community partnerships in long-term care … · rosalinda kibby, ceo grant county public hospital...
TRANSCRIPT
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
1 1 : 0 0 - 1 2 : 0 0
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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; [email protected]
Where Do We Go From Here?
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© 2008 1 Evidence-based Approaches to Promoting Critical Thinking Rosalinda Alfaro- LeFevre, RN, MSN
MSDS Organic Sunflower Oil - Natural Sourcing LLC Author Kibby Mac Created Date 7/14/2015 6:39:03 PM