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Federation Square Case Study

This document discusses aging services in Utah and proposes budget increases to better support seniors and their caregivers. It notes that Utah's senior population is growing rapidly and will continue to do so in the coming decades. Currently many seniors are able to age in place with minimal services, while others receive home and community-based services or move to nursing facilities. However, budgets for programs like Meals on Wheels and caregiver support are insufficient and not meeting growing needs. The presentation proposes targeted budget increases of $600,000 and $250,000 respectively to help more seniors and caregivers. It emphasizes the economic and moral importance of investing in these services to allow seniors to maintain quality of life and remain independent.

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Utah Representative Rebecca Chavez-Houck Mallory Bateman Scott McBeth Alan Ormsby Michael S. Styles Nan Mendenhall Anne Palmer M I N D T H E G A P OPTIMIZING QUALITY of LIFE for AGING UTAHNS H E A LT H and H U M A N S E R V I C E S I N T E R I M C O M M I T T E E P R E S E N TAT I O N
R E B E C C A C H A V E Z - H O U C K Democratic AssistantWhip, Utah House of Representatives M I N D T H E G A P OPTIMIZING QUALITY of LIFE for AGING UTAHNS OPTIMIZING QUALITY of LIFE for AGING UTAHNS M I N D T H E G A P
ACTUAL / PROJECTED SENIOR POPULATION 85+Years A C T U A L 85+Years P R O J E C T E D 65–84Years A C T U A L 65–84Years P R O J E C T E D
DELIVERY of CARE to OLDER ADULTS in UTAH 3 M A I N T Y P E S
AGING in PLACE at HOME with MINIMAL SUPPORTIVE SERVICES
RECEIVING HOME and COMMUNITY-BASED SERVICES
MOVING INTO a SKILLED NURSING FACILITY
CONTINUUM of SERVICES for OLDER ADULTS Agencies recognize and support the need for a full CONTINUUM of CARE to meet the complex and varied needs of older adults.
Many older adults can REMAIN IN THEIR OWN HOMES with a minimal amount of supportive services Many can remain in HOME AND COMMUNITY - BASED SETTINGS with more structured supports Others receive services in NURSING FACILITIES when the complexity of the individual’s needs cannot be safely met in a home and community based setting Many older adults can REMAIN IN THEIR OWN HOMES with a minimal amount of supportive services CONTINUUM of SERVICES for OLDER ADULTS Many can remain in HOME AND COMMUNITY - BASED SETTINGS with more structured supports Others receive services in NURSING FACILITIES when the complexity of the individual’s needs cannot be safely met in a home and community based setting
TYPICAL ANNUAL COST of PUBLICLY-FUNDED SERVICES $30 – 60,000 FAC ILITY BASED S E R V I C E S AGIN G in PLAC E With limited support services When services provided in home HC BS H O M E and C O M M U N I T Y - B A S E D S E R V I C E S <$1,000 $250 – 10,000 Alternatives Aging Waiver Including Publicly- funded Services Meals on Wheels Respite
C H A N G I N G D E M O G R A P H I C S M A L L O R Y B A T E M A N Research Analyst, Utah Foundation © Deseret News
8.7 8.5 9 9.8 12.6 12.4 13 14.1 1990 2000 2010 2013 PERCENT OF POPULATION 65 YEARS OR OLDER Utah U.S. Source: U.S. Census Bureau
MEDIAN AGE, UTAH AND U.S. Source: U.S. Census Bureau 1990 2000 2010 2013 UT 26.3 27.1 29.2 30.2 US 32.9 35.3 37.2 37.6
UTAH DEMOGRAPHICS 2010 Source: U.S. Census Bureau UT U.S. Boomer 18.7 24.9 Gen X 20.9 21.2 Millennial 26.0 27.7 1946–1964 1965–1980 1981–1995 % % %
YOUTH, WORKING AGE, AND 65+ POPULATION PROJECTIONS (UT) 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 1990 2000 2010 2020 2030 2040 2050 18 to 64 0 to 17 65 to 84 85 and over Source: Governor's Office of Management and Budget 2013 Population 2,900,872 2050 Population 5,257,242
13% 17% 14% 6% 11% 12% 29% 19% 15% 15% 14% 10% 21% 24% 27% 38% 22% 23% 1990 to 2000 2000 to 2010 2010 to 2020 2020 to 2030 2030 to 2040 2040 to 2050 0 to 17 18 to 64 65 and over PERCENT CHANGE by DECADE 1990 to 2050 Source: Governor’s Office of Management and Budget
76.0 67.0 65.8 54.2 53.0 52.4 47.5 46.2 47.1 46.7 14.0 13.0 15.8 14.4 15.2 17.6 24.2 26.7 31.1 33.7 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 Youth Retirement Age DEPENDENCY RATIO 1990 – 2050 90.0 80.0 81.6 68.5 68.2 70.0 71.7 72.9 78.2 80.4 Source: Bureau of Economic and Business Research analysis of Governor’s Office of Management and Budget, 2012 Projections. Note: Dependency Ratios are computed as the number of nonworking age persons per 100 working age (18-64 years old) persons in the population. Youth are less than 18 years old and retirement age is 65 years and older.
2010 M A L E 2000 M A L E 150,000 100,000 50,000 0 50,000 100,000 150,000 Under 5 5 – 9 10 – 14 15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 – 74 75 – 79 80 – 84 85 and over UTAH POPULATION by AGE and SEX 2000 and 2010 2010 F E M A L E 2000 F E M A L E Source: Bureau of Economic and Business Research analysis. U.S. Census Bureau, 2000 and 2010 Census.
80% 60% 40% 20% 0% 20% 40% 60% 80% 0 to 4 5 to 17 18 to 29 30 to 39 40 to 64 65 to 84 85 and over 2010-2030 Female 2010-2030 Male2000-2010 Female 2000-2010 Male POPULATION CHANGE 2000 to 2010 actual and projections for 2010 and 2030 Source: Governor's Office of Planning and Budget
AGING in PLACE at HOME with MINIMAL SUPPORTIVE SERVICES
A G I N G I N P L A C E A T H O M E S C O T T M C B E T H Director, MountainlandAging & Family Services Department Mountainland Area Agency on Aging smcbeth@mountainland.org 801-229-3805 © Deseret News
WHO ARE WE? 12 AREA AGENCIES ON AGING IN UTAH (AAA’S) LOCAL PROVIDERS OF SENIOR SERVICES ASSOCIATED WITH: Counties Association of Governments UTILIZING STATE, FEDERAL, AND LOCAL MONIES TO PROVIDE SENIOR SERVICES
SERVICES PROVIDED THROUGH AAAs Meals-on-Wheels Senior activity centers / meals Information and referral for services and resources Transportation Non-medical, in-home services programs Volunteer programs Health insurance information / guidance Ombudsman services in assisted and skilled nursing home facilities Caregiver programs © Enigma/Alamy © Deseret News
WHAT DO SERVICES ACCOMPLISH? Help seniors REMAIN AT HOME as they lose independence and face challenges of aging such as declining health, having less income, losing a spouse or not having family members nearby to assist them. Help seniors REMAIN INDEPENDENT in the community as they face transportation systems and community infrastructures that are not adequately designed for an aging population. Benefit tax payers by REDUCING ADDITIONAL GOVERNMENTAL SERVICES as family resources and informal social structures in the community are supported.
C A R E G I V I N G
ONE IN FOUR are CAREG IVERS in the US
365,000,000 HOURS 382,000 CAREGIVERS in UTAH
382,000 CAREGIVERS in UTAH 365,000,000 HOURS ofWORK
$4.2 BillionS E R V I C E S W O R T H H O U R S C A R E G I V E R S
C A R E G I V E R S FOREGO MEDICAL TREATMENT HIGHER MORTALITY RATE AMONG SENIORS DEPRESSION 67% 63% 40 –70%
C A R E G I V I N G FA C T S 46 Y/O 20 HOURS / WK More years spent caring for parents than children in lifetime
C A R E G I V I N G FA C T S 2010 2020 2050 8.3 5.8 3.4
LOST REVENUE for BUSINESSES $11– 29 Billion / yr. R E S P O N S I B I L I T I E S RELATED TO EMPLOYEE CAREGIVING
WHAT IS THE SOLUTION? I NV E ST in IN-HOME CAREGIVING support
CURRENT CAREGIVING PROGRAM S TAT E / A A A s YEAR $1,500 OR
CURRENT CAREGIVING PROGRAM S TAT E / A A A s A C C E S S T O Information and Resources for Caregivers Support Groups Educational Classes Short-Term Respite. Help with:  Identifying needs and services  PersonalCare  Light house-cleaning  Daycare for AdultsSupplemental Services
CURRENT COST / SERVICE LEVELS F Y 2 0 1 3 $1,186,905
4,700 CURRENT COST / SERVICE LEVELS F Y 2 0 1 3 CAREGIVERS ASSISTED
$252 PER CAREGIVER PER YEAR CURRENT COST / SERVICE LEVELS F Y 2 0 1 3
LOCAL SURVEY of CAREGIVER NEEDS 50% REQUESTED HELP WITH Reducing Stress Education Respite
P R O P O S E D B U D G E T I N C R E A S E 2015 LEGISLATIVE SESSION $600,000 ADDED TO BASE BUDGET Division of Aging andAdult Services
TOMORROW M E A L S: O N-G O I N G F U N D I N G CURRENT $300,000 ? PROPOSED $350,000 ON-GOING
PROPOSED C A R E G I V E R P R O G R A M S $250,000 ON-GOING = 1,000 more Caregivers assisted with: Education / Training / Info. Support Groups Respite Care Volunteer Respite Programs
W E H A V E A N A G I N G P O P U L A T I O N IT MAKES ECONOMIC SENSE WE ARE NOT MEETING THEIR NEEDS I F W E D O N ’ T A C T WE WILL NOT MEET THEIR NEEDS IT MAKES MORAL SENSE MAKES NO SENSE D O I N G L I T T L E O R N O T H I N G © Deseret News
W E C A N D O B E T T E R © Deseret News
S A F E S T R E E T S A L A N O R M S B Y State Director, AARP Utah
PROMOTE AGING IN PLACE THROUGH SAFE, WALKABLE COMMUNITIES aarp.org/livable
OVER HALF of CAREGIVERS PROVIDE: C O M P L E X C A R E  Multiple Medication Management  Wound Care  Specialized Diets  Operation of Medical Equipment
ENSURING ADEQUATE CAREGIVER TRAINING  Limits Hospital Readmission  Reduces Caregiver Stress
P O L I C Y C H O I C E
ENACT CARE Caregiver Advise, Record, Enable Act Records familyCaregiver Name Notifies Caregiver in the event a loved one is hospitalized Ensures adequateCaregiver education upon discharge of loved one from Hospital
EMPOWER CAREGIVERS to DO MORE UTAH is RANKED 50th IN SUPPORT for FAMILY CAREG IVERS
EMPOWER CAREGIVERS to DO MORE Administer Oral Medications Administer Medication on an as Needed Basis Administer Medication via Pre-Filled Insulin or Insulin Pen Draw Up Insulin for Dosage Measurement Administer Intramuscular Injection Medications Administer GlucometerTest Administer Medication throughTubes Insert Suppository Administer Eye/Ear Drops GastrostomyTube Feeding Administer Enema Perform Intermittent Catheterization Perform Ostomy Care Including Skin Care andChangingAppliance Perform NebulizerTreatment Administer OxygenTherapy PerformVentilator Respiratory Care Administer Oral Medications Administer Medication on an as Needed Basis Administer Medication via Pre-Filled Insulin or Insulin Pen Draw Up Insulin for Dosage Measurement Administer Intramuscular Injection Medications Administer GlucometerTest Administer Medication throughTubes Insert Suppository Administer Eye/Ear Drops GastrostomyTube Feeding Administer Enema Perform Intermittent Catheterization Perform Ostomy Care Including Skin Care andChangingAppliance Perform NebulizerTreatment Administer OxygenTherapy PerformVentilator Respiratory Care Perform Ostomy Care Including Skin Care andChangingAppliance UTAH is ONLY ALLOWED O N E In other states, 16 medical tasks are commonly delegated to home health workers
P O L I C Y C H O I C E
ALLOW DELEGATION OF 16 TO NURSE PRACTICE ALL TASKS www.longtermscorecard.org
RECEIVING HOME and COMMUNITY-BASED SERVICES Medicaid Waivers and Services for Older Adults
MEDICAID AGING WAIVER & ALTERNATIVES PROGRAM COST SAVING PROGRAMS M I C H A E L S . S T Y L E S Assistant Director, Division of Aging andAdult Services © PhotoAlto/Alamy
The goal of the Medicaid Aging Waiver and Alternatives Program is to provide services for low-income, medically frail seniors that would otherwise be placed in a nursing home or care facilities enabling them to be cared for safely, independently, and cost effectively in their homes. MEDICAID AGING WAIVER and the ALTERNATIVES PROGRAM COST SAVING PROGRAMS
The Utah Division of Aging and Adult Services is tasked with overseeing the Medicaid Aging Waiver and Alternatives Program which are carried out at the local level by county based Area Agencies on Aging. MEDICAID AGING WAIVER and the ALTERNATIVES PROGRAM COST SAVING PROGRAMS
On average, these individuals can be served at home for about one fifth the cost of nursing home placement. MEDICAID AGING WAIVER and the ALTERNATIVES PROGRAM COST SAVING PROGRAMS
Be 65 years of age or older 65 NURSING FACILITY LOC ADL IADL MEDICAID ELIGIBLE MEDICAID AGING WAIVER 1915 (c) The bulk of the funding is overseen by the DEPARTMENT of HEALTH CARE FINANCING . The Waiver is tasked with providing services statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, provided it is cost effective to do so. ELIGIBILITY REQUIREMENTS
Require nursing facility level of care approval (LOC) 65 NURSING FACILITY LOC ADL IADL MEDICAID ELIGIBLE MEDICAID AGING WAIVER 1915 (c) The bulk of the funding is overseen by the DEPARTMENT of HEALTH CARE FINANCING . The Waiver is tasked with providing services statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, provided it is cost effective to do so. ELIGIBILITY REQUIREMENTS
ADLs and IADLs score 65 NURSING FACILITY LOC ADL IADL MEDICAID ELIGIBLE MEDICAID AGING WAIVER 1915 (c) The bulk of the funding is overseen by the DEPARTMENT of HEALTH CARE FINANCING . The Waiver is tasked with providing services statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, provided it is cost effective to do so. ELIGIBILITY REQUIREMENTS
Meet financial eligibility requirements for Medicaid 65 NURSING FACILITY LOC ADL IADL MEDICAID ELIGIBLE MEDICAID AGING WAIVER 1915 (c) The bulk of the funding is overseen by the DEPARTMENT of HEALTH CARE FINANCING . The Waiver is tasked with providing services statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, provided it is cost effective to do so. ELIGIBILITY REQUIREMENTS
3,000,000.00 3,500,000.00 4,000,000.00 4,500,000.00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 MEDIC AID WAIV ER EXPEN DITURES FY2004Through FY 2013 C LIENT SERVIC ES AND ADMINISTRATIVE C OST $3,059,963 $3,362,053 $3,750,840 $3,922,632 $4,065,417 $4,065,417 $3,489,004 $3,506,592 $4,051,119 $4,289,625
500 600 700 800 900 C L I E N T S $2,000 $4,000 $6,000 $8,000 $10,000 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 C O S T P E R C L I E N T UNDUPLICATED CLIENTS SERVED and AVERAGE COST PER CLIENT 506 $9,606
150 225 178 185 350 225 135 200 161 140 362 192 135 225 155 140 362 203 Semi-private Low Semi-private High Semi-private Average Private Low Private High Private Average Salt Lake City Rest of Utah Averaged Source: The 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs, November 2012 http://www.massmutual.com/mmfg/pdf/Nursing_Home_Costs.pdf MASS MUTUAL INSURANCE AVERAGE $184 PER DAY, $67,343 PER YEAR
UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $67,343 $184 per day NURSING HOME STAY 1 $9,315MEDICAIDAGINGWAIVER 1915(c) 499 $4,648,815 499 $33,604,157 UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $67,343 $184 per day NURSING HOME STAY 1 $9,315 499 $4,648,815 499 $33,604,157 MEDICAIDAGINGWAIVER 1915(c) MEDICAID AGING WAIVER COST SAVINGS 2014 COST SAVINGS $28,955,342 Current Medicaid Aging- Waver Client
UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $67,343 $184 per day NURSING HOME STAY 1 $9,315MEDICAIDAGINGWAIVER 1915(c) 499 $4,648,815 499 $33,604,157 MEDICAIDAGINGWAIVER 1915(c) MEDICAID AGING WAIVER COST SAVINGS 2014 COST SAVINGS $28,955,342 Current Medicaid Aging- Waver Client
60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM In 1977 the Older AmericanAct allowed states to develop programs for Home Community Based Services /supportive Services. The Alternatives Program is a state-funded, non-Medicaid assistance program. ELIGIBILITY REQUIREMENTS
60 years of age or older, or 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
18 – 59 years of age with a disability 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
Utilizes Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) score 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
Meets financial eligibility based on the federal poverty level. 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
Means tested 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
CLIENT DIAGNOSES 10% LUNG / PULMONARY 35% 42% 13% MUSCULOSKELETAL HEART / CIRCULATORY DIGESTIVE
Falls ERVisits Hospital Stays OUTCOME MEASURES UTILIZED Homemaker Personal Care Bathing Help ERVisits QUICK FACTS 627 CURRENT CLIENTS $750 MONTHLY MAXIMUM $9,000 yearly MOST COMMON SERVICES Falls ERVisits Hospital Stays OUTCOME MEASURES UTILIZED QUICK FACTS 627 CURRENT CLIENTS $750 MONTHLY MAXIMUM $9,000 yearly Homemaker Personal Care Bathing Help ERVisits MOST COMMON SERVICES
3750000 3800000 3850000 3900000 3950000 4000000 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 $3,784,824 $3,909,906 $3,884,503 $3,945,226 $3,932,184 $3,950,492 $3,937,409 $3,881,090 $3,975,916 $3,883,473 In-Home ALTERNATIVES EXPENDITURES FY 2004 through FY 2014 $3,855,166
UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $30,000 Cost varies based on LOC ASSISTED LIVING FACILITY 1 $5,000 645 $3,225,000 645 $19,350,000 Source: Utah Assisted Living Association ALTERNATIVES PROGRAM COST SAVINGS $16,125,000 UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $30,000 Cost varies based on LOC ASSISTED LIVING FACILITY 1 $5,000 645 $3,225,000 645 $19,350,000 Source: Utah Assisted Living Association ALTERNATIVES PROGRAM COST SAVINGS 2014 Current Alternatives Program Clients
UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $30,000 Cost varies based on LOC ASSISTED LIVING FACILITY 1 $5,000 645 $3,225,000 645 $19,350,000 Source: Utah Assisted Living Association ALTERNATIVES PROGRAM COST SAVINGS $16,125,000 ALTERNATIVES PROGRAM COST SAVINGS 2014 Current Alternatives Program Clients
TOTAL COST SAVINGS For both Medicaid AgingWaiver Program and the Alternatives Program $45,080,300
With a current waiting list averaging around 165, an increase of ongoing funding of $250,000 for the Medicaid Aging Waiver Program could serve throughout the state 111 AN ADDITIONAL CLIENTS
WITH an INCREASE in the AGING POPULATION and an INCREASE IN NURSING HOME CARE and ASSISTED LIVING CARE IS THE INCREASE in FUNDING WORTH the COST SAVINGS?
A D U L T P R O T E C T I V E S E R V I C E S N A N M E N D E N H A L L State Director, Adult Protective Services © Chariclo/Alamy
Investigate referrals of abuse, neglect, or exploitation; Conduct assessments of vulnerability and functional capacity as it relates to the allegation. POWER and DUTIES of APS Investigate referrals of abuse, neglect, or exploitation; Conduct assessments of vulnerability and functional capacity as it relates to the allegation.
Coordinate with and refer to community resources for services; Provide short-term limited services when family or community resources are not available to provide protection. POWER and DUTIES of APS Provide short-term limited services when family or community resources are not available to provide protection. Coordinate with and refer to community resources for services;
POWER and DUTIES of APS Adults have the right to make personal choices and decisions — APS respects the lifestyle that is knowingly and voluntarily chosen by the vulnerable adult (VA)
678 744 1247 1306 1728 1416 1957 2248 3002 3258 3266 3027 3029 4196 2926 3746 4505 4572 4755 4445 6153 2008 2009 2010 2011 2012 2013 2014 Unaccepted Referrals Accepted Cases Total Reports TOTAL APS REPORTS to INTAKE FY 2008 – 2014
2926 3746 4505 4572 4755 4445 6153 3 3 3 3 3 3 3 2008 2009 2010 2011 2012 2013 2014 REPORTS COMPARED to FTE INTAKE STAFF FY 2008 – 2014 T O TA L R E P O R T S N U M B E R of F U L L T I M E I N TA K E W O R K E R S
847 1261 1367 1342 1236 1423 1979 499 740 848 690 600 669 1195 444 674 718 666 686 697 976 886 1036 1066 1229 869 736 786 2008 2009 2010 2011 2012 2013 2014 Exploitation Abuse Neglect Self Neglect
WHO ARE the PERPETRATORS? vs
of THOSE EXPLOITING SENIORS ARE FAMILY MEMBERS 72%
UTAH LOSES $52 million A YEAR TO EXPLOITATION
APS CASES FY 2008 – 2014 32.5 25 26 22.5 24 23 23 2248 3002 3258 3266 3027 3029 4196 2008 2009 2010 2011 2012 2013 2014 N U M B E R of C A S E S I N V E S T I G AT O R S
32.5 25 26 22.5 24 23 23 69.17 120.08 125.31 145.16 126.13 131.70 182.43 2008 2009 2010 2011 2012 2013 2014 C A S E S per I N V E S T I G AT O R I N V E S T I G AT O R S CASES PER INVESTIGATOR FY 2008 – 2014
A D D E D C A R E A T H O M E M I C H A E L H A L E S Deputy Director, Utah Department of Health, Director, Medicaid and Health Financing
UTAH MEDICAID SERVICES that SUPPORT OLDER ADULTS Medicaid services for older adults range in intensity from intermittent home-health care, to chronic care provided in home and community based waiver programs, to skilled nursing facility services and palliative care provided through the hospice benefit.
MEDIC AID H O ME AN D C O MMUN ITY BASED WAIV ER PRO GRAMS TH AT SERV E O LDER ADULTS FY 2013 Home and community based services (HCBS) are provided to individuals who, absent the availability of HCBS, would be eligible to receive care in a nursing facility. The following HCBS waivers are part of the CONTINUUM of CARE for older adults.
MEDIC AID H O ME AN D C O MMUN ITY BASED WAIV ER PRO GRAMS TH AT SERV E O LDER ADULTS FY 2013 PROGRAM NAME TOTAL # 55+ % 55+ AGING WAIVER (Serves People 65 or Older) 523 523 100% NEW CHOICES WAIVER 1,476 1,289 87% ACQUIRED BRAIN INJURY WAIVER 109 13 12% PHYSICAL DISABILITIES WAIVER 133 26 20% COMMUNITY SUPPORTS WAIVER for Individuals with Intellectual Disabilities 4,540 497 11% TOTAL NUMBER SERVED in Medicaid HCBS Aged 55 or Older 2,348
Home health, personal care and hospice services are among the array of services that assist older adults. MEDIC AID H O ME H EALTH AN D H O SPIC E SERV IC ES FY 2013
SERVICE TYPE TOTAL # 55+ % 55+ HOME HEALTH 5,122 2,336 46% HOSPICE 1,346 1,167 87% PERSONAL CARE 770 316 TOTAL NUMBER SERVED Aged 55 or Older 3,819 MEDIC AID H O ME H EALTH AN D H O SPIC E SERV IC ES FY 2013
MOVING INTO a SKILLED NURSING FACILITY
MEDICAID NURSING FACILITY SERVICES Nursing facility services continue to be an important component of services available to older adults.
Nursing facility services are available to meet a variety of needs such as a SHORT-TERM STAY when a person requires intensive rehabilitation after an illness, injury or surgery. MEDICAID NURSING FACILITY SERVICES
MEDICAID NURSING FACILITY SERVICES Services are also provided on a LONG-TERM basis when the complexity of the individuals needs can not be safely met in a home and community based program.
MEDICAID NURSING FACILITY SERVICES FY 2013 TYPIC AL MO N TH LY MEDIC AID C EN SUS 2,900people AV ERAGE LEN GTH O F MEDIC AID N URSING FAC ILITY STAY 206days 4,626 83% 55+Years
M O V I N G I N T O A S K I L L E D N U R S I N G F A C I L I T Y A N N E P A L M E R Executive Director, Utah Commission onAging
THE UTAH LEGISLATURE HAS ASKED CoA TO: Study, evaluate, and report on the impact of the aging population on government services
Identify and recommend implementation of specific policies, procedures, and programs to respond to the impact; and THE UTAH LEGISLATURE HAS ASKED CoA TO:
Encourage state government to analyze, plan, and prepare for the impacts on services and operations THE UTAH LEGISLATURE HAS ASKED CoA TO:
IN MEMORIAM
Helped in passage of state law creating LIFE WITH DIGNITY orders OUR ROLE in ADVANCED CARE PLANNING UT Code § 75 – 2a - 106
Utah Physician Orders for Life-SustainingTreatment OUR ROLE in ADVANCED CARE PLANNING Established POLST
Facilitator of BEST PRACTICES training OUR ROLE in ADVANCED CARE PLANNING
Support COMMUNITY ENGAGEMENT in crucial conversations around advance directives and end of life care POLICYSETTING
Support end of life COMFORT / PALLIATIVE CARE POLICYSETTING
Invest in the expansion of the ePOLST from pilot stage to the broader healthcare and electronic medical record systems POLICYSETTING
Mature Endorsed Developing None
WHY are we HERE?
“There are only four kinds of people in the world, those who have been caregivers, those who are currently caregivers, those who will be caregivers, those who need caregivers.” —Rosalyn Carter
Federation Square Case Study

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Federation Square Case Study

  • 1.
    Utah Representative Rebecca Chavez-Houck MalloryBateman Scott McBeth Alan Ormsby Michael S. Styles Nan Mendenhall Anne Palmer M I N D T H E G A P OPTIMIZING QUALITY of LIFE for AGING UTAHNS H E A LT H and H U M A N S E R V I C E S I N T E R I M C O M M I T T E E P R E S E N TAT I O N
  • 2.
    R E BE C C A C H A V E Z - H O U C K Democratic AssistantWhip, Utah House of Representatives M I N D T H E G A P OPTIMIZING QUALITY of LIFE for AGING UTAHNS OPTIMIZING QUALITY of LIFE for AGING UTAHNS M I N D T H E G A P
  • 5.
    ACTUAL / PROJECTED SENIORPOPULATION 85+Years A C T U A L 85+Years P R O J E C T E D 65–84Years A C T U A L 65–84Years P R O J E C T E D
  • 6.
    DELIVERY of CAREto OLDER ADULTS in UTAH 3 M A I N T Y P E S
  • 7.
    AGING in PLACEat HOME with MINIMAL SUPPORTIVE SERVICES
  • 8.
  • 9.
    MOVING INTO a SKILLEDNURSING FACILITY
  • 10.
    CONTINUUM of SERVICES forOLDER ADULTS Agencies recognize and support the need for a full CONTINUUM of CARE to meet the complex and varied needs of older adults.
  • 11.
    Many older adultscan REMAIN IN THEIR OWN HOMES with a minimal amount of supportive services Many can remain in HOME AND COMMUNITY - BASED SETTINGS with more structured supports Others receive services in NURSING FACILITIES when the complexity of the individual’s needs cannot be safely met in a home and community based setting Many older adults can REMAIN IN THEIR OWN HOMES with a minimal amount of supportive services CONTINUUM of SERVICES for OLDER ADULTS Many can remain in HOME AND COMMUNITY - BASED SETTINGS with more structured supports Others receive services in NURSING FACILITIES when the complexity of the individual’s needs cannot be safely met in a home and community based setting
  • 12.
    TYPICAL ANNUAL COSTof PUBLICLY-FUNDED SERVICES $30 – 60,000 FAC ILITY BASED S E R V I C E S AGIN G in PLAC E With limited support services When services provided in home HC BS H O M E and C O M M U N I T Y - B A S E D S E R V I C E S <$1,000 $250 – 10,000 Alternatives Aging Waiver Including Publicly- funded Services Meals on Wheels Respite
  • 13.
    C H AN G I N G D E M O G R A P H I C S M A L L O R Y B A T E M A N Research Analyst, Utah Foundation © Deseret News
  • 14.
    8.7 8.5 9 9.8 12.6 12.4 13 14.1 19902000 2010 2013 PERCENT OF POPULATION 65 YEARS OR OLDER Utah U.S. Source: U.S. Census Bureau
  • 15.
    MEDIAN AGE, UTAHAND U.S. Source: U.S. Census Bureau 1990 2000 2010 2013 UT 26.3 27.1 29.2 30.2 US 32.9 35.3 37.2 37.6
  • 16.
    UTAH DEMOGRAPHICS 2010 Source: U.S.Census Bureau UT U.S. Boomer 18.7 24.9 Gen X 20.9 21.2 Millennial 26.0 27.7 1946–1964 1965–1980 1981–1995 % % %
  • 17.
    YOUTH, WORKING AGE,AND 65+ POPULATION PROJECTIONS (UT) 0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 1990 2000 2010 2020 2030 2040 2050 18 to 64 0 to 17 65 to 84 85 and over Source: Governor's Office of Management and Budget 2013 Population 2,900,872 2050 Population 5,257,242
  • 18.
    13% 17% 14% 6% 11% 12% 29% 19% 15% 15% 14% 10% 21% 24% 27% 38% 22% 23% 1990to 2000 2000 to 2010 2010 to 2020 2020 to 2030 2030 to 2040 2040 to 2050 0 to 17 18 to 64 65 and over PERCENT CHANGE by DECADE 1990 to 2050 Source: Governor’s Office of Management and Budget
  • 19.
    76.0 67.0 65.8 54.2 53.052.4 47.5 46.2 47.1 46.7 14.0 13.0 15.8 14.4 15.2 17.6 24.2 26.7 31.1 33.7 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 Youth Retirement Age DEPENDENCY RATIO 1990 – 2050 90.0 80.0 81.6 68.5 68.2 70.0 71.7 72.9 78.2 80.4 Source: Bureau of Economic and Business Research analysis of Governor’s Office of Management and Budget, 2012 Projections. Note: Dependency Ratios are computed as the number of nonworking age persons per 100 working age (18-64 years old) persons in the population. Youth are less than 18 years old and retirement age is 65 years and older.
  • 20.
    2010 M A LE 2000 M A L E 150,000 100,000 50,000 0 50,000 100,000 150,000 Under 5 5 – 9 10 – 14 15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 – 74 75 – 79 80 – 84 85 and over UTAH POPULATION by AGE and SEX 2000 and 2010 2010 F E M A L E 2000 F E M A L E Source: Bureau of Economic and Business Research analysis. U.S. Census Bureau, 2000 and 2010 Census.
  • 21.
    80% 60% 40%20% 0% 20% 40% 60% 80% 0 to 4 5 to 17 18 to 29 30 to 39 40 to 64 65 to 84 85 and over 2010-2030 Female 2010-2030 Male2000-2010 Female 2000-2010 Male POPULATION CHANGE 2000 to 2010 actual and projections for 2010 and 2030 Source: Governor's Office of Planning and Budget
  • 22.
    AGING in PLACEat HOME with MINIMAL SUPPORTIVE SERVICES
  • 23.
    A G IN G I N P L A C E A T H O M E S C O T T M C B E T H Director, MountainlandAging & Family Services Department Mountainland Area Agency on Aging smcbeth@mountainland.org 801-229-3805 © Deseret News
  • 24.
    WHO ARE WE? 12AREA AGENCIES ON AGING IN UTAH (AAA’S) LOCAL PROVIDERS OF SENIOR SERVICES ASSOCIATED WITH: Counties Association of Governments UTILIZING STATE, FEDERAL, AND LOCAL MONIES TO PROVIDE SENIOR SERVICES
  • 25.
    SERVICES PROVIDED THROUGHAAAs Meals-on-Wheels Senior activity centers / meals Information and referral for services and resources Transportation Non-medical, in-home services programs Volunteer programs Health insurance information / guidance Ombudsman services in assisted and skilled nursing home facilities Caregiver programs © Enigma/Alamy © Deseret News
  • 26.
    WHAT DO SERVICESACCOMPLISH? Help seniors REMAIN AT HOME as they lose independence and face challenges of aging such as declining health, having less income, losing a spouse or not having family members nearby to assist them. Help seniors REMAIN INDEPENDENT in the community as they face transportation systems and community infrastructures that are not adequately designed for an aging population. Benefit tax payers by REDUCING ADDITIONAL GOVERNMENTAL SERVICES as family resources and informal social structures in the community are supported.
  • 27.
    C A RE G I V I N G
  • 28.
    ONE IN FOURare CAREG IVERS in the US
  • 29.
  • 30.
    382,000 CAREGIVERS inUTAH 365,000,000 HOURS ofWORK
  • 31.
    $4.2 BillionS ER V I C E S W O R T H H O U R S C A R E G I V E R S
  • 32.
    C A RE G I V E R S FOREGO MEDICAL TREATMENT HIGHER MORTALITY RATE AMONG SENIORS DEPRESSION 67% 63% 40 –70%
  • 33.
    C A RE G I V I N G FA C T S 46 Y/O 20 HOURS / WK More years spent caring for parents than children in lifetime
  • 34.
    C A RE G I V I N G FA C T S 2010 2020 2050 8.3 5.8 3.4
  • 35.
    LOST REVENUE forBUSINESSES $11– 29 Billion / yr. R E S P O N S I B I L I T I E S RELATED TO EMPLOYEE CAREGIVING
  • 36.
    WHAT IS THESOLUTION? I NV E ST in IN-HOME CAREGIVING support
  • 37.
    CURRENT CAREGIVING PROGRAM STAT E / A A A s YEAR $1,500 OR
  • 38.
    CURRENT CAREGIVING PROGRAM STAT E / A A A s A C C E S S T O Information and Resources for Caregivers Support Groups Educational Classes Short-Term Respite. Help with:  Identifying needs and services  PersonalCare  Light house-cleaning  Daycare for AdultsSupplemental Services
  • 39.
    CURRENT COST /SERVICE LEVELS F Y 2 0 1 3 $1,186,905
  • 40.
    4,700 CURRENT COST /SERVICE LEVELS F Y 2 0 1 3 CAREGIVERS ASSISTED
  • 41.
    $252 PER CAREGIVER PERYEAR CURRENT COST / SERVICE LEVELS F Y 2 0 1 3
  • 42.
    LOCAL SURVEY ofCAREGIVER NEEDS 50% REQUESTED HELP WITH Reducing Stress Education Respite
  • 43.
    P R OP O S E D B U D G E T I N C R E A S E 2015 LEGISLATIVE SESSION $600,000 ADDED TO BASE BUDGET Division of Aging andAdult Services
  • 44.
    TOMORROW M E AL S: O N-G O I N G F U N D I N G CURRENT $300,000 ? PROPOSED $350,000 ON-GOING
  • 45.
    PROPOSED C A RE G I V E R P R O G R A M S $250,000 ON-GOING = 1,000 more Caregivers assisted with: Education / Training / Info. Support Groups Respite Care Volunteer Respite Programs
  • 46.
    W E HA V E A N A G I N G P O P U L A T I O N IT MAKES ECONOMIC SENSE WE ARE NOT MEETING THEIR NEEDS I F W E D O N ’ T A C T WE WILL NOT MEET THEIR NEEDS IT MAKES MORAL SENSE MAKES NO SENSE D O I N G L I T T L E O R N O T H I N G © Deseret News
  • 47.
    W E CA N D O B E T T E R © Deseret News
  • 48.
    S A FE S T R E E T S A L A N O R M S B Y State Director, AARP Utah
  • 49.
    PROMOTE AGING INPLACE THROUGH SAFE, WALKABLE COMMUNITIES aarp.org/livable
  • 50.
    OVER HALF ofCAREGIVERS PROVIDE: C O M P L E X C A R E  Multiple Medication Management  Wound Care  Specialized Diets  Operation of Medical Equipment
  • 51.
    ENSURING ADEQUATE CAREGIVER TRAINING Limits Hospital Readmission  Reduces Caregiver Stress
  • 52.
    P O LI C Y C H O I C E
  • 53.
    ENACT CARE Caregiver Advise, Record,Enable Act Records familyCaregiver Name Notifies Caregiver in the event a loved one is hospitalized Ensures adequateCaregiver education upon discharge of loved one from Hospital
  • 54.
    EMPOWER CAREGIVERS toDO MORE UTAH is RANKED 50th IN SUPPORT for FAMILY CAREG IVERS
  • 55.
    EMPOWER CAREGIVERS toDO MORE Administer Oral Medications Administer Medication on an as Needed Basis Administer Medication via Pre-Filled Insulin or Insulin Pen Draw Up Insulin for Dosage Measurement Administer Intramuscular Injection Medications Administer GlucometerTest Administer Medication throughTubes Insert Suppository Administer Eye/Ear Drops GastrostomyTube Feeding Administer Enema Perform Intermittent Catheterization Perform Ostomy Care Including Skin Care andChangingAppliance Perform NebulizerTreatment Administer OxygenTherapy PerformVentilator Respiratory Care Administer Oral Medications Administer Medication on an as Needed Basis Administer Medication via Pre-Filled Insulin or Insulin Pen Draw Up Insulin for Dosage Measurement Administer Intramuscular Injection Medications Administer GlucometerTest Administer Medication throughTubes Insert Suppository Administer Eye/Ear Drops GastrostomyTube Feeding Administer Enema Perform Intermittent Catheterization Perform Ostomy Care Including Skin Care andChangingAppliance Perform NebulizerTreatment Administer OxygenTherapy PerformVentilator Respiratory Care Perform Ostomy Care Including Skin Care andChangingAppliance UTAH is ONLY ALLOWED O N E In other states, 16 medical tasks are commonly delegated to home health workers
  • 56.
    P O LI C Y C H O I C E
  • 57.
    ALLOW DELEGATION OF 16 TONURSE PRACTICE ALL TASKS www.longtermscorecard.org
  • 58.
    RECEIVING HOME and COMMUNITY-BASED SERVICES MedicaidWaivers and Services for Older Adults
  • 59.
    MEDICAID AGING WAIVER & ALTERNATIVESPROGRAM COST SAVING PROGRAMS M I C H A E L S . S T Y L E S Assistant Director, Division of Aging andAdult Services © PhotoAlto/Alamy
  • 60.
    The goal ofthe Medicaid Aging Waiver and Alternatives Program is to provide services for low-income, medically frail seniors that would otherwise be placed in a nursing home or care facilities enabling them to be cared for safely, independently, and cost effectively in their homes. MEDICAID AGING WAIVER and the ALTERNATIVES PROGRAM COST SAVING PROGRAMS
  • 61.
    The Utah Divisionof Aging and Adult Services is tasked with overseeing the Medicaid Aging Waiver and Alternatives Program which are carried out at the local level by county based Area Agencies on Aging. MEDICAID AGING WAIVER and the ALTERNATIVES PROGRAM COST SAVING PROGRAMS
  • 62.
    On average, theseindividuals can be served at home for about one fifth the cost of nursing home placement. MEDICAID AGING WAIVER and the ALTERNATIVES PROGRAM COST SAVING PROGRAMS
  • 63.
    Be 65 yearsof age or older 65 NURSING FACILITY LOC ADL IADL MEDICAID ELIGIBLE MEDICAID AGING WAIVER 1915 (c) The bulk of the funding is overseen by the DEPARTMENT of HEALTH CARE FINANCING . The Waiver is tasked with providing services statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, provided it is cost effective to do so. ELIGIBILITY REQUIREMENTS
  • 64.
    Require nursing facilitylevel of care approval (LOC) 65 NURSING FACILITY LOC ADL IADL MEDICAID ELIGIBLE MEDICAID AGING WAIVER 1915 (c) The bulk of the funding is overseen by the DEPARTMENT of HEALTH CARE FINANCING . The Waiver is tasked with providing services statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, provided it is cost effective to do so. ELIGIBILITY REQUIREMENTS
  • 65.
    ADLs and IADLsscore 65 NURSING FACILITY LOC ADL IADL MEDICAID ELIGIBLE MEDICAID AGING WAIVER 1915 (c) The bulk of the funding is overseen by the DEPARTMENT of HEALTH CARE FINANCING . The Waiver is tasked with providing services statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, provided it is cost effective to do so. ELIGIBILITY REQUIREMENTS
  • 66.
    Meet financial eligibilityrequirements for Medicaid 65 NURSING FACILITY LOC ADL IADL MEDICAID ELIGIBLE MEDICAID AGING WAIVER 1915 (c) The bulk of the funding is overseen by the DEPARTMENT of HEALTH CARE FINANCING . The Waiver is tasked with providing services statewide to help older adults who are nursing home eligible remain in their homes and live as independently as possible, provided it is cost effective to do so. ELIGIBILITY REQUIREMENTS
  • 67.
    3,000,000.00 3,500,000.00 4,000,000.00 4,500,000.00 2004 2005 20062007 2008 2009 2010 2011 2012 2013 MEDIC AID WAIV ER EXPEN DITURES FY2004Through FY 2013 C LIENT SERVIC ES AND ADMINISTRATIVE C OST $3,059,963 $3,362,053 $3,750,840 $3,922,632 $4,065,417 $4,065,417 $3,489,004 $3,506,592 $4,051,119 $4,289,625
  • 68.
    500 600 700 800 900 C L IE N T S $2,000 $4,000 $6,000 $8,000 $10,000 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 C O S T P E R C L I E N T UNDUPLICATED CLIENTS SERVED and AVERAGE COST PER CLIENT 506 $9,606
  • 69.
    150 225 178 185 350 225 135 200 161 140 362 192 135 225 155 140 362 203 Semi-private Low Semi-private High Semi-private Average Private LowPrivate High Private Average Salt Lake City Rest of Utah Averaged Source: The 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs, November 2012 http://www.massmutual.com/mmfg/pdf/Nursing_Home_Costs.pdf MASS MUTUAL INSURANCE AVERAGE $184 PER DAY, $67,343 PER YEAR
  • 70.
    UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $67,343 $184per day NURSING HOME STAY 1 $9,315MEDICAIDAGINGWAIVER 1915(c) 499 $4,648,815 499 $33,604,157 UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $67,343 $184 per day NURSING HOME STAY 1 $9,315 499 $4,648,815 499 $33,604,157 MEDICAIDAGINGWAIVER 1915(c) MEDICAID AGING WAIVER COST SAVINGS 2014 COST SAVINGS $28,955,342 Current Medicaid Aging- Waver Client
  • 71.
    UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $67,343 $184per day NURSING HOME STAY 1 $9,315MEDICAIDAGINGWAIVER 1915(c) 499 $4,648,815 499 $33,604,157 MEDICAIDAGINGWAIVER 1915(c) MEDICAID AGING WAIVER COST SAVINGS 2014 COST SAVINGS $28,955,342 Current Medicaid Aging- Waver Client
  • 72.
    60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM In1977 the Older AmericanAct allowed states to develop programs for Home Community Based Services /supportive Services. The Alternatives Program is a state-funded, non-Medicaid assistance program. ELIGIBILITY REQUIREMENTS
  • 73.
    60 years ofage or older, or 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
  • 74.
    18 – 59years of age with a disability 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
  • 75.
    Utilizes Activities ofDaily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) score 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
  • 76.
    Meets financial eligibilitybased on the federal poverty level. 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVES PROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
  • 77.
    Means tested 60 DISABILITY ADL IADL POVERTY SLIDING SCALE ALTERNATIVESPROGRAM ELIGIBILITY REQUIREMENTS It’s goal is to provide services to help older adults who are not nursing home eligible, but who are at risk for facility based care, remain in their homes and as independent as possible.
  • 78.
  • 79.
    Falls ERVisits Hospital Stays OUTCOME MEASURES UTILIZED Homemaker PersonalCare Bathing Help ERVisits QUICK FACTS 627 CURRENT CLIENTS $750 MONTHLY MAXIMUM $9,000 yearly MOST COMMON SERVICES Falls ERVisits Hospital Stays OUTCOME MEASURES UTILIZED QUICK FACTS 627 CURRENT CLIENTS $750 MONTHLY MAXIMUM $9,000 yearly Homemaker Personal Care Bathing Help ERVisits MOST COMMON SERVICES
  • 80.
    3750000 3800000 3850000 3900000 3950000 4000000 2004 2005 20062007 2008 2009 2010 2011 2012 2013 2014 $3,784,824 $3,909,906 $3,884,503 $3,945,226 $3,932,184 $3,950,492 $3,937,409 $3,881,090 $3,975,916 $3,883,473 In-Home ALTERNATIVES EXPENDITURES FY 2004 through FY 2014 $3,855,166
  • 81.
    UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $30,000 Costvaries based on LOC ASSISTED LIVING FACILITY 1 $5,000 645 $3,225,000 645 $19,350,000 Source: Utah Assisted Living Association ALTERNATIVES PROGRAM COST SAVINGS $16,125,000 UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $30,000 Cost varies based on LOC ASSISTED LIVING FACILITY 1 $5,000 645 $3,225,000 645 $19,350,000 Source: Utah Assisted Living Association ALTERNATIVES PROGRAM COST SAVINGS 2014 Current Alternatives Program Clients
  • 82.
    UNDUPLICATED CLIENTS AVERAGE ANNUAL COST 1 $30,000 Costvaries based on LOC ASSISTED LIVING FACILITY 1 $5,000 645 $3,225,000 645 $19,350,000 Source: Utah Assisted Living Association ALTERNATIVES PROGRAM COST SAVINGS $16,125,000 ALTERNATIVES PROGRAM COST SAVINGS 2014 Current Alternatives Program Clients
  • 83.
    TOTAL COST SAVINGS Forboth Medicaid AgingWaiver Program and the Alternatives Program $45,080,300
  • 84.
    With a currentwaiting list averaging around 165, an increase of ongoing funding of $250,000 for the Medicaid Aging Waiver Program could serve throughout the state 111 AN ADDITIONAL CLIENTS
  • 85.
    WITH an INCREASEin the AGING POPULATION and an INCREASE IN NURSING HOME CARE and ASSISTED LIVING CARE IS THE INCREASE in FUNDING WORTH the COST SAVINGS?
  • 86.
    A D UL T P R O T E C T I V E S E R V I C E S N A N M E N D E N H A L L State Director, Adult Protective Services © Chariclo/Alamy
  • 87.
    Investigate referrals ofabuse, neglect, or exploitation; Conduct assessments of vulnerability and functional capacity as it relates to the allegation. POWER and DUTIES of APS Investigate referrals of abuse, neglect, or exploitation; Conduct assessments of vulnerability and functional capacity as it relates to the allegation.
  • 88.
    Coordinate with andrefer to community resources for services; Provide short-term limited services when family or community resources are not available to provide protection. POWER and DUTIES of APS Provide short-term limited services when family or community resources are not available to provide protection. Coordinate with and refer to community resources for services;
  • 89.
    POWER and DUTIESof APS Adults have the right to make personal choices and decisions — APS respects the lifestyle that is knowingly and voluntarily chosen by the vulnerable adult (VA)
  • 90.
    678 744 1247 1306 1728 1416 1957 2248 3002 32583266 3027 3029 4196 2926 3746 4505 4572 4755 4445 6153 2008 2009 2010 2011 2012 2013 2014 Unaccepted Referrals Accepted Cases Total Reports TOTAL APS REPORTS to INTAKE FY 2008 – 2014
  • 91.
    2926 3746 4505 4572 4755 4445 6153 3 33 3 3 3 3 2008 2009 2010 2011 2012 2013 2014 REPORTS COMPARED to FTE INTAKE STAFF FY 2008 – 2014 T O TA L R E P O R T S N U M B E R of F U L L T I M E I N TA K E W O R K E R S
  • 92.
    847 1261 1367 1342 1236 1423 1979 499 740 848 690 600 669 1195 444 674 718 666 686697 976 886 1036 1066 1229 869 736 786 2008 2009 2010 2011 2012 2013 2014 Exploitation Abuse Neglect Self Neglect
  • 93.
    WHO ARE thePERPETRATORS? vs
  • 94.
    of THOSE EXPLOITINGSENIORS ARE FAMILY MEMBERS 72%
  • 95.
    UTAH LOSES $52 million AYEAR TO EXPLOITATION
  • 96.
    APS CASES FY 2008– 2014 32.5 25 26 22.5 24 23 23 2248 3002 3258 3266 3027 3029 4196 2008 2009 2010 2011 2012 2013 2014 N U M B E R of C A S E S I N V E S T I G AT O R S
  • 97.
    32.5 25 26 22.524 23 23 69.17 120.08 125.31 145.16 126.13 131.70 182.43 2008 2009 2010 2011 2012 2013 2014 C A S E S per I N V E S T I G AT O R I N V E S T I G AT O R S CASES PER INVESTIGATOR FY 2008 – 2014
  • 98.
    A D DE D C A R E A T H O M E M I C H A E L H A L E S Deputy Director, Utah Department of Health, Director, Medicaid and Health Financing
  • 99.
    UTAH MEDICAID SERVICESthat SUPPORT OLDER ADULTS Medicaid services for older adults range in intensity from intermittent home-health care, to chronic care provided in home and community based waiver programs, to skilled nursing facility services and palliative care provided through the hospice benefit.
  • 100.
    MEDIC AID HO ME AN D C O MMUN ITY BASED WAIV ER PRO GRAMS TH AT SERV E O LDER ADULTS FY 2013 Home and community based services (HCBS) are provided to individuals who, absent the availability of HCBS, would be eligible to receive care in a nursing facility. The following HCBS waivers are part of the CONTINUUM of CARE for older adults.
  • 101.
    MEDIC AID HO ME AN D C O MMUN ITY BASED WAIV ER PRO GRAMS TH AT SERV E O LDER ADULTS FY 2013 PROGRAM NAME TOTAL # 55+ % 55+ AGING WAIVER (Serves People 65 or Older) 523 523 100% NEW CHOICES WAIVER 1,476 1,289 87% ACQUIRED BRAIN INJURY WAIVER 109 13 12% PHYSICAL DISABILITIES WAIVER 133 26 20% COMMUNITY SUPPORTS WAIVER for Individuals with Intellectual Disabilities 4,540 497 11% TOTAL NUMBER SERVED in Medicaid HCBS Aged 55 or Older 2,348
  • 102.
    Home health, personalcare and hospice services are among the array of services that assist older adults. MEDIC AID H O ME H EALTH AN D H O SPIC E SERV IC ES FY 2013
  • 103.
    SERVICE TYPE TOTAL# 55+ % 55+ HOME HEALTH 5,122 2,336 46% HOSPICE 1,346 1,167 87% PERSONAL CARE 770 316 TOTAL NUMBER SERVED Aged 55 or Older 3,819 MEDIC AID H O ME H EALTH AN D H O SPIC E SERV IC ES FY 2013
  • 104.
    MOVING INTO a SKILLEDNURSING FACILITY
  • 105.
    MEDICAID NURSING FACILITY SERVICES Nursingfacility services continue to be an important component of services available to older adults.
  • 106.
    Nursing facility servicesare available to meet a variety of needs such as a SHORT-TERM STAY when a person requires intensive rehabilitation after an illness, injury or surgery. MEDICAID NURSING FACILITY SERVICES
  • 107.
    MEDICAID NURSING FACILITY SERVICES Servicesare also provided on a LONG-TERM basis when the complexity of the individuals needs can not be safely met in a home and community based program.
  • 108.
    MEDICAID NURSING FACILITY SERVICES FY2013 TYPIC AL MO N TH LY MEDIC AID C EN SUS 2,900people AV ERAGE LEN GTH O F MEDIC AID N URSING FAC ILITY STAY 206days 4,626 83% 55+Years
  • 109.
    M O VI N G I N T O A S K I L L E D N U R S I N G F A C I L I T Y A N N E P A L M E R Executive Director, Utah Commission onAging
  • 110.
    THE UTAH LEGISLATURE HASASKED CoA TO: Study, evaluate, and report on the impact of the aging population on government services
  • 111.
    Identify and recommend implementationof specific policies, procedures, and programs to respond to the impact; and THE UTAH LEGISLATURE HAS ASKED CoA TO:
  • 112.
    Encourage state governmentto analyze, plan, and prepare for the impacts on services and operations THE UTAH LEGISLATURE HAS ASKED CoA TO:
  • 113.
  • 114.
    Helped in passageof state law creating LIFE WITH DIGNITY orders OUR ROLE in ADVANCED CARE PLANNING UT Code § 75 – 2a - 106
  • 115.
    Utah Physician Ordersfor Life-SustainingTreatment OUR ROLE in ADVANCED CARE PLANNING Established POLST
  • 116.
    Facilitator of BEST PRACTICEStraining OUR ROLE in ADVANCED CARE PLANNING
  • 117.
    Support COMMUNITY ENGAGEMENT incrucial conversations around advance directives and end of life care POLICYSETTING
  • 118.
    Support end oflife COMFORT / PALLIATIVE CARE POLICYSETTING
  • 119.
    Invest in theexpansion of the ePOLST from pilot stage to the broader healthcare and electronic medical record systems POLICYSETTING
  • 120.
  • 121.
  • 122.
    “There are onlyfour kinds of people in the world, those who have been caregivers, those who are currently caregivers, those who will be caregivers, those who need caregivers.” —Rosalyn Carter