Crisis in Long Term Care for Minnesota's Seniors

1. Minnesota’s Seniors Public Policy Issues Crisis in Long Term Care Toby Pearson, Vice President of Advocacy, Care Providers of Minnesota Heidi Holste, Director of Government Affairs, Care Providers of Minnesota Kari Thurlow, Vice President of Advocacy, Aging Services of Minnesota

2. WHO WE ARE The Long-Term Care Imperative is a collaboration of Aging Services of Minnesota and Care Providers of Minnesota, two of the state’s largest long-term care associations. The Long-Term Care Imperative is committed to advancing a shared vision and future for older adult housing, health care and supportive services.

3. Supporting the Economy LTC Supports $6.7 billion in Economic Activity Economic Impact of Long Term Care Facilities for Minnesota Prepared by the Lewin Group for AHCA-NCAL

4. Powering the Workforce LTC Contribute to Approximately 112,600 Jobs Economic Impact of Long Term Care Facilities for Minnesota Prepared by the Lewin Group for AHCA-NCAL.

5. The Payment Gap Projected 2012 Nursing Facility Shortfall Between Medicaid Reimbursement and Allowable Medicaid Costs (Per Patient Day) Minnesota vs. North Dakota The annual cost of eliminating the shortfall to the State would be $78.5 million. Information and data on Shortfalls in Medicaid funding based on Report Prepared by ELJAY, LLC FOR THE AMERICAN HEALTH CARE ASSOCIATION

6. Nursing Facility Rebasing Unallottments, Suspensions, and Repeal (State Savings) Source: Long Term Care Imperative 2013

7. % of Nursing Facilities at Risk of Closure(Operating Margins of -5% or Worse) Approximately 85 Nursing Facilities in MN are facing a financial crisis, placing more than 12,000 jobs at risk. Northwest 21.1% Northeast 45.0% West Central 20.8% Legend East Central 29.4% =<15% =15%-25% =25%-35% Metro 8.2% =>25% Southwest 23.7% Southeast 32.7% LTC Imperative 2011 Nursing Facility Financial Survey Prepared by CliftonLarsonAllen LLP

8. The Wage Gap Senior Living Workers Underpaid in the Marketplace Gap=$17.39 per hour or $36,171 per year Gap=$15.77 per hour or $32,802 per year Gap=$2.07 per hour or $4,306 per year Gap=$1.81 per hour or $3,765 per year Gap=$5.79 per hour or $12,043 per year Gap=$6.13 per hour or $12,750 per year Sources: 2011 LTC Imperative Salary Survey and 2011 MN Health Care Cost Information Service Hospital Salary Data

9. The Worker Gap Estimated Number of Selected Vacant FTE Positions in Minnesota’s Nursing Homes Source: Long Term Care Imperative 2013 Legislative Survey

10. The Worker Gap Vacant FTE Positions as a Percent of Budgeted Positions in Minnesota’s Nursing Homes Source: Long Term Care Imperative 2013 Legislative Survey

11. Losing Workers Employee Retention Percentage Declined in Care Centers Source: DHS Nursing Home Cost Reports (2011)

12. Staff Turnover Source: American Health Care Association, LTC Trend Tracker

13. Nursing Home Costs Without the Elderly Waiver Program Elderly Waiver Program Saved State Up To $275 Million in 2010 Decrease due to increased Federal Match Source: DHS Spending Forecast November 2010

14. Rate Changes Nursing Facility and Elderly Waiver/Customized Living Assisted Living (Elderly Waiver Customized Living) Nursing Facility • No base increase in last four years • In 2011, 70 low rate homes received increases of up to 2.45% • In 2012, 7 homes were designated “critical access” and received rate increases Source: LTC Imperative 2012

15. 2013 Legislative Proposal Nursing Facility and Elderly Waiver Rate Increases Employees Quality 2% rate increases for both nursing facilities and EW providers to develop new quality improvement efforts.  Nursing facility increase to focus on Advancing Excellence EW is targets toward implementing a new quality improvement program. • 3% rate increases for nursing facilities and EW is targeted to cover increases in compensation and other operating costs, including wages, benefits, recruitment and new staff costs.  • 1% of these increases is to address workforce needs such as staff training and retention.