Michigan’s Nursing and Rehabilitation Communities

1. Michigan’s Nursing and Rehabilitation Communities U.P. Health Care Network Trustee Forum David LaLumia, President and CEO Health Care Association of Michigan April 19, 2013

2. Licensed and Certified Network of Care • Statewide: 427 licensed facilities, 47,379 beds • 29 state licensed and CMS certified skilled nursing and rehab communities in the U.P. • Certified by CMS to be Medicare and Medicaid providers • Authorized to operate a specific number of beds by state certificate of need (CON) process • Assessed provider tax (QAAP) which generates 18% of Medicaid rate and provides $500 million in funding for facility-based LTC

3. Keweenaw Houghton Ontonagon Baraga Luce Gogebic Iron Marquette Alger Schoolcraft Chippewa Dickinson Mackinac Delta Menominee 29 U.P. Nursing and Rehab Communities

4. 29 U.P. Nursing and Rehab Communities (2) • Aspirus Ontonagon Hospital, Ontonagon (46) • Bayside Village, L’Anse (59) • Bishop Noa Home for Senior Citizens, Escanaba (81) • Chippewa County War Memorial Hospital, Sault Ste. Marie (51)* • Christian Park Health Care Center, Escanaba (99) • Christian Park Village, Escanaba, (59) • Cypress Manor Health & Rehab Center, Hancock (63) • Eastwood Nursing Center, Negaunee (100) • Freeman Nursing & Rehab Community, Kingsford (45) • Gogebic County Medical Care Facility, Wakefield (109) • Helen Newberry Joy Hospital, Newberry (48)*

5. 29 U.P Nursing and Rehab Communities (3) • Houghton County Medical Care Facility, Hancock (197) • Hyland Convalescent Home, Iron Mountain (51) • Iron County Medical Care Facility, Crystal Falls, (200) • Iron River Care Center, Iron River (69) • Mackinac Straights Hospital & Health Center, St. Ignace (48) • Marquette County Medical Care Facility, Marquette (120)* • Manor Care Nursing & Rehab Center, Kingsford, (107) • Mather HealthCare, Ishpeming (122) • Menominee Care Center, Menominee (59) • Norlite Nursing Center, Marquette (99) • Our Lady of Mercy Health & Rehab, Hubbell (55)

6. 29 U.P. Nursing and Rehab Communities (4) • Pinecrest Medical Care Facility, Powers (160) • PortagePointe, Hancock (60) • Roubal Care & Rehab Center, Stephenson (39) • Schoolcraft County Medical Care Facility, Manistique (95)* • Tendercare, Munising (106) • Tendercare, Sault Ste. Marie (114) • Westgate Nursing, Rehab & Assisted Living Community, Ironwood (65) * Prospective HCAM Members

7. Serving MI Elderly and Disabled Citizens • 95,628 served each year* • 35,378 Medicaid beneficiaries* • 60,250 Medicare/post-acute care* • 31,150 Medicare-Medicaid (dual) eligibles • * 2011 Public Sector Consultants study of Issues and Trends in Long-Term Care including review of 2008 MDS data on SNF residents

8. Provider Profile • Proprietary • Non profit • County medical care facility • Hospital LTC units

9. Payer Mix • Medicaid 67% • Medicare 19% • Private pay 14% • State sets Medicaid SNF rates using cost-based reimbursement model

10. Two Populations Served • Short stay post acute patients discharged from the hospital and requiring intensive rehab and medical care • Longer stay residents with more medically complex conditions that require skilled nursing care and help with activities of daily living

11. LTC Resident Profile • Female • Median age 85 • Some form of dementia (20%) • Wheel chair user • Most experience some level of cognitive impairment (95%) • Admitted after hospital stay • Length of stay for Medicaid residents has been reduced by 50% over the past decade.

12. Post Acute Care Patient Profile • Over age 75 (70%) • Broad range of clinical conditions including pneumonia, congestive heart failure, stroke, joint replacement, kidney and urinary tract infections, septicemia and others • 40% discharged within 100 days of admission • SNF effectively managing complex post acute care patient population

13. Specialty Care • Skilled nursing care • Wound care, wound vacs, negative pressure therapy • Chest tube care • Trach care • IV antibiotics • Total parenteral nutrition (TPN) • Bariatric rehab

14. Specialty Care (2) • Ventilator care • Dialysis • Chronic disease management • Counseling and social services • Palliative care, pain management, end of life care • Speech, physical, occupational therapy • Full range of rehabilitation 7 days/week • Not all care specialties available in all locations

15. Transitions from SNF • 5,397 Medicaid beneficiaries discharged from SNF in 2008* • 91% through efforts of SNF • 9% by state transition program • SNF aggressively prepare residents to return home or other setting * PSC Issues and Trends study

16. Integrated Care for Medicare Medicaid Eligibles • DCH integrated care plan issued 3/5/12 • Current estimate of Michigan dual eligibles - 211,309 • Nursing facilities serve 31,150 (14.7%) • 63% are 85 and older • Duals in U.P. = 8,704 -- 4.1% of state total

17. Integrated Care Organization (ICO) • State integrated care plan designates ICO to manage physical health • Skilled nursing facilities • Home and community-based services • Home help program

18. Integrated Care Finances • $7.89 billion total expenditures • Long-term care (LTC) includes SNF, home and community-based waiver and home help services • LTC = 17% of Medicare expenditures • LTC = 69% of Medicaid expenditures • LTC = 39% of both MM expenditures • Approximately $323 million spent for duals in U.P.

19. HCAM 2011 Study on Issues and Trends in LTC • Michigan is growing older faster than the rest of the country • Caregiver population (age 25-44) has declined by more than 500,000 in MI over past decade • MI is already an efficient user of skilled nursing and rehab care • Nursing facilities are discharging people back home • 10,000 Americans turn 65 every day • Demand for care in future will challenge both facility and community-based LTC and responsible integrated care organizations (ICO)

20. Today’s Nursing Facilities • Culture change – person centered care model, resident choice • Focus on quality improvement • Downsizing the number of beds per facility, move to private rooms • Investing in physical plant improvements • 14 new builds in process around the state

21. Partners in Quality Care • Experienced post acute care providers • Aggressively discharging patients from SNF to home and other settings • Integrate care with other parts of the continuum of LTC supports and services • Partners in integrated care for individuals with dual (Medicare/Medicaid) eligibility • Collect and report quality data – nursing home compare (www.cms.gov)

22. Prepared for Change • Skilled nursing and rehabilitation communities, like all areas of health care, have advanced in terms of clinical practice, resident rights, quality improvement, and the overall approach to the needs and wishes of residents and patients.

23. Annual HCAM U.P. Education Conference • May 1-2, 2013, Holiday Inn Marquette • Nursing facility owners, administrators, directors of nursing and staff • Covering all the hot topics in LTC including managed long-term care • Keynote address -- Dennis Smith, U.P. Health Plan • More info -- www.hcam.org. Click on Provider Information, Education and Conventions, and Events Calendar.

24. Thank You David LaLumia, President and CEO Health Care Association of Michigan 7413 Westshire Drive, Lansing 48917 517.627.1561/517.420.8319(cell) davidlalumia@hcam.org www.hcam.org