Alaskas Continuum of Care A Skilled Nursing Facility

Alaska’s Continuum of Care A Skilled Nursing Facility Perspective —Dennis Murray, ASHNHA There are 17 skilled nursing facilities in Alaska. Most of them are co-located in a community with a hospital. Only 2 are free-standing

New SNF’s and Additions 96 Beds-8 Cottages: Providence Extended Care Center

50 beds: Providence Transitional Care Facility---To open mid-year, 2014

18 Bed SNF-- part of Norton Sound Health Corporation in Nome

SNF---18 Beds: Part of Maniilaq in Kotzebue

YKHC Elders SNF— 18 Beds, Opens in October

Hospital Readmissions

CMS Initiative: Reducing Off-Label Use of Antipsychotics

Federal Legislation

• What is Gero Prep? • A 10 -module learning program that prepares your RNs to pass the gerontological certification exam by the American Nurses Credentialing Center. • An important new member benefit for the challenging road ahead. • WHAT: AHCA/NCAL Gerontological Nurse Certification Prep Course. • WHY: Solving pressing challenges today yields big all-in dividends tomorrow. • HOW: Proven certification training - online, self-paced and on-demand 24/7. • Course Preview. • How Gero Prep began. • Good news spreads fast and far. • Meet your gerontological nursing education provider: UNMC College of Nursing. http: //app 1. unmc. edu/geronurseprep

DHSS Strategic Planning LTC Recommendations to DHSS from Stakeholder Group • Recommendation 1| Educate the public. • Recommendation 2| Develop additional levels of care along the continuum of long-term services and supports; and, incentivize movement towards the lower end through increased coordination at both the individual and systems level. • Recommendation 3| Reduce costs, diversify payers and increase private investment. • Recommendation 4| Improve quality and encourage innovation. • Recommendation 5| Develop in-state capacity for populations with specific needs. • Recommendation 6| Develop workforce and support caregivers. • Recommendation 7| Determine the appropriate number, type and location of skilled nursing and assisted living beds.

DHSS Comprehensive Behavior Collaborative

Recent Research on Long Term Services and Supports Users Septembe 22, 2013 Provided by the American Health Care Association (AHCA) 18

Overall Spending Community is Roughly Same Overall Spending in in thethe Community is Roughly thethe Same as Nursing Center Dual Older Adults as Nursing Center Care for Care Dual for Older Adults Spending is Roughly the Same in Total (e. g. , Medicare and Medicaid) LTC $ Medical Care $ nl y) re -O id ica ed ed No LT C (M (M al Du C LT -O nl y) Du al C LT No itu tio na l. N l. D tit In s on du al l ua y nl id -O ut io na In st No Co m m un ity M Co m m ed ica un ity Du al $80 000 $70 000 $60 000 $50 000 $40 000 $30 000 $20 000 $10 000 $0 Kane, R. , Wysocki, A. , Parashuram S. , Shippee, T. , Lum, T. Effective of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries. Medicare & Medicaid Research Review 2013: Volume 3, Number 3. 19

Executive Summary of Research Findings • Recent research indicates that Medicare spending is higher for people using home and community-based services (HCBS)) than nursing center residents • Certain demographic trends could exacerbate medical care challenges for people using HCBS • Such findings have notable implications for state and federal efforts to integrate Medicare and Medicaid for people who are dually eligible • Questions still linger about HCBS cost effectiveness and the new research raises further questions about outcomes for people enrolled in HCBS • Traditional managed care does not appear to be the solution 20

Higher Acute Care Costs in the Community • Some studies point to higher rates of avoidable hospitalization and emergency room use among HCBS participants • Historically, states have focused only on Medicaid outlays • Increased Medicare spending for expanding HCBS programs was not considered or not a primary concern for states • Low Medicaid reimbursement correlates with high Medicare spending R. Tamara Konetzka, Sarita L. Karon, and D. E. B. Potter. Users Of Medicaid Home And Community-Based Services Are Especially Vulnerable To Costly Avoidable Hospital Admissions. Health Affairs, 31, NO. 6 (2012): 1167– 1175; Kane, R. , Wysocki, A. , Parashuram S. , Shippee, T. , Lum, T. Effective of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries. Medicare & Medicaid Research Review 2013: Volume 3, Number 3. 21

Focus on Duals Could be a Game Changer • Financial Alignment Demonstration – Federal and State motivation to keep Medicaid and Medicare spending down – Memoranda of Understanding have Medicare and Medicaid savings targets – Plan metric to reduce hospitalizations related to quality withhold • Fully Integrated Dual Eligible (FIDE) Special Needs Plans – Plan interest in coordinating both Medicare and Medicaid in hopes of broader control and margin – Plans have a strong incentive to manage down costs in both programs 22

Caregiver Capacity Could Exacerbate Medical Care Challenges Caregiver Support Ratio, United States 8 7 6 5 4 3 2 1 0 Boomers turn 45 Boomers turn 65 1990 2000 2010 2020 Redfoot, D. , et. al. The Aging of the Baby Boom and Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers. AARP Public Policy Institute. Insight on the Issues 85, August 2013. 2030 Boomers turn 80 2040 2050 23