Community Partnerships in Long-Term Care

R U R A L H O S P I TA L L E A D E R S H I P C O N F E R E N C E

J U N E 2 5 B R E A K O U T S E S S I O N

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Presenters▪Jody Carona, Principal▪ Health Facilities Planning & Development

▪Rosalinda Kibby, CEO ▪ Grant County Public Hospital District #3,

Columbia Basin Hospital

▪Bea Rector, Director ▪ Home and Community Services Division Aging

and Long Term Support Administration Washington State Department of Social and Health Services

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Session Goals:▪Understanding:▪The array of community based services and providers

available in the State and issues specific to rural; and

▪The often “braided” nature of funding.

▪Clarifying why community-based LTC is part of our State’s transformation efforts, why it deserves as much attention as other initiatives and why it cannot be siloed from the rest of the delivery system.

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A Bit of Context… ▪The State has grown 24.1% since 2000, and today seniors (age 75+) represent 5.9% of the total State population (having grown 32.8% since 2000).

▪During the same time frame, rural Washington’s population grew by 8.0% and residents age 75+ now represent 8.5% of the total (having grown 26.8%-- or 3.5x faster than the total population) since 2000.

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The Concern…

The population is rapidly aging in rural WA, and services are difficult to sustain. For example,

Only 6 rural public hospital districts operate

nursing homes today, while 18 did in 2000.

Other community-based services lag as well.

And, sustaining an adequately sized and

trained workforce is an ongoing challenge.

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Medicare Spending in Rural WACounties Is Below US/WA Average

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Highest Cost Counties Due to High Post-Acute Care Spending

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And, there is Underspending on Home Health and Hospice in Rural Counties

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Most Counties Only 10-50% of U.S. Rate on Home Health $

Funding is already available throughexisting payment systems to filla portion of the service gap if theservices were available in rural communities

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CBLTCN…One Option ▪A proposal by 10 PHDs (now 13) to establish a formal network to develop and sustain community based long-term care in rural Washington.

▪Mission:

▪ A financially sustainable, coordinated, resident centered, silo-busting outcome driven rural network for delivery of quality community-based long term care services.

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Proposed CBLTCN ServicesIncludes the following services:

1) RN or Social Worker care coordination at the network level

2) Tele-monitoring at the network level

3) Community care workers embedded in primary care clinics

4) Home health as needed through primary care clinics

5) Day health integrated into existing swing bed programs

6) Congregate housing – TBD

7) Home safety/renovations

8) Caregiver support

9) Behavioral Health

10) Housing

11) Transportation

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Columbia Basin Hospital TodayE P H R ATA , WA

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Long Term Care Services▪12 bed Nursing Home

▪32 bed Assisted Living

▪Clinic provider assistance to near-by 42 bed nursing home

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Community Supported▪Services were developed initially through a community needs assessment.

▪No other long term care services exist except for an adult family home.

▪Services are supported through voter-approved bonds for remodeling projects.

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Nursing Home Costs▪Direct expenses of $880,826

▪Allocated expenses (shared expenses with the entire hospital) of $877,020

▪Total expenses of $1,757,847

▪Revenue of $1,238,872

▪Loss of $518,974

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Assisted Living Costs▪Direct expenses of $570,104

▪Allocated expenses of $1,454,304

▪Total expenses of $2,024,407

▪Revenue of $1,069,925

▪Loss of $954,482

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How can we afford this today?▪ProShare money for the nursing home▪ $284,000

▪Hospital subsidizes the losses

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Sustainability▪Hospital profit margins are decreasing.

▪Subsidy is no longer an option.

▪The need for service is increasing, not decreasing.

▪Institutional long term care is not supported well and will not receive increased payments.

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Future▪How can you provide long term care services outside of your walls?▪ Send your team out

▪ Transportation services

▪ Adult Family Homes

▪ Adult Day Care/Adult Day Health

▪Concerns▪ Regulatory burden

▪ Geriatric independence vs. isolation

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Clients Served in Home and Community

VisionSeniors and people with disabilities living in good health, independence, dignity, and control over

decisions that affect their lives

MissionTo Transform Lives by promoting choice,

independence and safety through innovative services

We ValueThe Pursuit of Excellence, Collaboration, Honesty,

Respect, Open Communication, Diversity, Accountability, and Compassion

Serving approximately 74,000 individuals per year(Average monthly caseload of 64,000)

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Long Term Care Delivery System

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Nursing Facility

Adult Family Homes

Assisted Living

Home Care Agencies

DSHS-Home & Community Services

• Financial Eligibility• Functional Eligibility• Residential Case

Management• Nursing Home

Transitions• Adult Protective Services

Individual Providers

Adult Day Services

Area Agencies on Aging

• Information & Assistance• In-home Case

Management• Family & Kinship

Caregivers• Senior Nutrition

Skilled Nursing & Therapies

Evidence Based Interventions

Family Caregiver Supports

Health Homes

How has service delivery changed?

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Shift from Nursing Home to Home & Community

1992 Snapshot

36,649 total clients

47% Nursing Home

53% Home & Community

2017 Snapshot

65,336 total clients

15% Nursing Home

85% Home & Community

Access to early interventions leads to decrease in avoidable use of nursing homes

How did WA get here? LTSS Program Innovations

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Initial Service Modality is Shifting Away from Nursing Homes to In-Home Personal Care

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40%

18%

42%

35%

19%

46%

29%

18%

53%

Nursing Home Community Residential In-Home Personal Care

Percent of clients who started LTSS services in:

Nursing Home

SFY

20

02

-20

05

SFY

20

10

-20

12

SFY

20

15

In home personal care

SFY

20

02

-20

05

SFY

20

10

-20

12

SFY

20

15

HCBS Clients Are Now Less Likely To Transition to Nursing Homes

Transitions Between LTSS Service Modalities for SFY 2002-2005 and SFY 2010-2012 Cohorts, 36-Month Follow-up Window

SFY 2002-2005 COHORT SFY 2010-2012 COHORT

Client starts in . . .

In-Home Personal Care

Community Residential

Nursing Home

In-Home Personal Care

Community Residential

Nursing Home

Ever transitions to . . . Client starts in . . . Ever transitions to. . .

9%15%

Community Residential

Nursing Home

7%11%

Community Residential

Nursing Home

9%

28%

In-Home Personal Care

Nursing Home

15%18%

In-Home Personal Care

Nursing Home

11% 11%

In-Home Personal Care

Community Residential

19%14%

In-HomePersonal Care

Community Residential

SOURCE: DSHS Research and Data Analysis Division, Integrated Client Databases.

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Opportunities for Rural Service Delivery

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Access to early interventions leads to decrease in avoidable use of nursing homes

• Partnership between health care and long term services and supports providers.

• Leverage and support paid and unpaid supports to serve individuals in community settings.

• Contract for skilled nursing and therapies.

• Telemedicine.

• Small residential settings.

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For more information on ALTSA, visit:

ALTSA Website: https://www.dshs.wa.gov/altsa

ALTSA Strategic Plan and Metrics:https://www.dshs.wa.gov/strategic-planning/current-dshs-strategic-plans#Aging

For questions, contact:Bea Rector, Director Home and Community Services Division(360) 725-2272; bea.rector@dshs.wa.gov

Where Do We Go From Here?

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