVICES BOARD

1

2:45-3:00 Current State of WA Medicaid and LTSS Ryan Blackwell

13-18 Information

3:00-3:10 Caregiver Outreach Materials Update Community Programs Staff

Handout Information

3:10-3:15 State Council on Aging Update (SCOA) Georgiann Dustin

Verbal Information

3:15-3:25 Updates from Our Communities Members

Verbal Discussion

3:30 Adjourn Verbal Motion

Upcoming Northwest Senior Services Board Meetings and Events: October 10-11, 2018 Fall Gathering and Conference Tacoma December 11, 2018 Regular Meeting Mount Vernon*

*NWRC Skagit Office- 301 Valley Mall Way, Suite 100, Mount Vernon

Upcoming Northwest Regional Council Meetings: December 7, 2018 Governing Board Meeting Mount Vernon^

^Skagit County Commissioner’s Office- 1800 Continental Pl #100, Mt Vernon

Meetings are held in accessible facilities. For more complete information, please contact the NWRC at 360-676-6749 or 1-800-585-6749, 600 Lakeway Drive, Suite 100, Bellingham WA 98225.

Anyone needing special accommodations to participate in a meeting should contact the NWRC at least 48 hours in advance of the scheduled meeting.

2

Q:\NWSSB\Agendas & Meeting Materials\2018\05- October\Workspace\5. 2018_08_14 NWSSB Minutes.docx

Northwest Senior Services Board Meeting Minutes August, 14 2018

Guests Present: Carneen Allen, Jon Rudicil, Peter Acosta

Members Present: Carl Bender, Georgiann Dustin, Jana Finkbonner, Shirley Forslof, Joan Fortune, Wendy Gilbert, Alberta Horn, Denise Irey, Leslie Lawson, Bob Monize, Barbara Pesola, Tasker Robinette, Mary Kanter, and Kathleen O’Connor

Members Absent: Anna Ankrum, Ken O’Mhuan, Jodi Sipes and Joan Fortune

Staff Present: Elizabeth Anderson, Ryan Blackwell, Dan Murphy

Review of Minutes Jodi Sipes sent an email with a correction to the June 12th minutes stating her presentations were to the Blaine and Birch Bay Chambers of Commerce, not Bellingham.

Motion was made by Bob Monize, Island County, and seconded by Georgiann Dustin, Whatcom County, that the minutes from the June 12th, 2018 meeting be approved with the noted correction. The motion passed unanimously.

Announcements: There were no announcements.

Public Comment: There was no public comment.

Expense Reimbursement Forms: Collected.

Welcome to New NWSSB Members Barbara Pesola, Chair Mary Kanter from Island County and Karen O’Connor from Whatcom County.

Long-Term Care Trust Act Dan Murphy, NWRC Executive Director Dan provided some background information on the history of Long-Term Care Trust Act and the coalition of stakeholders working on the issue.

Jon Rudicil, State Director, W4A (Washington Association of Area Agencies on Aging) Guest speaker from W4A who previously worked for 10 years in the state legislature. The goal is to have an amended bill (the long-term care trust act) prepared for the next session. Most people over 65 will need some sort of care in their lifetime, but the average retirement savings people have is far less than the average cost of care. This puts a strain on Medicaid funding for the state and a strain on spouses and children who are providing care for a family members.

Discussion followed.

3


NWRC Agency Update Dan Murphy Our governing board meeting was last Thursday and the funding allocation recommendations from the NWSSB were approved. Thanks to all of you who participated in the conference call to make these recommendations. The appropriate contracts will be updated and the funds will be allocated.

Dan presented a PowerPoint that included the following updates: • Medicaid Waiver – 2 years into the 5 year period.• Expansion of Family Caregiver Supports – Administrative cost of Medicaid

eligibility screening has increased.• Updates on the Family Caregiver Support Program.• 8/15 – DSHS will be moving out of our building. We have doubled our size in

Bellingham.• We are finalizing our contract with the BHO (Behavioral Health Organizations).

Our first Mental Health Clinician will be starting later this month.• DSHS completed contract, fiscal and program monitoring.• Northwest Adult Day Health center has closed for financial reasons.• Homage has been added to our Health Home network

Discussion followed.

Fall Conference Logistics Ryan Blackwell and Barbara Pesola October 10th and 11th is the Fall conference. Good opportunity to discuss senior issues. Our next NWSSB meeting is October 9th. From that meeting we can carpool to Tacoma prior to the conference.

Caregiver Outreach Materials Update Alberta Horn, Skagit County and Tasker Robinette, Skagit County, gave Caregiver Outreach presentations in Anacortes in July. Wendy Gilbert, Island County, gave a similar presentation to Whidbey Health in July.

State Council on Aging Update (SCOA) Georgiann Dustin Georgiann is on the planning committee for the Fall Gathering in Tacoma.

Updates from Our Communities Members shared updates from their communities.

Announcements and Adjourn December 7th, 2018 is the date of the next NWRC Governing Board meeting in Mount Vernon. October 9th, 2018 is the date of the next NWSSB Regular meeting in Mount Vernon.

4


There being no further business, Motion was made by Shirley Forslof, Whatcom County, and seconded by Georgiann Dustin, Whatcom County, that the NWSSB adjourn. The motion passed unanimously.

The meeting adjourned at 3:19 p.m.

_________________________________ Moorea Byrnes, Admin Assistant

Reviewed and approved by the Northwest Senior Services Board at the October 9th, 2018 meeting.

_________________________________ Barbara Pesola, NWSSB Chair

5


6

This certificate is awarded to

The Northwest Senior Services Board thanks you, Joan, for your years of dedicated service to the Northwest Senior Services Board. Your input and skill have been integral to the efforts of our advisory council. We will miss you, and we wish

you all the best!

NWRC Executive Director

Date

Date

NWSSB Chair

J OAN F ORTUNE

C e r t i f i c a t e o f A p p r e c i a t i o n

7


8

CYCLE JANUARY FEBRUARY MARCH APRIL MAY JUNEYEAR 1

Area Plan • Instruction from ALTSA

Planning Team

Top Drawer

Renegotiation

Contracts Team (CT)

YEAR 2

RFP - • Establish RFP Timeline • CT/Fiscal Reviews RFQ • Review/Update: Letter of

Top Drawer • Review/Update: Letter of Materials Intent

Contracts Interest • Finalize RFP Documents

Contracts Team (CT)

YEAR 3 Cycle Years: 2017, 2021, 2025, 2029, 2033, 2037

RFQ - • Establish RFQ Timeline • Prepare Legal Notices • Publish Legal Notices • Proposals Due via Email • NWSSB Review/Approves

Homecare/NEMT/ • CT Prepares RFQ Materials • Finalize RFQ Materials • Publish On-Line Notices • CT/Fiscal Review Proposals • NWRC Board Reviews/Approves

In & Out-Respite • Update Interested Party • CT/Fiscal Review Materials • Email RFQ Packets • RFQ Eval Committee Sends • Contracts Finalized by NWRC

Mailing List • Set RFQ Eval Committee • Prepare Scoring Document Recommendation to NWSSB • Emailed Back to Contractor

Contracts Team (CT)

Area Plan Update • Instruction from ALTSA

• Timeline to NWSSB for

Planning Team Approval

Top Drawer

Renegotiation

Contracts Team (CT)

YEAR 4

RFQ - • Establish Timeline • Finalize RFQ Packet • Packets Due via Email • CT Reviews Contracts

Ancillary Contracts • Seek Unmet Need Input • Prepare Legal Notice • CT Reviews Materials; • Contracts Emailed for Signature

(COPES; CgCons) • Review/Update Materials • Publish Legal Notice Notify Provider if Info • Contracts Finalized by OD

• Email RFQ Packet to Missing • Contracts Dated 07/01/XX

Contracts Team (CT) Current & New Providers • CT Develops Contracts • Contract Logs Updated

Top Drawer

Renegotiation

Contracts Team (CT)

Top Drawer 30 Day Letters Sent

Home Care Agency 30 Day Letters Sent

Out-of-Home Respite 30 Day Letters Sent

COPES 30 Day Letters Sent

ADH/MCW Providers 30 Day Letters Sent

Caregiver Consultants 30 Day Letters SentHealth Homes (RB)

MD/Fiscal

AR

MD/AR - Overlap with COPES providers

Finalize Risk Assessments for

All Contracted Providers

Cycle Years: 2018, 2022, 2026, 2030, 2034, 2038

Cycle Years: 2015, 2019, 2023, 2027, 2031, 2035

Cycle Years: 2016, 2020, 2024, 2028, 2032, 2036

• Develop Letter of Interest Mailing List

• CT Begins Development of RFP Packet Materials; Fiscal Team Reviews Budget Forms

• Planning Team Begins Development of Documents for Inclusion in Area Plan

Contract Monitoring Schedule

9

JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER JANUARY

• Draft AP Ready for Review • Public Hearings Held in • NWSSB Recommendations • Area Plan Due at ALTSA • NWRC Formally Approves

Each County Made after Public Hearings Area Plan document

• Prepare AP for Mailing

• CT/Fiscal Review Contract • Renegotiation Materials • Renegotiation Materials • CT/Fiscal Review Submissions • CT Develops Contracts • NWRC Board Reviews/Approves • Finalize Remaining Contracts

Renegotiation Materials Emailed to Current Contractors Due via Email • Materials readied for NWSSB • Contracts Dated 01/01/XX • Contracts Emailed for Signature • Invoice Forms Updated;

for Completion • NWSSB Reviews/Approves • Contracts Finalized by NWRC Sent to Contractors• Contract Logs Updated

• Publish Legal Notices • Email Competitive Track • Proposals Dues to CT • NWSSB Reviews/Approves • Appeals Heard • NWRC Board Reviews/Approves • Finalize Remaining Contracts

• Plan for Bidder's Conf. • Email Sole-Source Track • CT/Fiscal Review Proposals • Notification Emailed to • Contracts Finalized • Contracts Emailed for Signature • Invoice Forms Updated;

• E-mail NOFA Letter and • Bidder's Conference Tentative Successful Bidders • Contracts Dated 01/01/XX • Contracts Finalized by NWRC Sent to Contractors

Letter of Intent Packet • Letter of Intent Confirm Due • Written Appeals Due • Contract Log Updated• Due Date - Letter of Intent

• Contracts Date 07/01/XX

• Contract Logs Updated

• Invoice Forms Updated;

Sent to Contractors

• Update Due to ALTSA • AP Update Presented to

• Finance Develops Budget • Develop Plan to Distribute NWRC for Approval







LegendKG - Kristine Glasgow

MC - Melody Coleman

MD - Michael Dunckel

AR - Angela Ross

RB - Ryan Blackwell

Nutrition - KG/MD; IACM - KG/MC/MD; FCSP - KG/MC/MD; Fiscal (as needed)

MD/AR

KCSP - AR; VSERV - AR; LEGAL - MD; Fiscal (as needed)

MD/Community Program Staff (as needed)

• Planning Team Continues Updating Documents as Needed

10

Risk Assessment Criteria: Determine Level of Monitoring

Provider:

Date:

Contract #:

Monitoring Period: to

Services Provided:

Contracted Provider is a Contractor or a Subrecipient

If Contracted Provider is a Contractor and has not received any service authorizations during the monitoring period noted above, No Monitoring is required.

Step One: Critical Risk Assessment Elements Item # Risk Factor Value Notes/Comments

1.1 Performance History: Prior compliance issues with audit findings, litigation, or corrective actions from previous monitoring

Yes

No 1.2 Desk Monitoring: Desk monitoring reveals a

history of inaccurate/fluctuating financial and/or program reporting, and/or service levels or costs vary substantially from planned target.

Yes

No

1.3 Time Since Last Monitoring: No on-site or in-person monitoring visit in past three (3) years

Yes

No 1.4 Contracted for Less than One (1) Year Yes

No

Comprehensive Monitoring required if answered “Yes” to any of the above statements, otherwise continue assessment below

Step Two: Additional Risk Assessment Elements Item # Risk Factor Value Notes/Comments

2.1 Budget: A large percentage (≥ 50%) of pro-vider’s funding for this service comes through the AAA

Yes

No 2.2 Key Staff Turnover: Recent turnover of key

staff and/or abnormal frequency of staff turn-over

Yes

No 2.3 Client Health & Safety: Provider has

unsupervised client contact or access to their belongings or finances

[Yes = High; No = Mod or Low]

High Mod Low

11

Q:\NWSSB\Agendas & Meeting Materials\2018\05- October\Workspace\8. Risk Assessment Criteria ('18).docx

Item # Risk Factor Value Notes/Comments 2.4 Financial Review: Provider has had an

audit or financial review conducted by an independent CPA

[Yes = Low; No = Mod or High]

High Mod Low

2.5 Policy Changes: Major policy changes have occurred in last year regarding services and/or programs

[Yes = High; No = Mod or Low]

High Mod Low

2.6 Clinical Expertise: Provider has demon-strated the necessary level of clinical exper-tise required to provide services

[Yes = Low; No = Mod or High]

High Mod Low

Additional considerations to be taken into account to determine level of risk:

High Risk Overall Risk Level for Contract # is: Moderate Risk

Low Risk

High Risk Requires a Comprehensive Monitoring review, including in-person or on-site visit. Examine financial, programmatic records, client flies, observe operations.

Moderate Risk Requires a Focused Monitoring review with an in-person or optional on-site visit. Follow up concerns dealing with program activities, make appropriate inquires as needed.

Low Risk Continuation of on-going Desk Monitoring review of financial and performance reports.

Reviewed by: Date:

Approved by: Date:

Revised: 11/15/2016

12

September 2018

Uninsured Rates

total WA population

7.3million

WA ExpansionStatus:

Adults inExpansion Group:

601,000

Adopted

In WA, Medicaid Covers:

1 in 2 individualswith disabilities

2 in 5 children

3 in 5 nursinghome residents

1 in 7 Medicarebeneficiaries

1 in 6 adults,ages 19-64

WAMedian

EligibilityLevels

100% of FPL: $20,780 for a family of three; $12,140 for an individual

of adult Medicaid enrolleesare working in WA

of children with specialhealth care needs are

covered by Medicaid in WA

46%

62%

26% 22%

(as a % of FPL)

of WApopulation islow-income(<200% FPL)

of WApopulation iscovered byMedicaid/CHIP

MEDICAID IN WASHINGTON

13% 12%9%

7%

US WA

20132016

317%198%

138% 138%74%

Children PregnantWomen

Parents ChildlessAdults

Seniors & Peoplew/ Disabilities

13

September 2018

US Congress

Governor

US Senate

$$$$$$1 in 6 dollars in the health care system

Nationally Medicaid Pays For:

>1 in 3 dollars to safety-net hospitalsand health centers

$$$

1 in 2 dollars on long-term care$$

74%86%

70%89%

38%53%

Doctor Visit AmongAdults in Past Year

Satisfied with HealthCare in Past Year

Medicaid Private UninsuredNational Access & Satisfaction Measures

74%82%

65%

Total Democrats Republicans

National Share of Those that HoldFavorable Views of Medicaid

Medicaid Education Other

WA Medicaid Enrollees & Expenditures Distribution of WA Spending byFund & Category

Federal Funds State Funds

Patty Murray (D) (2022)Maria Cantwell (D) (2018)

# of Representatives: 10Party: 6-D, 4-R

WA State Legislature Party Affiliation

(No 2018 Election)

Current:Jay Inslee (D)

Democrat26

Democrat50

Republican23

Republican48

Senate

House

Elderly &Disabled 17%

Elderly &Disabled

40%

Adults &Children

83%

Adults &Children

60%

Enrollees Expenditures

45%

6%

49%

8%

31%61%

14

Across the States 2018:

Profile of Long-Term Services and Supports in Washington

Projected Population Growth in Washington, by Age Group, 2015-2050

0%

+50%

+100%

+150%

+200%

+250%

+300%

Percent Increase Since 2015

Ages 85+

Ages 75-84

Ages 65-74

Under 65

2015 2020 2025 2030 2035 2040 2045 2050

2015 2030 2050

State Rank U.S. State Rank U.S. State Rank U.S. Population (thousands) All Ages 7,170 13 321,419 8,348 13 358,380 9,937 13 395,882 Under 65 6,134 13 273,658 6,657 13 284,013 7,801 13 307,819 Ages 50+ 2,451 14 110,973 3,082 13 134,344 3,966 13 160,466 Ages 65+ 1,036 15 47,761 1,691 14 74,367 2,136 13 88,062 Ages 85+ 131 14 6,287 213 14 9,300 468 14 19,385 Percent of Total Population Ages 50+ 34.2% 34 34.5% 36.9% 35 37.5% 39.9% 35 40.5% Ages 65+ 14.4% 39 14.9% 20.3% 37 20.8% 21.5% 36 22.2% Ages 85+ 1.8% 32 2.0% 2.5% 33 2.6% 4.7% 33 4.9% Percent Change from 2015 All Ages +16% 3 +11% +39% 1 +23% Under 65 +9% 2 +4% +27% 1 +12% Ages 50+ +26% 8 +21% +62% 5 +45% Ages 65+ +63% 12 +56% +106% 9 +84% Ages 85+ +62% 14 +48% +257% 11 +208%

Projected Diversity of the Population Ages 65+ in Washington, by Year

2015 2030 2050

81%

6% 3%

10%

70%

11% 4%

15%

White

Hispanic

Black

Other

86%

3% 2%

9%

Note: Data are ranked from highest to lowest value; this does not necessarily correspond to level of performance.

Last updated 8/28/2018 Page 1 ©2018 AARP Public Policy Institute

15

Across the States 2018: Washington State Profile

Population Characteristics

Number

(1,000's) Living Arrangements and Poverty, 2016 Percent Rank U.S. People ages 75+ living alone 140 33.0% 22 31.6% People ages 65+ living in nonmetropolitan areas 154 14.2% 37 17.3% Below poverty level ages 65+ 81 7.6% 41 9.2% Below 250% of poverty level ages 65+ 333 31% 42 37%

Household Income, 2016 State Rank U.S. Median household income ages 65+ $48,217 12 $42,113

Disability Rates, 2016

Number

(1,000's) Percent Rank U.S. People ages 65+ with disabilities Self-care difficulty Cognitive difficulty Any disability

83 98 378

7.8% 9.2% 35.7%

24 19 20

8.1% 8.9% 35.0%

People ages 18-64 with disabilities Self-care difficulty Cognitive difficulty Any disability

79 221 495

1.7% 4.9% 11.0%

28 22 26

1.9% 4.5% 10.6%

Private Pay Costs

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

Nursing Facility Private Room

Nursing Facility Shared Room

Assisted Living Adult Day Services

Home Health Aide 30 hours/week

Median Annual Cost

Washington

United States

Annualized Private Pay Costs by LTSS Type, 2017 State Rank U.S. Nursing facility, private room Nursing facility, shared room Assisted living Adult day services Home health aide (30 hours/week)

$113,515 $102,930 $55,920 $16,900 $41,340

16 17 9 34 5

$97,455 $87,600 $45,000 $18,200 $33,540

Long-Term Care Insurance, 2015 State Rank U.S. Private long-term care insurance policies in effect 239,579 71 10 50

Per 1,000

Ages 40+

Note: Data are ranked from highest to lowest value; this does not necessarily correspond to level of performance.


16


Medicaid Long Term Services and Supports

Medicaid Spending Balance Year State Rank U.S.

Medicaid HCBS spending as a percent of LTSS spending for older people

and adults with physical disabilities

2011 * 2016 * % change

62% 71% +9.6%

3 2 8

38% 45% +7.0%

Medicaid LTSS Spending Balance in Washington, by Population, 2016

Older People and Adults with Physical Disabilities All Populations

29%

71%

32%

68%

Institutional services spending

HCBS spending

Medicaid Expenditures (Total Federal + State)

Total

(millions) Per Person Rank U.S. Medicaid LTSS spending for older people and adults with physical

disabilities, 2016 *

Nursing facility spending HCBS spending

$2,198 $633 $1,565

$302 $87 $215

23 48 9

$320 $175 $145

Medicaid LTSS spending for all populations, 2016 *

Institutional services spending HCBS spending

$3,169 $1,000 $2,169

$435 $137 $298

31 46 20

$515 $223 $292

State-funded HCBS expenditures for older people and adults with

physical disabilities, 2014 $33.3 $4.72 15 $3.36

Change in Medicaid Expenditures 2011-2016 *

% Change

2011-16 Rank U.S. Medicaid LTSS spending for older people and adults with physical disabilities

Nursing facility spending HCBS spending

+39% +4% +61%

10 38 10

+22% +8% +45%

Medicaid LTSS Users Ages 65+, 2013 State

Per 1,000

Ages 65+ Rank U.S. All Medicaid LTSS users ages 65+ ** Institutional services only *** HCBS only ** HCBS and institutional services **

44,705 11,321 30,916 2,468

47 12 33 2.6

18 37 5 16

47 22 23 2.8

Medicaid LTSS Users, All Ages, 2013 State

Per 1,000

People Rank U.S. All Medicaid LTSS users *** Institutional services only *** HCBS only *** HCBS and institutional services ***

91,902 17,870 70,081 3,951

13.2 2.6 10.1 0.6

28 37 21 19

16.4 4.7 11.1 0.7

Note: Data are ranked from highest to lowest value; this does not necessarily correspond to level of performance. * 2014 data used instead of 2016 for 4 states (AK, CA, ID, KS); base year other than 2011 for 3 states (MA, NJ, NM). ** 14 states are excluded because of missing, old, or unreliable data. The highest rank is 37. *** 9 states are excluded because of missing, old, or unreliable data. The highest rank is 42.


17


State

Per 1,000

People Rank U.S. Number of family caregivers, 2013 Economic value of family caregiving, 2013 (millions) Economic value per hour, 2013 Ratio of economic value to Medicaid HCBS spending, 2013

828,000 $10,700 $13.83 6.6

119 $1.54

34 18 12 26

127 $1.49 $12.51 6.2

Caregiver Support Ratio (age 45-64 per age 80+), 2015 Caregiver Support Ratio, 2050 (projected)

7.6 3.1

10 16

7.0 2.9

Family Caregivers

Home and Community-Based Services

Personal Care and Home Health Aides State

Per 1,000

AWD * Rank U.S. Personal care aides, 2015 ** Median hourly wage, 2017

Home health aides, 2015 ** Median hourly wage, 2017

37,229 $12.85 9,850 $12.69

238

63

5 5 36 14

148 $11.11 104 $11.16

Congregate and Home Delivered Meals, 2016 State

Per 1,000

Ages 65+ Rank U.S. People receiving OAA congregate meals People receiving OAA home delivered meals Total OAA meal expenditures (thousands)

44,588 11,481 $16,670

41 11 $15

24 43 48

32 17 $31

Assisted Living Supply, 2014 State

Per 1,000

Ages 75+ Rank U.S. Assisted living and residential care units *** 41,500 103 3 52

Nursing Facilities

Nursing Facilities, Utilization, and Resources State

Per 1,000

Ages 75+ Rank U.S. Total nursing facilities, 2016 Nursing facility beds, 2016 Nursing facility residents, 2016 Nursing facility occupancy rate, 2016

221 21,090 16,583 79%

0.52 50 39

45 45 45 32

0.76 80 65 81%

% Change in nursing facility residents, 2011-2016 -6.3% 35 -3.9% Direct care nursing hours per resident day, 2016 RN hours per resident day, 2016

4.28 1.02

13 10

4.03 0.79

Nursing assistants, 2015 ** Median hourly wage, 2017

14,824 $14.10

36 37 18

43 $13.23

Nursing Facility Quality and Resident Characteristics State Rank U.S. Long-stay residents receiving an antipsychotic medication, 2017 High-risk residents with pressure sores, 2017 Long-stay residents with a hospital admission, 2014

15.4% 4.7% 11.1%

26 33 44

15.5% 5.6% 17.0%

Nursing facility residents with low care needs, 2014 **** 8.4% 38 11.5% Residents with Medicaid as primary payer, 2016 Residents with Medicare as primary payer, 2016 Residents with “other” as primary payer, 2016

60% 18% 22%

32 3 32

62% 14% 25%

Note: Data are ranked from highest to lowest value; this does not necessarily correspond to level of performance. * Adults With Disabilities (defined as having self-care difficultly, equivalent to ADL level of disability). ** Average of three years 2014-2016. *** Total capacity is rounded to the nearest hundred. Data not reported for two states. The highest rank is 49.

**** Data not reported for two states. The highest rank is 49.

Last updated 8/28/2018 Page 4 ©2018 AARP Public Policy Institute 18