A CRO SS TH E STAT ES PROFILES OF LONG-TERM CARE AND INDEPENDENT LIVING by Ari Houser Wendy Fox-Grage Mary Jo Gibson ©1994-2009 AARP 2009 EIGHTH EDITION This page intentionally left blank Table of Contents Acknowledgements............................................................................................................................. 3 Introduction......................................................................................................................................... 4 Overview............................................................................................................................................. 5 Long-Term Care and Independent Living Maps............................................................................... 19 State Long-Term Care and Independent Living Profiles.................................................................. 29 United States National Profile.................................................................................................. 30 . State Profiles (and DC, PR, VI)................................................................................................ 36 State Data and Rankings................................................................................................................. 347 Data Documentation....................................................................................................................... 351 AARP State Offices........................................................................................................................ 365 Acknowledgements We extend our appreciation to the many individuals who contributed to this project by sharing data and research available through their organizations. In particular, we would like to thank Brian Burwell and Steve Eiken at Thomson Reuters, Jennifer Cook at the National Association of Insurance Commissioners, Nancy Cox at Wake Forest University School of Medicine, Marilyn Ellis at NCB Capital Impact, Charlene Harrington and Helen Carrillo at the University of California San Francisco, Katie Maslow at the Alzheimer’s Association, Jeanne Mejeur at the National Conference of State Legislatures, Robert Mollica, formerly at the National Academy for State Health Policy, Alan Schafer at the Arizona Health Care Cost Containment System / Division of Health Care Management, Lori Smetanka at the National Ombudsman Resource Center, Jim Swan at the University of North Texas, and Amy Venable at Genworth Financial. We also wish to thank our colleagues at the AARP Public Policy Institute who reviewed and contributed to this publication: Jean Accius, Enid Kassner, Keith Lind, Leigh Purvis, Don Redfoot, and Susan Reinhard. The information compiled in this document is presented for the purposes of information, discussion, and debate and does not necessarily represent formal policies of AARP. 3 Introduction Across the States 2009: Profiles of Long-Term Care and Independent Living is the eighth edition of the AARP Public Policy Institute’s state long-term care reference report. Published approximately every two years, the Across the States series was developed to help inform policy discussions among public and private sector leaders in long-term care throughout the United States. Across the States 2009 presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single convenient reference. This publication presents the most up-to-date data available at the time of production, and is displayed in easy-to-use maps, graphics, tables, and state profiles. Across the States 2009 comes in two volumes: •  full report with an overview of key findings and trends, maps and graphs, and individual A profiles for each state, the District of Columbia, Puerto Rico, the Virgin Islands, and the nation as a whole. The full report provides a complete picture of long-term services and supports in each state. •  n executive summary with an overview of key findings and trends, and ranking tables for each A indicator, such as percentage of Medicaid long-term care spending for older people and adults with physical disabilities going to home and community-based services, which permit readers to easily see variation among states. Some of the indicators in Across the States 2009 may be found in prior editions. Please exercise caution when making comparisons with information in earlier editions because of possible changes in the source or definition. Complete descriptions of all indicators, and how they may differ from previous editions, can be found in the Data Documentation section in the back of the full report. Data sources and descriptions of indicators are only found in the full report, not in the executive summary. Copies of Across the States 2009 are available free of charge. To order, please call the AARP Public Policy Institute at (202) 434-3890 or email jgasaway@aarp.org. The full report and executive summary are also available on the web. The most recent edition of Across the States can always be found at http://www.aarp.org/acrossthestates. 4 AARP Public Policy Institute OVERVIEW Across the States 2009: Profiles of Long-Term Care and Independent Living contains thousands of numbers. Taken alone, each number is simply that—a number. However, when these numbers are woven together, they tell a compelling story about the changing demand for long-term services and supports, more commonly known as long-term care, in the United States and the strategies for delivering such services and paying for them across all of the states. The report focuses on comparative state data, because much of the policymaking and innovation in long-term care is governed by the states. Given the growing older population, the rising demand for long-term care and the increasing cost of services, consistent data across all the states are critical in order to understand how to improve the lives of those with long-term care needs, their family caregivers, and others around them. In this overview we present 10 key findings from the state and national data, a small sampling of the data presented in this volume.   1:  The population age 85 or older—the age group that is most likely to need long-term care services—is growing at a dramatic rate.   2:   The older population is more racially and ethnically diverse than ever before.   3:   The older population is financially and socially diverse.   4:  Family caregivers are the main providers of long-term care services in all states.   5:  Older people with disabilities have a growing array of service options, but the services are costly and can deplete the life savings of older households.   6:  Nursing facility residents, beds, and occupancy rates have remained nearly constant over the last five years, despite an increase in the older population.   7:  The bulk of Medicaid long-term care dollars go to nursing homes rather than home and community-based services.   8:  The number of older people and adults with physical disabilities receiving Medicaid- funded home and community-based services has increased over the past five years.   9:  Long-term care spending is not the primary cause of Medicaid spending growth.   On average, Medicaid dollars can support nearly three older people and adults with 10: physical disabilities in home and community-based settings for every person in a nursing facility. Blue line = 50-64 Purple line = 65-74 The population age 85 or older—the age group that is most likely to 1: need long-term care Yellow line = 75-84 services—is growing at a dramatic rate. Red line = 85+ Projected Growth in the Older Population in United States as a Percentage of 2000 Census, by Age Group, 2000-2030 240% 220% 85+ Population (% of 2000 Census) 200% 75-84 180% 160% 50-64 140% 65-74 120% 100% 80% 2000 2005 2010 2015 2020 2025 2030 From 2007 to 2030, the population age 65+ is projected to grow by 89%, more than four times as fast as the population as a whole (+21%). Most of this growth, especially over the next 10 to 15 years, will be among the young old (age 65-74) because of the aging of the baby boomers. A better barometer for the potential demand for long-term care services is the growth in the population age 85 or older, which is expected to increase by 74% between 2007 and 2030. The oldest old not only have much higher rates of disability, but they also are much more likely to be widowed and without someone to provide assistance with daily activities. The 85+ population will grow even faster after 2030. The increase in the 85+ population between now and 2030 is largely driven by the aging of the parents of the baby boom generation; the baby boomers will begin to turn age 85 in 2031. Between 2030 and 2050, the age 85+ population is projected to increase by another 118 percent. The states with the greatest projected age 85+ population growth from 2007 to 2030 are: Alaska (+297%), Nevada (+176%), Arizona (+135%), Wyoming (+126%), and New Mexico (+123%). The age 85+ population is also projected to more than double during this time period in Virginia, Vermont, Colorado, and Texas. The older population is more racially and ethnically diverse than 2: ever before. Black: 8.7% Hispanic: 6.6% acif ic Islander: 3 ia n/P .6 % As Other: 1% Older People of Color: 19.3% Categories do not sum to total because individuals may belong to more than one racial/ethnic group. Nearly one out of every five people (19.3%) age 65+ is non-White or Hispanic, a percentage that is projected to increase in the coming decades. The growing racial and ethnic diversity of the older population has enormous implications for meeting diverse long-term care preferences, addressing the role of paid and unpaid caregivers, providing services with cultural sensitivity, and training the paid long-term care workforce in cultural competence in meeting diverse needs. Aging populations of color in Hawaii (Asian), Puerto Rico (Hispanic), and the District of Columbia and the Virgin Islands (Black) outnumber Whites. More than 30% of people age 65+ in New Mexico, California, and Texas—the states with the highest proportion of Hispanic elders— are people of color. The older population will continue to become more racially and ethnically diverse in the coming years. By 2030, when the last of the baby boomers have turned age 65, the Census Bureau projects that 29% of Americans age 65 or older will be people of color. By 2050, the proportion who are people of color will reach 42%. 3: The older population is financially and socially diverse. Education Disability Housing Need for Long-Term Care Poverty $ Economic Value of Family Caregiving in 2007: $375 billion $ Geography Medicaid LTC Spending Age is not the only factor affecting the need for and access to long-term of services. The demand in 2007 (Largest payer care for long-term care services is also driven by social and economic characteristics like income, formal LTC): $97 billion assets, education, marital status, and the availability of a family member or friend to provide care. Economic and even geographic factors can greatly affect a person’s ability to gain access to needed services. Poverty: Roughly one-half (51%) of people age 65+ have incomes at or below 300% of poverty (about $30,000 for a single person over age 65+ or $38,000 for a family of two), an income level that makes them financially vulnerable and unlikely to be able to afford to pay for long-term care services out-of-pocket. Geography: One out of every five people age 65+ lives in rural, non-metropolitan areas where home and community-based services are typically harder to find. Education: Level of education is one of the strongest predictors of the likelihood of having a long- term care need as well as having the economic capacity to pay for services. Less than one out of five (19%) people age 65+ has a bachelor’s degree or higher. Living Alone: One-third of people age 75+ live alone, which means that there is no one in the household to provide assistance if they need help with daily activities. People living alone are more likely to have to move to a care facility if they need long-term care. Disability: More than four out of 10 (41%) people age 65+ have one or more of the following disabilities that affects their ability to accomplish common tasks of everyday living: sensory, physical, mobility, self-care, and cognitive/mental. By 2010, 13% of people age 65+ are projected to have Alzheimer’s disease. Family caregivers are the main providers of long-term care services 4: in all states. $ $ Economic Value of Family Caregiving in 2007: Value billion Economic $375 of Family Caregiving in 2007: $375 billion $$ Medicaid LTC Spending in 2007 (LargestLTC Spending Medicaid payer of formalin 2007 $97 billion LTC): (Largest payer of formal LTC): $97 billion In the U.S., 34 million caregivers age 18 or older were providing unpaid care to friends and family at any given time during 2007. They provided an average of 21 hours of care per week, at an average value of $10.10 per hour. Since periods of caregiving may begin or end during the year, the number of adults providing care during the year is significantly higher, estimated at 52 million in 2007. Although Medicaid is the largest payer of long-term care services ($97 billion), the foundation of long-term care in all states is family caregivers. The estimated economic value of the 34 million caregivers’ unpaid contributions was $375 billion in 2007, and the economic value of family caregiving exceeded Medicaid long-term care spending in all states.1 A critical dimension of home and community-based services is support for family caregivers. By providing personal care and help with everyday tasks as well as health-related interventions, such as administering complex medications, family caregivers help to contain health and long-term care costs by delaying or preventing the use of nursing home and hospital care. Any strategy to promote home and community-based services will depend heavily on the continued support of family caregivers. They are essential to the financing and delivery of long-term care, yet they often are at risk of becoming “patients” themselves because of the physical and mental health effects of caregiving.2 1 Houser A., and Gibson, M.J. “Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update.” Washington DC: AARP Public Policy Institute. November 2008. 2 Reinhard, S., Brooks-Danso, A., Kelly, K. and Mason, D. “How Are You Doing? State the Science: Professional Partners Supporting Family Caregivers.” American Journal of Nursing 108(9) Supplement. September 2008. Older people with disabilities have a growing array of service 5: options, but the services are costly and can deplete the life savings of older households. In the United States, the primary responsibility for paying for long-term care services remains with the individuals who need those services. Medicare will pay for limited nursing home and home health services but only for a limited time after a major acute care episode, typically after a hospital stay. Medicaid pays for services only after beneficiaries have depleted their income and assets. Medicaid has lower payment rates for long-term care services than private pay, while Medicare has higher payment rates (Medicare spending for nursing home services is generally for medically intensive post-acute care, rehabilitation, or end-of-life care). For nursing facility care, the average private pay rate was $209 per day for a private room. Medicaid nursing facility reimbursement averaged $158 per day in 2007, and Medicare reimbursement averaged $305 per day in 2006. Assisted living has emerged as a major option for many older people with less intensive care needs than are typical in most nursing homes. The average private-pay base rate for assisted living services is about $3,000 per month, roughly half the private pay rate in a nursing home, though this does not typically include skilled nursing or other intensive health-related services that are included in nursing facility rates. While nearly two-thirds of nursing facility residents have Medicaid as the primary payer, the share of assisted living residents receiving such assistance ranges is far lower.1 The costs of home and community-based services vary significantly, depending primarily on the hours of care needed. Personal care services or adult day services a few times a week costs far less than 24-hour home care. The private pay daily rate for adult day services, often for older people with relatively mild cognitive disorders, averaged $59 per day in 2008. The private pay hourly rate for home health services was $19 in 2008, and $38 for Medicare- certified home health aides, who are often associated with a skilled nursing visit that could include specialized care such as bathing. The average Medicare reimbursement for a home health visit was $134 in 2006. 1 In 2007, there were about 1 million units in assisted living and residential care facilities; roughly 117,000 residents in these facilities were supported by Medicaid or state financing. The number of assisted living residents supported by Medicaid is down slightly and the number of units up slightly from 2004. See Mollica, R., Sims-Kastelein, K., and O’Keeffe, J. “Residential Care and Assisted Living Compendium: 2007.” National Academy for State Health Policy and RTI International. November 30, 2007. Nursing facility residents, beds, and occupancy rates have remained 6: nearly constant over the last five years, despite an increase in the older population. Percent Change in Number of Nursing Facility Residents and Beds, Occupancy Rate, and Population Age 85 or older, 2002-2007 +8% +6.5% +6% Percent Change, 2002-2007 +4% +1.7% +2% +0.9% 0% -0.7% -2% Nursing Facility Nursing Facility Occupancy Rate Age 85+ Residents Beds Population About 1.44 million Americans live in nursing facilities, occupying 85% of a total of 1.7 million nursing home beds. Although people tend to associate long-term care with nursing homes, the great majority of people with disabilities live in community settings. Only 3.3% of people age 65+ live in nursing facilities, though this rises to 14% of people age 85+. From 2002 to 2007, the number of nursing facility residents increased about 0.9% and the number of nursing facility beds increased about 1.7%, while the age 85+ population increased 6.5%. The average nursing facility occupancy rate declined 0.7 percentage points over this time period. South Carolina and Alabama had the largest increases in nursing facility beds and residents between 2002 and 2007, with South Carolina increasing the number of beds by 16% and residents by 18% and Alabama increasing beds by 14% and residents by 11%. In contrast, Louisiana had the largest nursing home bed and resident reduction of any state, in part because of the devastation of Hurricane Katrina: nursing facility beds declined by 15% and residents by 20%. South Dakota (-11%) and Wisconsin (-12%) also had large bed reductions. Minnesota and Iowa saw 10% declines in the number of nursing facility residents. In 2007, nearly one-half (46%) of residents had dementia, and most (64%) had Medicaid as the primary payer of nursing facility costs. These residents have low incomes and little savings or spent their life savings paying for long-term care services before becoming eligible for Medicaid coverage. The percentage of nursing facility residents with Medicaid as the primary payer has declined somewhat from 67% in 2002, while Medicare’s share increased from 11% in 2002 to 14% in 2007, illustrating a decline in the use of nursing homes for long-term care as providers increasingly move to providing post-acute care services, much of it funded by Medicare. The bulk of Medicaid long-term care dollars go to nursing homes 7: rather than home and community-based services. Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in the United States, 2007 10% 17% 73% Aged/Disabled Waivers PCS and other HCBS Nursing Homes Medicaid—jointly financed by the federal and state governments—pays for most formal long- term care in the United States. In 2007, nearly three out of every four (73%) Medicaid long-term care dollars for older people and adults with physical disabilities went toward nursing facility care even though most people prefer to live at home or in their communities.1 Medicaid home and community-based spending was $17 billion for older people and adults with physical disabilities compared to $47 billion for Medicaid nursing home spending. Many states maintain waiting lists or interest lists for Medicaid aged/disabled home and community-based waiver programs because of the great demand. In 2007, nearly 90,000 were reported to be on such lists. Despite its institutional bias, Medicaid plays an important and growing role in the funding of home and community-based services. Every state Medicaid program has federal waivers to provide a wide range of such services. Also, 30 states and the District of Columbia (see map) cover personal care services for adults in the home under their Medicaid state plans. However, the percentage of Medicaid long-term care funds going toward home and community- based services for older people and adults with physical disabilities varies enormously among the states, ranging from 1% to 61% of such spending. 1 These data update the analysis from Kassner, E. et al. “A Balancing Act: State Long-Term Care Reform.” Washington, DC: AARP Public Policy Institute. July 2008. Percentage of Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities going to HCBS, by State, 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 40% 20 - 40% ≤ 20% "Medicaid HCBS spending for older people and adults with In 2007, five states— New Mexico,disabilities, Washington,spending, 2007"California—spent more physical Oregon, as a % of LTC Alaska, and > 40% than 50% of their Medicaid 20 - 40% ≤ 20% long-term care funds on home and community-based services. On the other end of the range, Tennessee, Indiana, North Dakota, Utah, South Dakota, Kentucky, Alabama, Connecticut, and Delaware had the lowest percentages: 10% or less. Medicaid is not the only source of public funding for home and community-based services. State- funded home and community-based services totaled $1.2 billion in 2007. While the total amount of state-funding spending is only about 7% of Medicaid home and community-based services expenditures for older people and adults with physical disabilities, in some states these programs provide important services to people who might not qualify for Medicaid. ne = 65-74 ne = 75-84 = 85+ The number of older people and adults with physical disabilities 8: receiving Medicaid-funded home and community-based services (HCBS) has increased over the past five years. Older People and Adults with Physical Disabilities Receiving Medicaid HCBS, 2000-2005 1.5 Persons Served (Millions) 1.4 +34% line = 50-64 1.3 le line = 65-74 1.2 w line = 75-84 ine = 85+ 1.1 1.0 0.9 2000 2001 2002 2003 2004 2005 Year Medicaid HCBS Spending for Older People and Adults with Physical Disabilities, 2002-2007 $21 Spending (Billions of Dollars) $18 +68% $15 $12 $9 $6 2002 2003 2004 2005 2006 2007 Year The number of older people and adults with physical disabilities receiving Medicaid-funded home and community-based services increased by about one-third from 2000 to 2005, to a total of nearly 1.4 million beneficiaries in 2005. From 2002 to 2007, Medicaid home and community-based spending for older people and adults with physical disabilities increased by 68% to $17 billion in 2007.1 1 These measures of Medicaid home and community-based services exclude home health services, since home health programs in many states provide mostly or entirely post-acute care services, not long-term care, and it is not possible to differentiate the spending and participants between post-acute and long-term care. This choice is further discussed in Kassner, E. et al. “A Balancing Act: State Long-Term Care Reform.” Washington, DC: AARP Public Policy Institute. July 2008. The number of older people and adults with physical disabilities receiving Medicaid home and community-based services increased from 2000 to 2005 in 46 states and declined in only five states: Kentucky, West Virginia, Arkansas, South Carolina, and New York. The states with the biggest percentage gains in home and community-based participants were New Mexico, North Dakota, and Louisiana. From 2002 to 2007, all states—except Kentucky—increased Medicaid home and community-based expenditures. The largest percentage increases in Medicaid home and community expenditures were in the District of Columbia, Louisiana, Nevada, and Pennsylvania. The District of Columbia, Louisiana, and Minnesota had the greatest percentage point increases in the proportion of Medicaid long-term care spending going to home community-based services from 2002 to 2007. Increase in Medicaid Long-Term Care Spending in the United States, 2002-2007, by Service $9,000 $7,712 $8,000 $7,000 Millions of Dollars $6,000 $4,551 $5,000 $4,000 $2,651 $2,433 $3,000 $2,000 $629 $1,000 $0 ICF-MR MR/DD Nursing Aged/ PCS and Waivers Facilities Disabled other Waivers HCBS Although Medicaid spending on home and community-based services increased for older people and adults with physical disabilities, people with mental retardation or developmental disabilities (MR/DD) made even more progress toward access to Medicaid-funded home and community- based services and can serve as a model for reform. More Medicaid funding goes toward MR/ DD waiver programs, serving people in their homes and communities, than goes to institutional Intermediate Care Facilities for Mental Retardation (ICF-MRs). The spending increase for MR/ DD waiver programs from 2002 to 2007 ($7.712 billion) was more than 10 times as great as the spending increase for ICF-MRs ($629 million). In comparison, the spending increase for home and community-based services for older people and adults with physical disabilities ($6.984 billion) was about three times the spending increase for nursing homes ($2.651 billion). Long-term care spending is not the primary cause of Medicaid 9: spending growth. Percent Increase in Total Medicaid Spending and Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities, 2002-2007 +35% 0.3 +30% +28% 0.3 0.2 Relative to 2002 Spending +25% Percent Change +20% +18% 0.2 +15% 0.1 +10% 0.1 +5% 0.0 0% 0.0 2002 2003 2004 2005 2006 2007 Year Total Medicaid Spending Medicaid LTC for Older People and Adults with Physical Disabilities Despite the growth in the older population who are primary users of long-term care services, total Medicaid spending has increased at a faster rate than Medicaid long-term care spending for older people and adults with physical disabilities over the past five years. Total Medicaid spending increased from $243 billion in 2002 to $312 billion in 2007, an increase of 28%. During the same time period, Medicaid long-term care spending for older people and adults with physical disabilities increased by 18%, from $54 billion to $64 billion. On average, Medicaid dollars can support nearly three older people 10: and adults with physical disabilities in home and community-based settings for every person in a nursing facility. Medicaid Long-Term Care Spending per Person Served, by Service, 2005 } Aged/Disabled $9,176 Waiver Services Home and Community-Based Services Personal Care $9,666 Services Nursing Facility $26,096 Services $0 $10,000 $20,000 $30,000 Spending per Person Served Per person served, nursing facility services are generally more costly than home and community- based services. On average, Medicaid spending for home and community-based services for each older person and adult with physical disabilities receiving services was $9,459 in 2005, compared to $26,096 for each person receiving services in a nursing facility. It is important to note, however, that a dollar spent on home and community-based services is not equivalent to a dollar spent on nursing home services. Medicaid pays for services and room and board costs in nursing homes. In contrast, Medicaid is required by law to exclude coverage of room and board costs for home and community-based beneficiaries, even if they live in residential care settings such as assisted living. It is also the case that people receiving home and community-based services may have less intense needs, especially for medically oriented services. Conclusion This report provides the latest available data on long-term care in the United States at a time of rapid change in the delivery and financing of such services. Each state is unique, and the states exhibit great diversity in demographics, service delivery, and financing. Across the States offers a picture of past and present trends at both the national and state levels as well as factors that could potentially drive future trends. It provides comparable data across all the states, so policymakers in each state can use it to benchmark progress in improving the quality of life for those who need, use, and provide long-term care services. This page intentionally left blank AARP Public Policy Institute Long-Term Care and Independent Living Maps Long-Term Care Maps Percent of Population Age 85+, 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 2.5% 1.5 - 2.5% ≤ 1.5% Percent of Population Age 85+, 2030 (projected) WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 2.5% 1.5 - 2.5% ≤ 1.5% 20 Long-Term Care Maps Medicaid HCBS Spending for Older People and Adults with Physical Disabilities, as a Percentage of LTC Spending, 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 40% 20 - 40% ≤ 20% Medicaid HCBS Participants, as a Percentage of Older People and Adults with Physical Disabilities Receiving Medicaid LTC, 2007 "Medicaid HCBS spending for older people and adults with physical disabilities, as a % of LTC spending, 2007" > 40% WA MT - 40% 20 ≤ 20% ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 60% 30 - 60% ≤ 30% 21 Long-Term Care Maps Percent of Nursing Facilities that are For-Profit, 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 70% 50 - 70% ≤ 50% Nursing Facility Occupancy Rate, 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 90% 80 - 90% ≤ 80% 22 Long-Term Care Maps Medicaid Personal Needs Allowance (per month), 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > $50 $40 - $50 ≤ $40 Medicaid Aged/Disabled Waiver Waiting List, 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI ≥ 1000 < 1000 None 23 Long-Term Care Maps Federal Medicaid Assistance Percentage (FMAP), 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 65% 50 - 65% 50% States Offering PCS Benefit for Adults in State Plan, 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI IL IN OH NJ CT NV UT CO WV DE KS MO KY VA MD CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Offered Not Offered 24 Long-Term Care Maps States with Green Houses WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Has Green House Projects No Operating Projects States Exceeding Federal Requirements for Family and Medical Leave Acts, 2008 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Exceeds Federal Requirements Federal Requirements Only 25 Long-Term Care Maps States Receiving FY 2007-2011 Money Follows the Person Grants WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Received Grant Did not Receive Grant States Receiving FY 2003-2005 Aging and Disability Resource Center Grants WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Received Grant Did not Receive Grant 26 Long-Term Care Maps States with Cash and Counseling Programs WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Participating Not Participating States with Own Your Future Programs WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Participating Not Participating 27 Long-Term Care Maps States with Long-Term Care Partnership Programs WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Participating Not Participating States Adopting Most Recent NAIC Model Long-Term Care Insurance Act, 2008 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Adopted Not Adopted 28 AARP Public Policy Institute State Long-Term Care and Independent Living Profiles AARP Public Policy Institute United States % of Total Population (thousands) Year Value Population All ages 2007 301,621 2030 363,584 % change +21% Age 50-64 2007 53,725 17.8% 2030 59,928 16.5% % change +12% Age 65+ 2007 37,888 12.6% 2030 71,453 19.7% % change +89% Age 65-74 2007 19,352 6.4% 2030 Blue line = 50-64 37,948 10.4% % change Purple line = 65-74 +96% Age 75-84 Yellow line = 75-84 2007 13,024 4.3% Red line = 85+2030 23,903 6.6% % change +84% Age 85+ 2007 5,512 1.8% 2030 9,603 2.6% % change +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in the United States as a Percentage of 2000 Census, by Age Group, 2000-2030 Older People of Color (%), 2007 240% 19.3% Population (% of 2000 Census) 220% 85+ Asian/Pacific Islander 200% 180%   3.6% 75-84 160% 50-64 Black 140%   8.7% 65-74 120% 100% Hispanic 80%   6.6% 2000 2005 2010 2015 2020 2025 2030 30 Population & Characteristics Un it ed States Population Characteristics Value Men per 100 women age 85+, 2007 48 Persons age 75+ living alone, 2007 33% Non-metropolitan population age 65+, 2007/2008 20% Bachelor level education or higher age 65+, 2007 19% Persons age 60+ raising grandchildren, 2007 1.6% Income & Poverty Value Median household income age 65+, 2007 $32,158 At/below poverty level age 65+, 2007 9.5% At/below 200% of poverty level age 65+, 2007 32% At/below 300% of poverty level age 65+, 2007 51% Women age 75+ at/below poverty level, 2007 13% Number Disability Rates (1,000s) Percent Persons age 65+ with disabilities, 2007 Sensory disability 5,893 16% Physical disability 11,285 31% Mobility disability 6,354 18% Self-care disability 3,772 10% Cognitive/mental disability 4,467 12% Any disability (one or more of the five 14,735 41%   listed above) Cognitive/mental disability + any other disability 4,010 11% Persons age 18-64 with disabilities, 2007 Any disability 21,460 11% Cognitive/mental disability + any other disability 6,002 3.2% Persons age 65+ with Alzheimer’s disease, 2010 5,300 13% (projected) Family Caregivers Value Family caregivers (thousands), 2007 34,000 Economic value of family caregiving (millions), 2007 $375,000 Economic value per hour, 2007 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.7 long-term care spending, 2007 31 Long-Term Care Financing United States Medicaid Expenditures Value Total Medicaid expenditures (millions), 2007 $311,848 Medicaid home and community-based services (HCBS) spending 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in the United States, 2007 United States 10% 17% 73% Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Medicaid LTC expenditures for older people and $64,168 $213 adults with physical disabilities, 2007 Nursing facilities $46,980 $156 HCBS $17,188 $57 Personal care services (PCS) ** $10,396 $34 Aged/disabled waiver services $6,340 $21 Medicaid LTC expenditures for all populations, 2007 $97,295 $323 Institutional services $58,993 $196 HCBS $38,303 $127 Waiver services (all populations) $27,455 $91 Medicaid home health expenditures * $3,966 $13 Expenditures Per Person Served Value Medicaid nursing facility expenditures per person served, 2005 $26,096 Medicaid HCBS expenditures for older people and adults with $9,459 physical disabilities per person served, 2005 Personal care services ** $9,666 Aged/disabled waiver services $9,176 HCBS waiver services (all populations) $21,681 * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. 32 Federal/State/Personal Contributions Value Un it ed States Federal Medical Assistance Percentage (FMAP), 2007 NA Medicaid personal needs allowance (per month), 2007 *** $50 State-funded HCBS for older people (millions), 2007 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization Value Medicare beneficiaries receiving home health services, 2006 8.4% Medicare home health visits per user, 2006 35 Per 1,000 Medicaid HCBS Utilization Value Population Medicaid HCBS participants, 2005 1,854,998 6.3 Personal care services ** 794,642 2.7 HCBS waiver services 1,060,356 3.6 Aged/disabled waiver services 582,342 2.0 Medicaid aged/disabled waiver participants per 34 34 100 beneficiaries using nursing facilities, 2005 117,265 Persons in assisted living/residential care covered by 924,259 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 3.1 Nursing Facility Utilization Value Total nursing facility residents, 2007 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.8 Nursing facility residents per 100 age 75+, 2007 7.8 Total nursing facility stays, 2006 3,176,119 Residents with Medicaid as primary payer, 2007 64% Residents with Medicare as primary payer, 2007 14% Residents with “other” as primary payer, 2007 22% Residents with dementia, 2007 46% Long-Term Care Costs Public & Private Payment Rates Value Medicaid payment per day for nursing facility care, 2007 $158 Medicare payment per day for nursing facility care, 2006 $305 Average private pay rate per day in nursing facility, 2008 $209 Average private pay rate per month in assisted living, 2008 $3,008 Medicare reimbursement per home health visit, 2006 $134 Average private pay hourly rate for home health aide, 2008 $19 Medicare-certified home health aide, 2008 $38 Average private pay daily rate for adult day care, 2008 $59 33 Long-Term Care Resources United States Per 1,000 HCBS Resources Value Age 65+ Medicare-certified home health agencies, 2006 8,448 0.22 Adult day facilities, 2001-02 3,407 0.09 Assisted living and residential care facilities, 2007 39,005 1.0 Assisted living and residential care units, 2007 1,000,476 26 Personal and home care aides, 2007 595,350 16 Median hourly wage, 2007 $8.89 $8.89 Home health aides, 2007 834,580 22 Median hourly wage, 2007 $9.62 $9.62 Medicaid aged/disabled waiver waiting list, 2007 89,938 89,938 Per 1,000 Nursing Facility Resources Value Age 65+ Total nursing facilities, 2007 1,699,494 0.43 Nursing facility beds, 2007 1 45 Nursing facility occupancy rate, 2007 18% 85% Quality & Oversight of Nursing Facilities Value Direct care nursing hours per patient day, 2007 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 18% residents, 2007 Residents with physical restraints (%), 2007 6% Long-term care facility beds per FTE ombudsman, 2006 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service $9,000 80% 72% $8,000 $7,712 60% 62% $7,000 Millions of Dollars 60% $6,000 $5,000 $4,551 40% $4,000 $3,000 $2,651 $2,433 20% $2,000 $1,000 $629 6% 6% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS 34 Trends Un it ed States Home & Community-Based Services Year Value Medicaid HCBS participants, older people and 2000 1,026,374 adults with physical disabilities 2005 1,376,984 % change +34% Medicaid aged/disabled waiver participants 2000 448,167 2005 582,342 % change +30% Medicare home health visits per user 2001 31 2006 35 % change +13% Nursing Facilities Year Value Nursing facility residents 2002 1,428,117 2007 1,440,358 % change +1% Nursing facility beds 2002 1,671,744 2007 1,699,494 % change +2% Nursing facility occupancy rate 2002 85% 2007 85% change -1% Long-Term Care Financing Year Value Total Medicaid spending (millions) 2002 $243,497 2007 $311,848 % change +28% Medicaid LTC spending for older people and adults 2002 $54,261 with physical disabilities (millions) 2007 $64,168 % change +18% Medicaid HCBS spending for older people and adults 2002 $10,204 with physical disabilities (millions) 2007 $17,188 % change +68% Medicaid nursing facility spending (millions) 2002 $44,057 2007 $46,980 % change +7% Medicaid HCBS spending for older people and adults 2002 19% with physical disabilities, as a percentage of total 2007 27% LTC spending change +8% 35 AARP Public Policy Institute ALABAMA % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 4,628 23 301,621 2030 4,874 24 363,584 % change +5% 39 +21% Age 50-64 2007 853 18.4% 20 17.8% 2030 880 18.0% 8 16.5% % change +3% 21 +12% Age 65+ 2007 626 13.5% 14 12.6% 2030 1,039 21.3% 19 19.7% % change +66% 34 +89% Age 65-74 2007 333 7.2% 5 6.4% 2030 Blue line = 50-64 559 11.5% 14 10.4% % change Purple line = 65-74 +68% 39 +96% Yellow line = 75-84 Age 75-84 2007 210 4.5% Red line = 85+ 22 4.3% 2030 348 7.1% 21 6.6% % change +66% 30 +84% Age 85+ 2007 82 1.8% 25 1.8% 2030 132 2.7% 23 2.6% % change +61% 30 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Alabama as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 20.3% 17 19.3% 85+ Population (% of 2000 Census) Asian/Pacific Islander 180% State Rank U.S. 65-74 160% 0.6% 41 3.6% Black 140% 50-64 State Rank U.S. 120% 18.2% 7 8.7% 75-84 Hispanic 100% State Rank U.S. 80% 0.9% 39 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 36 Population & Characteristics Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 36% 10 33% Non-metropolitan population age 65+, 2007/2008 40% 18 20% Bachelor level education or higher age 65+, 2007 15% 39 19% ALABAMA Persons age 60+ raising grandchildren, 2007 2.1% 11 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $27,112 45 $32,158 At/below poverty level age 65+, 2007 11.9% 12 9.5% At/below 200% of poverty level age 65+, 2007 39% 7 32% At/below 300% of poverty level age 65+, 2007 59% 6 51% Women age 75+ at/below poverty level, 2007 16% 11 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 125 21% 4 16% Physical disability 237 40% 2 31% Mobility disability 135 22% 2 18% Self-care disability 83 14% 2 10% Cognitive/mental disability 99 16% 2 12% Any disability (one or more of the five 298 50% 2 41%   listed above) Cognitive/mental disability + any other disability 89 15% 3 11% Persons age 18-64 with disabilities, 2007 Any disability 491 17% 2 11% Cognitive/mental disability + any other disability 147 5.2% 5 3.2% Persons age 65+ with Alzheimer’s disease, 2010 91 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 570 34,000 Economic value of family caregiving (millions), 2007 $5,200 $375,000 Economic value per hour, 2007 $8.49 48 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.2 18 3.7 long-term care spending, 2007 37 Long-Term Care Financing ALABAMA Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $4,122 26 $311,848 Medicaid home and community-based services (HCBS) spending 9% 44 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Alabama and the U.S., 2007 Alabama United States 9% 10% 17% 91% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $953 $206 23 $213 adults with physical disabilities, 2007 Nursing facilities $871 $188 15 $156 HCBS $82 $18 45 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $82 $18 33 $21 Medicaid LTC expenditures for all populations, 2007 $1,211 $262 37 $323 Institutional services $903 $195 23 $196 HCBS $308 $67 46 $127 Waiver services (all populations) $308 $67 41 $91 Medicaid home health expenditures * $49 $11 14 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $29,278 13 $26,096 Medicaid HCBS expenditures for older people and adults with $7,870 27 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $7,870 28 $9,176 HCBS waiver services (all populations) $18,964 30 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 38 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 68.5% 12 Medicaid personal needs allowance (per month), 2007 *** $30 46 $50 State-funded HCBS for older people (millions), 2007 $0.0 48 $1,192.4 Long-Term Care Utilization ALABAMA Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 8.6% 14 8.4% Medicare home health visits per user, 2006 36 9 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 13,572 3.0 44 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 13,572 3.0 35 3.6 Aged/disabled waiver services 8,373 1.8 26 2.0 Medicaid aged/disabled waiver participants per 32 28 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 6,757 1.5 25 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 23,588 24 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.8 28 3.8 Nursing facility residents per 100 age 75+, 2007 8.1 28 7.8 Total nursing facility stays, 2006 49,922 22 3,176,119 Residents with Medicaid as primary payer, 2007 69% 10 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 18% 39 22% Residents with dementia, 2007 51% 10 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $158 22 $158 Medicare payment per day for nursing facility care, 2006 $263 47 $305 Average private pay rate per day in nursing facility, 2008 $158 39 $209 Average private pay rate per month in assisted living, 2008 $2,440 43 $3,008 Medicare reimbursement per home health visit, 2006 $130 38 $134 Average private pay hourly rate for home health aide, 2008 $15 48 $19 Medicare-certified home health aide, 2008 $76 1 $38 Average private pay daily rate for adult day care, 2008 $32 49 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 39 Long-Term Care Resources ALABAMA Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 145 0.23 23 0.22 Adult day facilities, 2001-02 40 0.06 36 0.09 Assisted living and residential care facilities, 2007 307 0.5 36 1.0 Assisted living and residential care units, 2007 9,509 15 38 26 Personal and home care aides, 2007 2,580 4 47 16 Median hourly wage, 2007 $7.47 46 $8.89 Home health aides, 2007 10,070 16 31 22 Median hourly wage, 2007 $8.05 48 $9.62 Medicaid aged/disabled waiver waiting list, 2007 1,985 9 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 232 0.37 35 0.43 Nursing facility beds, 2007 26,696 43 29 45 Nursing facility occupancy rate, 2007 88% 20 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4.1 7 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 14% 33 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 1,849 27 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 200 $200 80% 79% $178 150 60% 55% $150 Millions of Dollars 40% 100 $100 26% $100 20% NA 50 0% $50 $29 -20% NA 0 $0 -40% -$29 -48% $-50 -60% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -50 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 40 Trends Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 6,205 1,026,374 adults with physical disabilities 2005 8,373 1,376,984 % change +35% 30 +34% Medicaid aged/disabled waiver participants 2000 6,205 448,167 ALABAMA 2005 8,373 582,342 % change +35% 24 +30% Medicare home health visits per user 2001 38 9 31 2006 36 9 35 % change -6% 34 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 21,189 1,428,117 2007 23,588 1,440,358 % change +11% 2 +1% Nursing facility beds 2002 23,354 1,671,744 2007 26,696 1,699,494 % change +14% 2 +2% Nursing facility occupancy rate 2002 91% 11 85% 2007 88% 20 85% change -2% 30 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $3,123 $243,497 2007 $4,122 $311,848 % change +32% 23 +28% Medicaid LTC spending for older people and adults 2002 $746 $54,261 with physical disabilities (millions) 2007 $953 $64,168 % change +28% 22 +18% Medicaid HCBS spending for older people and adults 2002 $53 $10,204 with physical disabilities (millions) 2007 $82 $17,188 % change +55% 34 +68% Medicaid nursing facility spending (millions) 2002 $693 $44,057 2007 $871 $46,980 % change +26% 13 +7% Medicaid HCBS spending for older people and adults 2002 7% 38 19% with physical disabilities, as a percentage of total 2007 9% 44 27% LTC spending change +2% 42 +8% 41 AARP Public Policy Institute alaska % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 683 47 301,621 2030 868 46 363,584 % change +27% 12 +21% Age 50-64 2007 126 18.4% 20 17.8% 2030 100 11.6% 51 16.5% % change -20% 50 +12% Age 65+ 2007 48 7.0% 51 12.6% 2030 127 14.7% 49 19.7% % change +165% 3 +89% Age 65-74 2007 29 4.3% 51 6.4% 2030 Blue line = 50-64 64 7.4% 49 10.4% % change Purple line = 65-74 +119% 6 +96% Yellow line = 75-84 Age 75-84 2007 14 2.1% Red line = 85+ 51 4.3% 2030 45 5.2% 47 6.6% % change +218% 1 +84% Age 85+ 2007 5 0.7% 51 1.8% 2030 18 2.1% 46 2.6% % change +297% 1 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Alaska as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 800% 27.5% 6 19.3% Population (% of 2000 Census) Asian/Pacific Islander 680% 85+ State Rank U.S. 560% 6.2% 4 3.6% Black 440% 75-84 State Rank U.S. 320% 2.3% 34 8.7% 65-74 Hispanic 200% State Rank U.S. 50-64 80% 2.3% 22 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 42 Population & Characteristics Alaska Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 56 8 48 Persons age 75+ living alone, 2007 28% 47 33% Non-metropolitan population age 65+, 2007/2008 37% 20 20% Bachelor level education or higher age 65+, 2007 21% 17 19% Persons age 60+ raising grandchildren, 2007 2.9% 1 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $41,109 3 $32,158 At/below poverty level age 65+, 2007 5.4% 50 9.5% At/below 200% of poverty level age 65+, 2007 25% 46 32% At/below 300% of poverty level age 65+, 2007 38% 50 51% Women age 75+ at/below poverty level, 2007 6% 51 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 11 23% 1 16% Physical disability 16 35% 10 31% Mobility disability 9 19% 10 18% Self-care disability 5 12% 7 10% Cognitive/mental disability 8 16% 2 12% Any disability (one or more of the five 22 48% 5 41%   listed above) Cognitive/mental disability + any other disability 6 14% 4 11% Persons age 18-64 with disabilities, 2007 Any disability 61 14% 10 11% Cognitive/mental disability + any other disability 14 3.1% 28 3.2% Persons age 65+ with Alzheimer’s disease, 2010 5 9% 50 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 74 34,000 Economic value of family caregiving (millions), 2007 $1,050 $375,000 Economic value per hour, 2007 $13.10 1 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.1 34 3.7 long-term care spending, 2007 43 Long-Term Care Financing Alaska Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $954 47 $311,848 Medicaid home and community-based services (HCBS) spending 51% 4 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Alaska and the U.S., 2007 Alaska United States 21% 10% 17% 49% 30% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $255 $373 4 $213 adults with physical disabilities, 2007 Nursing facilities $126 $184 18 $156 HCBS $129 $188 1 $57 Personal care services (PCS) ** $75 $110 2 $34 Aged/disabled waiver services $53 $78 1 $21 Medicaid LTC expenditures for all populations, 2007 $337 $492 6 $323 Institutional services $126 $185 25 $196 HCBS $210 $308 3 $127 Waiver services (all populations) $135 $198 7 $91 Medicaid home health expenditures * $1 $1 43 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $63,932 1 $26,096 Medicaid HCBS expenditures for older people and adults with $16,551 4 $9,459 physical disabilities per person served, 2005 Personal care services ** $15,227 6 $9,666 Aged/disabled waiver services $18,097 3 $9,176 HCBS waiver services (all populations) $31,865 9 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 44 Federal/State/Personal Contributions State Rank U.S. Alaska Federal Medical Assistance Percentage (FMAP), 2007 51.1% 38 Medicaid personal needs allowance (per month), 2007 *** $75 3 $50 State-funded HCBS for older people (millions), 2007 $4.6 36 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 4.2% 49 8.4% Medicare home health visits per user, 2006 22 40 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 6,307 9.4 7 6.3 Personal care services ** 2,742 4.1 9 2.7 HCBS waiver services 3,565 5.3 15 3.6 Aged/disabled waiver services 2,347 3.5 11 2.0 Medicaid aged/disabled waiver participants per 221 2 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 730 1.07 9 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 304 0.5 47 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 628 51 1,440,358 Nursing facility residents per 100 age 65+, 2007 1.3 51 3.8 Nursing facility residents per 100 age 75+, 2007 3.4 49 7.8 Total nursing facility stays, 2006 1,335 51 3,176,119 Residents with Medicaid as primary payer, 2007 73% 5 64% Residents with Medicare as primary payer, 2007 12% 33 14% Residents with “other” as primary payer, 2007 15% 45 22% Residents with dementia, 2007 52% 6 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $384 1 $158 Medicare payment per day for nursing facility care, 2006 $466 1 $305 Average private pay rate per day in nursing facility, 2008 $515 1 $209 Average private pay rate per month in assisted living, 2008 $4,567 2 $3,008 Medicare reimbursement per home health visit, 2006 $191 2 $134 Average private pay hourly rate for home health aide, 2008 $24 1 $19 Medicare-certified home health aide, 2008 $74 2 $38 Average private pay daily rate for adult day care, 2008 $99 1 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 45 Long-Term Care Resources Alaska Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 16 0.33 23 0.22 Adult day facilities, 2001-02 11 0.23 4 0.09 Assisted living and residential care facilities, 2007 229 4.8 1 1.0 Assisted living and residential care units, 2007 1,912 40 6 26 Personal and home care aides, 2007 3,980 83 1 16 Median hourly wage, 2007 $12.91 1 $8.89 Home health aides, 2007 1,500 31 4 22 Median hourly wage, 2007 $13.35 1 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 15 0.31 41 0.43 Nursing facility beds, 2007 725 15 51 45 Nursing facility occupancy rate, 2007 87% 27 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 5.5 1 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 7% 47 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 859 49 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 80% 34 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 70 $70 300% 60 280% $60 250% 50 $55 Millions of Dollars $50 200% 40 $40 $39 150% 30 $30 $20 $22 100% $20 20 69% 50% 38% 45% $10 10 $0 0% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 46 Trends Alaska Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 2,879 1,026,374 adults with physical disabilities 2005 5,089 1,376,984 % change +77% 17 +34% Medicaid aged/disabled waiver participants 2000 1,423 448,167 2005 2,347 582,342 % change +65% 14 +30% Medicare home health visits per user 2001 19 48 31 2006 22 40 35 % change +19% 5 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 628 1,428,117 2007 628 1,440,358 % change +0% 28 +1% Nursing facility beds 2002 703 1,671,744 2007 725 1,699,494 % change +3% 21 +2% Nursing facility occupancy rate 2002 89% 22 85% 2007 87% 27 85% change -3% 38 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $700 $243,497 2007 $954 $311,848 % change +36% 19 +28% Medicaid LTC spending for older people and adults 2002 $139 $54,261 with physical disabilities (millions) 2007 $255 $64,168 % change +84% 1 +18% Medicaid HCBS spending for older people and adults 2002 $51 $10,204 with physical disabilities (millions) 2007 $129 $17,188 % change +150% 10 +68% Medicaid nursing facility spending (millions) 2002 $87 $44,057 2007 $126 $46,980 % change +45% 3 +7% Medicaid HCBS spending for older people and adults 2002 37% 5 19% with physical disabilities, as a percentage of total 2007 51% 4 27% LTC spending change +13% 7 +8% 47 AARP Public Policy Institute Arizona % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 6,339 16 301,621 2030 10,712 10 363,584 % change +69% 1 +21% Age 50-64 2007 1,045 16.5% 48 17.8% 2030 1,762 16.4% 34 16.5% % change +69% 2 +12% Age 65+ 2007 820 12.9% 28 12.6% 2030 2,371 22.1% 14 19.7% % change +189% 1 +89% Age 65-74 2007 421 6.6% 22 6.4% 2030 Blue line = 50-64 1,318 12.3% 9 10.4% % change Purple line = 65-74 +213% 1 +96% Yellow line = 75-84 Age 75-84 2007 287 4.5% Red line = 85+ 22 4.3% 2030 788 7.4% 14 6.6% % change +175% 2 +84% Age 85+ 2007 113 1.8% 25 1.8% 2030 265 2.5% 31 2.6% % change +135% 3 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Arizona as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 440% 16.6% 20 19.3% Population (% of 2000 Census) Asian/Pacific Islander 380% State Rank U.S. 320% 1.8% 18 3.6% 65-74 Black 260% State Rank U.S. 50-64 200% 2.1% 36 8.7% 85+ Hispanic 140% 75-84 State Rank U.S. 80% 10.5% 5 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 48 Population & Characteristics Arizona Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 62 2 48 Persons age 75+ living alone, 2007 28% 47 33% Non-metropolitan population age 65+, 2007/2008 16% 35 20% Bachelor level education or higher age 65+, 2007 23% 11 19% Persons age 60+ raising grandchildren, 2007 1.7% 21 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $35,480 15 $32,158 At/below poverty level age 65+, 2007 8.6% 26 9.5% At/below 200% of poverty level age 65+, 2007 29% 39 32% At/below 300% of poverty level age 65+, 2007 48% 36 51% Women age 75+ at/below poverty level, 2007 10% 43 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 132 16% 25 16% Physical disability 237 29% 30 31% Mobility disability 127 16% 27 18% Self-care disability 73 9% 30 10% Cognitive/mental disability 95 12% 21 12% Any disability (one or more of the five 313 39% 27 41%   listed above) Cognitive/mental disability + any other disability 86 11% 20 11% Persons age 18-64 with disabilities, 2007 Any disability 407 11% 27 11% Cognitive/mental disability + any other disability 122 3.2% 25 3.2% Persons age 65+ with Alzheimer’s disease, 2010 97 11% 46 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 610 34,000 Economic value of family caregiving (millions), 2007 $6,900 $375,000 Economic value per hour, 2007 $10.50 20 $10.10 Ratio of the economic value of family caregiving to Medicaid 5.6 9 3.7 long-term care spending, 2007 49 Long-Term Care Financing Arizona Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $6,596 15 $311,848 Medicaid home and community-based services (HCBS) spending 40% 7 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Arizona and the U.S., 2007 Arizona United States 10% 40% 17% 60% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service ** (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $654 $103 49 $213 adults with physical disabilities, 2007 Nursing facilities $392 $62 49 $156 HCBS $262 $41 24 $57 Personal care services (PCS) $262 $41 10 $34 Aged/disabled waiver services NA NA NA $21 Medicaid LTC expenditures for all populations, 2007 $1,226 $193 48 $323 Institutional services $416 $66 51 $196 HCBS $810 $128 21 $127 Waiver services (all populations) $547 $86 31 $91 Expenditures Per Person Served **, *** State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $38,023 NA $26,096 Medicaid HCBS expenditures for older people and adults with $15,024 NA $9,459 physical disabilities per person served, 2005 Personal care services $15,024 NA $9,666 Aged/disabled waiver services NA NA $9,176 HCBS waiver services (all populations) $25,990 NA $21,681 Note: the highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value, the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC. ** Nearly all of Arizona’s Medicaid LTC is provided through managed care programs. In order to fairly present the state’s data, we have attempted to match program spending and participation to the service categories used for other states. Please see the data documentation section for more details. *** Arizona’s persons served data were only available in participant-years (full years of program participation), not unique participants during the year. Therefore, the expenditures per person served numbers are inflated relative to the U.S. totals and are not directly comparable to other states. 50 Federal/State/Personal Contributions State Rank U.S. Arizona Federal Medical Assistance Percentage (FMAP), 2007 66.5% 14 Medicaid personal needs allowance (per month), 2007 † $93 1 $50 State-funded HCBS for older people (millions), 2007 $16.2 15 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 4.8% 46 8.4% Medicare home health visits per user, 2006 21 45 35 Per 1,000 Medicaid HCBS Utilization †, ‡ State Population Rank U.S. Medicaid HCBS participants, 2005 32,348 5.4 28 6.3 Personal care services 15,352 2.6 14 2.7 HCBS waiver services 16,996 2.9 37 3.6 Aged/disabled waiver services NA NA NA 2.0 Medicaid aged/disabled waiver participants per NA NA 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 4,034 0.64 16 0.39 Medicaid or state funding, 2007 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 12,574 33 1,440,358 Nursing facility residents per 100 age 65+, 2007 1.5 50 3.8 Nursing facility residents per 100 age 75+, 2007 3.1 51 7.8 Total nursing facility stays, 2006 40,229 26 3,176,119 Residents with Medicaid as primary payer, 2007 61% 32 64% Residents with Medicare as primary payer, 2007 13% 27 14% Residents with “other” as primary payer, 2007 26% 13 22% Residents with dementia, 2007 42% 40 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $145 31 $158 Medicare payment per day for nursing facility care, 2006 $312 24 $305 Average private pay rate per day in nursing facility, 2008 $203 21 $209 Average private pay rate per month in assisted living, 2008 $2,617 36 $3,008 Medicare reimbursement per home health visit, 2006 $159 12 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $37 22 $38 Average private pay daily rate for adult day care, 2008 $46 41 $59 † 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. ‡ Arizona’s HCBS utilization numbers are reported in participant-years, and thus under-reported compared to other states and the U.S. totals. The state would rank somewhat higher if more directly comparable data were available. 51 Long-Term Care Resources Arizona Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 80 0.1 23 0.22 Adult day facilities, 2001-02 22 0.03 45 0.09 Assisted living and residential care facilities, 2007 1,951 2.4 5 1.0 Assisted living and residential care units, 2007 27,000 33 15 26 Personal and home care aides, 2007 13,780 17 17 16 Median hourly wage, 2007 $10.06 12 $8.89 Home health aides, 2007 15,400 19 20 22 Median hourly wage, 2007 $9.97 23 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 137 0.17 50 0.43 Nursing facility beds, 2007 16,218 20 49 45 Nursing facility occupancy rate, 2007 78% 41 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.5 42 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 15% 28 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 2,743 19 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 99% 20 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 300 $300 100% 250 89% $258 83% $250 80% 200 Millions of Dollars $200 60% 150 $150 $119 40% $101 35% 100 $100 32% 20% $50 50 $6 $0 0% ICF-MR MR/DD Nursing PCS and ICF-MR MR/DD Nursing PCS and 0 HCBS Facilities other HCBS Facilities other HCBS HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 52 Trends Arizona Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 8,407 1,026,374 adults with physical disabilities 2005 15,352 1,376,984 % change +83% 13 +34% Medicaid aged/disabled waiver participants 2000 NA 448,167 2005 NA 582,342 % change NA NA +30% Medicare home health visits per user 2001 21 46 31 2006 21 45 35 % change +2% 18 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 13,462 1,428,117 2007 12,574 1,440,358 % change -7% 46 +1% Nursing facility beds 2002 15,904 1,671,744 2007 16,218 1,699,494 % change +2% 25 +2% Nursing facility occupancy rate 2002 85% 32 85% 2007 78% 41 85% change -7% 49 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $3,535 $243,497 2007 $6,596 $311,848 % change +87% 1 +28% Medicaid LTC spending for older people and adults 2002 $434 $54,261 with physical disabilities (millions) 2007 $654 $64,168 % change +51% 6 +18% Medicaid HCBS spending for older people and adults 2002 $143 $10,204 with physical disabilities (millions) 2007 $262 $17,188 % change +83% 25 +68% Medicaid nursing facility spending (millions) 2002 $290 $44,057 2007 $392 $46,980 % change +35% 5 +7% Medicaid HCBS spending for older people and adults 2002 33% 9 19% with physical disabilities, as a percentage of total 2007 40% 7 27% LTC spending change +7% 17 +8% 53 AARP Public Policy Institute Arkansas % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 2,835 32 301,621 2030 3,240 32 363,584 % change +14% 22 +21% Age 50-64 2007 515 18.2% 29 17.8% 2030 574 17.7% 12 16.5% % change +11% 12 +12% Age 65+ 2007 397 14.0% 9 12.6% 2030 656 20.3% 25 19.7% % change +65% 35 +89% Age 65-74 2007 Blue line = 50-64 7.3% 207 4 6.4% 2030 Purple line = 65-74 360 11.1% 18 10.4% % change Yellow line = 75-84 +74% 34 +96% Age 75-84 2007 Red line = 85+ 4.7% 133 10 4.3% 2030 214 6.6% 26 6.6% % change +61% 36 +84% Age 85+ 2007 57 2.0% 16 1.8% 2030 82 2.5% 31 2.6% % change +45% 41 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Arkansas as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 12.2% 26 19.3% Population (% of 2000 Census) 180% Asian/Pacific Islander 65-74 State Rank U.S. 160% 0.6% 41 3.6% 85+ Black 140% 50-64 State Rank U.S. 120% 9.5% 16 8.7% 75-84 Hispanic 100% State Rank U.S. 80% 1.2% 35 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 54 Population & Characteristics Arkansas Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 48 16 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 42% 14 20% Bachelor level education or higher age 65+, 2007 14% 46 19% Persons age 60+ raising grandchildren, 2007 2.3% 8 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $26,189 47 $32,158 At/below poverty level age 65+, 2007 12.1% 7 9.5% At/below 200% of poverty level age 65+, 2007 40% 4 32% At/below 300% of poverty level age 65+, 2007 60% 4 51% Women age 75+ at/below poverty level, 2007 17% 6 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 82 22% 2 16% Physical disability 147 39% 3 31% Mobility disability 72 19% 10 18% Self-care disability 43 11% 13 10% Cognitive/mental disability 61 16% 2 12% Any disability (one or more of the five 188 50% 2 41%   listed above) Cognitive/mental disability + any other disability 54 14% 4 11% Persons age 18-64 with disabilities, 2007 Any disability 297 17% 2 11% Cognitive/mental disability + any other disability 91 5.3% 4 3.2% Persons age 65+ with Alzheimer’s disease, 2010 60 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 360 34,000 Economic value of family caregiving (millions), 2007 $3,500 $375,000 Economic value per hour, 2007 $8.80 46 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.5 29 3.7 long-term care spending, 2007 55 Long-Term Care Financing Arkansas Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $3,159 29 $311,848 Medicaid home and community-based services (HCBS) spending 21% 27 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Arkansas and the U.S., 2007 Arkansas United States 10% 10% 11% 17% 79% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $683 $241 18 $213 adults with physical disabilities, 2007 Nursing facilities $541 $191 14 $156 HCBS $142 $50 22 $57 Personal care services (PCS) ** $68 $24 19 $34 Aged/disabled waiver services $69 $24 29 $21 Medicaid LTC expenditures for all populations, 2007 $936 $330 22 $323 Institutional services $688 $243 12 $196 HCBS $248 $88 38 $127 Waiver services (all populations) $176 $62 44 $91 Medicaid home health expenditures * $48 $17 6 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $15,856 50 $26,096 Medicaid HCBS expenditures for older people and adults with $4,600 46 $9,459 physical disabilities per person served, 2005 Personal care services ** $3,956 25 $9,666 Aged/disabled waiver services $5,736 43 $9,176 HCBS waiver services (all populations) $10,373 48 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 56 Federal/State/Personal Contributions State Rank U.S. Arkansas Federal Medical Assistance Percentage (FMAP), 2007 73.4% 2 Medicaid personal needs allowance (per month), 2007 *** $40 35 $50 State-funded HCBS for older people (millions), 2007 $7.7 24 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 6.7% 33 8.4% Medicare home health visits per user, 2006 38 8 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 27,583 10.0 5 6.3 Personal care services ** 15,452 5.6 5 2.7 HCBS waiver services 12,131 4.4 24 3.6 Aged/disabled waiver services 8,749 3.2 15 2.0 Medicaid aged/disabled waiver participants per 32 28 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 211 0.07 36 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 6,788 2.4 17 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 18,746 28 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.7 15 3.8 Nursing facility residents per 100 age 75+, 2007 9.9 15 7.8 Total nursing facility stays, 2006 33,370 31 3,176,119 Residents with Medicaid as primary payer, 2007 70% 8 64% Residents with Medicare as primary payer, 2007 11% 37 14% Residents with “other” as primary payer, 2007 19% 35 22% Residents with dementia, 2007 40% 48 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $132 38 $158 Medicare payment per day for nursing facility care, 2006 $248 51 $305 Average private pay rate per day in nursing facility, 2008 $137 48 $209 Average private pay rate per month in assisted living, 2008 $1,981 51 $3,008 Medicare reimbursement per home health visit, 2006 $109 48 $134 Average private pay hourly rate for home health aide, 2008 $16 46 $19 Medicare-certified home health aide, 2008 $26 43 $38 Average private pay daily rate for adult day care, 2008 $43 44 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 57 Long-Term Care Resources Arkansas Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 174 0.44 23 0.22 Adult day facilities, 2001-02 33 0.08 28 0.09 Assisted living and residential care facilities, 2007 119 0.3 44 1.0 Assisted living and residential care units, 2007 5,018 13 43 26 Personal and home care aides, 2007 5,480 14 22 16 Median hourly wage, 2007 $7.57 45 $8.89 Home health aides, 2007 5,430 14 37 22 Median hourly wage, 2007 $8.27 47 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 253 0.64 10 0.43 Nursing facility beds, 2007 26,166 66 5 45 Nursing facility occupancy rate, 2007 72% 46 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4 9 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 15% 28 18% residents, 2007 Residents with physical restraints (%), 2007 12% 1 6% Long-term care facility beds per FTE ombudsman, 2006 2,637 20 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 140 $140 500% 120 $118 $120 407% 100 400% Millions of Dollars $100 80 $80 300% 60 $60 $51 200% $44 $40 40 $29 93% 100% 71% $20 $15 20 26% 9% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 58 Trends Arkansas Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 26,534 1,026,374 adults with physical disabilities 2005 24,201 1,376,984 % change -9% 49 +34% Medicaid aged/disabled waiver participants 2000 8,818 448,167 2005 8,749 582,342 % change -1% 44 +30% Medicare home health visits per user 2001 35 12 31 2006 38 8 35 % change +9% 9 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 17,827 1,428,117 2007 18,746 1,440,358 % change +5% 12 +1% Nursing facility beds 2002 24,438 1,671,744 2007 26,166 1,699,494 % change +7% 9 +2% Nursing facility occupancy rate 2002 73% 48 85% 2007 72% 46 85% change -1% 24 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $2,250 $243,497 2007 $3,159 $311,848 % change +40% 15 +28% Medicaid LTC spending for older people and adults 2002 $595 $54,261 with physical disabilities (millions) 2007 $683 $64,168 % change +15% 33 +18% Medicaid HCBS spending for older people and adults 2002 $98 $10,204 with physical disabilities (millions) 2007 $142 $17,188 % change +45% 39 +68% Medicaid nursing facility spending (millions) 2002 $497 $44,057 2007 $541 $46,980 % change +9% 29 +7% Medicaid HCBS spending for older people and adults 2002 16% 23 19% with physical disabilities, as a percentage of total 2007 21% 27 27% LTC spending change +4% 29 +8% 59 AARP Public Policy Institute California % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 36,553 1 301,621 2030 46,445 1 363,584 % change +27% 11 +21% Age 50-64 2007 5,966 16.3% 49 17.8% 2030 7,069 15.2% 44 16.5% % change +18% 10 +12% Age 65+ 2007 4,004 11.0% 46 12.6% 2030 8,288 17.8% 43 19.7% % change +107% 9 +89% Age 65-74 2007 2,049 5.6% 46 6.4% Blue line = 50-64 2030 4,332 9.3% 42 10.4% Purple line = 65-74 % change +111% 9 +96% Yellow line = 75-84 Age 75-84 2007 1,370line = 85+ Red 3.7% 45 4.3% 2030 2,797 6.0% 41 6.6% % change +104% 16 +84% Age 85+ 2007 585 1.6% 38 1.8% 2030 1,159 2.5% 31 2.6% % change +98% 10 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in California as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 36.2% 4 19.3% Population (% of 2000 Census) 280% Asian/Pacific Islander State Rank U.S. 85+ 240% 13.6% 2 3.6% 200% Black 75-84 State Rank U.S. 160% 5.5% 25 8.7% 50-64 65-74 Hispanic 120% State Rank U.S. 80% 16.8% 3 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 60 Population & Characteristics California Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 53 10 48 Persons age 75+ living alone, 2007 30% 44 33% Non-metropolitan population age 65+, 2007/2008 3% 44 20% Bachelor level education or higher age 65+, 2007 24% 5 19% Persons age 60+ raising grandchildren, 2007 1.8% 17 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $38,154 6 $32,158 At/below poverty level age 65+, 2007 8.2% 33 9.5% At/below 200% of poverty level age 65+, 2007 30% 35 32% At/below 300% of poverty level age 65+, 2007 47% 37 51% Women age 75+ at/below poverty level, 2007 10% 43 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 628 16% 25 16% Physical disability 1,213 31% 17 31% Mobility disability 749 19% 10 18% Self-care disability 457 12% 7 10% Cognitive/mental disability 534 14% 11 12% Any disability (one or more of the five 1,582 41% 19 41%   listed above) Cognitive/mental disability + any other disability 480 12% 13 11% Persons age 18-64 with disabilities, 2007 Any disability 2,193 10% 34 11% Cognitive/mental disability + any other disability 611 2.7% 35 3.2% Persons age 65+ with Alzheimer’s disease, 2010 480 11% 46 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 4,000 34,000 Economic value of family caregiving (millions), 2007 $48,000 $375,000 Economic value per hour, 2007 $11.05 13 $10.10 Ratio of the economic value of family caregiving to Medicaid 5.0 11 3.7 long-term care spending, 2007 61 Long-Term Care Financing California Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $31,045 2 $311,848 Medicaid home and community-based services (HCBS) spending 51% 4 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in California and the U.S., 2007 California United States 1% 10% 17% 49% 50% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $7,477 $205 24 $213 adults with physical disabilities, 2007 Nursing facilities $3,657 $100 41 $156 HCBS $3,820 $105 7 $57 Personal care services (PCS) ** $3,711 $102 4 $34 Aged/disabled waiver services $110 $3 47 $21 Medicaid LTC expenditures for all populations, 2007 $9,551 $261 38 $323 Institutional services $4,434 $121 42 $196 HCBS $5,117 $140 18 $127 Waiver services (all populations) $1,406 $38 50 $91 Medicaid home health expenditures * $160 $4 33 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $25,833 29 $26,096 Medicaid HCBS expenditures for older people and adults with $9,001 22 $9,459 physical disabilities per person served, 2005 Personal care services ** $9,103 11 $9,666 Aged/disabled waiver services $6,870 32 $9,176 HCBS waiver services (all populations) $17,008 33 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 62 Federal/State/Personal Contributions State Rank U.S. California Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $49 28 $50 State-funded HCBS for older people (millions), 2007 $13.3 19 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.3% 27 8.4% Medicare home health visits per user, 2006 32 14 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 394,373 11.0 3 6.3 Personal care services ** 313,893 8.7 1 2.7 HCBS waiver services 80,480 2.2 43 3.6 Aged/disabled waiver services 14,985 0.4 48 2.0 Medicaid aged/disabled waiver participants per 13 43 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 205 0.01 39 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 87,027 2.4 17 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 104,779 2 1,440,358 Nursing facility residents per 100 age 65+, 2007 2.6 41 3.8 Nursing facility residents per 100 age 75+, 2007 5.4 42 7.8 Total nursing facility stays, 2006 254,793 1 3,176,119 Residents with Medicaid as primary payer, 2007 65% 19 64% Residents with Medicare as primary payer, 2007 13% 27 14% Residents with “other” as primary payer, 2007 22% 28 22% Residents with dementia, 2007 39% 49 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $150 27 $158 Medicare payment per day for nursing facility care, 2006 $372 2 $305 Average private pay rate per day in nursing facility, 2008 $238 10 $209 Average private pay rate per month in assisted living, 2008 $3,098 19 $3,008 Medicare reimbursement per home health visit, 2006 $162 9 $134 Average private pay hourly rate for home health aide, 2008 $21 7 $19 Medicare-certified home health aide, 2008 $51 10 $38 Average private pay daily rate for adult day care, 2008 $77 4 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 63 Long-Term Care Resources California Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 621 0.16 23 0.22 Adult day facilities, 2001-02 467 0.12 17 0.09 Assisted living and residential care facilities, 2007 7,471 1.9 9 1.0 Assisted living and residential care units, 2007 161,586 40 6 26 Personal and home care aides, 2007 39,770 10 35 16 Median hourly wage, 2007 $9.87 17 $8.89 Home health aides, 2007 48,820 12 44 22 Median hourly wage, 2007 $9.56 29 $9.62 Medicaid aged/disabled waiver waiting list, 2007 1,942 10 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 1,283 0.32 39 0.43 Nursing facility beds, 2007 123,228 31 43 45 Nursing facility occupancy rate, 2007 85% 31 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.8 19 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 12% 36 18% residents, 2007 Residents with physical restraints (%), 2007 11% 2 6% Long-term care facility beds per FTE ombudsman, 2006 1,472 33 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 88% 30 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 2500 $2,500 120% 111% 2000 $1,953 100% $2,000 Millions of Dollars 1500 80% $1,500 60% 1000 $1,000 44% $779 40% 27% $500 $394 20% 17% 17% 500 $114 $16 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. S 64 Trends California Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 223,042 1,026,374 adults with physical disabilities 2005 328,878 1,376,984 % change +47% 26 +34% Medicaid aged/disabled waiver participants 2000 11,423 448,167 2005 14,985 582,342 % change +31% 26 +30% Medicare home health visits per user 2001 26 31 31 2006 32 14 35 % change +21% 4 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 97,954 1,428,117 2007 104,779 1,440,358 % change +7% 7 +1% Nursing facility beds 2002 115,516 1,671,744 2007 123,228 1,699,494 % change +7% 9 +2% Nursing facility occupancy rate 2002 85% 32 85% 2007 85% 31 85% change +0% 17 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $23,523 $243,497 2007 $31,045 $311,848 % change +32% 23 +28% Medicaid LTC spending for older people and adults 2002 $4,729 $54,261 with physical disabilities (millions) 2007 $7,477 $64,168 % change +58% 4 +18% Medicaid HCBS spending for older people and adults 2002 $1,851 $10,204 with physical disabilities (millions) 2007 $3,820 $17,188 % change +106% 16 +68% Medicaid nursing facility spending (millions) 2002 $2,878 $44,057 2007 $3,657 $46,980 % change +27% 11 +7% Medicaid HCBS spending for older people and adults 2002 39% 4 19% with physical disabilities, as a percentage of total 2007 51% 4 27% LTC spending change +12% 9 +8% 65 AARP Public Policy Institute Colorado % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 4,862 22 301,621 2030 5,792 22 363,584 % change +19% 18 +21% Age 50-64 2007 875 18.0% 35 17.8% 2030 881 15.2% 44 16.5% % change +1% 27 +12% Age 65+ 2007 493 10.1% 47 12.6% 2030 956 16.5% 46 19.7% % change +94% 20 +89% Age 65-74 2007 265 5.5% 47 6.4% 2030 Blue line = 50-64 491 8.5% 47 10.4% % change Purple line = 65-74 +85% 24 +96% Yellow line = 75-84 Age 75-84 2007 163 3.3% Red line = 85+ 47 4.3% 2030 333 5.8% 44 6.6% % change +105% 13 +84% Age 85+ 2007 65 1.3% 46 1.8% 2030 132 2.3% 43 2.6% % change +104% 8 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Colorado as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 15.3% 22 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 85+ 240% 2.2% 14 3.6% Black 200% State Rank U.S. 65-74 75-84 160% 2.8% 31 8.7% 50-64 Hispanic 120% State Rank U.S. 80% 9.8% 6 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 66 Population & Characteristics Colorado Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 48 16 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 NA NA 20% Bachelor level education or higher age 65+, 2007 27% 2 19% Persons age 60+ raising grandchildren, 2007 1.4% 26 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $36,759 13 $32,158 At/below poverty level age 65+, 2007 8.5% 27 9.5% At/below 200% of poverty level age 65+, 2007 28% 40 32% At/below 300% of poverty level age 65+, 2007 45% 40 51% Women age 75+ at/below poverty level, 2007 13% 24 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 75 16% 25 16% Physical disability 126 26% 46 31% Mobility disability 72 15% 35 18% Self-care disability 41 9% 30 10% Cognitive/mental disability 49 10% 34 12% Any disability (one or more of the five 175 37% 40 41%   listed above) Cognitive/mental disability + any other disability 43 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 310 10% 34 11% Cognitive/mental disability + any other disability 84 2.7% 35 3.2% Persons age 65+ with Alzheimer’s disease, 2010 72 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 540 34,000 Economic value of family caregiving (millions), 2007 $6,500 $375,000 Economic value per hour, 2007 $11.04 14 $10.10 Ratio of the economic value of family caregiving to Medicaid 5.8 5 3.7 long-term care spending, 2007 67 Long-Term Care Financing Colorado Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $2,959 30 $311,848 Medicaid home and community-based services (HCBS) spending 22% 25 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Colorado and the U.S., 2007 Colorado United States 20% 10% 17% 2% 78% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $661 $136 44 $213 adults with physical disabilities, 2007 Nursing facilities $517 $106 39 $156 HCBS $144 $30 38 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $132 $27 25 $21 Medicaid LTC expenditures for all populations, 2007 $986 $203 46 $323 Institutional services $541 $111 44 $196 HCBS $444 $91 37 $127 Waiver services (all populations) $432 $89 30 $91 Medicaid home health expenditures * $133 $27 4 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $27,718 16 $26,096 Medicaid HCBS expenditures for older people and adults with $6,336 36 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $6,336 36 $9,176 HCBS waiver services (all populations) $14,015 41 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 68 Federal/State/Personal Contributions State Rank U.S. Colorado Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $7.0 26 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.2% 29 8.4% Medicare home health visits per user, 2006 26 27 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 25,575 5.5 26 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 25,575 5.5 12 3.6 Aged/disabled waiver services 15,219 3.3 12 2.0 Medicaid aged/disabled waiver participants per 94 5 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 3,800 0.78 14 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 8,687 1.9 24 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 16,820 30 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.4 35 3.8 Nursing facility residents per 100 age 75+, 2007 7.4 34 7.8 Total nursing facility stays, 2006 37,557 27 3,176,119 Residents with Medicaid as primary payer, 2007 58% 40 64% Residents with Medicare as primary payer, 2007 12% 33 14% Residents with “other” as primary payer, 2007 30% 8 22% Residents with dementia, 2007 46% 25 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $164 20 $158 Medicare payment per day for nursing facility care, 2006 $335 13 $305 Average private pay rate per day in nursing facility, 2008 $202 22 $209 Average private pay rate per month in assisted living, 2008 $3,249 12 $3,008 Medicare reimbursement per home health visit, 2006 $142 24 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $34 24 $38 Average private pay daily rate for adult day care, 2008 $56 24 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 69 Long-Term Care Resources Colorado Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 128 0.26 23 0.22 Adult day facilities, 2001-02 42 0.09 25 0.09 Assisted living and residential care facilities, 2007 495 1.0 19 1.0 Assisted living and residential care units, 2007 14,237 29 22 26 Personal and home care aides, 2007 10,850 22 7 16 Median hourly wage, 2007 $8.97 31 $8.89 Home health aides, 2007 7,910 16 31 22 Median hourly wage, 2007 $10.68 10 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 214 0.43 28 0.43 Nursing facility beds, 2007 20,093 41 32 45 Nursing facility occupancy rate, 2007 84% 34 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.7 26 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 43% 2 18% residents, 2007 Residents with physical restraints (%), 2007 7% 7 6% Long-term care facility beds per FTE ombudsman, 2006 1,219 40 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 140 $140 50% 120 46% $119 $120 100 40% Millions of Dollars $100 30% 80 $80 30% 27% No spending in 2002 60 $60 20% $42 40 $40 $32 13% 10% $20 $12 20 $5 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 70 Trends Colorado Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 13,006 1,026,374 adults with physical disabilities 2005 15,219 1,376,984 % change +17% 39 +34% Medicaid aged/disabled waiver participants 2000 13,006 448,167 2005 15,219 582,342 % change +17% 37 +30% Medicare home health visits per user 2001 27 24 31 2006 26 27 35 % change -2% 24 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 16,543 1,428,117 2007 16,820 1,440,358 % change +2% 23 +1% Nursing facility beds 2002 20,213 1,671,744 2007 20,093 1,699,494 % change -1% 32 +2% Nursing facility occupancy rate 2002 82% 39 85% 2007 84% 34 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $2,326 $243,497 2007 $2,959 $311,848 % change +27% 28 +28% Medicaid LTC spending for older people and adults 2002 $488 $54,261 with physical disabilities (millions) 2007 $661 $64,168 % change +35% 12 +18% Medicaid HCBS spending for older people and adults 2002 $90 $10,204 with physical disabilities (millions) 2007 $144 $17,188 % change +60% 31 +68% Medicaid nursing facility spending (millions) 2002 $398 $44,057 2007 $517 $46,980 % change +30% 9 +7% Medicaid HCBS spending for older people and adults 2002 18% 19 19% with physical disabilities, as a percentage of total 2007 22% 25 27% LTC spending change +3% 35 +8% 71 AARP Public Policy Institute Connecticut % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 3,502 29 301,621 2030 3,689 30 363,584 % change +5% 39 +21% Age 50-64 2007 664 18.9% 10 17.8% 2030 611 16.6% 30 16.5% % change -8% 41 +12% Age 65+ 2007 472 13.5% 14 12.6% 2030 794 21.5% 16 19.7% % change +68% 32 +89% Age 65-74 2007 229 6.5% 25 6.4% 2030 Blue line = 50-64 395 10.7% 26 10.4% % change Purple line = 65-74 +73% 35 +96% Yellow line = 75-84 Age 75-84 2007 166 4.7% Red line = 85+ 10 4.3% 2030 267 7.2% 16 6.6% % change +61% 36 +84% Age 85+ 2007 78 2.2% 9 1.8% 2030 132 3.6% 4 2.6% % change +70% 26 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Connecticut as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 11.6% 27 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% State Rank U.S. 200% 1.6% 19 3.6% 85+ Black 170% 65-74 State Rank U.S. 140% 6.0% 22 8.7% 50-64 Hispanic 110% State Rank U.S. 75-84 80% 4.0% 12 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 72 Population & Characteristics Conne Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 44 32 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 5% 42 20% Bachelor level education or higher age 65+, 2007 24% 5 19% Persons age 60+ raising grandchildren, 2007 1.1% 35 1.6% ctic ut Income & Poverty State Rank U.S. Median household income age 65+, 2007 $37,965 8 $32,158 At/below poverty level age 65+, 2007 6.4% 48 9.5% At/below 200% of poverty level age 65+, 2007 24% 48 32% At/below 300% of poverty level age 65+, 2007 41% 48 51% Women age 75+ at/below poverty level, 2007 9% 46 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 63 14% 43 16% Physical disability 116 26% 46 31% Mobility disability 70 16% 27 18% Self-care disability 39 9% 30 10% Cognitive/mental disability 44 10% 34 12% Any disability (one or more of the five 159 36% 43 41%   listed above) Cognitive/mental disability + any other disability 38 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 204 9% 46 11% Cognitive/mental disability + any other disability 52 2.4% 43 3.2% Persons age 65+ with Alzheimer’s disease, 2010 70 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 370 34,000 Economic value of family caregiving (millions), 2007 $4,900 $375,000 Economic value per hour, 2007 $12.37 2 $10.10 Ratio of the economic value of family caregiving to Medicaid 2.2 48 3.7 long-term care spending, 2007 73 Long-Term Care Financing Connecticut Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $4,348 24 $311,848 Medicaid home and community-based services (HCBS) spending 9% 44 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Connecticut and the U.S., 2007 Connecticut United States 9% 10% 17% 91% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,355 $387 3 $213 adults with physical disabilities, 2007 Nursing facilities $1,233 $352 1 $156 HCBS $122 $35 30 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $122 $35 14 $21 Medicaid LTC expenditures for all populations, 2007 $2,084 $595 3 $323 Institutional services $1,473 $421 3 $196 HCBS $611 $175 11 $127 Waiver services (all populations) $611 $175 9 $91 Medicaid home health expenditures * $200 $57 2 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $26,973 20 $26,096 Medicaid HCBS expenditures for older people and adults with $8,617 23 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $8,617 25 $9,176 HCBS waiver services (all populations) $28,655 14 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 74 Federal/State/Personal Contributions State Rank U.S. Conne Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $63 6 $50 State-funded HCBS for older people (millions), 2007 $42.9 8 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 10.1% 7 8.4% ctic ut Medicare home health visits per user, 2006 34 12 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 18,272 5.2 30 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 18,272 5.2 16 3.6 Aged/disabled waiver services 11,675 3.3 12 2.0 Medicaid aged/disabled waiver participants per 28 33 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 439 0.13 33 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 21,753 6.2 4 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 27,257 19 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.8 3 3.8 Nursing facility residents per 100 age 75+, 2007 11.2 3 7.8 Total nursing facility stays, 2006 61,463 20 3,176,119 Residents with Medicaid as primary payer, 2007 66% 14 64% Residents with Medicare as primary payer, 2007 16% 7 14% Residents with “other” as primary payer, 2007 18% 39 22% Residents with dementia, 2007 47% 20 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $211 3 $158 Medicare payment per day for nursing facility care, 2006 $325 20 $305 Average private pay rate per day in nursing facility, 2008 $345 2 $209 Average private pay rate per month in assisted living, 2008 $3,928 6 $3,008 Medicare reimbursement per home health visit, 2006 $124 41 $134 Average private pay hourly rate for home health aide, 2008 $21 7 $19 Medicare-certified home health aide, 2008 $28 36 $38 Average private pay daily rate for adult day care, 2008 $70 9 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 75 Long-Term Care Resources Connecticut Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 79 0.17 23 0.22 Adult day facilities, 2001-02 68 0.14 12 0.09 Assisted living and residential care facilities, 2007 263 0.6 30 1.0 Assisted living and residential care units, 2007 2,808 6 49 26 Personal and home care aides, 2007 6,660 14 22 16 Median hourly wage, 2007 $9.89 15 $8.89 Home health aides, 2007 12,180 26 9 22 Median hourly wage, 2007 $12.76 2 $9.62 Medicaid aged/disabled waiver waiting list, 2007 71 19 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 244 0.52 21 0.43 Nursing facility beds, 2007 29,612 63 10 45 Nursing facility occupancy rate, 2007 92% 4 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.7 26 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 41% 3 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 6,407 4 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 250 $250 120% 113% 200 $206 100% $200 Millions of Dollars 150 80% $150 $132 60% 100 $100 40% 40% $65 $50 20% 50 $27 20% 13% NA NA $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 76 Trends Conne Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 9,740 1,026,374 adults with physical disabilities 2005 11,675 1,376,984 % change +20% 36 +34% Medicaid aged/disabled waiver participants 2000 9,740 448,167 2005 11,675 582,342 % change +20% 32 +30% ctic ut Medicare home health visits per user 2001 38 9 31 2006 34 12 35 % change -12% 42 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 29,343 1,428,117 2007 27,257 1,440,358 % change -7% 46 +1% Nursing facility beds 2002 31,412 1,671,744 2007 29,612 1,699,494 % change -6% 44 +2% Nursing facility occupancy rate 2002 93% 3 85% 2007 92% 4 85% change -1% 24 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $3,577 $243,497 2007 $4,348 $311,848 % change +22% 33 +28% Medicaid LTC spending for older people and adults 2002 $1,084 $54,261 with physical disabilities (millions) 2007 $1,355 $64,168 % change +25% 27 +18% Medicaid HCBS spending for older people and adults 2002 $57 $10,204 with physical disabilities (millions) 2007 $122 $17,188 % change +113% 14 +68% Medicaid nursing facility spending (millions) 2002 $1,026 $44,057 2007 $1,233 $46,980 % change +20% 22 +7% Medicaid HCBS spending for older people and adults 2002 5% 43 19% with physical disabilities, as a percentage of total 2007 9% 44 27% LTC spending change +4% 29 +8% 77 AARP Public Policy Institute Delaware % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 865 45 301,621 2030 1,013 45 363,584 % change +17% 19 +21% Age 50-64 2007 160 18.4% 20 17.8% 2030 189 18.7% 4 16.5% % change +19% 9 +12% Age 65+ 2007 118 13.6% 12 12.6% 2030 238 23.5% 9 19.7% % change +102% 14 +89% Age 65-74 2007 62 7.1% 8 6.4% 2030 Blue line = 50-64 131 12.9% 5 10.4% % change Purple line = 65-74 +112% 8 +96% Yellow line = 75-84 Age 75-84 2007 41 4.7% Red line = 85+ 10 4.3% 2030 78 7.7% 11 6.6% % change +92% 20 +84% Age 85+ 2007 15 1.8% 25 1.8% 2030 29 2.9% 21 2.6% % change +89% 18 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Delaware as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 16.2% 21 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 85+ 240% 1.6% 19 3.6% Black 200% 65-74 75-84 State Rank U.S. 160% 12.5% 11 8.7% 50-64 Hispanic 120% State Rank U.S. 80% 1.7% 29 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 78 Population & Characteristics Delaware Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 49 14 48 Persons age 75+ living alone, 2007 33% 33 33% Non-metropolitan population age 65+, 2007/2008 30% 24 20% Bachelor level education or higher age 65+, 2007 21% 17 19% Persons age 60+ raising grandchildren, 2007 1.6% 23 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $37,445 10 $32,158 At/below poverty level age 65+, 2007 7.8% 41 9.5% At/below 200% of poverty level age 65+, 2007 28% 40 32% At/below 300% of poverty level age 65+, 2007 45% 40 51% Women age 75+ at/below poverty level, 2007 10% 43 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 16 14% 43 16% Physical disability 32 28% 35 31% Mobility disability 16 14% 41 18% Self-care disability 10 9% 30 10% Cognitive/mental disability 11 10% 34 12% Any disability (one or more of the five 42 38% 34 41%   listed above) Cognitive/mental disability + any other disability 9 8% 44 11% Persons age 18-64 with disabilities, 2007 Any disability 59 11% 27 11% Cognitive/mental disability + any other disability 13 2.5% 39 3.2% Persons age 65+ with Alzheimer’s disease, 2010 14 11% 46 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 105 34,000 Economic value of family caregiving (millions), 2007 $1,280 $375,000 Economic value per hour, 2007 $11.31 9 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.4 15 3.7 long-term care spending, 2007 79 Long-Term Care Financing Delaware Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $991 46 $311,848 Medicaid home and community-based services (HCBS) spending 10% 43 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Delaware and the U.S., 2007 Delaware United States 10% 10% 17% 90% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $180 $208 22 $213 adults with physical disabilities, 2007 Nursing facilities $163 $188 15 $156 HCBS $18 $20 42 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $18 $20 31 $21 Medicaid LTC expenditures for all populations, 2007 $285 $329 23 $323 Institutional services $189 $219 18 $196 HCBS $96 $110 33 $127 Waiver services (all populations) $96 $110 24 $91 Medicaid home health expenditures * $8 $9 19 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $43,231 3 $26,096 Medicaid HCBS expenditures for older people and adults with $10,429 16 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $10,429 17 $9,176 HCBS waiver services (all populations) $26,630 18 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 80 Federal/State/Personal Contributions State Rank U.S. Delaware Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $44 33 $50 State-funded HCBS for older people (millions), 2007 $1.5 44 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.2% 29 8.4% Medicare home health visits per user, 2006 23 39 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 2,642 3.1 43 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 2,642 3.1 32 3.6 Aged/disabled waiver services 1,312 1.6 30 2.0 Medicaid aged/disabled waiver participants per 36 24 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 217 0.25 24 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 989 1.2 30 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 4,015 46 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.4 35 3.8 Nursing facility residents per 100 age 75+, 2007 7.2 36 7.8 Total nursing facility stays, 2006 8,942 46 3,176,119 Residents with Medicaid as primary payer, 2007 58% 40 64% Residents with Medicare as primary payer, 2007 15% 14 14% Residents with “other” as primary payer, 2007 27% 11 22% Residents with dementia, 2007 47% 20 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $208 5 $158 Medicare payment per day for nursing facility care, 2006 $306 28 $305 Average private pay rate per day in nursing facility, 2008 $210 18 $209 Average private pay rate per month in assisted living, 2008 $3,774 7 $3,008 Medicare reimbursement per home health visit, 2006 $147 16 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $43 14 $38 Average private pay daily rate for adult day care, 2008 $67 11 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 81 Long-Term Care Resources Delaware Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 16 0.14 23 0.22 Adult day facilities, 2001-02 15 0.13 15 0.09 Assisted living and residential care facilities, 2007 32 0.3 44 1.0 Assisted living and residential care units, 2007 1,804 15 38 26 Personal and home care aides, 2007 520 4 47 16 Median hourly wage, 2007 $10.83 5 $8.89 Home health aides, 2007 1,920 16 31 22 Median hourly wage, 2007 $11.50 6 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 45 0.38 33 0.43 Nursing facility beds, 2007 4,714 40 33 45 Nursing facility occupancy rate, 2007 85% 31 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4 9 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 39% 4 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 1,181 41 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 50 $50 100% 40 87% 89% $40 $38 80% $35 30 Millions of Dollars $30 60% 20 $20 40% 31% 10 $10 $8 20% $0 NA 0% NA 0 -$5 -$10 -20% -15% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -10 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 82 Trends Delaware Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 805 1,026,374 adults with physical disabilities 2005 1,312 1,376,984 % change +63% 22 +34% Medicaid aged/disabled waiver participants 2000 805 448,167 2005 1,312 582,342 % change +63% 16 +30% Medicare home health visits per user 2001 27 24 31 2006 23 39 35 % change -16% 47 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 3,913 1,428,117 2007 4,015 1,440,358 % change +3% 18 +1% Nursing facility beds 2002 4,262 1,671,744 2007 4,714 1,699,494 % change +11% 5 +2% Nursing facility occupancy rate 2002 92% 6 85% 2007 85% 31 85% change -7% 49 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $636 $243,497 2007 $991 $311,848 % change +56% 2 +28% Medicaid LTC spending for older people and adults 2002 $134 $54,261 with physical disabilities (millions) 2007 $180 $64,168 % change +35% 12 +18% Medicaid HCBS spending for older people and adults 2002 $9 $10,204 with physical disabilities (millions) 2007 $18 $17,188 % change +89% 24 +68% Medicaid nursing facility spending (millions) 2002 $124 $44,057 2007 $163 $46,980 % change +31% 8 +7% Medicaid HCBS spending for older people and adults 2002 7% 38 19% with physical disabilities, as a percentage of total 2007 10% 43 27% LTC spending change +3% 35 +8% 83 AARP Public Policy Institute District of Columbia % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 588 50 301,621 2030 433 51 363,584 % change -26% 51 +21% Age 50-64 2007 99 16.8% 47 17.8% 2030 63 14.5% 49 16.5% % change -36% 51 +12% Age 65+ 2007 70 11.9% 40 12.6% 2030 58 13.4% 50 19.7% % change -16% 51 +89% Age 65-74 2007 36 6.1% 41 6.4% 2030 Blue line = 50-64 29 6.8% 51 10.4% % change Purple line = 65-74 -18% 51 +96% Yellow line = 75-84 Age 75-84 2007 23 3.9% Red line = 85+ 41 4.3% 2030 20 4.6% 50 6.6% % change -14% 51 +84% Age 85+ 2007 11 1.8% 25 1.8% 2030 9 2.0% 47 2.6% % change -17% 51 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in the District of Columbia as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 120% 70.8% 2 19.3% Population (% of 2000 Census) Asian/Pacific Islander 110% 85+ State Rank U.S. 50-64 100% 2.2% 14 3.6% 65-74 Black 90% State Rank U.S. 80% 65.1% 1 8.7% 75-84 Hispanic 70% State Rank U.S. 60% 3.9% 13 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 84 Population & Characteristics Distr Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 41 50 48 Persons age 75+ living alone, 2007 40% 1 33% Non-metropolitan population age 65+, 2007/2008 0% 45 20% ict of Columbia Bachelor level education or higher age 65+, 2007 34% 1 19% Persons age 60+ raising grandchildren, 2007 2.4% 5 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $39,186 4 $32,158 At/below poverty level age 65+, 2007 13.7% 2 9.5% At/below 200% of poverty level age 65+, 2007 33% 21 32% At/below 300% of poverty level age 65+, 2007 43% 45 51% Women age 75+ at/below poverty level, 2007 16% 11 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 9 14% 43 16% Physical disability 19 29% 30 31% Mobility disability 12 19% 10 18% Self-care disability 8 11% 13 10% Cognitive/mental disability 9 13% 17 12% Any disability (one or more of the five 25 38% 34 41%   listed above) Cognitive/mental disability + any other disability 8 11% 20 11% Persons age 18-64 with disabilities, 2007 Any disability 41 10% 34 11% Cognitive/mental disability + any other disability 8 2.1% 51 3.2% Persons age 65+ with Alzheimer’s disease, 2010 9 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 57 34,000 Economic value of family caregiving (millions), 2007 $670 $375,000 Economic value per hour, 2007 $10.82 16 $10.10 Ratio of the economic value of family caregiving to Medicaid 1.8 50 3.7 long-term care spending, 2007 85 Long-Term Care Financing District of Columbia Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,354 40 $311,848 Medicaid home and community-based services (HCBS) spending 34% 12 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in the District of Columbia and the U.S., 2007 District of Columbia United States 12% 10% 17% 21% 66% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $261 $443 2 $213 adults with physical disabilities, 2007 Nursing facilities $173 $294 4 $156 HCBS $88 $149 2 $57 Personal care services (PCS) ** $56 $95 5 $34 Aged/disabled waiver services $32 $54 7 $21 Medicaid LTC expenditures for all populations, 2007 $378 $642 2 $323 Institutional services $258 $439 2 $196 HCBS $120 $204 9 $127 Waiver services (all populations) $64 $109 26 $91 Medicaid home health expenditures * $5 $9 19 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $35,399 5 $26,096 Medicaid HCBS expenditures for older people and adults with $5,143 44 $9,459 physical disabilities per person served, 2005 Personal care services ** $4,642 21 $9,666 Aged/disabled waiver services $7,405 31 $9,176 HCBS waiver services (all populations) $9,799 49 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 86 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 70.0% 7 Distr Medicaid personal needs allowance (per month), 2007 *** $70 4 $50 State-funded HCBS for older people (millions), 2007 $16.8 14 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. ict of Columbia Medicare beneficiaries receiving home health services, 2006 7.9% 19 8.4% Medicare home health visits per user, 2006 22 40 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 3,306 5.7 23 6.3 Personal care services ** 2,352 4 10 2.7 HCBS waiver services 954 1.6 49 3.6 Aged/disabled waiver services 521 0.9 41 2.0 Medicaid aged/disabled waiver participants per 11 46 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 2,124 3.6 11 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 2,804 49 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.0 24 3.8 Nursing facility residents per 100 age 75+, 2007 8.3 24 7.8 Total nursing facility stays, 2006 5,755 49 3,176,119 Residents with Medicaid as primary payer, 2007 80% 1 64% Residents with Medicare as primary payer, 2007 10% 43 14% Residents with “other” as primary payer, 2007 10% 50 22% Residents with dementia, 2007 49% 16 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $234 2 $158 Medicare payment per day for nursing facility care, 2006 $327 18 $305 Average private pay rate per day in nursing facility, 2008 $216 15 $209 Average private pay rate per month in assisted living, 2008 $4,027 5 $3,008 Medicare reimbursement per home health visit, 2006 $165 6 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $22 47 $38 Average private pay daily rate for adult day care, 2008 $62 17 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 87 Long-Term Care Resources District of Columbia Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 21 0.3 23 0.22 Adult day facilities, 2001-02 9 0.13 15 0.09 Assisted living and residential care facilities, 2007 22 0.3 44 1.0 Assisted living and residential care units, 2007 509 7 48 26 Personal and home care aides, 2007 970 14 22 16 Median hourly wage, 2007 $9.89 15 $8.89 Home health aides, 2007 1,210 17 26 22 Median hourly wage, 2007 $10.43 15 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 20 0.29 44 0.43 Nursing facility beds, 2007 2,982 43 29 45 Nursing facility occupancy rate, 2007 94% 2 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4.2 5 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 44% 1 18% residents, 2007 Residents with physical restraints (%), 2007 2% 44 6% Long-term care facility beds per FTE ombudsman, 2006 879 47 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 0% 51 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 60 $60 2,500% $52 2,168% 40 2,000% $40 1,648% Millions of Dollars 1,522% $31 $30 1,500% 20 $20 1,000% $6 500% $0 0 0% 7% -$8 -4% -$20 -500% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -20 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 88 Trends Distr Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 1,704 1,026,374 adults with physical disabilities 2005 2,873 1,376,984 % change +69% 20 +34% Medicaid aged/disabled waiver participants 2000 79 448,167 ict of Columbia 2005 521 582,342 % change +559% 2 +30% Medicare home health visits per user 2001 26 31 31 2006 22 40 35 % change -15% 45 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 2,834 1,428,117 2007 2,804 1,440,358 % change -1% 30 +1% Nursing facility beds 2002 3,114 1,671,744 2007 2,982 1,699,494 % change -4% 37 +2% Nursing facility occupancy rate 2002 91% 11 85% 2007 94% 2 85% change +3% 1 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,035 $243,497 2007 $1,354 $311,848 % change +31% 25 +28% Medicaid LTC spending for older people and adults 2002 $186 $54,261 with physical disabilities (millions) 2007 $261 $64,168 % change +40% 10 +18% Medicaid HCBS spending for older people and adults 2002 $5 $10,204 with physical disabilities (millions) 2007 $88 $17,188 % change +1,600% 1 +68% Medicaid nursing facility spending (millions) 2002 $181 $44,057 2007 $173 $46,980 % change -4% 41 +7% Medicaid HCBS spending for older people and adults 2002 3% 46 19% with physical disabilities, as a percentage of total 2007 34% 12 27% LTC spending change +31% 1 +8% 89 AARP Public Policy Institute Florida % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 18,251 4 301,621 2030 28,686 3 363,584 % change +57% 3 +21% Age 50-64 2007 3,331 18.3% 26 17.8% 2030 5,120 17.8% 11 16.5% % change +54% 3 +12% Age 65+ 2007 3,098 17.0% 1 12.6% 2030 7,769 27.1% 1 19.7% % change +151% 4 +89% Age 65-74 2007 1,479 8.1% 1 6.4% 2030 Blue line = 50-64 4,306 15.0% 1 10.4% % change Purple line = 65-74 +191% 2 +96% Yellow line = 75-84 Age 75-84 2007 1,126line = 85+ Red 6.2% 1 4.3% 2030 2,519 8.8% 6 6.6% % change +124% 6 +84% Age 85+ 2007 494 2.7% 1 1.8% 2030 944 3.3% 10 2.6% % change +91% 15 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Florida as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 21.4% 15 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% 65-74 State Rank U.S. 85+ 240% 1.4% 21 3.6% Black 200% 50-64 State Rank U.S. 75-84 160% 7.6% 19 8.7% Hispanic 120% State Rank U.S. 80% 12.6% 4 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 90 Population & Characteristics Florida Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 61 4 48 Persons age 75+ living alone, 2007 30% 44 33% Non-metropolitan population age 65+, 2007/2008 6% 40 20% Bachelor level education or higher age 65+, 2007 21% 17 19% Persons age 60+ raising grandchildren, 2007 1.3% 31 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $33,469 17 $32,158 At/below poverty level age 65+, 2007 9.4% 19 9.5% At/below 200% of poverty level age 65+, 2007 31% 29 32% At/below 300% of poverty level age 65+, 2007 50% 32 51% Women age 75+ at/below poverty level, 2007 12% 28 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 460 15% 34 16% Physical disability 873 29% 30 31% Mobility disability 473 16% 27 18% Self-care disability 269 9% 30 10% Cognitive/mental disability 348 12% 21 12% Any disability (one or more of the five 1,157 38% 34 41%   listed above) Cognitive/mental disability + any other disability 312 10% 27 11% Persons age 18-64 with disabilities, 2007 Any disability 1,183 11% 27 11% Cognitive/mental disability + any other disability 329 3.0% 31 3.2% Persons age 65+ with Alzheimer’s disease, 2010 450 13% 31 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 1,800 34,000 Economic value of family caregiving (millions), 2007 $19,200 $375,000 Economic value per hour, 2007 $9.89 29 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.6 13 3.7 long-term care spending, 2007 91 Long-Term Care Financing Florida Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $13,742 5 $311,848 Medicaid home and community-based services (HCBS) spending 14% 35 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Florida and the U.S., 2007 Florida United States 12% 10% 2% 17% 86% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $2,767 $152 40 $213 adults with physical disabilities, 2007 Nursing facilities $2,393 $131 31 $156 HCBS $374 $20 42 $57 Personal care services (PCS) ** $27 $1 33 $34 Aged/disabled waiver services $321 $18 33 $21 Medicaid LTC expenditures for all populations, 2007 $3,993 $219 44 $323 Institutional services $2,722 $149 36 $196 HCBS $1,272 $70 44 $127 Waiver services (all populations) $1,219 $67 41 $91 Medicaid home health expenditures * $158 $9 19 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $23,856 34 $26,096 Medicaid HCBS expenditures for older people and adults with $7,183 32 $9,459 physical disabilities per person served, 2005 Personal care services ** $2,390 27 $9,666 Aged/disabled waiver services $9,783 20 $9,176 HCBS waiver services (all populations) $15,235 38 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 92 Federal/State/Personal Contributions State Rank U.S. Florida Federal Medical Assistance Percentage (FMAP), 2007 58.2% 29 Medicaid personal needs allowance (per month), 2007 *** $35 43 $50 State-funded HCBS for older people (millions), 2007 $67.2 5 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 11.7% 3 8.4% Medicare home health visits per user, 2006 50 5 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 73,131 4.1 37 6.3 Personal care services ** 13,980 0.8 27 2.7 HCBS waiver services 59,151 3.3 31 3.6 Aged/disabled waiver services 25,773 1.5 34 2.0 Medicaid aged/disabled waiver participants per 27 34 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 11,389 0.62 18 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 21,192 1.2 30 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 72,447 7 1,440,358 Nursing facility residents per 100 age 65+, 2007 2.3 46 3.8 Nursing facility residents per 100 age 75+, 2007 4.5 46 7.8 Total nursing facility stays, 2006 203,903 3 3,176,119 Residents with Medicaid as primary payer, 2007 58% 40 64% Residents with Medicare as primary payer, 2007 20% 1 14% Residents with “other” as primary payer, 2007 23% 23 22% Residents with dementia, 2007 45% 30 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $173 13 $158 Medicare payment per day for nursing facility care, 2006 $319 22 $305 Average private pay rate per day in nursing facility, 2008 $213 16 $209 Average private pay rate per month in assisted living, 2008 $2,642 35 $3,008 Medicare reimbursement per home health visit, 2006 $106 50 $134 Average private pay hourly rate for home health aide, 2008 $18 33 $19 Medicare-certified home health aide, 2008 $22 47 $38 Average private pay daily rate for adult day care, 2008 $52 31 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 93 Long-Term Care Resources Florida Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 735 0.24 23 0.22 Adult day facilities, 2001-02 165 0.05 38 0.09 Assisted living and residential care facilities, 2007 2,400 0.8 23 1.0 Assisted living and residential care units, 2007 75,450 24 28 26 Personal and home care aides, 2007 9,820 3 49 16 Median hourly wage, 2007 $8.98 29 $8.89 Home health aides, 2007 29,720 10 46 22 Median hourly wage, 2007 $9.54 30 $9.62 Medicaid aged/disabled waiver waiting list, 2007 7,410 4 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 684 0.22 49 0.43 Nursing facility beds, 2007 81,966 26 46 45 Nursing facility occupancy rate, 2007 88% 20 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4.6 2 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 8% 44 18% residents, 2007 Residents with physical restraints (%), 2007 7% 7 6% Long-term care facility beds per FTE ombudsman, 2006 7,319 2 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 26% 49 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 600 $600 200% 500 187% $518 $500 152% 400 150% Millions of Dollars $403 $400 300 $300 100% 83% $194 200 $200 50% $100 28% 100 $18 $34 6% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 94 Trends Florida Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 27,404 1,026,374 adults with physical disabilities 2005 39,753 1,376,984 % change +45% 27 +34% Medicaid aged/disabled waiver participants 2000 17,941 448,167 2005 25,773 582,342 % change +44% 22 +30% Medicare home health visits per user 2001 30 17 31 2006 50 5 35 % change +67% 1 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 67,822 1,428,117 2007 72,447 1,440,358 % change +7% 7 +1% Nursing facility beds 2002 78,810 1,671,744 2007 81,966 1,699,494 % change +4% 18 +2% Nursing facility occupancy rate 2002 86% 30 85% 2007 88% 20 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $9,957 $243,497 2007 $13,742 $311,848 % change +38% 17 +28% Medicaid LTC spending for older people and adults 2002 $2,021 $54,261 with physical disabilities (millions) 2007 $2,767 $64,168 % change +37% 11 +18% Medicaid HCBS spending for older people and adults 2002 $146 $10,204 with physical disabilities (millions) 2007 $374 $17,188 % change +157% 7 +68% Medicaid nursing facility spending (millions) 2002 $1,876 $44,057 2007 $2,393 $46,980 % change +28% 10 +7% Medicaid HCBS spending for older people and adults 2002 7% 38 19% with physical disabilities, as a percentage of total 2007 14% 35 27% LTC spending change +6% 21 +8% 95 AARP Public Policy Institute Georgia % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 9,545 9 301,621 2030 12,018 8 363,584 % change +26% 13 +21% Age 50-64 2007 1,609 16.9% 46 17.8% 2030 1,992 16.6% 30 16.5% % change +24% 8 +12% Age 65+ 2007 943 9.9% 49 12.6% 2030 1,908 15.9% 47 19.7% % change +102% 14 +89% Age 65-74 2007 524 5.5% 47 6.4% 2030 Blue line = 50-64 1,068 8.9% 46 10.4% % change Purple line = 65-74 +104% 10 +96% Yellow line = 75-84 Age 75-84 2007 300 3.1% Red line = 85+ 49 4.3% 2030 615 5.1% 48 6.6% % change +105% 13 +84% Age 85+ 2007 118 1.2% 48 1.8% 2030 225 1.9% 48 2.6% % change +91% 15 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Georgia as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 24.6% 11 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 85+ 240% 1.9% 17 3.6% 65-74 Black 200% State Rank U.S. 50-64 160% 20.5% 5 8.7% 75-84 Hispanic 120% State Rank U.S. 80% 2.1% 25 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 96 Population & Characteristics Georgia Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 41 50 48 Persons age 75+ living alone, 2007 32% 36 33% Non-metropolitan population age 65+, 2007/2008 19% 33 20% Bachelor level education or higher age 65+, 2007 17% 33 19% Persons age 60+ raising grandchildren, 2007 2.4% 5 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $31,143 26 $32,158 At/below poverty level age 65+, 2007 12.1% 7 9.5% At/below 200% of poverty level age 65+, 2007 35% 15 32% At/below 300% of poverty level age 65+, 2007 53% 22 51% Women age 75+ at/below poverty level, 2007 18% 4 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 158 17% 18 16% Physical disability 313 35% 10 31% Mobility disability 182 20% 7 18% Self-care disability 105 12% 7 10% Cognitive/mental disability 137 15% 6 12% Any disability (one or more of the five 405 45% 11 41%   listed above) Cognitive/mental disability + any other disability 123 14% 4 11% Persons age 18-64 with disabilities, 2007 Any disability 676 11% 27 11% Cognitive/mental disability + any other disability 194 3.2% 25 3.2% Persons age 65+ with Alzheimer’s disease, 2010 120 12% 39 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 1,330 34,000 Economic value of family caregiving (millions), 2007 $13,000 $375,000 Economic value per hour, 2007 $9.07 44 $10.10 Ratio of the economic value of family caregiving to Medicaid 8.7 3 3.7 long-term care spending, 2007 97 Long-Term Care Financing Georgia Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $7,170 12 $311,848 Medicaid home and community-based services (HCBS) spending 18% 30 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Georgia and the U.S., 2007 Georgia United States 17% 10% 1% 17% 82% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,003 $105 48 $213 adults with physical disabilities, 2007 Nursing facilities $821 $86 46 $156 HCBS $183 $19 44 $57 Personal care services (PCS) ** $12 $1 33 $34 Aged/disabled waiver services $171 $18 33 $21 Medicaid LTC expenditures for all populations, 2007 $1,410 $148 49 $323 Institutional services $918 $96 47 $196 HCBS $492 $52 49 $127 Waiver services (all populations) $480 $50 45 $91 Medicaid home health expenditures * $76 $8 26 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $20,618 42 $26,096 Medicaid HCBS expenditures for older people and adults with $6,153 38 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $6,153 38 $9,176 HCBS waiver services (all populations) $13,217 43 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 98 Federal/State/Personal Contributions State Rank U.S. Georgia Federal Medical Assistance Percentage (FMAP), 2007 62.0% 21 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $16.0 16 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.3% 27 8.4% Medicare home health visits per user, 2006 30 18 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 24,686 2.7 45 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 24,686 2.7 38 3.6 Aged/disabled waiver services 15,418 1.7 27 2.0 Medicaid aged/disabled waiver participants per 32 28 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 2,300 0.24 26 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 14,014 1.5 25 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 35,682 14 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.8 28 3.8 Nursing facility residents per 100 age 75+, 2007 8.5 23 7.8 Total nursing facility stays, 2006 65,045 18 3,176,119 Residents with Medicaid as primary payer, 2007 74% 3 64% Residents with Medicare as primary payer, 2007 11% 37 14% Residents with “other” as primary payer, 2007 15% 45 22% Residents with dementia, 2007 49% 16 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $122 42 $158 Medicare payment per day for nursing facility care, 2006 $276 39 $305 Average private pay rate per day in nursing facility, 2008 $158 39 $209 Average private pay rate per month in assisted living, 2008 $2,340 45 $3,008 Medicare reimbursement per home health visit, 2006 $145 20 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $66 6 $38 Average private pay daily rate for adult day care, 2008 $49 37 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 99 Long-Term Care Resources Georgia Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 97 0.1 23 0.22 Adult day facilities, 2001-02 62 0.07 29 0.09 Assisted living and residential care facilities, 2007 1,860 2.0 8 1.0 Assisted living and residential care units, 2007 26,500 28 23 26 Personal and home care aides, 2007 8,710 9 39 16 Median hourly wage, 2007 $9.01 28 $8.89 Home health aides, 2007 10,010 11 45 22 Median hourly wage, 2007 $8.61 46 $9.62 Medicaid aged/disabled waiver waiting list, 2007 763 12 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 362 0.38 33 0.43 Nursing facility beds, 2007 40,159 43 29 45 Nursing facility occupancy rate, 2007 89% 18 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.4 46 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 16% 22 18% residents, 2007 Residents with physical restraints (%), 2007 6% 13 6% Long-term care facility beds per FTE ombudsman, 2006 1,373 36 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 98% 21 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 200 $200 150% 150 $153 No spending in 2002 $150 103% 100% Millions of Dollars 100 $100 60% $64 50% 50 $50 $12 0% $0 -2% 0 -13% -$14 -$15 $-50 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -50 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 100 Trends Georgia Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 12,636 1,026,374 adults with physical disabilities 2005 15,418 1,376,984 % change +22% 34 +34% Medicaid aged/disabled waiver participants 2000 12,636 448,167 2005 15,418 582,342 % change +22% 29 +30% Medicare home health visits per user 2001 34 13 31 2006 30 18 35 % change -11% 40 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 33,620 1,428,117 2007 35,682 1,440,358 % change +6% 10 +1% Nursing facility beds 2002 36,836 1,671,744 2007 40,159 1,699,494 % change +9% 7 +2% Nursing facility occupancy rate 2002 91% 11 85% 2007 89% 18 85% change -2% 30 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $6,400 $243,497 2007 $7,170 $311,848 % change +12% 45 +28% Medicaid LTC spending for older people and adults 2002 $942 $54,261 with physical disabilities (millions) 2007 $1,003 $64,168 % change +6% 43 +18% Medicaid HCBS spending for older people and adults 2002 $107 $10,204 with physical disabilities (millions) 2007 $183 $17,188 % change +71% 28 +68% Medicaid nursing facility spending (millions) 2002 $835 $44,057 2007 $821 $46,980 % change -2% 38 +7% Medicaid HCBS spending for older people and adults 2002 11% 30 19% with physical disabilities, as a percentage of total 2007 18% 30 27% LTC spending change +7% 17 +8% 101 AARP Public Policy Institute Hawaii % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 1,283 42 301,621 2030 1,466 41 363,584 % change +14% 23 +21% Age 50-64 2007 241 18.7% 12 17.8% 2030 217 14.8% 48 16.5% % change -10% 48 +12% Age 65+ 2007 184 14.3% 7 12.6% 2030 327 22.3% 13 19.7% % change +78% 27 +89% Age 65-74 2007 87 6.8% 15 6.4% 2030 Blue line = 50-64 159 10.9% 22 10.4% % change Purple line = 65-74 +84% 26 +96% Yellow line = 75-84 Age 75-84 2007 68 5.3% Red line = 85+ 4 4.3% 2030 119 8.1% 9 6.6% % change +76% 27 +84% Age 85+ 2007 29 2.3% 7 1.8% 2030 48 3.3% 10 2.6% % change +64% 28 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Hawaii as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 77.5% 1 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 85+ 240% 78.5% 1 3.6% Black 200% State Rank U.S. 65-74 75-84 160% 1.0% 40 8.7% Hispanic 120% 50-64 State Rank U.S. 80% 2.7% 16 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 102 Population & Characteristics Hawa ii Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 62 2 48 Persons age 75+ living alone, 2007 23% 51 33% Non-metropolitan population age 65+, 2007/2008 27% 27 20% Bachelor level education or higher age 65+, 2007 22% 13 19% Persons age 60+ raising grandchildren, 2007 2.4% 5 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $52,393 1 $32,158 At/below poverty level age 65+, 2007 6.3% 49 9.5% At/below 200% of poverty level age 65+, 2007 21% 51 32% At/below 300% of poverty level age 65+, 2007 36% 51 51% Women age 75+ at/below poverty level, 2007 9% 46 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 26 14% 43 16% Physical disability 51 28% 35 31% Mobility disability 32 18% 16 18% Self-care disability 18 10% 19 10% Cognitive/mental disability 24 13% 17 12% Any disability (one or more of the five 69 38% 34 41%   listed above) Cognitive/mental disability + any other disability 21 12% 13 11% Persons age 18-64 with disabilities, 2007 Any disability 78 10% 34 11% Cognitive/mental disability + any other disability 20 2.4% 43 3.2% Persons age 65+ with Alzheimer’s disease, 2010 27 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 113 34,000 Economic value of family caregiving (millions), 2007 $1,450 $375,000 Economic value per hour, 2007 $11.92 4 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.9 22 3.7 long-term care spending, 2007 103 Long-Term Care Financing Hawaii Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,116 43 $311,848 Medicaid home and community-based services (HCBS) spending 17% 33 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Hawaii and the U.S., 2007 Hawaii United States 17% 10% 17% 83% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $261 $203 25 $213 adults with physical disabilities, 2007 Nursing facilities $215 $167 25 $156 HCBS $46 $36 28 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $46 $36 12 $21 Medicaid LTC expenditures for all populations, 2007 $371 $289 32 $323 Institutional services $224 $174 31 $196 HCBS $148 $115 30 $127 Waiver services (all populations) $148 $115 19 $91 Medicaid home health expenditures * $1 $1 43 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $35,393 6 $26,096 Medicaid HCBS expenditures for older people and adults with $17,602 2 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $17,602 5 $9,176 HCBS waiver services (all populations) $27,226 15 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 104 Federal/State/Personal Contributions State Rank U.S. Hawa ii Federal Medical Assistance Percentage (FMAP), 2007 57.6% 31 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $7.0 26 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 2.7% 51 8.4% Medicare home health visits per user, 2006 18 50 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 4,363 3.4 41 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 4,363 3.4 30 3.6 Aged/disabled waiver services 2,195 1.7 27 2.0 Medicaid aged/disabled waiver participants per 41 21 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 1,400 1.09 8 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 1,300 1 35 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 3,965 47 1,440,358 Nursing facility residents per 100 age 65+, 2007 2.2 47 3.8 Nursing facility residents per 100 age 75+, 2007 4.1 47 7.8 Total nursing facility stays, 2006 8,231 47 3,176,119 Residents with Medicaid as primary payer, 2007 70% 8 64% Residents with Medicare as primary payer, 2007 9% 46 14% Residents with “other” as primary payer, 2007 21% 31 22% Residents with dementia, 2007 53% 5 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $205 6 $158 Medicare payment per day for nursing facility care, 2006 $339 10 $305 Average private pay rate per day in nursing facility, 2008 $295 5 $209 Average private pay rate per month in assisted living, 2008 $3,443 9 $3,008 Medicare reimbursement per home health visit, 2006 $198 1 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $45 13 $38 Average private pay daily rate for adult day care, 2008 $59 20 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 105 Long-Term Care Resources Hawaii Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 13 0.07 23 0.22 Adult day facilities, 2001-02 27 0.15 9 0.09 Assisted living and residential care facilities, 2007 490 2.7 4 1.0 Assisted living and residential care units, 2007 4,284 23 30 26 Personal and home care aides, 2007 3,410 19 15 16 Median hourly wage, 2007 $9.09 27 $8.89 Home health aides, 2007 1,630 9 47 22 Median hourly wage, 2007 $11.79 5 $9.62 Medicaid aged/disabled waiver waiting list, 2007 100 18 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 48 0.26 47 0.43 Nursing facility beds, 2007 4,185 23 48 45 Nursing facility occupancy rate, 2007 95% 1 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.8 19 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 7% 47 18% residents, 2007 Residents with physical restraints (%), 2007 4% 28 6% Long-term care facility beds per FTE ombudsman, 2006 2,849 17 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 96% 23 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 80 $80 200% 186% 60 $65 $60 150% Millions of Dollars $46 40 $40 100% 67% $20 $18 50% 20 27% $0 NA 1% NA $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 106 Trends Hawa ii Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 991 1,026,374 adults with physical disabilities 2005 2,195 1,376,984 % change +121% 12 +34% Medicaid aged/disabled waiver participants 2000 991 448,167 2005 2,195 582,342 % change +121% 7 +30% Medicare home health visits per user 2001 19 48 31 2006 18 50 35 % change -5% 33 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 3,881 1,428,117 2007 3,965 1,440,358 % change +2% 23 +1% Nursing facility beds 2002 4,089 1,671,744 2007 4,185 1,699,494 % change +2% 25 +2% Nursing facility occupancy rate 2002 95% 1 85% 2007 95% 1 85% change +0% 17 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $750 $243,497 2007 $1,116 $311,848 % change +49% 9 +28% Medicaid LTC spending for older people and adults 2002 $196 $54,261 with physical disabilities (millions) 2007 $261 $64,168 % change +33% 16 +18% Medicaid HCBS spending for older people and adults 2002 $27 $10,204 with physical disabilities (millions) 2007 $46 $17,188 % change +67% 29 +68% Medicaid nursing facility spending (millions) 2002 $169 $44,057 2007 $215 $46,980 % change +27% 11 +7% Medicaid HCBS spending for older people and adults 2002 14% 25 19% with physical disabilities, as a percentage of total 2007 17% 33 27% LTC spending change +4% 29 +8% 107 AARP Public Policy Institute Idaho % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 1,499 39 301,621 2030 1,970 37 363,584 % change +31% 8 +21% Age 50-64 2007 262 17.5% 43 17.8% 2030 336 17.1% 19 16.5% % change +28% 6 +12% Age 65+ 2007 175 11.7% 43 12.6% 2030 361 18.3% 38 19.7% % change +106% 10 +89% Age 65-74 2007 92 6.1% 41 6.4% 2030 Blue line = 50-64 188 9.6% 39 10.4% % change Purple line = 65-74 +104% 10 +96% Yellow line = 75-84 Age 75-84 2007 58 3.9% Red line = 85+ 41 4.3% 2030 126 6.4% 36 6.6% % change +116% 8 +84% Age 85+ 2007 25 1.6% 38 1.8% 2030 47 2.4% 40 2.6% % change +91% 15 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Idaho as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 5.1% 43 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% 85+ State Rank U.S. 65-74 240% 1.0% 28 3.6% Black 200% State Rank U.S. 50-64 160% 0.2% 48 8.7% 75-84 Hispanic 120% State Rank U.S. 80% 2.7% 16 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 108 Population & Characteristics Idaho Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 57 6 48 Persons age 75+ living alone, 2007 32% 36 33% Non-metropolitan population age 65+, 2007/2008 38% 19 20% Bachelor level education or higher age 65+, 2007 19% 24 19% Persons age 60+ raising grandchildren, 2007 1.1% 35 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $30,813 28 $32,158 At/below poverty level age 65+, 2007 8.0% 37 9.5% At/below 200% of poverty level age 65+, 2007 32% 25 32% At/below 300% of poverty level age 65+, 2007 55% 14 51% Women age 75+ at/below poverty level, 2007 14% 19 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 30 18% 13 16% Physical disability 50 30% 24 31% Mobility disability 24 15% 35 18% Self-care disability 14 8% 40 10% Cognitive/mental disability 18 11% 27 12% Any disability (one or more of the five 66 40% 23 41%   listed above) Cognitive/mental disability + any other disability 17 10% 27 11% Persons age 18-64 with disabilities, 2007 Any disability 104 12% 20 11% Cognitive/mental disability + any other disability 30 3.3% 21 3.2% Persons age 65+ with Alzheimer’s disease, 2010 26 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 162 34,000 Economic value of family caregiving (millions), 2007 $1,600 $375,000 Economic value per hour, 2007 $9.13 43 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.3 16 3.7 long-term care spending, 2007 109 Long-Term Care Financing Idaho Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,100 44 $311,848 Medicaid home and community-based services (HCBS) spending 39% 9 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Idaho and the U.S., 2007 Idaho United States 10% 28% 17% 11% 61% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $237 $158 38 $213 adults with physical disabilities, 2007 Nursing facilities $146 $97 42 $156 HCBS $91 $61 15 $57 Personal care services (PCS) ** $25 $17 24 $34 Aged/disabled waiver services $66 $44 10 $21 Medicaid LTC expenditures for all populations, 2007 $362 $242 40 $323 Institutional services $208 $139 40 $196 HCBS $154 $103 35 $127 Waiver services (all populations) $129 $86 31 $91 Medicaid home health expenditures * $7 $5 28 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $26,547 25 $26,096 Medicaid HCBS expenditures for older people and adults with $7,711 28 $9,459 physical disabilities per person served, 2005 Personal care services ** $7,581 12 $9,666 Aged/disabled waiver services $7,771 29 $9,176 HCBS waiver services (all populations) $11,715 45 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 110 Federal/State/Personal Contributions State Rank U.S. Idaho Federal Medical Assistance Percentage (FMAP), 2007 70.4% 5 Medicaid personal needs allowance (per month), 2007 *** $40 35 $50 State-funded HCBS for older people (millions), 2007 $1.3 45 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 6.6% 34 8.4% Medicare home health visits per user, 2006 29 21 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 13,215 9.3 8 6.3 Personal care services ** 3,601 2.5 15 2.7 HCBS waiver services 9,614 6.7 4 3.6 Aged/disabled waiver services 7,733 5.4 3 2.0 Medicaid aged/disabled waiver participants per 153 3 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 2,231 1.49 6 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 3,326 2.3 19 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 4,533 45 1,440,358 Nursing facility residents per 100 age 65+, 2007 2.6 41 3.8 Nursing facility residents per 100 age 75+, 2007 5.5 41 7.8 Total nursing facility stays, 2006 12,558 41 3,176,119 Residents with Medicaid as primary payer, 2007 59% 38 64% Residents with Medicare as primary payer, 2007 16% 7 14% Residents with “other” as primary payer, 2007 26% 13 22% Residents with dementia, 2007 41% 46 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $169 18 $158 Medicare payment per day for nursing facility care, 2006 $306 28 $305 Average private pay rate per day in nursing facility, 2008 $185 26 $209 Average private pay rate per month in assisted living, 2008 $2,749 30 $3,008 Medicare reimbursement per home health visit, 2006 $132 35 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $33 25 $38 Average private pay daily rate for adult day care, 2008 $66 13 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 111 Long-Term Care Resources Idaho Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 50 0.29 23 0.22 Adult day facilities, 2001-02 4 0.02 48 0.09 Assisted living and residential care facilities, 2007 278 1.6 11 1.0 Assisted living and residential care units, 2007 6,819 39 8 26 Personal and home care aides, 2007 2,050 12 30 16 Median hourly wage, 2007 $8.49 40 $8.89 Home health aides, 2007 3,820 22 15 22 Median hourly wage, 2007 $8.85 41 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 79 0.45 27 0.43 Nursing facility beds, 2007 6,090 35 39 45 Nursing facility occupancy rate, 2007 74% 42 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4.5 3 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 34% 6 18% residents, 2007 Residents with physical restraints (%), 2007 4% 28 6% Long-term care facility beds per FTE ombudsman, 2006 1,175 42 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 35 $35 120% 30 $31 $30 100% 25 100% Millions of Dollars $25 $23 80% 20 $21 $20 60% 15 $15 47% 50% 40% 10 $10 $8 $5 20% 19% $5 5 8% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 112 Trends Idaho Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 4,910 1,026,374 adults with physical disabilities 2005 11,334 1,376,984 % change +131% 11 +34% Medicaid aged/disabled waiver participants 2000 2,989 448,167 2005 7,733 582,342 % change +159% 6 +30% Medicare home health visits per user 2001 23 41 31 2006 29 21 35 % change +24% 3 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 4,407 1,428,117 2007 4,533 1,440,358 % change +3% 18 +1% Nursing facility beds 2002 5,675 1,671,744 2007 6,090 1,699,494 % change +7% 9 +2% Nursing facility occupancy rate 2002 78% 44 85% 2007 74% 42 85% change -3% 38 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $799 $243,497 2007 $1,100 $311,848 % change +38% 17 +28% Medicaid LTC spending for older people and adults 2002 $184 $54,261 with physical disabilities (millions) 2007 $237 $64,168 % change +29% 19 +18% Medicaid HCBS spending for older people and adults 2002 $62 $10,204 with physical disabilities (millions) 2007 $91 $17,188 % change +48% 37 +68% Medicaid nursing facility spending (millions) 2002 $123 $44,057 2007 $146 $46,980 % change +19% 24 +7% Medicaid HCBS spending for older people and adults 2002 34% 8 19% with physical disabilities, as a percentage of total 2007 39% 9 27% LTC spending change +5% 26 +8% 113 AARP Public Policy Institute Illinois % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 12,853 5 301,621 2030 13,433 5 363,584 % change +5% 41 +21% Age 50-64 2007 2,216 17.2% 45 17.8% 2030 2,188 16.3% 36 16.5% % change -1% 30 +12% Age 65+ 2007 1,549 12.1% 39 12.6% 2030 2,412 18.0% 42 19.7% % change +56% 44 +89% Age 65-74 2007 785 6.1% 41 6.4% 2030 Blue line = 50-64 1,259 9.4% 41 10.4% % change Purple line = 65-74 +60% 45 +96% Yellow line = 75-84 Age 75-84 2007 530 4.1% Red line = 85+ 35 4.3% 2030 801 6.0% 41 6.6% % change +51% 46 +84% Age 85+ 2007 234 1.8% 25 1.8% 2030 352 2.6% 29 2.6% % change +51% 35 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Illinois as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 19.4% 18 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 85+ State Rank U.S. 65-74 160% 3.0% 10 3.6% 75-84 Black 140% State Rank U.S. 50-64 120% 11.2% 12 8.7% Hispanic 100% State Rank U.S. 80% 5.0% 10 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 114 Population & Characteristics Illinois Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 35% 16 33% Non-metropolitan population age 65+, 2007/2008 15% 37 20% Bachelor level education or higher age 65+, 2007 18% 31 19% Persons age 60+ raising grandchildren, 2007 1.5% 24 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $32,731 19 $32,158 At/below poverty level age 65+, 2007 8.5% 27 9.5% At/below 200% of poverty level age 65+, 2007 31% 29 32% At/below 300% of poverty level age 65+, 2007 51% 29 51% Women age 75+ at/below poverty level, 2007 11% 35 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 213 14% 43 16% Physical disability 440 30% 24 31% Mobility disability 247 17% 20 18% Self-care disability 140 10% 19 10% Cognitive/mental disability 158 11% 27 12% Any disability (one or more of the five 567 39% 27 41%   listed above) Cognitive/mental disability + any other disability 140 10% 27 11% Persons age 18-64 with disabilities, 2007 Any disability 732 9% 46 11% Cognitive/mental disability + any other disability 193 2.4% 43 3.2% Persons age 65+ with Alzheimer’s disease, 2010 210 13% 31 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 1,490 34,000 Economic value of family caregiving (millions), 2007 $17,100 $375,000 Economic value per hour, 2007 $10.60 19 $10.10 Ratio of the economic value of family caregiving to Medicaid 5.7 6 3.7 long-term care spending, 2007 115 Long-Term Care Financing Illinois Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $12,651 7 $311,848 Medicaid home and community-based services (HCBS) spending 23% 24 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Illinois and the U.S., 2007 Illinois United States 10% 23% 17% 77% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,757 $137 43 $213 adults with physical disabilities, 2007 Nursing facilities $1,355 $105 40 $156 HCBS $402 $31 34 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $402 $31 18 $21 Medicaid LTC expenditures for all populations, 2007 $2,957 $230 41 $323 Institutional services $2,061 $160 34 $196 HCBS $896 $70 44 $127 Waiver services (all populations) $896 $70 40 $91 Medicaid home health expenditures * $48 $4 33 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $20,062 46 $26,096 Medicaid HCBS expenditures for older people and adults with $6,625 34 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $6,625 33 $9,176 HCBS waiver services (all populations) $11,002 47 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 116 Federal/State/Personal Contributions State Rank U.S. Illinois Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $30 46 $50 State-funded HCBS for older people (millions), 2007 $155.2 3 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 9.1% 12 8.4% Medicare home health visits per user, 2006 27 24 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 68,953 5.4 28 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 68,953 5.4 14 3.6 Aged/disabled waiver services 51,831 4.1 7 2.0 Medicaid aged/disabled waiver participants per 67 10 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 4,681 0.36 21 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 74,236 5.8 6 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 77,779 6 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.0 12 3.8 Nursing facility residents per 100 age 75+, 2007 10.2 11 7.8 Total nursing facility stays, 2006 166,511 7 3,176,119 Residents with Medicaid as primary payer, 2007 63% 26 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 24% 21 22% Residents with dementia, 2007 42% 40 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $104 49 $158 Medicare payment per day for nursing facility care, 2006 $304 30 $305 Average private pay rate per day in nursing facility, 2008 $178 30 $209 Average private pay rate per month in assisted living, 2008 $3,732 8 $3,008 Medicare reimbursement per home health visit, 2006 $170 5 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $39 19 $38 Average private pay daily rate for adult day care, 2008 $56 24 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 117 Long-Term Care Resources Illinois Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 422 0.27 23 0.22 Adult day facilities, 2001-02 88 0.06 36 0.09 Assisted living and residential care facilities, 2007 346 0.2 48 1.0 Assisted living and residential care units, 2007 16,800 11 46 26 Personal and home care aides, 2007 19,490 13 26 16 Median hourly wage, 2007 $8.36 41 $8.89 Home health aides, 2007 24,040 16 31 22 Median hourly wage, 2007 $9.85 24 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 810 0.52 21 0.43 Nursing facility beds, 2007 98,594 64 9 45 Nursing facility occupancy rate, 2007 79% 40 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.3 49 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 25% 11 18% residents, 2007 Residents with physical restraints (%), 2007 4% 28 6% Long-term care facility beds per FTE ombudsman, 2006 1,503 31 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 91% 29 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 300 $300 150% 200 $207 106% $200 $185 100% Millions of Dollars 100 74% $100 50% $0 0 $0 -$16 0% NA -$100 -2% -100 -10% -$157 -$200 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -200 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 118 Trends Illinois Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 33,831 1,026,374 adults with physical disabilities 2005 51,831 1,376,984 % change +53% 24 +34% Medicaid aged/disabled waiver participants 2000 33,831 448,167 2005 51,831 582,342 % change +53% 19 +30% Medicare home health visits per user 2001 25 37 31 2006 27 24 35 % change +8% 11 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 81,719 1,428,117 2007 77,779 1,440,358 % change -5% 38 +1% Nursing facility beds 2002 100,344 1,671,744 2007 98,594 1,699,494 % change -2% 34 +2% Nursing facility occupancy rate 2002 81% 40 85% 2007 79% 40 85% change -3% 38 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $8,947 $243,497 2007 $12,651 $311,848 % change +41% 14 +28% Medicaid LTC spending for older people and adults 2002 $1,707 $54,261 with physical disabilities (millions) 2007 $1,757 $64,168 % change +3% 45 +18% Medicaid HCBS spending for older people and adults 2002 $195 $10,204 with physical disabilities (millions) 2007 $402 $17,188 % change +106% 16 +68% Medicaid nursing facility spending (millions) 2002 $1,512 $44,057 2007 $1,355 $46,980 % change -10% 45 +7% Medicaid HCBS spending for older people and adults 2002 11% 30 19% with physical disabilities, as a percentage of total 2007 23% 24 27% LTC spending change +11% 12 +8% 119 AARP Public Policy Institute Indiana % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 6,345 15 301,621 2030 6,810 18 363,584 % change +7% 33 +21% Age 50-64 2007 1,140 18.0% 35 17.8% 2030 1,123 16.5% 33 16.5% % change -1% 30 +12% Age 65+ 2007 795 12.5% 33 12.6% 2030 1,232 18.1% 40 19.7% % change +55% 45 +89% Age 65-74 2007 408 6.4% 32 6.4% 2030 Blue line = 50-64 648 9.5% 40 10.4% % change Purple line = 65-74 +59% 46 +96% Yellow line = 75-84 Age 75-84 2007 273 4.3% Red line = 85+ 28 4.3% 2030 415 6.1% 40 6.6% % change +52% 45 +84% Age 85+ 2007 115 1.8% 25 1.8% 2030 169 2.5% 31 2.6% % change +48% 36 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Indiana as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 8.5% 33 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 85+ State Rank U.S. 160% 0.7% 37 3.6% 65-74 Black 140% 75-84 State Rank U.S. 120% 50-64 6.0% 22 8.7% Hispanic 100% State Rank U.S. 80% 1.5% 30 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 120 Population & Characteristics Indiana Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 27% 27 20% Bachelor level education or higher age 65+, 2007 14% 46 19% Persons age 60+ raising grandchildren, 2007 1.3% 31 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $30,931 27 $32,158 At/below poverty level age 65+, 2007 7.8% 41 9.5% At/below 200% of poverty level age 65+, 2007 32% 25 32% At/below 300% of poverty level age 65+, 2007 54% 19 51% Women age 75+ at/below poverty level, 2007 11% 35 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 120 16% 25 16% Physical disability 229 31% 17 31% Mobility disability 121 16% 27 18% Self-care disability 72 10% 19 10% Cognitive/mental disability 83 11% 27 12% Any disability (one or more of the five 303 40% 23 41%   listed above) Cognitive/mental disability + any other disability 73 10% 27 11% Persons age 18-64 with disabilities, 2007 Any disability 483 12% 20 11% Cognitive/mental disability + any other disability 126 3.2% 25 3.2% Persons age 65+ with Alzheimer’s disease, 2010 120 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 720 34,000 Economic value of family caregiving (millions), 2007 $7,800 $375,000 Economic value per hour, 2007 $9.91 28 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.7 12 3.7 long-term care spending, 2007 121 Long-Term Care Financing Indiana Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $5,141 19 $311,848 Medicaid home and community-based services (HCBS) spending 5% 48 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Indiana and the U.S., 2007 Indiana United States 5% 10% 17% 95% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $840 $132 45 $213 adults with physical disabilities, 2007 Nursing facilities $794 $125 35 $156 HCBS $46 $7 49 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $46 $7 43 $21 Medicaid LTC expenditures for all populations, 2007 $1,574 $248 39 $323 Institutional services $1,110 $175 29 $196 HCBS $464 $73 42 $127 Waiver services (all populations) $464 $73 39 $91 Medicaid home health expenditures * $89 $14 9 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $20,374 44 $26,096 Medicaid HCBS expenditures for older people and adults with $8,404 25 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $8,404 27 $9,176 HCBS waiver services (all populations) $30,537 11 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 122 Federal/State/Personal Contributions State Rank U.S. Indiana Federal Medical Assistance Percentage (FMAP), 2007 62.6% 20 Medicaid personal needs allowance (per month), 2007 *** $52 15 $50 State-funded HCBS for older people (millions), 2007 $48.8 6 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 6.1% 37 8.4% Medicare home health visits per user, 2006 31 16 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 13,484 2.2 49 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 13,484 2.2 43 3.6 Aged/disabled waiver services 3,836 0.6 47 2.0 Medicaid aged/disabled waiver participants per 7 49 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 8,879 1.4 28 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 40,322 11 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.1 10 3.8 Nursing facility residents per 100 age 75+, 2007 10.4 9 7.8 Total nursing facility stays, 2006 85,348 12 3,176,119 Residents with Medicaid as primary payer, 2007 62% 30 64% Residents with Medicare as primary payer, 2007 15% 14 14% Residents with “other” as primary payer, 2007 23% 23 22% Residents with dementia, 2007 45% 30 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $137 35 $158 Medicare payment per day for nursing facility care, 2006 $283 36 $305 Average private pay rate per day in nursing facility, 2008 $190 25 $209 Average private pay rate per month in assisted living, 2008 $2,732 31 $3,008 Medicare reimbursement per home health visit, 2006 $129 39 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $24 46 $38 Average private pay daily rate for adult day care, 2008 $51 34 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 123 Long-Term Care Resources Indiana Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 172 0.22 23 0.22 Adult day facilities, 2001-02 68 0.09 25 0.09 Assisted living and residential care facilities, 2007 461 0.6 30 1.0 Assisted living and residential care units, 2007 33,313 42 5 26 Personal and home care aides, 2007 11,280 14 22 16 Median hourly wage, 2007 $9.41 21 $8.89 Home health aides, 2007 11,910 15 36 22 Median hourly wage, 2007 $9.59 28 $9.62 Medicaid aged/disabled waiver waiting list, 2007 1,299 11 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 523 0.66 9 0.43 Nursing facility beds, 2007 49,709 62 11 45 Nursing facility occupancy rate, 2007 81% 37 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.6 34 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 35% 5 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 4,751 6 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 300 $300 200% $256 162% 200 150% $200 Millions of Dollars 117% 100% 100 $100 50% $25 $0 $0 0 0% NA -$25 -7% -8% -$69 -$100 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -100 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 124 Trends Indiana Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 2,345 1,026,374 adults with physical disabilities 2005 3,836 1,376,984 % change +64% 21 +34% Medicaid aged/disabled waiver participants 2000 2,345 448,167 2005 3,836 582,342 % change +64% 15 +30% Medicare home health visits per user 2001 28 20 31 2006 31 16 35 % change +10% 8 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 42,166 1,428,117 2007 40,322 1,440,358 % change -4% 36 +1% Nursing facility beds 2002 53,292 1,671,744 2007 49,709 1,699,494 % change -7% 45 +2% Nursing facility occupancy rate 2002 79% 42 85% 2007 81% 37 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $4,415 $243,497 2007 $5,141 $311,848 % change +16% 38 +28% Medicaid LTC spending for older people and adults 2002 $884 $54,261 with physical disabilities (millions) 2007 $840 $64,168 % change -5% 48 +18% Medicaid HCBS spending for older people and adults 2002 $21 $10,204 with physical disabilities (millions) 2007 $46 $17,188 % change +117% 13 +68% Medicaid nursing facility spending (millions) 2002 $863 $44,057 2007 $794 $46,980 % change -8% 44 +7% Medicaid HCBS spending for older people and adults 2002 2% 49 19% with physical disabilities, as a percentage of total 2007 5% 48 27% LTC spending change +3% 35 +8% 125 AARP Public Policy Institute Iowa % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 2,988 30 301,621 2030 2,955 34 363,584 % change -1% 48 +21% Age 50-64 2007 550 18.4% 20 17.8% 2030 517 17.5% 13 16.5% % change -6% 39 +12% Age 65+ 2007 438 14.7% 5 12.6% 2030 663 22.4% 12 19.7% % change +51% 50 +89% Age 65-74 2007 207 6.9% 13 6.4% 2030 Blue line = 50-64 330 11.2% 17 10.4% % change Purple line = 65-74 +59% 46 +96% Yellow line = 75-84 Age 75-84 2007 154 5.1% Red line = 85+ 6 4.3% 2030 228 7.7% 11 6.6% % change +49% 47 +84% Age 85+ 2007 77 2.6% 3 1.8% 2030 105 3.6% 4 2.6% % change +36% 49 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Iowa as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 2.8% 48 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% State Rank U.S. 160% 0.6% 41 3.6% 65-74 85+ Black 140% State Rank U.S. 120% 1.0% 40 8.7% 50-64 75-84 Hispanic 100% State Rank U.S. 80% 0.9% 39 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 126 Population & Characteristics Iowa Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 39% 2 33% Non-metropolitan population age 65+, 2007/2008 52% 9 20% Bachelor level education or higher age 65+, 2007 15% 39 19% Persons age 60+ raising grandchildren, 2007 0.7% 46 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $29,228 38 $32,158 At/below poverty level age 65+, 2007 7.7% 43 9.5% At/below 200% of poverty level age 65+, 2007 34% 18 32% At/below 300% of poverty level age 65+, 2007 56% 11 51% Women age 75+ at/below poverty level, 2007 13% 24 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 61 15% 34 16% Physical disability 107 26% 46 31% Mobility disability 51 13% 48 18% Self-care disability 29 7% 48 10% Cognitive/mental disability 35 9% 45 12% Any disability (one or more of the five 147 36% 43 41%   listed above) Cognitive/mental disability + any other disability 29 7% 49 11% Persons age 18-64 with disabilities, 2007 Any disability 205 11% 27 11% Cognitive/mental disability + any other disability 57 3.1% 28 3.2% Persons age 65+ with Alzheimer’s disease, 2010 69 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 300 34,000 Economic value of family caregiving (millions), 2007 $3,400 $375,000 Economic value per hour, 2007 $10.25 25 $10.10 Ratio of the economic value of family caregiving to Medicaid 2.9 42 3.7 long-term care spending, 2007 127 Long-Term Care Financing Iowa Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $2,649 32 $311,848 Medicaid home and community-based services (HCBS) spending 14% 35 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Iowa and the U.S., 2007 Iowa United States 14% 10% 17% 86% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $523 $175 37 $213 adults with physical disabilities, 2007 Nursing facilities $448 $150 28 $156 HCBS $75 $25 39 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $75 $25 28 $21 Medicaid LTC expenditures for all populations, 2007 $1,079 $361 20 $323 Institutional services $724 $242 14 $196 HCBS $355 $119 27 $127 Waiver services (all populations) $355 $119 18 $91 Medicaid home health expenditures * $83 $28 3 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $20,546 43 $26,096 Medicaid HCBS expenditures for older people and adults with $6,215 37 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $6,215 37 $9,176 HCBS waiver services (all populations) $15,293 36 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 128 Federal/State/Personal Contributions State Rank U.S. Iowa Federal Medical Assistance Percentage (FMAP), 2007 62.0% 21 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $12.7 20 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 4.8% 46 8.4% Medicare home health visits per user, 2006 25 30 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 18,060 6.1 22 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 18,060 6.1 8 3.6 Aged/disabled waiver services 6,268 2.1 23 2.0 Medicaid aged/disabled waiver participants per 31 32 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 497 0.17 30 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 24,558 8.3 1 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 27,042 20 1,440,358 Nursing facility residents per 100 age 65+, 2007 6.2 2 3.8 Nursing facility residents per 100 age 75+, 2007 11.7 1 7.8 Total nursing facility stays, 2006 49,441 23 3,176,119 Residents with Medicaid as primary payer, 2007 48% 51 64% Residents with Medicare as primary payer, 2007 7% 50 14% Residents with “other” as primary payer, 2007 45% 1 22% Residents with dementia, 2007 46% 25 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $114 45 $158 Medicare payment per day for nursing facility care, 2006 $352 5 $305 Average private pay rate per day in nursing facility, 2008 $137 48 $209 Average private pay rate per month in assisted living, 2008 $2,614 37 $3,008 Medicare reimbursement per home health visit, 2006 $116 46 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $36 23 $38 Average private pay daily rate for adult day care, 2008 $66 13 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 129 Long-Term Care Resources Iowa Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 172 0.39 23 0.22 Adult day facilities, 2001-02 71 0.16 8 0.09 Assisted living and residential care facilities, 2007 248 0.6 30 1.0 Assisted living and residential care units, 2007 13,072 30 19 26 Personal and home care aides, 2007 5,620 13 26 16 Median hourly wage, 2007 $9.50 19 $8.89 Home health aides, 2007 10,140 23 13 22 Median hourly wage, 2007 $10.14 19 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 466 1.06 1 0.43 Nursing facility beds, 2007 33,693 77 1 45 Nursing facility occupancy rate, 2007 80% 38 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.3 49 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 14% 33 18% residents, 2007 Residents with physical restraints (%), 2007 2% 44 6% Long-term care facility beds per FTE ombudsman, 2006 9,781 1 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 19% 50 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 200 $200 200% 150 $150 $141 149% 150% 100 Millions of Dollars 114% $100 $84 100% 50 $50 $45 50% -43% NA 0 $0 NA 0% -$50 -50 -$47 -10% -$100 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -100 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 130 Trends Iowa Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 4,691 1,026,374 adults with physical disabilities 2005 6,268 1,376,984 % change +34% 31 +34% Medicaid aged/disabled waiver participants 2000 4,691 448,167 2005 6,268 582,342 % change +34% 25 +30% Medicare home health visits per user 2001 25 37 31 2006 25 30 35 % change +2% 18 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 30,151 1,428,117 2007 27,042 1,440,358 % change -10% 49 +1% Nursing facility beds 2002 35,550 1,671,744 2007 33,693 1,699,494 % change -5% 41 +2% Nursing facility occupancy rate 2002 85% 32 85% 2007 80% 38 85% change -5% 44 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $2,313 $243,497 2007 $2,649 $311,848 % change +15% 41 +28% Medicaid LTC spending for older people and adults 2002 $525 $54,261 with physical disabilities (millions) 2007 $523 $64,168 % change +0% 46 +18% Medicaid HCBS spending for older people and adults 2002 $30 $10,204 with physical disabilities (millions) 2007 $75 $17,188 % change +149% 11 +68% Medicaid nursing facility spending (millions) 2002 $495 $44,057 2007 $448 $46,980 % change -10% 45 +7% Medicaid HCBS spending for older people and adults 2002 6% 41 19% with physical disabilities, as a percentage of total 2007 14% 35 27% LTC spending change +9% 16 +8% 131 AARP Public Policy Institute Kansas % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 2,776 33 301,621 2030 2,940 35 363,584 % change +6% 37 +21% Age 50-64 2007 492 17.7% 41 17.8% 2030 474 16.1% 39 16.5% % change -4% 36 +12% Age 65+ 2007 360 13.0% 24 12.6% 2030 593 20.2% 26 19.7% % change +65% 35 +89% Age 65-74 2007 174 6.3% 39 6.4% 2030 Blue line = 50-64 301 10.2% 34 10.4% % change Purple line = 65-74 +73% 35 +96% Yellow line = 75-84 Age 75-84 2007 125 4.5% Red line = 85+ 22 4.3% 2030 204 7.0% 22 6.6% % change +63% 32 +84% Age 85+ 2007 61 2.2% 9 1.8% 2030 88 3.0% 17 2.6% % change +45% 41 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Kansas as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 8.3% 34 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% State Rank U.S. 65-74 85+ 160% 1.1% 26 3.6% Black 140% 50-64 State Rank U.S. 120% 3.6% 29 8.7% 75-84 Hispanic 100% State Rank U.S. 80% 2.6% 18 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 132 Population & Characteristics Kansas Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 44 32 48 Persons age 75+ living alone, 2007 35% 16 33% Non-metropolitan population age 65+, 2007/2008 44% 12 20% Bachelor level education or higher age 65+, 2007 19% 24 19% Persons age 60+ raising grandchildren, 2007 1.1% 35 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $31,634 24 $32,158 At/below poverty level age 65+, 2007 8.1% 36 9.5% At/below 200% of poverty level age 65+, 2007 30% 35 32% At/below 300% of poverty level age 65+, 2007 49% 35 51% Women age 75+ at/below poverty level, 2007 12% 28 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 52 16% 25 16% Physical disability 99 30% 24 31% Mobility disability 46 14% 41 18% Self-care disability 26 8% 40 10% Cognitive/mental disability 32 10% 34 12% Any disability (one or more of the five 133 40% 23 41%   listed above) Cognitive/mental disability + any other disability 29 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 184 11% 27 11% Cognitive/mental disability + any other disability 49 2.9% 32 3.2% Persons age 65+ with Alzheimer’s disease, 2010 53 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 270 34,000 Economic value of family caregiving (millions), 2007 $2,700 $375,000 Economic value per hour, 2007 $9.24 40 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.1 34 3.7 long-term care spending, 2007 133 Long-Term Care Financing Kansas Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $2,147 35 $311,848 Medicaid home and community-based services (HCBS) spending 34% 12 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Kansas and the U.S., 2007 Kansas United States 10% 30% 17% 3% 66% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $526 $189 32 $213 adults with physical disabilities, 2007 Nursing facilities $349 $126 34 $156 HCBS $177 $64 13 $57 Personal care services (PCS) ** $18 $6 27 $34 Aged/disabled waiver services $159 $57 6 $21 Medicaid LTC expenditures for all populations, 2007 $873 $314 25 $323 Institutional services $413 $149 36 $196 HCBS $460 $166 15 $127 Waiver services (all populations) $442 $159 11 $91 Medicaid home health expenditures * $13 $5 28 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $19,675 48 $26,096 Medicaid HCBS expenditures for older people and adults with $9,333 18 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $9,333 22 $9,176 HCBS waiver services (all populations) $15,087 39 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 134 Federal/State/Personal Contributions State Rank U.S. Kansas Federal Medical Assistance Percentage (FMAP), 2007 60.3% 26 Medicaid personal needs allowance (per month), 2007 *** $60 7 $50 State-funded HCBS for older people (millions), 2007 $6.8 28 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 5.3% 40 8.4% Medicare home health visits per user, 2006 26 27 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 23,348 8.5 12 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 23,348 8.5 3 3.6 Aged/disabled waiver services 14,193 5.2 4 2.0 Medicaid aged/disabled waiver participants per 87 6 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 5,865 2.1 22 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 20,170 26 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.6 6 3.8 Nursing facility residents per 100 age 75+, 2007 10.8 6 7.8 Total nursing facility stays, 2006 35,465 30 3,176,119 Residents with Medicaid as primary payer, 2007 53% 49 64% Residents with Medicare as primary payer, 2007 9% 46 14% Residents with “other” as primary payer, 2007 38% 2 22% Residents with dementia, 2007 46% 25 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $129 40 $158 Medicare payment per day for nursing facility care, 2006 $330 15 $305 Average private pay rate per day in nursing facility, 2008 $133 50 $209 Average private pay rate per month in assisted living, 2008 $2,468 41 $3,008 Medicare reimbursement per home health visit, 2006 $135 30 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $27 40 $38 Average private pay daily rate for adult day care, 2008 $72 7 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 135 Long-Term Care Resources Kansas Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 133 0.37 23 0.22 Adult day facilities, 2001-02 19 0.05 38 0.09 Assisted living and residential care facilities, 2007 239 0.7 28 1.0 Assisted living and residential care units, 2007 10,726 30 19 26 Personal and home care aides, 2007 9,270 26 5 16 Median hourly wage, 2007 $8.72 34 $8.89 Home health aides, 2007 8,300 23 13 22 Median hourly wage, 2007 $9.04 38 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 363 1.01 2 0.43 Nursing facility beds, 2007 23,849 66 5 45 Nursing facility occupancy rate, 2007 85% 31 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.6 34 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 28% 9 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 3,193 13 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 80 $80 40% 35% 60 31% $60 $59 30% 29% Millions of Dollars 40 $41 $40 20% 20 $20 10% $10 3% $4 $0 0% 0 -$2 -2% -$20 -10% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -20 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 136 Trends Kansas Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 11,746 1,026,374 adults with physical disabilities 2005 14,193 1,376,984 % change +21% 35 +34% Medicaid aged/disabled waiver participants 2000 11,746 448,167 2005 14,193 582,342 % change +21% 30 +30% Medicare home health visits per user 2001 27 24 31 2006 26 27 35 % change -3% 27 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 21,508 1,428,117 2007 20,170 1,440,358 % change -6% 41 +1% Nursing facility beds 2002 24,862 1,671,744 2007 23,849 1,699,494 % change -4% 37 +2% Nursing facility occupancy rate 2002 87% 26 85% 2007 85% 31 85% change -2% 30 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,852 $243,497 2007 $2,147 $311,848 % change +16% 38 +28% Medicaid LTC spending for older people and adults 2002 $471 $54,261 with physical disabilities (millions) 2007 $526 $64,168 % change +12% 35 +18% Medicaid HCBS spending for older people and adults 2002 $132 $10,204 with physical disabilities (millions) 2007 $177 $17,188 % change +34% 47 +68% Medicaid nursing facility spending (millions) 2002 $340 $44,057 2007 $349 $46,980 % change +3% 33 +7% Medicaid HCBS spending for older people and adults 2002 28% 10 19% with physical disabilities, as a percentage of total 2007 34% 12 27% LTC spending change +6% 21 +8% 137 AARP Public Policy Institute Kentucky % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 4,241 26 301,621 2030 4,555 27 363,584 % change +7% 32 +21% Age 50-64 2007 792 18.7% 12 17.8% 2030 814 17.9% 9 16.5% % change +3% 21 +12% Age 65+ 2007 550 13.0% 24 12.6% 2030 903 19.8% 30 19.7% % change +64% 38 +89% Age 65-74 2007 295 7.0% 10 6.4% 2030 Blue line = 50-64 497 10.9% 22 10.4% % change Purple line = 65-74 +68% 39 +96% Yellow line = 75-84 Age 75-84 2007 182 4.3% Red line = 85+ 28 4.3% 2030 301 6.6% 26 6.6% % change +65% 31 +84% Age 85+ 2007 72 1.7% 33 1.8% 2030 106 2.3% 43 2.6% % change +48% 36 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Kentucky as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 6.9% 38 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 65-74 State Rank U.S. 85+ 160% 0.5% 46 3.6% Black 140% 50-64 State Rank U.S. 120% 5.2% 26 8.7% 75-84 Hispanic 100% State Rank U.S. 80% 0.7% 46 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 138 Population & Characteristics Kentucky Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 35% 16 33% Non-metropolitan population age 65+, 2007/2008 54% 8 20% Bachelor level education or higher age 65+, 2007 13% 49 19% Persons age 60+ raising grandchildren, 2007 1.8% 17 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $25,834 48 $32,158 At/below poverty level age 65+, 2007 12.9% 5 9.5% At/below 200% of poverty level age 65+, 2007 40% 4 32% At/below 300% of poverty level age 65+, 2007 61% 3 51% Women age 75+ at/below poverty level, 2007 17% 6 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 110 21% 4 16% Physical disability 201 39% 3 31% Mobility disability 113 22% 2 18% Self-care disability 65 13% 4 10% Cognitive/mental disability 86 16% 2 12% Any disability (one or more of the five 254 49% 4 41%   listed above) Cognitive/mental disability + any other disability 81 16% 2 11% Persons age 18-64 with disabilities, 2007 Any disability 462 17% 2 11% Cognitive/mental disability + any other disability 144 5.4% 3 3.2% Persons age 65+ with Alzheimer’s disease, 2010 80 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 530 34,000 Economic value of family caregiving (millions), 2007 $5,400 $375,000 Economic value per hour, 2007 $9.51 37 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.2 18 3.7 long-term care spending, 2007 139 Long-Term Care Financing Kentucky Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $4,588 23 $311,848 Medicaid home and community-based services (HCBS) spending 8% 46 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Kentucky and the U.S., 2007 Kentucky United States 8% 10% 17% 92% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $825 $194 29 $213 adults with physical disabilities, 2007 Nursing facilities $759 $179 20 $156 HCBS $66 $16 46 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $66 $16 37 $21 Medicaid LTC expenditures for all populations, 2007 $1,192 $281 35 $323 Institutional services $909 $214 19 $196 HCBS $282 $67 46 $127 Waiver services (all populations) $282 $67 41 $91 Medicaid home health expenditures * $111 $26 5 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $25,519 30 $26,096 Medicaid HCBS expenditures for older people and adults with $4,795 45 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $4,795 46 $9,176 HCBS waiver services (all populations) $15,069 40 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 140 Federal/State/Personal Contributions State Rank U.S. Kentucky Federal Medical Assistance Percentage (FMAP), 2007 69.6% 9 Medicaid personal needs allowance (per month), 2007 *** $40 35 $50 State-funded HCBS for older people (millions), 2007 $29.8 11 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.9% 19 8.4% Medicare home health visits per user, 2006 31 16 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 14,922 3.6 40 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 14,922 3.6 29 3.6 Aged/disabled waiver services 12,165 2.9 17 2.0 Medicaid aged/disabled waiver participants per 43 18 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 22,415 5.4 9 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 23,657 23 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.3 20 3.8 Nursing facility residents per 100 age 75+, 2007 9.3 17 7.8 Total nursing facility stays, 2006 49,438 24 3,176,119 Residents with Medicaid as primary payer, 2007 67% 11 64% Residents with Medicare as primary payer, 2007 15% 14 14% Residents with “other” as primary payer, 2007 18% 39 22% Residents with dementia, 2007 48% 18 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $152 24 $158 Medicare payment per day for nursing facility care, 2006 $269 44 $305 Average private pay rate per day in nursing facility, 2008 $177 31 $209 Average private pay rate per month in assisted living, 2008 $2,793 28 $3,008 Medicare reimbursement per home health visit, 2006 $133 33 $134 Average private pay hourly rate for home health aide, 2008 $16 46 $19 Medicare-certified home health aide, 2008 $62 7 $38 Average private pay daily rate for adult day care, 2008 $56 24 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 141 Long-Term Care Resources Kentucky Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 101 0.18 23 0.22 Adult day facilities, 2001-02 119 0.22 5 0.09 Assisted living and residential care facilities, 2007 289 0.5 36 1.0 Assisted living and residential care units, 2007 6,802 12 45 26 Personal and home care aides, 2007 3,730 7 43 16 Median hourly wage, 2007 $8.19 42 $8.89 Home health aides, 2007 3,710 7 50 22 Median hourly wage, 2007 $10.10 20 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 295 0.54 19 0.43 Nursing facility beds, 2007 26,186 48 21 45 Nursing facility occupancy rate, 2007 90% 13 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4 9 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 7% 47 18% residents, 2007 Residents with physical restraints (%), 2007 6% 13 6% Long-term care facility beds per FTE ombudsman, 2006 914 45 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 94% 25 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 200 $200 150% 150 126% $150 $144 100% Millions of Dollars $115 100 $100 54% 50% $52 50 $50 23% 0% NA NA 0 $0 -$14 -17% $-50 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -50 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 142 Trends Kentucky Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 14,399 1,026,374 adults with physical disabilities 2005 12,165 1,376,984 % change -16% 51 +34% Medicaid aged/disabled waiver participants 2000 14,399 448,167 2005 12,165 582,342 % change -16% 48 +30% Medicare home health visits per user 2001 37 11 31 2006 31 16 35 % change -16% 47 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 21,875 1,428,117 2007 23,657 1,440,358 % change +8% 6 +1% Nursing facility beds 2002 23,857 1,671,744 2007 26,186 1,699,494 % change +10% 6 +2% Nursing facility occupancy rate 2002 92% 6 85% 2007 90% 13 85% change -1% 24 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $3,815 $243,497 2007 $4,588 $311,848 % change +20% 36 +28% Medicaid LTC spending for older people and adults 2002 $695 $54,261 with physical disabilities (millions) 2007 $825 $64,168 % change +19% 31 +18% Medicaid HCBS spending for older people and adults 2002 $80 $10,204 with physical disabilities (millions) 2007 $66 $17,188 % change -17% 51 +68% Medicaid nursing facility spending (millions) 2002 $615 $44,057 2007 $759 $46,980 % change +23% 21 +7% Medicaid HCBS spending for older people and adults 2002 11% 30 19% with physical disabilities, as a percentage of total 2007 8% 46 27% LTC spending change -3% 51 +8% 143 AARP Public Policy Institute Louisiana % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 4,293 25 301,621 2030 4,803 26 363,584 % change +12% 25 +21% Age 50-64 2007 767 17.9% 37 17.8% 2030 781 16.3% 36 16.5% % change +2% 23 +12% Age 65+ 2007 522 12.2% 35 12.6% 2030 944 19.7% 31 19.7% % change +81% 24 +89% Age 65-74 2007 277 6.4% 32 6.4% 2030 Blue line = 50-64 500 10.4% 29 10.4% % change Purple line = 65-74 +81% 29 +96% Yellow line = 75-84 Age 75-84 2007 177 4.1% Red line = 85+ 35 4.3% 2030 318 6.6% 26 6.6% % change +80% 26 +84% Age 85+ 2007 69 1.6% 38 1.8% 2030 126 2.6% 29 2.6% % change +84% 23 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Louisiana as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 26.1% 9 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% State Rank U.S. 85+ 200% 1.0% 28 3.6% Black 170% 65-74 State Rank U.S. 75-84 140% 22.4% 3 8.7% 50-64 Hispanic 110% State Rank U.S. 80% 2.2% 24 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 144 Population & Characteristics Louisiana Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 32% 36 33% Non-metropolitan population age 65+, 2007/2008 NA NA 20% Bachelor level education or higher age 65+, 2007 15% 39 19% Persons age 60+ raising grandchildren, 2007 2.7% 3 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $26,344 46 $32,158 At/below poverty level age 65+, 2007 13.3% 3 9.5% At/below 200% of poverty level age 65+, 2007 40% 4 32% At/below 300% of poverty level age 65+, 2007 59% 6 51% Women age 75+ at/below poverty level, 2007 18% 4 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 97 20% 8 16% Physical disability 184 37% 6 31% Mobility disability 106 21% 5 18% Self-care disability 68 14% 2 10% Cognitive/mental disability 77 15% 6 12% Any disability (one or more of the five 236 47% 7 41%   listed above) Cognitive/mental disability + any other disability 70 14% 4 11% Persons age 18-64 with disabilities, 2007 Any disability 384 15% 8 11% Cognitive/mental disability + any other disability 109 4.2% 9 3.2% Persons age 65+ with Alzheimer’s disease, 2010 83 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 560 34,000 Economic value of family caregiving (millions), 2007 $4,900 $375,000 Economic value per hour, 2007 $8.13 51 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.7 26 3.7 long-term care spending, 2007 145 Long-Term Care Financing Louisiana Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $4,840 22 $311,848 Medicaid home and community-based services (HCBS) spending 24% 22 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Louisiana and the U.S., 2007 Louisiana United States 7% 10% 17% 17% 76% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $670 $156 39 $213 adults with physical disabilities, 2007 Nursing facilities $509 $119 37 $156 HCBS $160 $37 26 $57 Personal care services (PCS) ** $113 $26 17 $34 Aged/disabled waiver services $48 $11 41 $21 Medicaid LTC expenditures for all populations, 2007 $1,312 $306 27 $323 Institutional services $854 $199 21 $196 HCBS $458 $107 34 $127 Waiver services (all populations) $346 $81 34 $91 Medicaid home health expenditures * $26 $6 27 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $20,643 41 $26,096 Medicaid HCBS expenditures for older people and adults with $10,436 15 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $10,436 16 $9,176 HCBS waiver services (all populations) $29,634 12 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 146 Federal/State/Personal Contributions State Rank U.S. Louisiana Federal Medical Assistance Percentage (FMAP), 2007 69.7% 8 Medicaid personal needs allowance (per month), 2007 *** $38 42 $50 State-funded HCBS for older people (millions), 2007 $6.0 30 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 12.7% 2 8.4% Medicare home health visits per user, 2006 57 1 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 9,414 2.1 50 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 9,414 2.1 45 3.6 Aged/disabled waiver services 4,009 0.9 41 2.0 Medicaid aged/disabled waiver participants per 13 43 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 12,187 2.7 15 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 26,460 21 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.1 10 3.8 Nursing facility residents per 100 age 75+, 2007 10.8 6 7.8 Total nursing facility stays, 2006 43,012 25 3,176,119 Residents with Medicaid as primary payer, 2007 74% 3 64% Residents with Medicare as primary payer, 2007 11% 37 14% Residents with “other” as primary payer, 2007 15% 45 22% Residents with dementia, 2007 43% 37 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $114 45 $158 Medicare payment per day for nursing facility care, 2006 $251 50 $305 Average private pay rate per day in nursing facility, 2008 $125 51 $209 Average private pay rate per month in assisted living, 2008 $2,528 39 $3,008 Medicare reimbursement per home health visit, 2006 $118 45 $134 Average private pay hourly rate for home health aide, 2008 $14 49 $19 Medicare-certified home health aide, 2008 $69 4 $38 Average private pay daily rate for adult day care, 2008 $52 31 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 147 Long-Term Care Resources Louisiana Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 217 0.42 23 0.22 Adult day facilities, 2001-02 12 0.02 48 0.09 Assisted living and residential care facilities, 2007 123 0.2 48 1.0 Assisted living and residential care units, 2007 5,357 10 47 26 Personal and home care aides, 2007 10,290 20 12 16 Median hourly wage, 2007 $7.16 48 $8.89 Home health aides, 2007 9,040 17 26 22 Median hourly wage, 2007 $7.61 50 $9.62 Medicaid aged/disabled waiver waiting list, 2007 9,209 3 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 289 0.55 17 0.43 Nursing facility beds, 2007 35,821 69 2 45 Nursing facility occupancy rate, 2007 74% 42 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.4 46 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 12% 36 18% residents, 2007 Residents with physical restraints (%), 2007 11% 2 6% Long-term care facility beds per FTE ombudsman, 2006 1,554 29 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 200 $200 400% 369% 150 $150 $150 300% 100 No spending in 2002 $113 Millions of Dollars $100 200% 50 $50 $37 101% 100% -$88 0 $0 -$18 0% -$50 -5% -50 -15% -$100 -100% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS-100 and Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 148 Trends Louisiana Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 902 1,026,374 adults with physical disabilities 2005 4,009 1,376,984 % change +344% 3 +34% Medicaid aged/disabled waiver participants 2000 902 448,167 2005 4,009 582,342 % change +344% 3 +30% Medicare home health visits per user 2001 57 1 31 2006 57 1 35 % change +1% 20 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 33,282 1,428,117 2007 26,460 1,440,358 % change -20% 51 +1% Nursing facility beds 2002 42,323 1,671,744 2007 35,821 1,699,494 % change -15% 51 +2% Nursing facility occupancy rate 2002 79% 42 85% 2007 74% 42 85% change -5% 44 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $4,925 $243,497 2007 $4,840 $311,848 % change -2% 51 +28% Medicaid LTC spending for older people and adults 2002 $607 $54,261 with physical disabilities (millions) 2007 $670 $64,168 % change +10% 38 +18% Medicaid HCBS spending for older people and adults 2002 $10 $10,204 with physical disabilities (millions) 2007 $160 $17,188 % change +1,480% 2 +68% Medicaid nursing facility spending (millions) 2002 $597 $44,057 2007 $509 $46,980 % change -15% 48 +7% Medicaid HCBS spending for older people and adults 2002 2% 49 19% with physical disabilities, as a percentage of total 2007 24% 22 27% LTC spending change +22% 2 +8% 149 AARP Public Policy Institute Maine % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 1,317 40 301,621 2030 1,411 42 363,584 % change +7% 34 +21% Age 50-64 2007 280 21.3% 2 17.8% 2030 266 18.9% 3 16.5% % change -5% 37 +12% Age 65+ 2007 195 14.8% 4 12.6% 2030 374 26.5% 2 19.7% % change +92% 21 +89% Age 65-74 2007 99 7.5% 3 6.4% 2030 Blue line = 50-64 190 13.5% 2 10.4% % change Purple line = 65-74 +92% 21 +96% Yellow line = 75-84 Age 75-84 2007 68 5.1% Red line = 85+ 6 4.3% 2030 131 9.3% 3 6.6% % change +94% 19 +84% Age 85+ 2007 28 2.1% 12 1.8% 2030 52 3.7% 2 2.6% % change +87% 20 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Maine as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 1.7% 51 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% 85+ State Rank U.S. 200% 0.5% 46 3.6% 65-74 Black 170% State Rank U.S. 140% 0.3% 46 8.7% 75-84 50-64 Hispanic 110% State Rank U.S. 80% 0.5% 50 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 150 Population & Characteristics Maine Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 37% 6 33% Non-metropolitan population age 65+, 2007/2008 61% 7 20% Bachelor level education or higher age 65+, 2007 20% 22 19% Persons age 60+ raising grandchildren, 2007 1.0% 39 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $29,101 39 $32,158 At/below poverty level age 65+, 2007 9.2% 23 9.5% At/below 200% of poverty level age 65+, 2007 39% 7 32% At/below 300% of poverty level age 65+, 2007 57% 9 51% Women age 75+ at/below poverty level, 2007 14% 19 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 35 19% 10 16% Physical disability 58 31% 17 31% Mobility disability 26 14% 41 18% Self-care disability 15 8% 40 10% Cognitive/mental disability 20 11% 27 12% Any disability (one or more of the five 79 43% 13 41%   listed above) Cognitive/mental disability + any other disability 16 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 135 16% 6 11% Cognitive/mental disability + any other disability 38 4.6% 6 3.2% Persons age 65+ with Alzheimer’s disease, 2010 25 12% 39 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 153 34,000 Economic value of family caregiving (millions), 2007 $1,840 $375,000 Economic value per hour, 2007 $11.18 10 $10.10 Ratio of the economic value of family caregiving to Medicaid 2.8 43 3.7 long-term care spending, 2007 151 Long-Term Care Financing Maine Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $2,116 36 $311,848 Medicaid home and community-based services (HCBS) spending 26% 19 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Maine and the U.S., 2007 Maine United States 11% 10% 15% 17% 74% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $322 $245 16 $213 adults with physical disabilities, 2007 Nursing facilities $240 $182 19 $156 HCBS $82 $62 14 $57 Personal care services (PCS) ** $47 $36 14 $34 Aged/disabled waiver services $35 $27 25 $21 Medicaid LTC expenditures for all populations, 2007 $644 $489 7 $323 Institutional services $315 $239 15 $196 HCBS $329 $249 6 $127 Waiver services (all populations) $282 $214 5 $91 Medicaid home health expenditures * $5 $4 33 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $26,369 26 $26,096 Medicaid HCBS expenditures for older people and adults with $7,480 31 $9,459 physical disabilities per person served, 2005 Personal care services ** $5,907 17 $9,666 Aged/disabled waiver services $15,781 7 $9,176 HCBS waiver services (all populations) $55,642 2 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 152 Federal/State/Personal Contributions State Rank U.S. Maine Federal Medical Assistance Percentage (FMAP), 2007 63.3% 18 Medicaid personal needs allowance (per month), 2007 *** $40 35 $50 State-funded HCBS for older people (millions), 2007 $9.5 23 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 8.2% 17 8.4% Medicare home health visits per user, 2006 25 30 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 11,922 9.1 9 6.3 Personal care services ** 7,861 6 3 2.7 HCBS waiver services 4,061 3.1 32 3.6 Aged/disabled waiver services 1,489 1.1 37 2.0 Medicaid aged/disabled waiver participants per 16 39 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 4,571 3.47 1 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 2,875 2.2 20 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 6,546 39 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.4 35 3.8 Nursing facility residents per 100 age 75+, 2007 6.8 38 7.8 Total nursing facility stays, 2006 18,043 36 3,176,119 Residents with Medicaid as primary payer, 2007 66% 14 64% Residents with Medicare as primary payer, 2007 16% 7 14% Residents with “other” as primary payer, 2007 18% 39 22% Residents with dementia, 2007 59% 1 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $173 13 $158 Medicare payment per day for nursing facility care, 2006 $333 14 $305 Average private pay rate per day in nursing facility, 2008 $233 11 $209 Average private pay rate per month in assisted living, 2008 $4,103 4 $3,008 Medicare reimbursement per home health visit, 2006 $138 27 $134 Average private pay hourly rate for home health aide, 2008 $21 7 $19 Medicare-certified home health aide, 2008 $54 8 $38 Average private pay daily rate for adult day care, 2008 $44 43 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 153 Long-Term Care Resources Maine Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 28 0.14 23 0.22 Adult day facilities, 2001-02 42 0.22 5 0.09 Assisted living and residential care facilities, 2007 681 3.5 3 1.0 Assisted living and residential care units, 2007 8,703 45 1 26 Personal and home care aides, 2007 5,110 26 5 16 Median hourly wage, 2007 $8.98 29 $8.89 Home health aides, 2007 4,860 25 10 22 Median hourly wage, 2007 $10.52 13 $9.62 Medicaid aged/disabled waiver waiting list, 2007 107 17 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 112 0.57 15 0.43 Nursing facility beds, 2007 7,196 37 38 45 Nursing facility occupancy rate, 2007 91% 10 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4.3 4 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 7% 47 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 2,083 26 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 100 $100 800% $91 80 711% $80 600% Millions of Dollars 60 $60 400% $41 40 $40 $25 200% $20 20 $10 50% 58% 39% $3 1% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 154 Trends Maine Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 3,266 1,026,374 adults with physical disabilities 2005 9,350 1,376,984 % change +186% 7 +34% Medicaid aged/disabled waiver participants 2000 1,977 448,167 2005 1,489 582,342 % change -25% 50 +30% Medicare home health visits per user 2001 33 14 31 2006 25 30 35 % change -24% 51 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 6,917 1,428,117 2007 6,546 1,440,358 % change -5% 38 +1% Nursing facility beds 2002 7,575 1,671,744 2007 7,196 1,699,494 % change -5% 41 +2% Nursing facility occupancy rate 2002 91% 11 85% 2007 91% 10 85% change +0% 17 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,459 $243,497 2007 $2,116 $311,848 % change +45% 11 +28% Medicaid LTC spending for older people and adults 2002 $268 $54,261 with physical disabilities (millions) 2007 $322 $64,168 % change +20% 29 +18% Medicaid HCBS spending for older people and adults 2002 $31 $10,204 with physical disabilities (millions) 2007 $82 $17,188 % change +163% 5 +68% Medicaid nursing facility spending (millions) 2002 $237 $44,057 2007 $240 $46,980 % change +1% 37 +7% Medicaid HCBS spending for older people and adults 2002 12% 27 19% with physical disabilities, as a percentage of total 2007 26% 19 27% LTC spending change +14% 6 +8% 155 AARP Public Policy Institute Maryland % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 5,618 19 301,621 2030 7,022 16 363,584 % change +25% 15 +21% Age 50-64 2007 1,033 18.4% 20 17.8% 2030 1,056 15.0% 46 16.5% % change +2% 23 +12% Age 65+ 2007 662 11.8% 41 12.6% 2030 1,236 17.6% 45 19.7% % change +87% 23 +89% Age 65-74 2007 350 6.2% 40 6.4% 2030 Blue line = 50-64 647 9.2% 44 10.4% % change Purple line = 65-74 +85% 24 +96% Yellow line = 75-84 Age 75-84 2007 222 4.0% Red line = 85+ 40 4.3% 2030 412 5.9% 43 6.6% % change +85% 23 +84% Age 85+ 2007 89 1.6% 38 1.8% 2030 177 2.5% 31 2.6% % change +98% 10 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Maryland as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 27.4% 7 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 85+ 240% 4.0% 8 3.6% 65-74 Black 200% State Rank U.S. 75-84 160% 21.0% 4 8.7% 50-64 Hispanic 120% State Rank U.S. 80% 2.3% 22 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 156 Population & Characteristics Maryland Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 32% 36 33% Non-metropolitan population age 65+, 2007/2008 6% 40 20% Bachelor level education or higher age 65+, 2007 25% 4 19% Persons age 60+ raising grandchildren, 2007 1.7% 21 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $41,707 2 $32,158 At/below poverty level age 65+, 2007 8.2% 33 9.5% At/below 200% of poverty level age 65+, 2007 24% 48 32% At/below 300% of poverty level age 65+, 2007 40% 49 51% Women age 75+ at/below poverty level, 2007 12% 28 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 85 13% 50 16% Physical disability 177 28% 35 31% Mobility disability 102 16% 27 18% Self-care disability 60 9% 30 10% Cognitive/mental disability 69 11% 27 12% Any disability (one or more of the five 235 37% 40 41%   listed above) Cognitive/mental disability + any other disability 61 10% 27 11% Persons age 18-64 with disabilities, 2007 Any disability 341 10% 34 11% Cognitive/mental disability + any other disability 87 2.4% 43 3.2% Persons age 65+ with Alzheimer’s disease, 2010 86 12% 39 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 600 34,000 Economic value of family caregiving (millions), 2007 $6,600 $375,000 Economic value per hour, 2007 $10.12 26 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.8 24 3.7 long-term care spending, 2007 157 Long-Term Care Financing Maryland Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $5,540 18 $311,848 Medicaid home and community-based services (HCBS) spending 11% 39 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Maryland and the U.S., 2007 Maryland United States 8% 10% 3% 17% 89% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,077 $192 30 $213 adults with physical disabilities, 2007 Nursing facilities $955 $170 23 $156 HCBS $123 $22 40 $57 Personal care services (PCS) ** $32 $6 27 $34 Aged/disabled waiver services $91 $16 37 $21 Medicaid LTC expenditures for all populations, 2007 $1,666 $297 30 $323 Institutional services $1,015 $181 26 $196 HCBS $651 $116 29 $127 Waiver services (all populations) $619 $110 24 $91 Medicaid home health expenditures * $57 $10 18 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $32,977 7 $26,096 Medicaid HCBS expenditures for older people and adults with $11,456 11 $9,459 physical disabilities per person served, 2005 Personal care services ** $4,436 22 $9,666 Aged/disabled waiver services $20,233 2 $9,176 HCBS waiver services (all populations) $34,067 6 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 158 Federal/State/Personal Contributions State Rank U.S. Maryland Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $66 5 $50 State-funded HCBS for older people (millions), 2007 $4.9 34 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 6.9% 32 8.4% Medicare home health visits per user, 2006 21 45 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 19,109 3.4 41 6.3 Personal care services ** 4,643 0.8 27 2.7 HCBS waiver services 14,466 2.6 39 3.6 Aged/disabled waiver services 3,714 0.7 46 2.0 Medicaid aged/disabled waiver participants per 14 42 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 2,326 0.41 19 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 4,393 0.8 39 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 25,555 22 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.9 27 3.8 Nursing facility residents per 100 age 75+, 2007 8.2 25 7.8 Total nursing facility stays, 2006 64,388 19 3,176,119 Residents with Medicaid as primary payer, 2007 61% 32 64% Residents with Medicare as primary payer, 2007 16% 7 14% Residents with “other” as primary payer, 2007 23% 23 22% Residents with dementia, 2007 43% 37 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $193 8 $158 Medicare payment per day for nursing facility care, 2006 $317 23 $305 Average private pay rate per day in nursing facility, 2008 $221 13 $209 Average private pay rate per month in assisted living, 2008 $3,144 16 $3,008 Medicare reimbursement per home health visit, 2006 $164 7 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $29 33 $38 Average private pay daily rate for adult day care, 2008 $69 10 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 159 Long-Term Care Resources Maryland Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 50 0.08 23 0.22 Adult day facilities, 2001-02 81 0.12 17 0.09 Assisted living and residential care facilities, 2007 1,366 2.1 7 1.0 Assisted living and residential care units, 2007 20,093 30 19 26 Personal and home care aides, 2007 4,570 7 43 16 Median hourly wage, 2007 $10.28 10 $8.89 Home health aides, 2007 11,280 17 26 22 Median hourly wage, 2007 $10.49 14 $9.62 Medicaid aged/disabled waiver waiting list, 2007 7,200 5 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 235 0.36 36 0.43 Nursing facility beds, 2007 29,250 44 28 45 Nursing facility occupancy rate, 2007 87% 27 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.8 19 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 16% 22 18% residents, 2007 Residents with physical restraints (%), 2007 4% 28 6% Long-term care facility beds per FTE ombudsman, 2006 1,124 44 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 95% 24 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 400 $400 600% 300 $330 508% 500% $300 Millions of Dollars 400% 200 $200 $193 300% 200% 100 $100 167% $76 100% $0 25% 0 -$1 -$1 0% -2% -3% $-100 -100% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS-100 and Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 160 Trends Maryland Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 4,834 1,026,374 adults with physical disabilities 2005 8,357 1,376,984 % change +73% 19 +34% Medicaid aged/disabled waiver participants 2000 157 448,167 2005 3,714 582,342 % change +2,266% 1 +30% Medicare home health visits per user 2001 22 44 31 2006 21 45 35 % change -6% 34 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 24,576 1,428,117 2007 25,555 1,440,358 % change +4% 14 +1% Nursing facility beds 2002 28,261 1,671,744 2007 29,250 1,699,494 % change +3% 21 +2% Nursing facility occupancy rate 2002 87% 26 85% 2007 87% 27 85% change +0% 17 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $3,671 $243,497 2007 $5,540 $311,848 % change +51% 6 +28% Medicaid LTC spending for older people and adults 2002 $810 $54,261 with physical disabilities (millions) 2007 $1,077 $64,168 % change +33% 16 +18% Medicaid HCBS spending for older people and adults 2002 $48 $10,204 with physical disabilities (millions) 2007 $123 $17,188 % change +157% 7 +68% Medicaid nursing facility spending (millions) 2002 $762 $44,057 2007 $955 $46,980 % change +25% 16 +7% Medicaid HCBS spending for older people and adults 2002 6% 41 19% with physical disabilities, as a percentage of total 2007 11% 39 27% LTC spending change +5% 26 +8% 161 AARP Public Policy Institute Massachusetts % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 6,450 14 301,621 2030 7,012 17 363,584 % change +9% 30 +21% Age 50-64 2007 1,198 18.6% 17 17.8% 2030 1,193 17.0% 23 16.5% % change +0% 28 +12% Age 65+ 2007 859 13.3% 18 12.6% 2030 1,463 20.9% 21 19.7% % change +70% 31 +89% Age 65-74 2007 415 6.4% 32 6.4% 2030 Blue line = 50-64 764 10.9% 22 10.4% % change Purple line = 65-74 +84% 26 +96% Yellow line = 75-84 Age 75-84 2007 304 4.7% Red line = 85+ 10 4.3% 2030 487 7.0% 22 6.6% % change +60% 39 +84% Age 85+ 2007 140 2.2% 9 1.8% 2030 212 3.0% 17 2.6% % change +52% 34 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Massachusetts as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 8.8% 32 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 65-74 State Rank U.S. 85+ 160% 2.5% 12 3.6% Black 140% State Rank U.S. 50-64 120% 3.8% 28 8.7% 75-84 Hispanic 100% State Rank U.S. 80% 2.6% 18 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 162 Population & Characteristics Massa chuse tts Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 42 48 48 Persons age 75+ living alone, 2007 35% 16 33% Non-metropolitan population age 65+, 2007/2008 4% 43 20% Bachelor level education or higher age 65+, 2007 24% 5 19% Persons age 60+ raising grandchildren, 2007 0.9% 42 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $33,332 18 $32,158 At/below poverty level age 65+, 2007 9.3% 20 9.5% At/below 200% of poverty level age 65+, 2007 30% 35 32% At/below 300% of poverty level age 65+, 2007 47% 37 51% Women age 75+ at/below poverty level, 2007 12% 28 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 120 15% 34 16% Physical disability 224 28% 35 31% Mobility disability 125 15% 35 18% Self-care disability 72 9% 30 10% Cognitive/mental disability 80 10% 34 12% Any disability (one or more of the five 294 36% 43 41%   listed above) Cognitive/mental disability + any other disability 71 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 421 10% 34 11% Cognitive/mental disability + any other disability 116 2.8% 33 3.2% Persons age 65+ with Alzheimer’s disease, 2010 120 13% 31 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 690 34,000 Economic value of family caregiving (millions), 2007 $8,800 $375,000 Economic value per hour, 2007 $11.86 5 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.0 37 3.7 long-term care spending, 2007 163 Long-Term Care Financing Massachusetts Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $10,230 8 $311,848 Medicaid home and community-based services (HCBS) spending 24% 22 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Massachusetts and the U.S., 2007 Massachusetts United States 1% 10% 22% 17% 76% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $2,117 $328 6 $213 adults with physical disabilities, 2007 Nursing facilities $1,613 $250 7 $156 HCBS $504 $78 11 $57 Personal care services (PCS) ** $476 $74 6 $34 Aged/disabled waiver services $28 $4 45 $21 Medicaid LTC expenditures for all populations, 2007 $2,895 $449 11 $323 Institutional services $1,819 $282 9 $196 HCBS $1,076 $167 14 $127 Waiver services (all populations) $600 $93 29 $91 Medicaid home health expenditures * $73 $11 14 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $30,792 11 $26,096 Medicaid HCBS expenditures for older people and adults with $12,602 7 $9,459 physical disabilities per person served, 2005 Personal care services ** $17,087 4 $9,666 Aged/disabled waiver services $3,866 48 $9,176 HCBS waiver services (all populations) $33,860 7 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 164 Federal/State/Personal Contributions State Rank U.S. Massa chuse tts Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $60 7 $50 State-funded HCBS for older people (millions), 2007 $171.5 2 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 11.3% 4 8.4% Medicare home health visits per user, 2006 34 12 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 32,793 5.1 32 6.3 Personal care services ** 13,767 2.1 19 2.7 HCBS waiver services 19,026 3.0 35 3.6 Aged/disabled waiver services 7,068 1.1 37 2.0 Medicaid aged/disabled waiver participants per 12 45 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 17,875 2.8 14 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 45,172 9 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.3 9 3.8 Nursing facility residents per 100 age 75+, 2007 10.2 11 7.8 Total nursing facility stays, 2006 101,292 9 3,176,119 Residents with Medicaid as primary payer, 2007 65% 19 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 22% 28 22% Residents with dementia, 2007 51% 10 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $187 9 $158 Medicare payment per day for nursing facility care, 2006 $329 16 $305 Average private pay rate per day in nursing facility, 2008 $296 4 $209 Average private pay rate per month in assisted living, 2008 $4,187 3 $3,008 Medicare reimbursement per home health visit, 2006 $133 33 $134 Average private pay hourly rate for home health aide, 2008 $23 3 $19 Medicare-certified home health aide, 2008 $32 26 $38 Average private pay daily rate for adult day care, 2008 $56 24 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 165 Long-Term Care Resources Massachusetts Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 119 0.14 23 0.22 Adult day facilities, 2001-02 133 0.15 9 0.09 Assisted living and residential care facilities, 2007 285 0.3 44 1.0 Assisted living and residential care units, 2007 14,869 17 36 26 Personal and home care aides, 2007 13,030 15 20 16 Median hourly wage, 2007 $11.24 2 $8.89 Home health aides, 2007 18,190 21 17 22 Median hourly wage, 2007 $11.89 4 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 457 0.53 20 0.43 Nursing facility beds, 2007 50,037 58 14 45 Nursing facility occupancy rate, 2007 90% 13 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.8 19 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 17% 20 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 1,505 30 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 250 $250 80% 200 71% $195 $197 $200 60% Millions of Dollars 150 $150 40% 100 $100 25% $47 20% $50 14% 50 9% $9 $6 4% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 166 Trends Massa chuse tts Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 11,718 1,026,374 adults with physical disabilities 2005 20,835 1,376,984 % change +78% 16 +34% Medicaid aged/disabled waiver participants 2000 6,052 448,167 2005 7,068 582,342 % change +17% 37 +30% Medicare home health visits per user 2001 39 7 31 2006 34 12 35 % change -13% 44 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 46,397 1,428,117 2007 45,172 1,440,358 % change -3% 34 +1% Nursing facility beds 2002 51,173 1,671,744 2007 50,037 1,699,494 % change -2% 34 +2% Nursing facility occupancy rate 2002 91% 11 85% 2007 90% 13 85% change +0% 17 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $8,747 $243,497 2007 $10,230 $311,848 % change +17% 37 +28% Medicaid LTC spending for older people and adults 2002 $1,719 $54,261 with physical disabilities (millions) 2007 $2,117 $64,168 % change +23% 28 +18% Medicaid HCBS spending for older people and adults 2002 $301 $10,204 with physical disabilities (millions) 2007 $504 $17,188 % change +67% 29 +68% Medicaid nursing facility spending (millions) 2002 $1,418 $44,057 2007 $1,613 $46,980 % change +14% 25 +7% Medicaid HCBS spending for older people and adults 2002 18% 19 19% with physical disabilities, as a percentage of total 2007 24% 22 27% LTC spending change +6% 21 +8% 167 AARP Public Policy Institute Michigan % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 10,072 8 301,621 2030 10,694 11 363,584 % change +6% 36 +21% Age 50-64 2007 1,886 18.7% 12 17.8% 2030 1,851 17.3% 15 16.5% % change -2% 33 +12% Age 65+ 2007 1,280 12.7% 30 12.6% 2030 2,081 19.5% 32 19.7% % change +63% 39 +89% Age 65-74 2007 655 6.5% 25 6.4% 2030 Blue line = 50-64 1,090 10.2% 34 10.4% % change Purple line = 65-74 +66% 41 +96% Yellow line = 75-84 Age 75-84 2007 443 4.4% Red line = 85+ 26 4.3% 2030 703 6.6% 26 6.6% % change +59% 40 +84% Age 85+ 2007 182 1.8% 25 1.8% 2030 287 2.7% 23 2.6% % change +58% 33 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Michigan as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 13.0% 24 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% State Rank U.S. 200% 1.2% 24 3.6% 85+ Black 170% 65-74 State Rank U.S. 140% 75-84 9.9% 15 8.7% 50-64 Hispanic 110% State Rank U.S. 80% 1.4% 31 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 168 Population & Characteristics Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 46 20 48 Persons age 75+ living alone, 2007 35% 16 33% Michigan Non-metropolitan population age 65+, 2007/2008 18% 34 20% Bachelor level education or higher age 65+, 2007 16% 37 19% Persons age 60+ raising grandchildren, 2007 1.2% 33 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $31,513 25 $32,158 At/below poverty level age 65+, 2007 8.0% 37 9.5% At/below 200% of poverty level age 65+, 2007 31% 29 32% At/below 300% of poverty level age 65+, 2007 53% 22 51% Women age 75+ at/below poverty level, 2007 11% 35 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 198 16% 25 16% Physical disability 381 31% 17 31% Mobility disability 212 17% 20 18% Self-care disability 123 10% 19 10% Cognitive/mental disability 142 12% 21 12% Any disability (one or more of the five 501 41% 19 41%   listed above) Cognitive/mental disability + any other disability 132 11% 20 11% Persons age 18-64 with disabilities, 2007 Any disability 807 13% 11 11% Cognitive/mental disability + any other disability 240 3.8% 11 3.2% Persons age 65+ with Alzheimer’s disease, 2010 180 13% 31 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 1,280 34,000 Economic value of family caregiving (millions), 2007 $14,400 $375,000 Economic value per hour, 2007 $10.41 22 $10.10 Ratio of the economic value of family caregiving to Medicaid 6.3 4 3.7 long-term care spending, 2007 169 Long-Term Care Financing Michigan Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $9,215 10 $311,848 Medicaid home and community-based services (HCBS) spending 18% 30 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Michigan and the U.S., 2007 Michigan United States 5% 10% 13% 17% 82% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,807 $179 35 $213 adults with physical disabilities, 2007 Nursing facilities $1,483 $147 29 $156 HCBS $324 $32 33 $57 Personal care services (PCS) ** $236 $23 20 $34 Aged/disabled waiver services $88 $9 42 $21 Medicaid LTC expenditures for all populations, 2007 $2,268 $225 42 $323 Institutional services $1,528 $152 35 $196 HCBS $740 $73 42 $127 Waiver services (all populations) $504 $50 45 $91 Medicaid home health expenditures * $24 $2 40 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $27,005 19 $26,096 Medicaid HCBS expenditures for older people and adults with $4,395 48 $9,459 physical disabilities per person served, 2005 Personal care services ** $4,302 23 $9,666 Aged/disabled waiver services $4,958 45 $9,176 HCBS waiver services (all populations) $22,322 24 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 170 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 56.4% 33 Medicaid personal needs allowance (per month), 2007 *** $60 7 $50 State-funded HCBS for older people (millions), 2007 $31.1 10 $1,192.4 Michigan Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 10.2% 6 8.4% Medicare home health visits per user, 2006 27 24 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 72,607 7.2 20 6.3 Personal care services ** 55,158 5.5 6 2.7 HCBS waiver services 17,449 1.7 48 3.6 Aged/disabled waiver services 9,144 0.9 41 2.0 Medicaid aged/disabled waiver participants per 17 37 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 10,300 1.02 10 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 6,573 0.7 43 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 41,833 10 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.3 38 3.8 Nursing facility residents per 100 age 75+, 2007 6.7 39 7.8 Total nursing facility stays, 2006 97,667 10 3,176,119 Residents with Medicaid as primary payer, 2007 64% 24 64% Residents with Medicare as primary payer, 2007 17% 3 14% Residents with “other” as primary payer, 2007 19% 35 22% Residents with dementia, 2007 56% 2 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $148 28 $158 Medicare payment per day for nursing facility care, 2006 $303 31 $305 Average private pay rate per day in nursing facility, 2008 $209 19 $209 Average private pay rate per month in assisted living, 2008 $2,825 26 $3,008 Medicare reimbursement per home health visit, 2006 $162 9 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $32 26 $38 Average private pay daily rate for adult day care, 2008 $50 35 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 171 Long-Term Care Resources Michigan Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 327 0.26 23 0.22 Adult day facilities, 2001-02 85 0.07 29 0.09 Assisted living and residential care facilities, 2007 4,706 3.7 2 1.0 Assisted living and residential care units, 2007 46,095 36 12 26 Personal and home care aides, 2007 12,400 10 35 16 Median hourly wage, 2007 $9.45 20 $8.89 Home health aides, 2007 32,210 25 10 22 Median hourly wage, 2007 $9.26 35 $9.62 Medicaid aged/disabled waiver waiting list, 2007 3,404 7 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 438 0.34 37 0.43 Nursing facility beds, 2007 48,078 38 37 45 Nursing facility occupancy rate, 2007 87% 27 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.7 26 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 30% 8 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 4,592 7 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 69% 40 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 200 $200 100% 100 80% 76% $100 $81 $58 62% 0 $38 $17 Millions of Dollars 60% $0 40% 33%-100 -$100 24% 20% -200 -$200 0% -$300 -20% -300 -$297 -17% -$400 -40% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -400 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 172 Trends Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 57,650 1,026,374 adults with physical disabilities 2005 64,302 1,376,984 % change +12% 43 +34% Michigan Medicaid aged/disabled waiver participants 2000 11,341 448,167 2005 9,144 582,342 % change -19% 49 +30% Medicare home health visits per user 2001 28 20 31 2006 27 24 35 % change -4% 29 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 40,422 1,428,117 2007 41,833 1,440,358 % change +3% 18 +1% Nursing facility beds 2002 46,320 1,671,744 2007 48,078 1,699,494 % change +4% 18 +2% Nursing facility occupancy rate 2002 87% 26 85% 2007 87% 27 85% change +0% 17 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $7,576 $243,497 2007 $9,215 $311,848 % change +22% 33 +28% Medicaid LTC spending for older people and adults 2002 $2,008 $54,261 with physical disabilities (millions) 2007 $1,807 $64,168 % change -10% 50 +18% Medicaid HCBS spending for older people and adults 2002 $228 $10,204 with physical disabilities (millions) 2007 $324 $17,188 % change +42% 41 +68% Medicaid nursing facility spending (millions) 2002 $1,780 $44,057 2007 $1,483 $46,980 % change -17% 50 +7% Medicaid HCBS spending for older people and adults 2002 11% 30 19% with physical disabilities, as a percentage of total 2007 18% 30 27% LTC spending change +7% 17 +8% 173 AARP Public Policy Institute Minnesota % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 5,198 21 301,621 2030 6,306 20 363,584 % change +21% 16 +21% Age 50-64 2007 940 18.1% 33 17.8% 2030 1,018 16.1% 39 16.5% % change +8% 17 +12% Age 65+ 2007 636 12.2% 35 12.6% 2030 1,193 18.9% 35 19.7% % change +88% 22 +89% Age 65-74 2007 317 6.1% 41 6.4% 2030 Blue line = 50-64 627 9.9% 36 10.4% % change Purple line = 65-74 +98% 17 +96% Yellow line = 75-84 Age 75-84 2007 215 4.1% Red line = 85+ 35 4.3% 2030 398 6.3% 37 6.6% % change +85% 23 +84% Age 85+ 2007 105 2.0% 16 1.8% 2030 168 2.7% 23 2.6% % change +61% 30 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Minnesota as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 4.2% 45 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% 65-74 State Rank U.S. 200% 1.4% 21 3.6% 85+ Black 170% State Rank U.S. 140% 50-64 1.3% 39 8.7% 75-84 Hispanic 110% State Rank U.S. 80% 0.9% 39 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 174 Population & Characteristics Minnesota Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 38% 4 33% Non-metropolitan population age 65+, 2007/2008 31% 23 20% Bachelor level education or higher age 65+, 2007 19% 24 19% Persons age 60+ raising grandchildren, 2007 0.8% 44 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $32,714 20 $32,158 At/below poverty level age 65+, 2007 8.0% 37 9.5% At/below 200% of poverty level age 65+, 2007 30% 35 32% At/below 300% of poverty level age 65+, 2007 50% 32 51% Women age 75+ at/below poverty level, 2007 13% 24 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 85 14% 43 16% Physical disability 153 26% 46 31% Mobility disability 78 13% 48 18% Self-care disability 43 7% 48 10% Cognitive/mental disability 51 9% 45 12% Any disability (one or more of the five 210 35% 49 41%   listed above) Cognitive/mental disability + any other disability 41 7% 49 11% Persons age 18-64 with disabilities, 2007 Any disability 309 9% 46 11% Cognitive/mental disability + any other disability 76 2.3% 49 3.2% Persons age 65+ with Alzheimer’s disease, 2010 94 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 590 34,000 Economic value of family caregiving (millions), 2007 $7,100 $375,000 Economic value per hour, 2007 $11.11 12 $10.10 Ratio of the economic value of family caregiving to Medicaid 2.6 44 3.7 long-term care spending, 2007 175 Long-Term Care Financing Minnesota Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $6,195 16 $311,848 Medicaid home and community-based services (HCBS) spending 44% 6 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Minnesota and the U.S., 2007 Minnesota United States 10% 23% 17% 56% 21% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,485 $286 9 $213 adults with physical disabilities, 2007 Nursing facilities $835 $161 26 $156 HCBS $650 $125 5 $57 Personal care services (PCS) ** $314 $60 7 $34 Aged/disabled waiver services $335 $65 4 $21 Medicaid LTC expenditures for all populations, 2007 $2,648 $509 5 $323 Institutional services $1,011 $194 24 $196 HCBS $1,637 $315 2 $127 Waiver services (all populations) $1,323 $254 2 $91 Medicaid home health expenditures * $79 $15 7 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $23,724 35 $26,096 Medicaid HCBS expenditures for older people and adults with $12,242 8 $9,459 physical disabilities per person served, 2005 Personal care services ** $18,169 3 $9,666 Aged/disabled waiver services $10,130 18 $9,176 HCBS waiver services (all populations) $26,868 17 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 176 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Minnesota Medicaid personal needs allowance (per month), 2007 *** $82 2 $50 State-funded HCBS for older people (millions), 2007 $48.2 7 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 5.0% 42 8.4% Medicare home health visits per user, 2006 22 40 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 54,096 10.6 4 6.3 Personal care services ** 9,940 1.9 23 2.7 HCBS waiver services 44,156 8.6 2 3.6 Aged/disabled waiver services 27,893 5.5 2 2.0 Medicaid aged/disabled waiver participants per 83 7 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 3,486 0.67 15 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 5,229 1 35 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 32,052 17 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.0 12 3.8 Nursing facility residents per 100 age 75+, 2007 10.0 14 7.8 Total nursing facility stays, 2006 69,791 16 3,176,119 Residents with Medicaid as primary payer, 2007 57% 45 64% Residents with Medicare as primary payer, 2007 10% 43 14% Residents with “other” as primary payer, 2007 33% 6 22% Residents with dementia, 2007 41% 46 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $147 29 $158 Medicare payment per day for nursing facility care, 2006 $337 12 $305 Average private pay rate per day in nursing facility, 2008 $156 44 $209 Average private pay rate per month in assisted living, 2008 $3,204 13 $3,008 Medicare reimbursement per home health visit, 2006 $147 16 $134 Average private pay hourly rate for home health aide, 2008 $23 3 $19 Medicare-certified home health aide, 2008 $28 36 $38 Average private pay daily rate for adult day care, 2008 $58 22 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 177 Long-Term Care Resources Minnesota Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 196 0.31 23 0.22 Adult day facilities, 2001-02 66 0.10 22 0.09 Assisted living and residential care facilities, 2007 1,239 1.9 9 1.0 Assisted living and residential care units, 2007 NA NA NA 26 Personal and home care aides, 2007 28,290 44 3 16 Median hourly wage, 2007 $10.95 3 $8.89 Home health aides, 2007 28,200 44 3 22 Median hourly wage, 2007 $10.75 9 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 397 0.62 12 0.43 Nursing facility beds, 2007 34,892 55 16 45 Nursing facility occupancy rate, 2007 92% 4 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.6 34 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 15% 28 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 5,885 5 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 60% 42 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 300 $300 200% 187% 200 $218 150% $195 130% $200 $178 Millions of Dollars 100% 100 $100 50% 27% $0 0 0% -$32 -7% -$58 -15% -$100 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -100 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 178 Trends Minnesota Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 21,539 1,026,374 adults with physical disabilities 2005 37,833 1,376,984 % change +76% 18 +34% Medicaid aged/disabled waiver participants 2000 14,222 448,167 2005 27,893 582,342 % change +96% 9 +30% Medicare home health visits per user 2001 22 44 31 2006 22 40 35 % change +0% 21 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 35,799 1,428,117 2007 32,052 1,440,358 % change -10% 49 +1% Nursing facility beds 2002 38,385 1,671,744 2007 34,892 1,699,494 % change -9% 48 +2% Nursing facility occupancy rate 2002 93% 3 85% 2007 92% 4 85% change -1% 24 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $4,611 $243,497 2007 $6,195 $311,848 % change +34% 21 +28% Medicaid LTC spending for older people and adults 2002 $1,147 $54,261 with physical disabilities (millions) 2007 $1,485 $64,168 % change +29% 19 +18% Medicaid HCBS spending for older people and adults 2002 $253 $10,204 with physical disabilities (millions) 2007 $650 $17,188 % change +156% 9 +68% Medicaid nursing facility spending (millions) 2002 $893 $44,057 2007 $835 $46,980 % change -7% 43 +7% Medicaid HCBS spending for older people and adults 2002 22% 15 19% with physical disabilities, as a percentage of total 2007 44% 6 27% LTC spending change +22% 2 +8% 179 AARP Public Policy Institute Mississippi % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 2,919 31 301,621 2030 3,092 33 363,584 % change +6% 37 +21% Age 50-64 2007 509 17.4% 44 17.8% 2030 579 18.7% 4 16.5% % change +14% 11 +12% Age 65+ 2007 365 12.5% 33 12.6% 2030 634 20.5% 23 19.7% % change +74% 29 +89% Age 65-74 2007 193 6.6% 22 6.4% 2030 Blue line = 50-64 355 11.5% 14 10.4% % change Purple line = 65-74 +84% 26 +96% Yellow line = 75-84 Age 75-84 2007 121 4.2% Red line = 85+ 33 4.3% 2030 205 6.6% 26 6.6% % change +69% 29 +84% Age 85+ 2007 51 1.7% 33 1.8% 2030 74 2.4% 40 2.6% % change +45% 41 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Mississippi as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 26.5% 8 19.3% Population (% of 2000 Census) 65-74 Asian/Pacific Islander 180% State Rank U.S. 160% 0.6% 41 3.6% 50-64 Black 140% State Rank U.S. 85+ 120% 24.6% 2 8.7% 75-84 Hispanic 100% State Rank U.S. 80% 0.9% 39 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 180 Population & Characteristics Mississ Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 36% 10 33% Non-metropolitan population age 65+, 2007/2008 63% 6 20% Bachelor level education or higher age 65+, 2007 14% 46 19% Persons age 60+ raising grandchildren, 2007 2.9% 1 1.6% ippi Income & Poverty State Rank U.S. Median household income age 65+, 2007 $23,892 51 $32,158 At/below poverty level age 65+, 2007 14.9% 1 9.5% At/below 200% of poverty level age 65+, 2007 44% 1 32% At/below 300% of poverty level age 65+, 2007 63% 2 51% Women age 75+ at/below poverty level, 2007 19% 2 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 76 22% 2 16% Physical disability 146 42% 1 31% Mobility disability 80 23% 1 18% Self-care disability 52 15% 1 10% Cognitive/mental disability 66 19% 1 12% Any disability (one or more of the five 182 53% 1 41%   listed above) Cognitive/mental disability + any other disability 60 18% 1 11% Persons age 18-64 with disabilities, 2007 Any disability 301 17% 2 11% Cognitive/mental disability + any other disability 97 5.5% 2 3.2% Persons age 65+ with Alzheimer’s disease, 2010 53 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 460 34,000 Economic value of family caregiving (millions), 2007 $4,000 $375,000 Economic value per hour, 2007 $8.18 50 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.7 26 3.7 long-term care spending, 2007 181 Long-Term Care Financing Mississippi Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $3,286 28 $311,848 Medicaid home and community-based services (HCBS) spending 11% 39 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Mississippi and the U.S., 2007 Mississippi United States 11% 10% <0.5% 17% 89% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $785 $269 14 $213 adults with physical disabilities, 2007 Nursing facilities $695 $238 9 $156 HCBS $90 $31 34 $57 Personal care services (PCS) ** $4 $1 33 $34 Aged/disabled waiver services $86 $29 21 $21 Medicaid LTC expenditures for all populations, 2007 $1,077 $369 16 $323 Institutional services $950 $326 6 $196 HCBS $126 $43 51 $127 Waiver services (all populations) $123 $42 49 $91 Medicaid home health expenditures * $12 $4 33 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $28,059 15 $26,096 Medicaid HCBS expenditures for older people and adults with $6,616 35 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $6,616 34 $9,176 HCBS waiver services (all populations) $8,383 50 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 182 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 75.9% 1 Mississ Medicaid personal needs allowance (per month), 2007 *** $44 33 $50 State-funded HCBS for older people (millions), 2007 $0.0 48 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 9.8% 8 8.4% Medicare home health visits per user, 2006 40 7 35 ippi Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 14,540 5.0 33 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 14,540 5.0 18 3.6 Aged/disabled waiver services 11,884 4.1 7 2.0 Medicaid aged/disabled waiver participants per 55 13 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 200 0.07 36 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 8,834 3 13 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 16,762 31 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.6 16 3.8 Nursing facility residents per 100 age 75+, 2007 9.8 16 7.8 Total nursing facility stays, 2006 28,018 32 3,176,119 Residents with Medicaid as primary payer, 2007 77% 2 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 10% 50 22% Residents with dementia, 2007 52% 6 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 NA NA $158 Medicare payment per day for nursing facility care, 2006 $273 40 $305 Average private pay rate per day in nursing facility, 2008 $174 33 $209 Average private pay rate per month in assisted living, 2008 $2,277 47 $3,008 Medicare reimbursement per home health visit, 2006 $132 35 $134 Average private pay hourly rate for home health aide, 2008 $14 49 $19 Medicare-certified home health aide, 2008 $74 2 $38 Average private pay daily rate for adult day care, 2008 $43 44 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 183 Long-Term Care Resources Mississippi Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 56 0.15 23 0.22 Adult day facilities, 2001-02 12 0.03 45 0.09 Assisted living and residential care facilities, 2007 185 0.5 36 1.0 Assisted living and residential care units, 2007 5,133 14 41 26 Personal and home care aides, 2007 1,980 5 46 16 Median hourly wage, 2007 $6.87 49 $8.89 Home health aides, 2007 3,240 9 47 22 Median hourly wage, 2007 $8.80 42 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 206 0.56 16 0.43 Nursing facility beds, 2007 18,652 51 20 45 Nursing facility occupancy rate, 2007 90% 13 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.9 14 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 12% 36 18% residents, 2007 Residents with physical restraints (%), 2007 9% 6 6% Long-term care facility beds per FTE ombudsman, 2006 1,356 37 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 300 $300 80% 250 71% $250 $246 200 60% Millions of Dollars 55% $200 43% 150 No spending in 2002 40% $150 40% 100 $100 $77 20% $50 $36 50 $11 $4 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 184 Trends Mississ Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 4,124 1,026,374 adults with physical disabilities 2005 11,884 1,376,984 % change +188% 5 +34% Medicaid aged/disabled waiver participants 2000 4,124 448,167 2005 11,884 582,342 % change +188% 5 +30% ippi Medicare home health visits per user 2001 41 4 31 2006 40 7 35 % change -3% 27 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 15,656 1,428,117 2007 16,762 1,440,358 % change +7% 7 +1% Nursing facility beds 2002 17,854 1,671,744 2007 18,652 1,699,494 % change +4% 18 +2% Nursing facility occupancy rate 2002 88% 24 85% 2007 90% 13 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $2,905 $243,497 2007 $3,286 $311,848 % change +13% 44 +28% Medicaid LTC spending for older people and adults 2002 $499 $54,261 with physical disabilities (millions) 2007 $785 $64,168 % change +57% 5 +18% Medicaid HCBS spending for older people and adults 2002 $50 $10,204 with physical disabilities (millions) 2007 $90 $17,188 % change +78% 26 +68% Medicaid nursing facility spending (millions) 2002 $449 $44,057 2007 $695 $46,980 % change +55% 2 +7% Medicaid HCBS spending for older people and adults 2002 10% 34 19% with physical disabilities, as a percentage of total 2007 11% 39 27% LTC spending change +1% 45 +8% 185 AARP Public Policy Institute Missouri % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 5,878 18 301,621 2030 6,430 19 363,584 % change +9% 27 +21% Age 50-64 2007 1,072 18.2% 29 17.8% 2030 1,057 16.4% 34 16.5% % change -1% 30 +12% Age 65+ 2007 788 13.4% 17 12.6% 2030 1,302 20.2% 26 19.7% % change +65% 35 +89% Age 65-74 2007 402 6.8% 15 6.4% 2030 Blue line = 50-64 694 10.8% 25 10.4% % change Purple line = 65-74 +73% 35 +96% Yellow line = 75-84 Age 75-84 2007 268 4.6% Red line = 85+ 17 4.3% 2030 433 6.7% 25 6.6% % change +62% 33 +84% Age 85+ 2007 118 2.0% 16 1.8% 2030 174 2.7% 23 2.6% % change +48% 36 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Missouri as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 10.0% 30 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 65-74 State Rank U.S. 160% 85+ 0.9% 32 3.6% 75-84 Black 140% State Rank U.S. 120% 50-64 7.4% 20 8.7% Hispanic 100% State Rank U.S. 80% 1.0% 37 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 186 Population & Characteristics Missouri Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 36% 10 33% Non-metropolitan population age 65+, 2007/2008 30% 24 20% Bachelor level education or higher age 65+, 2007 15% 39 19% Persons age 60+ raising grandchildren, 2007 1.4% 26 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $29,833 35 $32,158 At/below poverty level age 65+, 2007 9.3% 20 9.5% At/below 200% of poverty level age 65+, 2007 35% 15 32% At/below 300% of poverty level age 65+, 2007 55% 14 51% Women age 75+ at/below poverty level, 2007 14% 19 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 125 17% 18 16% Physical disability 245 33% 14 31% Mobility disability 132 18% 16 18% Self-care disability 77 10% 19 10% Cognitive/mental disability 94 13% 17 12% Any disability (one or more of the five 315 42% 16 41%   listed above) Cognitive/mental disability + any other disability 86 12% 13 11% Persons age 18-64 with disabilities, 2007 Any disability 489 13% 11 11% Cognitive/mental disability + any other disability 136 3.8% 11 3.2% Persons age 65+ with Alzheimer’s disease, 2010 110 13% 31 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 590 34,000 Economic value of family caregiving (millions), 2007 $6,300 $375,000 Economic value per hour, 2007 $9.84 31 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.0 20 3.7 long-term care spending, 2007 187 Long-Term Care Financing Missouri Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $6,598 14 $311,848 Medicaid home and community-based services (HCBS) spending 31% 15 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Missouri and the U.S., 2007 Missouri United States 9% 10% 22% 17% 69% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,098 $187 33 $213 adults with physical disabilities, 2007 Nursing facilities $760 $129 33 $156 HCBS $338 $58 16 $57 Personal care services (PCS) ** $241 $41 10 $34 Aged/disabled waiver services $97 $17 36 $21 Medicaid LTC expenditures for all populations, 2007 $1,574 $268 36 $323 Institutional services $870 $148 38 $196 HCBS $703 $120 26 $127 Waiver services (all populations) $462 $79 36 $91 Medicaid home health expenditures * $5 $1 43 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $20,102 45 $26,096 Medicaid HCBS expenditures for older people and adults with $4,483 47 $9,459 physical disabilities per person served, 2005 Personal care services ** $4,840 19 $9,666 Aged/disabled waiver services $3,743 49 $9,176 HCBS waiver services (all populations) $11,714 46 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 188 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 61.6% 23 Missouri Medicaid personal needs allowance (per month), 2007 *** $30 46 $50 State-funded HCBS for older people (millions), 2007 $12.2 21 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.7% 22 8.4% Medicare home health visits per user, 2006 25 30 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 81,505 14.1 1 6.3 Personal care services ** 49,481 8.5 2 2.7 HCBS waiver services 32,024 5.5 12 3.6 Aged/disabled waiver services 23,817 4.1 7 2.0 Medicaid aged/disabled waiver participants per 60 11 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 6,000 1.02 10 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 7,739 1.3 29 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 38,791 12 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.9 14 3.8 Nursing facility residents per 100 age 75+, 2007 10.1 13 7.8 Total nursing facility stays, 2006 77,243 13 3,176,119 Residents with Medicaid as primary payer, 2007 61% 32 64% Residents with Medicare as primary payer, 2007 13% 27 14% Residents with “other” as primary payer, 2007 26% 13 22% Residents with dementia, 2007 44% 36 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $112 47 $158 Medicare payment per day for nursing facility care, 2006 $269 44 $305 Average private pay rate per day in nursing facility, 2008 $162 35 $209 Average private pay rate per month in assisted living, 2008 $2,806 27 $3,008 Medicare reimbursement per home health visit, 2006 $140 26 $134 Average private pay hourly rate for home health aide, 2008 $18 33 $19 Medicare-certified home health aide, 2008 $31 30 $38 Average private pay daily rate for adult day care, 2008 $60 18 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 189 Long-Term Care Resources Missouri Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 165 0.21 23 0.22 Adult day facilities, 2001-02 59 0.07 29 0.09 Assisted living and residential care facilities, 2007 616 0.8 23 1.0 Assisted living and residential care units, 2007 21,166 27 26 26 Personal and home care aides, 2007 15,940 20 12 16 Median hourly wage, 2007 $8.51 39 $8.89 Home health aides, 2007 11,290 14 37 22 Median hourly wage, 2007 $8.76 45 $9.62 Medicaid aged/disabled waiver waiting list, 2007 39 21 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 534 0.68 8 0.43 Nursing facility beds, 2007 52,404 66 5 45 Nursing facility occupancy rate, 2007 74% 42 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.6 34 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 16% 22 18% residents, 2007 Residents with physical restraints (%), 2007 6% 13 6% Long-term care facility beds per FTE ombudsman, 2006 4,306 9 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 72% 37 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 150 $150 60% 100 $111 44% $100 40% 30% 50 Millions of Dollars $56 $50 20% 16% $21 $13 0 3% $0 0% -50 -$50 -20% -$100 -40% -100 -$120 -52% -$150 -60% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -150 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 190 Trends Missouri Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 63,005 1,026,374 adults with physical disabilities 2005 73,298 1,376,984 % change +16% 40 +34% Medicaid aged/disabled waiver participants 2000 23,802 448,167 2005 23,817 582,342 % change +0% 43 +30% Medicare home health visits per user 2001 26 31 31 2006 25 30 35 % change -2% 24 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 38,391 1,428,117 2007 38,791 1,440,358 % change +1% 25 +1% Nursing facility beds 2002 51,865 1,671,744 2007 52,404 1,699,494 % change +1% 28 +2% Nursing facility occupancy rate 2002 74% 47 85% 2007 74% 42 85% change +0% 17 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $5,359 $243,497 2007 $6,598 $311,848 % change +23% 31 +28% Medicaid LTC spending for older people and adults 2002 $1,008 $54,261 with physical disabilities (millions) 2007 $1,098 $64,168 % change +9% 40 +18% Medicaid HCBS spending for older people and adults 2002 $269 $10,204 with physical disabilities (millions) 2007 $338 $17,188 % change +26% 49 +68% Medicaid nursing facility spending (millions) 2002 $739 $44,057 2007 $760 $46,980 % change +3% 33 +7% Medicaid HCBS spending for older people and adults 2002 27% 11 19% with physical disabilities, as a percentage of total 2007 31% 15 27% LTC spending change +4% 29 +8% 191 AARP Public Policy Institute Montana % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 958 44 301,621 2030 1,045 44 363,584 % change +9% 28 +21% Age 50-64 2007 198 20.7% 3 17.8% 2030 192 18.4% 6 16.5% % change -3% 35 +12% Age 65+ 2007 134 13.9% 10 12.6% 2030 270 25.8% 5 19.7% % change +102% 14 +89% Age 65-74 2007 69 7.2% 5 6.4% 2030 Blue line = 50-64 134 12.8% 6 10.4% % change Purple line = 65-74 +95% 20 +96% Yellow line = 75-84 Age 75-84 2007 45 4.7% Red line = 85+ 10 4.3% 2030 98 9.4% 2 6.6% % change +118% 7 +84% Age 85+ 2007 20 2.1% 12 1.8% 2030 37 3.6% 4 2.6% % change +88% 19 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Montana as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 5.2% 41 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 240% 0.5% 46 3.6% 65-74 85+ Black 200% State Rank U.S. 160% 0.2% 48 8.7% 75-84 50-64 Hispanic 120% State Rank U.S. 80% 1.0% 37 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 192 Population & Characteristics Montana Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 53 10 48 Persons age 75+ living alone, 2007 32% 36 33% Non-metropolitan population age 65+, 2007/2008 70% 3 20% Bachelor level education or higher age 65+, 2007 22% 13 19% Persons age 60+ raising grandchildren, 2007 1.8% 17 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $30,767 30 $32,158 At/below poverty level age 65+, 2007 10.0% 18 9.5% At/below 200% of poverty level age 65+, 2007 33% 21 32% At/below 300% of poverty level age 65+, 2007 52% 26 51% Women age 75+ at/below poverty level, 2007 16% 11 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 25 20% 8 16% Physical disability 39 31% 17 31% Mobility disability 19 15% 35 18% Self-care disability 10 8% 40 10% Cognitive/mental disability 15 12% 21 12% Any disability (one or more of the five 53 42% 16 41%   listed above) Cognitive/mental disability + any other disability 14 11% 20 11% Persons age 18-64 with disabilities, 2007 Any disability 71 12% 20 11% Cognitive/mental disability + any other disability 21 3.5% 19 3.2% Persons age 65+ with Alzheimer’s disease, 2010 21 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 111 34,000 Economic value of family caregiving (millions), 2007 $1,140 $375,000 Economic value per hour, 2007 $9.53 36 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.9 22 3.7 long-term care spending, 2007 193 Long-Term Care Financing Montana Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $733 48 $311,848 Medicaid home and community-based services (HCBS) spending 26% 19 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Montana and the U.S., 2007 Montana United States 13% 10% 13% 17% 74% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $200 $209 21 $213 adults with physical disabilities, 2007 Nursing facilities $149 $155 27 $156 HCBS $52 $54 18 $57 Personal care services (PCS) ** $26 $27 16 $34 Aged/disabled waiver services $25 $26 27 $21 Medicaid LTC expenditures for all populations, 2007 $280 $292 31 $323 Institutional services $159 $166 33 $196 HCBS $120 $126 22 $127 Waiver services (all populations) $94 $98 27 $91 Medicaid home health expenditures * $10 $11 14 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $26,720 22 $26,096 Medicaid HCBS expenditures for older people and adults with $9,131 20 $9,459 physical disabilities per person served, 2005 Personal care services ** $7,490 13 $9,666 Aged/disabled waiver services $11,896 13 $9,176 HCBS waiver services (all populations) $20,015 28 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 194 Federal/State/Personal Contributions State Rank U.S. Montana Federal Medical Assistance Percentage (FMAP), 2007 69.1% 11 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $0.0 48 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 4.9% 43 8.4% Medicare home health visits per user, 2006 22 40 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 7,121 7.6 18 6.3 Personal care services ** 3,124 3.3 12 2.7 HCBS waiver services 3,997 4.3 25 3.6 Aged/disabled waiver services 1,853 2 24 2.0 Medicaid aged/disabled waiver participants per 36 24 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 614 0.64 16 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 437 0.5 47 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 5,281 43 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.0 24 3.8 Nursing facility residents per 100 age 75+, 2007 8.1 28 7.8 Total nursing facility stays, 2006 11,762 43 3,176,119 Residents with Medicaid as primary payer, 2007 58% 40 64% Residents with Medicare as primary payer, 2007 11% 37 14% Residents with “other” as primary payer, 2007 32% 7 22% Residents with dementia, 2007 42% 40 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $146 30 $158 Medicare payment per day for nursing facility care, 2006 $312 24 $305 Average private pay rate per day in nursing facility, 2008 $163 34 $209 Average private pay rate per month in assisted living, 2008 $2,826 25 $3,008 Medicare reimbursement per home health visit, 2006 $146 18 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $27 40 $38 Average private pay daily rate for adult day care, 2008 $67 11 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 195 Long-Term Care Resources Montana Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 36 0.27 23 0.22 Adult day facilities, 2001-02 56 0.42 1 0.09 Assisted living and residential care facilities, 2007 184 1.4 12 1.0 Assisted living and residential care units, 2007 4,351 33 15 26 Personal and home care aides, 2007 3,000 22 7 16 Median hourly wage, 2007 $8.86 32 $8.89 Home health aides, 2007 2,390 18 22 22 Median hourly wage, 2007 $9.31 33 $9.62 Medicaid aged/disabled waiver waiting list, 2007 600 13 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 96 0.72 7 0.43 Nursing facility beds, 2007 7,299 55 16 45 Nursing facility occupancy rate, 2007 72% 46 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4 9 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 19% 18 18% residents, 2007 Residents with physical restraints (%), 2007 2% 44 6% Long-term care facility beds per FTE ombudsman, 2006 795 50 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 30 $30 80% $26 61% 20 60% $20 Millions of Dollars $15 40% 31% 10 $10 20% $6 11% 0% $0 0 -7% -$2 -20% -$4 -25% -$10 -40% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -10 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 196 Trends Montana Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 4,420 1,026,374 adults with physical disabilities 2005 4,977 1,376,984 % change +13% 42 +34% Medicaid aged/disabled waiver participants 2000 1,626 448,167 2005 1,853 582,342 % change +14% 39 +30% Medicare home health visits per user 2001 26 31 31 2006 22 40 35 % change -16% 47 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 5,617 1,428,117 2007 5,281 1,440,358 % change -6% 41 +1% Nursing facility beds 2002 7,230 1,671,744 2007 7,299 1,699,494 % change +1% 28 +2% Nursing facility occupancy rate 2002 78% 44 85% 2007 72% 46 85% change -5% 44 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $590 $243,497 2007 $733 $311,848 % change +24% 30 +28% Medicaid LTC spending for older people and adults 2002 $181 $54,261 with physical disabilities (millions) 2007 $200 $64,168 % change +10% 38 +18% Medicaid HCBS spending for older people and adults 2002 $48 $10,204 with physical disabilities (millions) 2007 $52 $17,188 % change +8% 50 +68% Medicaid nursing facility spending (millions) 2002 $134 $44,057 2007 $149 $46,980 % change +11% 28 +7% Medicaid HCBS spending for older people and adults 2002 26% 12 19% with physical disabilities, as a percentage of total 2007 26% 19 27% LTC spending change -1% 50 +8% 197 AARP Public Policy Institute Nebraska % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 1,775 38 301,621 2030 1,820 38 363,584 % change +3% 43 +21% Age 50-64 2007 313 17.6% 42 17.8% 2030 289 15.9% 41 16.5% % change -8% 41 +12% Age 65+ 2007 237 13.3% 18 12.6% 2030 376 20.6% 22 19.7% % change +59% 42 +89% Age 65-74 2007 114 6.4% 32 6.4% 2030 Blue line = 50-64 189 10.4% 29 10.4% % change Purple line = 65-74 +66% 41 +96% Yellow line = 75-84 Age 75-84 2007 83 4.7% Red line = 85+ 10 4.3% 2030 131 7.2% 16 6.6% % change +58% 41 +84% Age 85+ 2007 40 2.3% 7 1.8% 2030 56 3.1% 15 2.6% % change +40% 46 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Nebraska as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 5.2% 41 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 65-74 State Rank U.S. 160% 0.7% 37 3.6% 85+ Black 140% 50-64 State Rank U.S. 120% 2.2% 35 8.7% 75-84 Hispanic 100% State Rank U.S. 80% 1.8% 28 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 198 Population & Characteristics Nebraska Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 44 32 48 Persons age 75+ living alone, 2007 37% 6 33% Non-metropolitan population age 65+, 2007/2008 47% 10 20% Bachelor level education or higher age 65+, 2007 17% 33 19% Persons age 60+ raising grandchildren, 2007 0.7% 46 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $30,468 31 $32,158 At/below poverty level age 65+, 2007 8.3% 31 9.5% At/below 200% of poverty level age 65+, 2007 31% 29 32% At/below 300% of poverty level age 65+, 2007 52% 26 51% Women age 75+ at/below poverty level, 2007 14% 19 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 32 15% 34 16% Physical disability 59 27% 42 31% Mobility disability 31 14% 41 18% Self-care disability 18 8% 40 10% Cognitive/mental disability 20 9% 45 12% Any disability (one or more of the five 79 36% 43 41%   listed above) Cognitive/mental disability + any other disability 18 8% 44 11% Persons age 18-64 with disabilities, 2007 Any disability 106 10% 34 11% Cognitive/mental disability + any other disability 27 2.5% 39 3.2% Persons age 65+ with Alzheimer’s disease, 2010 37 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 177 34,000 Economic value of family caregiving (millions), 2007 $2,000 $375,000 Economic value per hour, 2007 $10.48 21 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.2 33 3.7 long-term care spending, 2007 199 Long-Term Care Financing Nebraska Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,535 38 $311,848 Medicaid home and community-based services (HCBS) spending 18% 30 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Nebraska and the U.S., 2007 Nebraska United States 15% 10% 3% 17% 82% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $401 $226 19 $213 adults with physical disabilities, 2007 Nursing facilities $328 $185 17 $156 HCBS $72 $41 24 $57 Personal care services (PCS) ** $14 $8 26 $34 Aged/disabled waiver services $59 $33 16 $21 Medicaid LTC expenditures for all populations, 2007 $612 $345 21 $323 Institutional services $395 $223 17 $196 HCBS $217 $122 25 $127 Waiver services (all populations) $203 $114 21 $91 Medicaid home health expenditures * $22 $12 12 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $24,669 31 $26,096 Medicaid HCBS expenditures for older people and adults with $9,464 17 $9,459 physical disabilities per person served, 2005 Personal care services ** $6,317 14 $9,666 Aged/disabled waiver services $10,481 15 $9,176 HCBS waiver services (all populations) $21,240 26 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 200 Federal/State/Personal Contributions State Rank U.S. Nebraska Federal Medical Assistance Percentage (FMAP), 2007 57.9% 30 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $3.6 39 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 5.2% 41 8.4% Medicare home health visits per user, 2006 22 40 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 9,732 5.5 26 6.3 Personal care services ** 1,549 0.9 26 2.7 HCBS waiver services 8,183 4.7 21 3.6 Aged/disabled waiver services 4,792 2.7 20 2.0 Medicaid aged/disabled waiver participants per 43 18 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 1,693 0.95 13 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 6,292 3.6 11 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 13,484 32 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.7 5 3.8 Nursing facility residents per 100 age 75+, 2007 11.0 4 7.8 Total nursing facility stays, 2006 26,663 34 3,176,119 Residents with Medicaid as primary payer, 2007 54% 48 64% Residents with Medicare as primary payer, 2007 10% 43 14% Residents with “other” as primary payer, 2007 36% 4 22% Residents with dementia, 2007 42% 40 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $131 39 $158 Medicare payment per day for nursing facility care, 2006 $328 17 $305 Average private pay rate per day in nursing facility, 2008 $156 44 $209 Average private pay rate per month in assisted living, 2008 $2,335 46 $3,008 Medicare reimbursement per home health visit, 2006 $144 22 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $26 43 $38 Average private pay daily rate for adult day care, 2008 $55 28 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 201 Long-Term Care Resources Nebraska Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 65 0.27 23 0.22 Adult day facilities, 2001-02 21 0.09 25 0.09 Assisted living and residential care facilities, 2007 276 1.2 15 1.0 Assisted living and residential care units, 2007 10,063 43 3 26 Personal and home care aides, 2007 1,320 6 45 16 Median hourly wage, 2007 $9.21 25 $8.89 Home health aides, 2007 4,040 17 26 22 Median hourly wage, 2007 $10.64 11 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 228 0.96 4 0.43 Nursing facility beds, 2007 16,297 69 2 45 Nursing facility occupancy rate, 2007 83% 36 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.7 26 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 25% 11 18% residents, 2007 Residents with physical restraints (%), 2007 2% 44 6% Long-term care facility beds per FTE ombudsman, 2006 4,512 8 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 45% 46 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 40 $40 150% 20 $31 $20 $19 114% $10 0 $5 100% Millions of Dollars $0 59%-20 -$20 50% 40% -40 -$40 8% 0% -$60 -60 -16% -$63 -$80 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -80 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 202 Trends Nebraska Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 3,466 1,026,374 adults with physical disabilities 2005 6,341 1,376,984 % change +83% 13 +34% Medicaid aged/disabled waiver participants 2000 2,357 448,167 2005 4,792 582,342 % change +103% 8 +30% Medicare home health visits per user 2001 23 41 31 2006 22 40 35 % change -6% 34 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 14,116 1,428,117 2007 13,484 1,440,358 % change -4% 36 +1% Nursing facility beds 2002 15,972 1,671,744 2007 16,297 1,699,494 % change +2% 25 +2% Nursing facility occupancy rate 2002 88% 24 85% 2007 83% 36 85% change -6% 48 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,377 $243,497 2007 $1,535 $311,848 % change +11% 48 +28% Medicaid LTC spending for older people and adults 2002 $427 $54,261 with physical disabilities (millions) 2007 $401 $64,168 % change -6% 49 +18% Medicaid HCBS spending for older people and adults 2002 $36 $10,204 with physical disabilities (millions) 2007 $72 $17,188 % change +100% 18 +68% Medicaid nursing facility spending (millions) 2002 $391 $44,057 2007 $328 $46,980 % change -16% 49 +7% Medicaid HCBS spending for older people and adults 2002 8% 36 19% with physical disabilities, as a percentage of total 2007 18% 30 27% LTC spending change +10% 14 +8% 203 AARP Public Policy Institute Nevada % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 2,565 35 301,621 2030 4,282 28 363,584 % change +67% 2 +21% Age 50-64 2007 457 17.8% 39 17.8% 2030 821 19.2% 2 16.5% % change +80% 1 +12% Age 65+ 2007 286 11.1% 45 12.6% 2030 797 18.6% 37 19.7% % change +179% 2 +89% Age 65-74 2007 163 6.4% 32 6.4% 2030 Blue line = 50-64 471 11.0% 20 10.4% % change Purple line = 65-74 +188% 3 +96% Yellow line = 75-84 Age 75-84 2007 92 3.6% Red line = 85+ 46 4.3% 2030 244 5.7% 46 6.6% % change +164% 3 +84% Age 85+ 2007 30 1.2% 48 1.8% 2030 83 1.9% 48 2.6% % change +176% 2 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Nevada as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 500% 22.4% 13 19.3% Population (% of 2000 Census) 85+ Asian/Pacific Islander 430% State Rank U.S. 360% 7.0% 3 3.6% 65-74 Black 290% State Rank U.S. 50-64 220% 5.8% 24 8.7% 75-84 Hispanic 150% State Rank U.S. 80% 8.9% 8 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 204 Population & Characteristics Nevada Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 65 1 48 Persons age 75+ living alone, 2007 27% 49 33% Non-metropolitan population age 65+, 2007/2008 NA NA 20% Bachelor level education or higher age 65+, 2007 20% 22 19% Persons age 60+ raising grandchildren, 2007 2.1% 11 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $38,993 5 $32,158 At/below poverty level age 65+, 2007 6.8% 45 9.5% At/below 200% of poverty level age 65+, 2007 27% 43 32% At/below 300% of poverty level age 65+, 2007 44% 44 51% Women age 75+ at/below poverty level, 2007 9% 46 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 41 15% 34 16% Physical disability 79 28% 35 31% Mobility disability 41 15% 35 18% Self-care disability 24 9% 30 10% Cognitive/mental disability 28 10% 34 12% Any disability (one or more of the five 102 36% 43 41%   listed above) Cognitive/mental disability + any other disability 26 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 159 10% 34 11% Cognitive/mental disability + any other disability 38 2.4% 43 3.2% Persons age 65+ with Alzheimer’s disease, 2010 29 9% 50 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 280 34,000 Economic value of family caregiving (millions), 2007 $3,300 $375,000 Economic value per hour, 2007 $10.81 17 $10.10 Ratio of the economic value of family caregiving to Medicaid 10.2 1 3.7 long-term care spending, 2007 205 Long-Term Care Financing Nevada Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,239 41 $311,848 Medicaid home and community-based services (HCBS) spending 34% 12 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Nevada and the U.S., 2007 Nevada United States 6% 10% 29% 17% 66% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $236 $92 50 $213 adults with physical disabilities, 2007 Nursing facilities $155 $60 51 $156 HCBS $81 $31 34 $57 Personal care services (PCS) ** $67 $26 17 $34 Aged/disabled waiver services $13 $5 44 $21 Medicaid LTC expenditures for all populations, 2007 $319 $125 51 $323 Institutional services $176 $69 50 $196 HCBS $143 $56 48 $127 Waiver services (all populations) $76 $30 51 $91 Medicaid home health expenditures * $3 $1 43 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $26,632 24 $26,096 Medicaid HCBS expenditures for older people and adults with $6,818 33 $9,459 physical disabilities per person served, 2005 Personal care services ** $10,319 10 $9,666 Aged/disabled waiver services $4,002 47 $9,176 HCBS waiver services (all populations) $11,911 44 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 206 Federal/State/Personal Contributions State Rank U.S. Nevada Federal Medical Assistance Percentage (FMAP), 2007 53.9% 35 Medicaid personal needs allowance (per month), 2007 *** $35 43 $50 State-funded HCBS for older people (millions), 2007 $1.9 42 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.7% 22 8.4% Medicare home health visits per user, 2006 30 18 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 5,878 2.4 48 6.3 Personal care services ** 2,038 0.8 27 2.7 HCBS waiver services 3,840 1.6 49 3.6 Aged/disabled waiver services 2,534 1.1 37 2.0 Medicaid aged/disabled waiver participants per 44 16 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 380 0.15 32 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 1,551 0.6 44 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 4,724 44 1,440,358 Nursing facility residents per 100 age 65+, 2007 1.7 48 3.8 Nursing facility residents per 100 age 75+, 2007 3.9 48 7.8 Total nursing facility stays, 2006 11,908 42 3,176,119 Residents with Medicaid as primary payer, 2007 58% 40 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 28% 10 22% Residents with dementia, 2007 38% 50 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $169 18 $158 Medicare payment per day for nursing facility care, 2006 $349 7 $305 Average private pay rate per day in nursing facility, 2008 $211 17 $209 Average private pay rate per month in assisted living, 2008 $2,504 40 $3,008 Medicare reimbursement per home health visit, 2006 $163 8 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $53 9 $38 Average private pay daily rate for adult day care, 2008 $73 5 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 207 Long-Term Care Resources Nevada Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 63 0.22 23 0.22 Adult day facilities, 2001-02 6 0.02 48 0.09 Assisted living and residential care facilities, 2007 258 0.9 20 1.0 Assisted living and residential care units, 2007 3,941 14 41 26 Personal and home care aides, 2007 2,850 10 35 16 Median hourly wage, 2007 $10.16 11 $8.89 Home health aides, 2007 3,600 13 41 22 Median hourly wage, 2007 $10.54 12 $9.62 Medicaid aged/disabled waiver waiting list, 2007 488 14 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 48 0.17 50 0.43 Nursing facility beds, 2007 5,643 20 49 45 Nursing facility occupancy rate, 2007 84% 34 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.5 42 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 15% 28 18% residents, 2007 Residents with physical restraints (%), 2007 10% 5 6% Long-term care facility beds per FTE ombudsman, 2006 863 48 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 63% 41 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 60 $60 500% $54 $48 40 400% 400% $40 $38 Millions of Dollars 300% 20 $20 200% 151% $5 100% $0 45% 51% 0 0% -$9 -29% -$20 -100% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -20 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 208 Trends Nevada Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 1,928 1,026,374 adults with physical disabilities 2005 4,572 1,376,984 % change +137% 9 +34% Medicaid aged/disabled waiver participants 2000 1,479 448,167 2005 2,534 582,342 % change +71% 13 +30% Medicare home health visits per user 2001 28 20 31 2006 30 18 35 % change +9% 9 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 4,297 1,428,117 2007 4,724 1,440,358 % change +10% 3 +1% Nursing facility beds 2002 5,286 1,671,744 2007 5,643 1,699,494 % change +7% 9 +2% Nursing facility occupancy rate 2002 81% 40 85% 2007 84% 34 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $824 $243,497 2007 $1,239 $311,848 % change +51% 6 +28% Medicaid LTC spending for older people and adults 2002 $130 $54,261 with physical disabilities (millions) 2007 $236 $64,168 % change +82% 2 +18% Medicaid HCBS spending for older people and adults 2002 $22 $10,204 with physical disabilities (millions) 2007 $81 $17,188 % change +261% 3 +68% Medicaid nursing facility spending (millions) 2002 $107 $44,057 2007 $155 $46,980 % change +45% 3 +7% Medicaid HCBS spending for older people and adults 2002 17% 21 19% with physical disabilities, as a percentage of total 2007 34% 12 27% LTC spending change +17% 4 +8% 209 AARP Public Policy Institute New Hampshire % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 1,316 41 301,621 2030 1,646 40 363,584 % change +25% 14 +21% Age 50-64 2007 264 20.1% 5 17.8% 2030 282 17.1% 19 16.5% % change +7% 20 +12% Age 65+ 2007 166 12.6% 32 12.6% 2030 353 21.4% 17 19.7% % change +113% 8 +89% Age 65-74 2007 85 6.5% 25 6.4% 2030 Blue line = 50-64 189 11.5% 14 10.4% % change Purple line = 65-74 +122% 4 +96% Yellow line = 75-84 Age 75-84 2007 56 4.3% Red line = 85+ 28 4.3% 2030 119 7.2% 16 6.6% % change +110% 12 +84% Age 85+ 2007 24 1.8% 25 1.8% 2030 45 2.7% 23 2.6% % change +87% 20 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in New Hampshire as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 2.5% 49 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 240% 0.9% 32 3.6% 65-74 85+ Black 200% State Rank U.S. 75-84 160% 0.4% 45 8.7% 50-64 Hispanic 120% State Rank U.S. 80% 0.9% 39 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 210 Population & Characteristics New Hamps hire Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 44 32 48 Persons age 75+ living alone, 2007 31% 42 33% Non-metropolitan population age 65+, 2007/2008 42% 14 20% Bachelor level education or higher age 65+, 2007 24% 5 19% Persons age 60+ raising grandchildren, 2007 0.8% 44 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $37,156 11 $32,158 At/below poverty level age 65+, 2007 6.5% 47 9.5% At/below 200% of poverty level age 65+, 2007 25% 46 32% At/below 300% of poverty level age 65+, 2007 43% 45 51% Women age 75+ at/below poverty level, 2007 9% 46 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 25 16% 25 16% Physical disability 40 26% 46 31% Mobility disability 21 14% 41 18% Self-care disability 12 8% 40 10% Cognitive/mental disability 14 9% 45 12% Any disability (one or more of the five 56 36% 43 41%   listed above) Cognitive/mental disability + any other disability 13 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 86 10% 34 11% Cognitive/mental disability + any other disability 21 2.5% 39 3.2% Persons age 65+ with Alzheimer’s disease, 2010 22 12% 39 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 147 34,000 Economic value of family caregiving (millions), 2007 $1,830 $375,000 Economic value per hour, 2007 $11.55 6 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.5 29 3.7 long-term care spending, 2007 211 Long-Term Care Financing New Hampshire Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,193 42 $311,848 Medicaid home and community-based services (HCBS) spending 13% 38 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in New Hampshire and the U.S., 2007 New Hampshire United States 11% 10% 2% 17% 87% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $364 $277 12 $213 adults with physical disabilities, 2007 Nursing facilities $318 $242 8 $156 HCBS $46 $35 30 $57 Personal care services (PCS) ** $6 $5 29 $34 Aged/disabled waiver services $40 $30 20 $21 Medicaid LTC expenditures for all populations, 2007 $523 $398 14 $323 Institutional services $320 $243 12 $196 HCBS $203 $154 17 $127 Waiver services (all populations) $196 $149 12 $91 Medicaid home health expenditures * $7 $5 28 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $26,678 23 $26,096 Medicaid HCBS expenditures for older people and adults with $8,525 24 $9,459 physical disabilities per person served, 2005 Personal care services ** $20,438 2 $9,666 Aged/disabled waiver services $8,410 26 $9,176 HCBS waiver services (all populations) $31,951 8 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 212 Federal/State/Personal Contributions State Rank U.S. New Hamps hire Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $56 13 $50 State-funded HCBS for older people (millions), 2007 $0.4 47 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 8.5% 16 8.4% Medicare home health visits per user, 2006 30 18 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 4,924 3.8 38 6.3 Personal care services ** 25 0 31 2.7 HCBS waiver services 4,899 3.8 27 3.6 Aged/disabled waiver services 2,590 2 24 2.0 Medicaid aged/disabled waiver participants per 34 26 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 243 0.18 29 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 2,841 2.2 20 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 7,063 37 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.3 20 3.8 Nursing facility residents per 100 age 75+, 2007 8.8 21 7.8 Total nursing facility stays, 2006 15,215 39 3,176,119 Residents with Medicaid as primary payer, 2007 65% 19 64% Residents with Medicare as primary payer, 2007 15% 14 14% Residents with “other” as primary payer, 2007 20% 33 22% Residents with dementia, 2007 55% 4 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $176 12 $158 Medicare payment per day for nursing facility care, 2006 $347 8 $305 Average private pay rate per day in nursing facility, 2008 $259 7 $209 Average private pay rate per month in assisted living, 2008 $3,426 10 $3,008 Medicare reimbursement per home health visit, 2006 $136 29 $134 Average private pay hourly rate for home health aide, 2008 $24 1 $19 Medicare-certified home health aide, 2008 $39 19 $38 Average private pay daily rate for adult day care, 2008 $58 22 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 213 Long-Term Care Resources New Hampshire Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 35 0.21 23 0.22 Adult day facilities, 2001-02 23 0.14 12 0.09 Assisted living and residential care facilities, 2007 142 0.9 20 1.0 Assisted living and residential care units, 2007 4,283 26 27 26 Personal and home care aides, 2007 2,470 15 20 16 Median hourly wage, 2007 $10.36 9 $8.89 Home health aides, 2007 2,780 17 26 22 Median hourly wage, 2007 $10.97 7 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 83 0.5 23 0.43 Nursing facility beds, 2007 7,877 48 21 45 Nursing facility occupancy rate, 2007 90% 13 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.9 14 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 11% 39 18% residents, 2007 Residents with physical restraints (%), 2007 2% 44 6% Long-term care facility beds per FTE ombudsman, 2006 2,419 24 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 92% 28 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 100 $250 120% 80 105% $83 100% $200 Millions of Dollars 60 80% $150 60% 50%40 $100 40% 35% $21 29% $20 $50 17% 20 20% $1 $2 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 214 Trends New Hamps hire Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 1,753 1,026,374 adults with physical disabilities 2005 2,615 1,376,984 % change +49% 25 +34% Medicaid aged/disabled waiver participants 2000 1,629 448,167 2005 2,590 582,342 % change +59% 17 +30% Medicare home health visits per user 2001 33 14 31 2006 30 18 35 % change -11% 40 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 6,796 1,428,117 2007 7,063 1,440,358 % change +4% 14 +1% Nursing facility beds 2002 7,485 1,671,744 2007 7,877 1,699,494 % change +5% 16 +2% Nursing facility occupancy rate 2002 91% 11 85% 2007 90% 13 85% change -1% 24 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,030 $243,497 2007 $1,193 $311,848 % change +16% 38 +28% Medicaid LTC spending for older people and adults 2002 $259 $54,261 with physical disabilities (millions) 2007 $364 $64,168 % change +41% 9 +18% Medicaid HCBS spending for older people and adults 2002 $24 $10,204 with physical disabilities (millions) 2007 $46 $17,188 % change +95% 22 +68% Medicaid nursing facility spending (millions) 2002 $235 $44,057 2007 $318 $46,980 % change +35% 5 +7% Medicaid HCBS spending for older people and adults 2002 9% 35 19% with physical disabilities, as a percentage of total 2007 13% 38 27% LTC spending change +4% 29 +8% 215 AARP Public Policy Institute New Jersey % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 8,686 11 301,621 2030 9,802 13 363,584 % change +13% 24 +21% Age 50-64 2007 1,589 18.3% 26 17.8% 2030 1,711 17.5% 13 16.5% % change +8% 17 +12% Age 65+ 2007 1,135 13.1% 22 12.6% 2030 1,960 20.0% 29 19.7% % change +73% 30 +89% Age 65-74 2007 569 6.5% 25 6.4% 2030 Blue line = 50-64 1,027 10.5% 28 10.4% % change Purple line = 65-74 +81% 29 +96% Yellow line = 75-84 Age 75-84 2007 397 4.6% Red line = 85+ 17 4.3% 2030 641 6.5% 32 6.6% % change +62% 33 +84% Age 85+ 2007 169 1.9% 21 1.8% 2030 291 3.0% 17 2.6% % change +72% 25 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in New Jersey as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 21.9% 14 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% State Rank U.S. 85+ 200% 4.5% 7 3.6% Black 170% 65-74 State Rank U.S. 140% 10.0% 14 8.7% 50-64 Hispanic 110% State Rank U.S. 75-84 80% 7.7% 9 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 216 Population & Characteristics New Jersey Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 33% 33 33% Non-metropolitan population age 65+, 2007/2008 0% 45 20% Bachelor level education or higher age 65+, 2007 21% 17 19% Persons age 60+ raising grandchildren, 2007 1.2% 33 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $37,507 9 $32,158 At/below poverty level age 65+, 2007 8.4% 29 9.5% At/below 200% of poverty level age 65+, 2007 26% 44 32% At/below 300% of poverty level age 65+, 2007 43% 45 51% Women age 75+ at/below poverty level, 2007 12% 28 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 136 13% 50 16% Physical disability 298 27% 42 31% Mobility disability 185 17% 20 18% Self-care disability 112 10% 19 10% Cognitive/mental disability 108 10% 34 12% Any disability (one or more of the five 384 35% 49 41%   listed above) Cognitive/mental disability + any other disability 98 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 455 8% 51 11% Cognitive/mental disability + any other disability 126 2.3% 49 3.2% Persons age 65+ with Alzheimer’s disease, 2010 150 12% 39 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 980 34,000 Economic value of family caregiving (millions), 2007 $11,800 $375,000 Economic value per hour, 2007 $11.16 11 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.4 31 3.7 long-term care spending, 2007 217 Long-Term Care Financing New Jersey Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $8,879 11 $311,848 Medicaid home and community-based services (HCBS) spending 20% 28 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in New Jersey and the U.S., 2007 New Jersey United States 6% 10% 14% 17% 80% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $2,226 $256 15 $213 adults with physical disabilities, 2007 Nursing facilities $1,780 $205 12 $156 HCBS $445 $51 20 $57 Personal care services (PCS) ** $319 $37 13 $34 Aged/disabled waiver services $126 $15 39 $21 Medicaid LTC expenditures for all populations, 2007 $3,393 $391 15 $323 Institutional services $2,409 $277 10 $196 HCBS $985 $113 31 $127 Waiver services (all populations) $666 $77 37 $91 Medicaid home health expenditures * $27 $3 39 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $36,112 4 $26,096 Medicaid HCBS expenditures for older people and adults with $12,118 10 $9,459 physical disabilities per person served, 2005 Personal care services ** $12,894 7 $9,666 Aged/disabled waiver services $9,775 21 $9,176 HCBS waiver services (all populations) $26,068 19 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 218 Federal/State/Personal Contributions State Rank U.S. New Jersey Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $35 43 $50 State-funded HCBS for older people (millions), 2007 $20.8 13 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.7% 22 8.4% Medicare home health visits per user, 2006 24 35 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 38,243 4.4 36 6.3 Personal care services ** 20,884 2.4 18 2.7 HCBS waiver services 17,359 2.0 46 3.6 Aged/disabled waiver services 6,915 0.8 44 2.0 Medicaid aged/disabled waiver participants per 15 40 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 2,966 0.34 22 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 10,219 1.2 30 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 45,860 8 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.0 24 3.8 Nursing facility residents per 100 age 75+, 2007 8.1 28 7.8 Total nursing facility stays, 2006 114,190 8 3,176,119 Residents with Medicaid as primary payer, 2007 63% 26 64% Residents with Medicare as primary payer, 2007 17% 3 14% Residents with “other” as primary payer, 2007 20% 33 22% Residents with dementia, 2007 42% 40 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $187 9 $158 Medicare payment per day for nursing facility care, 2006 $370 3 $305 Average private pay rate per day in nursing facility, 2008 $276 6 $209 Average private pay rate per month in assisted living, 2008 $4,682 1 $3,008 Medicare reimbursement per home health visit, 2006 $154 13 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $32 26 $38 Average private pay daily rate for adult day care, 2008 $81 3 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 219 Long-Term Care Resources New Jersey Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 50 0.04 23 0.22 Adult day facilities, 2001-02 114 0.10 22 0.09 Assisted living and residential care facilities, 2007 222 0.2 48 1.0 Assisted living and residential care units, 2007 17,761 16 37 26 Personal and home care aides, 2007 9,380 8 41 16 Median hourly wage, 2007 $10.89 4 $8.89 Home health aides, 2007 20,020 18 22 22 Median hourly wage, 2007 $10.91 8 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 367 0.32 39 0.43 Nursing facility beds, 2007 51,401 45 27 45 Nursing facility occupancy rate, 2007 89% 18 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.6 34 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 16% 22 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 3,881 11 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 94% 25 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 400 $400 80% $356 72% 300 $300 60% Millions of Dollars 48% $215 200 $200 40% 36% $165 33% 25% $100 $80 20% 100 $41 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 220 Trends New Jersey Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 26,410 1,026,374 adults with physical disabilities 2005 27,799 1,376,984 % change +5% 46 +34% Medicaid aged/disabled waiver participants 2000 5,818 448,167 2005 6,915 582,342 % change +19% 34 +30% Medicare home health visits per user 2001 27 24 31 2006 24 35 35 % change -10% 39 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 43,601 1,428,117 2007 45,860 1,440,358 % change +5% 12 +1% Nursing facility beds 2002 50,062 1,671,744 2007 51,401 1,699,494 % change +3% 21 +2% Nursing facility occupancy rate 2002 87% 26 85% 2007 89% 18 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $7,737 $243,497 2007 $8,879 $311,848 % change +15% 41 +28% Medicaid LTC spending for older people and adults 2002 $1,749 $54,261 with physical disabilities (millions) 2007 $2,226 $64,168 % change +27% 24 +18% Medicaid HCBS spending for older people and adults 2002 $324 $10,204 with physical disabilities (millions) 2007 $445 $17,188 % change +37% 44 +68% Medicaid nursing facility spending (millions) 2002 $1,424 $44,057 2007 $1,780 $46,980 % change +25% 16 +7% Medicaid HCBS spending for older people and adults 2002 19% 17 19% with physical disabilities, as a percentage of total 2007 20% 28 27% LTC spending change +1% 45 +8% 221 AARP Public Policy Institute New Mexico % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 1,970 36 301,621 2030 2,100 36 363,584 % change +7% 35 +21% Age 50-64 2007 352 17.9% 37 17.8% 2030 360 17.2% 17 16.5% % change +2% 23 +12% Age 65+ 2007 250 12.7% 30 12.6% 2030 555 26.4% 4 19.7% % change +122% 5 +89% Age 65-74 2007 132 6.7% 18 6.4% 2030 Blue line = 50-64 284 13.5% 2 10.4% % change Purple line = 65-74 +116% 7 +96% Yellow line = 75-84 Age 75-84 2007 85 4.3% Red line = 85+ 28 4.3% 2030 196 9.3% 3 6.6% % change +131% 5 +84% Age 85+ 2007 34 1.7% 33 1.8% 2030 76 3.6% 4 2.6% % change +123% 5 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in New Mexico as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 380% 39.4% 3 19.3% Population (% of 2000 Census) Asian/Pacific Islander 330% State Rank U.S. 85+ 280% 1.1% 26 3.6% 230% 65-74 Black State Rank U.S. 75-84 180% 1.7% 38 8.7% 50-64 Hispanic 130% State Rank U.S. 80% 31.4% 1 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 222 Population & Characteristics New Mex ic o Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 57 6 48 Persons age 75+ living alone, 2007 31% 42 33% Non-metropolitan population age 65+, 2007/2008 37% 20 20% Bachelor level education or higher age 65+, 2007 22% 13 19% Persons age 60+ raising grandchildren, 2007 2.0% 14 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $30,441 32 $32,158 At/below poverty level age 65+, 2007 13.3% 3 9.5% At/below 200% of poverty level age 65+, 2007 37% 10 32% At/below 300% of poverty level age 65+, 2007 56% 11 51% Women age 75+ at/below poverty level, 2007 17% 6 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 51 21% 4 16% Physical disability 88 36% 8 31% Mobility disability 49 20% 7 18% Self-care disability 32 13% 4 10% Cognitive/mental disability 36 15% 6 12% Any disability (one or more of the five 113 46% 9 41%   listed above) Cognitive/mental disability + any other disability 31 13% 8 11% Persons age 18-64 with disabilities, 2007 Any disability 158 13% 11 11% Cognitive/mental disability + any other disability 43 3.6% 16 3.2% Persons age 65+ with Alzheimer’s disease, 2010 31 11% 46 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 210 34,000 Economic value of family caregiving (millions), 2007 $2,100 $375,000 Economic value per hour, 2007 $9.36 39 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.0 37 3.7 long-term care spending, 2007 223 Long-Term Care Financing New Mexico Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $2,609 33 $311,848 Medicaid home and community-based services (HCBS) spending 61% 1 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in New Mexico and the U.S., 2007 New Mexico United States 14% 10% 39% 17% 47% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $441 $224 20 $213 adults with physical disabilities, 2007 Nursing facilities $174 $88 45 $156 HCBS $268 $136 4 $57 Personal care services (PCS) ** $206 $105 3 $34 Aged/disabled waiver services $61 $31 18 $21 Medicaid LTC expenditures for all populations, 2007 $717 $364 19 $323 Institutional services $195 $99 46 $196 HCBS $522 $265 5 $127 Waiver services (all populations) $316 $160 10 $91 Medicaid home health expenditures * $1 $0 48 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $27,170 18 $26,096 Medicaid HCBS expenditures for older people and adults with $16,632 3 $9,459 physical disabilities per person served, 2005 Personal care services ** $15,657 5 $9,666 Aged/disabled waiver services $20,472 1 $9,176 HCBS waiver services (all populations) $45,135 3 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 224 Federal/State/Personal Contributions State Rank U.S. New Mex ic o Federal Medical Assistance Percentage (FMAP), 2007 71.9% 4 Medicaid personal needs allowance (per month), 2007 *** $58 12 $50 State-funded HCBS for older people (millions), 2007 $24.0 12 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 6.6% 34 8.4% Medicare home health visits per user, 2006 32 14 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 15,630 8.2 15 6.3 Personal care services ** 9,614 5 7 2.7 HCBS waiver services 6,016 3.1 32 3.6 Aged/disabled waiver services 2,442 1.3 35 2.0 Medicaid aged/disabled waiver participants per 34 26 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 254 0.13 33 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 431 0.2 50 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 5,981 40 1,440,358 Nursing facility residents per 100 age 65+, 2007 2.4 44 3.8 Nursing facility residents per 100 age 75+, 2007 5.0 44 7.8 Total nursing facility stays, 2006 13,198 40 3,176,119 Residents with Medicaid as primary payer, 2007 64% 24 64% Residents with Medicare as primary payer, 2007 11% 37 14% Residents with “other” as primary payer, 2007 25% 18 22% Residents with dementia, 2007 45% 30 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $152 24 $158 Medicare payment per day for nursing facility care, 2006 $279 38 $305 Average private pay rate per day in nursing facility, 2008 $162 35 $209 Average private pay rate per month in assisted living, 2008 $2,981 22 $3,008 Medicare reimbursement per home health visit, 2006 $135 30 $134 Average private pay hourly rate for home health aide, 2008 $18 33 $19 Medicare-certified home health aide, 2008 $28 36 $38 Average private pay daily rate for adult day care, 2008 $23 50 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 225 Long-Term Care Resources New Mexico Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 66 0.26 23 0.22 Adult day facilities, 2001-02 18 0.07 29 0.09 Assisted living and residential care facilities, 2007 284 1.1 18 1.0 Assisted living and residential care units, 2007 NA NA NA 26 Personal and home care aides, 2007 10,140 41 4 16 Median hourly wage, 2007 $8.86 32 $8.89 Home health aides, 2007 6,650 27 6 22 Median hourly wage, 2007 $9.03 39 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 72 0.29 44 0.43 Nursing facility beds, 2007 6,808 27 45 45 Nursing facility occupancy rate, 2007 88% 20 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.4 46 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 27% 10 18% residents, 2007 Residents with physical restraints (%), 2007 6% 13 6% Long-term care facility beds per FTE ombudsman, 2006 1,489 32 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 120 $120 150% 100 130% $100 $97 $89 80 Millions of Dollars $80 100% 89% 60 $60 55% 40 $40 $35 50% $20 20 12% $2 $5 3% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 226 Trends New Mex ic o Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 2,234 1,026,374 adults with physical disabilities 2005 12,056 1,376,984 % change +440% 1 +34% Medicaid aged/disabled waiver participants 2000 1,351 448,167 2005 2,442 582,342 % change +81% 10 +30% Medicare home health visits per user 2001 27 24 31 2006 32 14 35 % change +18% 6 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 5,948 1,428,117 2007 5,981 1,440,358 % change +1% 25 +1% Nursing facility beds 2002 7,051 1,671,744 2007 6,808 1,699,494 % change -3% 36 +2% Nursing facility occupancy rate 2002 84% 36 85% 2007 88% 20 85% change +3% 1 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,744 $243,497 2007 $2,609 $311,848 % change +50% 8 +28% Medicaid LTC spending for older people and adults 2002 $305 $54,261 with physical disabilities (millions) 2007 $441 $64,168 % change +45% 7 +18% Medicaid HCBS spending for older people and adults 2002 $136 $10,204 with physical disabilities (millions) 2007 $268 $17,188 % change +97% 20 +68% Medicaid nursing facility spending (millions) 2002 $169 $44,057 2007 $174 $46,980 % change +3% 33 +7% Medicaid HCBS spending for older people and adults 2002 45% 2 19% with physical disabilities, as a percentage of total 2007 61% 1 27% LTC spending change +16% 5 +8% 227 AARP Public Policy Institute New York % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 19,298 3 301,621 2030 19,477 4 363,584 % change +1% 44 +21% Age 50-64 2007 3,498 18.1% 33 17.8% 2030 3,246 16.7% 28 16.5% % change -7% 40 +12% Age 65+ 2007 2,546 13.2% 21 12.6% 2030 3,917 20.1% 28 19.7% % change +54% 46 +89% Age 65-74 2007 1,282 6.6% 22 6.4% 2030 Blue line = 50-64 2,003 10.3% 31 10.4% % change Purple line = 65-74 +56% 49 +96% Yellow line = 75-84 Age 75-84 2007 880 4.6% Red line = 85+ 17 4.3% 2030 1,292 6.6% 26 6.6% % change +47% 49 +84% Age 85+ 2007 385 2.0% 16 1.8% 2030 622 3.2% 13 2.6% % change +62% 29 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in New York as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 25.5% 10 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% State Rank U.S. 200% 4.9% 6 3.6% 85+ Black 170% 65-74 State Rank U.S. 140% 12.8% 10 8.7% 50-64 Hispanic 110% State Rank U.S. 75-84 80% 9.0% 7 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 228 Population & Characteristics New York Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 10% 39 20% Bachelor level education or higher age 65+, 2007 21% 17 19% Persons age 60+ raising grandchildren, 2007 1.4% 26 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $31,734 23 $32,158 At/below poverty level age 65+, 2007 11.7% 13 9.5% At/below 200% of poverty level age 65+, 2007 33% 21 32% At/below 300% of poverty level age 65+, 2007 51% 29 51% Women age 75+ at/below poverty level, 2007 15% 16 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 365 15% 34 16% Physical disability 738 30% 24 31% Mobility disability 455 19% 10 18% Self-care disability 271 11% 13 10% Cognitive/mental disability 297 12% 21 12% Any disability (one or more of the five 954 39% 27 41%   listed above) Cognitive/mental disability + any other disability 268 11% 20 11% Persons age 18-64 with disabilities, 2007 Any disability 1,265 10% 34 11% Cognitive/mental disability + any other disability 340 2.8% 33 3.2% Persons age 65+ with Alzheimer’s disease, 2010 320 12% 39 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 2,200 34,000 Economic value of family caregiving (millions), 2007 $25,000 $375,000 Economic value per hour, 2007 $10.61 18 $10.10 Ratio of the economic value of family caregiving to Medicaid 1.4 51 3.7 long-term care spending, 2007 229 Long-Term Care Financing New York Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $41,397 1 $311,848 Medicaid home and community-based services (HCBS) spending 29% 16 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in New York and the U.S., 2007 New York United States <0.5% 10% 28% 17% 71% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $9,480 $491 1 $213 adults with physical disabilities, 2007 Nursing facilities $6,750 $350 2 $156 HCBS $2,729 $141 3 $57 Personal care services (PCS) ** $2,690 $139 1 $34 Aged/disabled waiver services $39 $2 50 $21 Medicaid LTC expenditures for all populations, 2007 $16,340 $847 1 $323 Institutional services $9,466 $491 1 $196 HCBS $6,874 $356 1 $127 Waiver services (all populations) $4,185 $217 4 $91 Medicaid home health expenditures * $1,640 $85 1 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $32,134 9 $26,096 Medicaid HCBS expenditures for older people and adults with $19,551 1 $9,459 physical disabilities per person served, 2005 Personal care services ** $24,268 1 $9,666 Aged/disabled waiver services $1,326 50 $9,176 HCBS waiver services (all populations) $45,129 4 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 230 Federal/State/Personal Contributions State Rank U.S. New York Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $95.3 4 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 8.2% 17 8.4% Medicare home health visits per user, 2006 35 11 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 162,387 8.4 13 6.3 Personal care services ** 84,270 4.4 8 2.7 HCBS waiver services 78,117 4.1 26 3.6 Aged/disabled waiver services 21,809 1.1 37 2.0 Medicaid aged/disabled waiver participants per 11 46 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 3,335 0.17 30 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 109,244 5.7 8 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 111,313 1 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.4 18 3.8 Nursing facility residents per 100 age 75+, 2007 8.8 21 7.8 Total nursing facility stays, 2006 224,233 2 3,176,119 Residents with Medicaid as primary payer, 2007 72% 6 64% Residents with Medicare as primary payer, 2007 13% 27 14% Residents with “other” as primary payer, 2007 15% 45 22% Residents with dementia, 2007 46% 25 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $210 4 $158 Medicare payment per day for nursing facility care, 2006 $307 26 $305 Average private pay rate per day in nursing facility, 2008 $319 3 $209 Average private pay rate per month in assisted living, 2008 $3,295 11 $3,008 Medicare reimbursement per home health visit, 2006 $120 44 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $30 31 $38 Average private pay daily rate for adult day care, 2008 $72 7 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 231 Long-Term Care Resources New York Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 178 0.07 23 0.22 Adult day facilities, 2001-02 175 0.07 29 0.09 Assisted living and residential care facilities, 2007 500 0.2 48 1.0 Assisted living and residential care units, 2007 39,170 15 38 26 Personal and home care aides, 2007 54,160 21 11 16 Median hourly wage, 2007 $10.39 8 $8.89 Home health aides, 2007 145,490 57 2 22 Median hourly wage, 2007 $10.04 22 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 654 0.26 47 0.43 Nursing facility beds, 2007 120,629 47 24 45 Nursing facility occupancy rate, 2007 92% 4 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.6 34 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 18% 19 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 3,077 15 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 33% 48 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 2000 $2,000 80% $1,755 73% 1500 $1,500 60% Millions of Dollars 1000 $1,000 40% 36% $713 25% 500 $500 20% $243 10% $8 $0 0% 0 -2% -$125 -$500 -20% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -500 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. S 232 Trends New York Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 109,071 1,026,374 adults with physical disabilities 2005 106,079 1,376,984 % change -3% 47 +34% Medicaid aged/disabled waiver participants 2000 20,283 448,167 2005 21,809 582,342 % change +8% 40 +30% Medicare home health visits per user 2001 33 14 31 2006 35 11 35 % change +5% 14 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 105,315 1,428,117 2007 111,313 1,440,358 % change +6% 10 +1% Nursing facility beds 2002 113,116 1,671,744 2007 120,629 1,699,494 % change +7% 9 +2% Nursing facility occupancy rate 2002 93% 3 85% 2007 92% 4 85% change -1% 24 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $36,047 $243,497 2007 $41,397 $311,848 % change +15% 41 +28% Medicaid LTC spending for older people and adults 2002 $8,883 $54,261 with physical disabilities (millions) 2007 $9,480 $64,168 % change +7% 41 +18% Medicaid HCBS spending for older people and adults 2002 $2,008 $10,204 with physical disabilities (millions) 2007 $2,729 $17,188 % change +36% 46 +68% Medicaid nursing facility spending (millions) 2002 $6,875 $44,057 2007 $6,750 $46,980 % change -2% 38 +7% Medicaid HCBS spending for older people and adults 2002 23% 14 19% with physical disabilities, as a percentage of total 2007 29% 16 27% LTC spending change +6% 21 +8% 233 AARP Public Policy Institute North Carolina % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 9,061 10 301,621 2030 12,228 7 363,584 % change +35% 5 +21% Age 50-64 2007 1,648 18.2% 29 17.8% 2030 2,092 17.1% 19 16.5% % change +27% 7 +12% Age 65+ 2007 1,103 12.2% 35 12.6% 2030 2,173 17.8% 43 19.7% % change +97% 18 +89% Age 65-74 2007 592 6.5% 25 6.4% 2030 Blue line = 50-64 1,199 9.8% 38 10.4% % change Purple line = 65-74 +103% 13 +96% Yellow line = 75-84 Age 75-84 2007 369 4.1% Red line = 85+ 35 4.3% 2030 707 5.8% 44 6.6% % change +92% 20 +84% Age 85+ 2007 143 1.6% 38 1.8% 2030 267 2.2% 45 2.6% % change +87% 20 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in North Carolina as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 19.0% 19 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 240% 85+ 1.0% 28 3.6% Black 200% State Rank U.S. 160% 50-64 15.8% 8 8.7% 65-74 Hispanic 120% 75-84 State Rank U.S. 80% 1.3% 32 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 234 Population & Characteristics Nor th Carolina Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 44% 12 20% Bachelor level education or higher age 65+, 2007 18% 31 19% Persons age 60+ raising grandchildren, 2007 1.9% 15 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $28,535 41 $32,158 At/below poverty level age 65+, 2007 11.0% 15 9.5% At/below 200% of poverty level age 65+, 2007 37% 10 32% At/below 300% of poverty level age 65+, 2007 55% 14 51% Women age 75+ at/below poverty level, 2007 16% 11 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 182 17% 18 16% Physical disability 359 34% 13 31% Mobility disability 190 18% 16 18% Self-care disability 114 11% 13 10% Cognitive/mental disability 148 14% 11 12% Any disability (one or more of the five 458 43% 13 41%   listed above) Cognitive/mental disability + any other disability 135 13% 8 11% Persons age 18-64 with disabilities, 2007 Any disability 752 13% 11 11% Cognitive/mental disability + any other disability 202 3.6% 16 3.2% Persons age 65+ with Alzheimer’s disease, 2010 170 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 1,110 34,000 Economic value of family caregiving (millions), 2007 $11,600 $375,000 Economic value per hour, 2007 $9.63 35 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.0 20 3.7 long-term care spending, 2007 235 Long-Term Care Financing North Carolina Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $9,744 9 $311,848 Medicaid home and community-based services (HCBS) spending 39% 9 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in North Carolina and the U.S., 2007 North Carolina United States 14% 10% 17% 24% 61% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,839 $203 25 $213 adults with physical disabilities, 2007 Nursing facilities $1,126 $124 36 $156 HCBS $713 $79 10 $57 Personal care services (PCS) ** $449 $50 8 $34 Aged/disabled waiver services $264 $29 21 $21 Medicaid LTC expenditures for all populations, 2007 $2,769 $306 27 $323 Institutional services $1,595 $176 28 $196 HCBS $1,175 $130 20 $127 Waiver services (all populations) $725 $80 35 $91 Medicaid home health expenditures * $126 $14 9 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $25,887 28 $26,096 Medicaid HCBS expenditures for older people and adults with $8,205 26 $9,459 physical disabilities per person served, 2005 Personal care services ** $5,641 18 $9,666 Aged/disabled waiver services $17,696 4 $9,176 HCBS waiver services (all populations) $25,472 20 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 236 Federal/State/Personal Contributions State Rank U.S. Nor th Carolina Federal Medical Assistance Percentage (FMAP), 2007 64.5% 16 Medicaid personal needs allowance (per month), 2007 *** $30 46 $50 State-funded HCBS for older people (millions), 2007 $34.2 9 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.7% 22 8.4% Medicare home health visits per user, 2006 24 35 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 72,221 8.3 14 6.3 Personal care services ** 50,818 5.9 4 2.7 HCBS waiver services 21,403 2.5 41 3.6 Aged/disabled waiver services 13,729 1.6 30 2.0 Medicaid aged/disabled waiver participants per 32 28 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 20,442 2.26 3 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 38,668 4.5 10 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 38,282 13 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.5 34 3.8 Nursing facility residents per 100 age 75+, 2007 7.5 33 7.8 Total nursing facility stays, 2006 85,873 11 3,176,119 Residents with Medicaid as primary payer, 2007 67% 11 64% Residents with Medicare as primary payer, 2007 16% 7 14% Residents with “other” as primary payer, 2007 17% 44 22% Residents with dementia, 2007 46% 25 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $135 37 $158 Medicare payment per day for nursing facility care, 2006 $273 40 $305 Average private pay rate per day in nursing facility, 2008 $184 28 $209 Average private pay rate per month in assisted living, 2008 $2,730 32 $3,008 Medicare reimbursement per home health visit, 2006 $153 14 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $39 19 $38 Average private pay daily rate for adult day care, 2008 $45 42 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 237 Long-Term Care Resources North Carolina Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 165 0.15 23 0.22 Adult day facilities, 2001-02 107 0.10 22 0.09 Assisted living and residential care facilities, 2007 1,307 1.2 15 1.0 Assisted living and residential care units, 2007 41,642 38 9 26 Personal and home care aides, 2007 17,170 16 19 16 Median hourly wage, 2007 $8.64 37 $8.89 Home health aides, 2007 73,770 67 1 22 Median hourly wage, 2007 $9.18 36 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 425 0.39 31 0.43 Nursing facility beds, 2007 43,580 39 36 45 Nursing facility occupancy rate, 2007 88% 20 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.7 26 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 10% 42 18% residents, 2007 Residents with physical restraints (%), 2007 7% 7 6% Long-term care facility beds per FTE ombudsman, 2006 2,935 16 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 250 $250 80% $232 200 68% 67% $200 $173 $180 60% Millions of Dollars 150 $150 40% 100 $100 29% 26% $53 $59 20% $50 13% 50 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 238 Trends Nor th Carolina Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 22,663 1,026,374 adults with physical disabilities 2005 64,547 1,376,984 % change +185% 8 +34% Medicaid aged/disabled waiver participants 2000 11,427 448,167 2005 13,729 582,342 % change +20% 32 +30% Medicare home health visits per user 2001 26 31 31 2006 24 35 35 % change -7% 37 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 37,213 1,428,117 2007 38,282 1,440,358 % change +3% 18 +1% Nursing facility beds 2002 41,299 1,671,744 2007 43,580 1,699,494 % change +6% 15 +2% Nursing facility occupancy rate 2002 90% 18 85% 2007 88% 20 85% change -2% 30 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $6,803 $243,497 2007 $9,744 $311,848 % change +43% 12 +28% Medicaid LTC spending for older people and adults 2002 $1,368 $54,261 with physical disabilities (millions) 2007 $1,839 $64,168 % change +34% 15 +18% Medicaid HCBS spending for older people and adults 2002 $474 $10,204 with physical disabilities (millions) 2007 $713 $17,188 % change +50% 36 +68% Medicaid nursing facility spending (millions) 2002 $894 $44,057 2007 $1,126 $46,980 % change +26% 13 +7% Medicaid HCBS spending for older people and adults 2002 35% 6 19% with physical disabilities, as a percentage of total 2007 39% 9 27% LTC spending change +4% 29 +8% 239 AARP Public Policy Institute North Dakota % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 640 48 301,621 2030 607 49 363,584 % change -5% 50 +21% Age 50-64 2007 117 18.3% 26 17.8% 2030 101 16.7% 28 16.5% % change -13% 49 +12% Age 65+ 2007 93 14.6% 6 12.6% 2030 152 25.1% 6 19.7% % change +63% 39 +89% Age 65-74 2007 43 6.7% 18 6.4% 2030 Blue line = 50-64 76 12.5% 8 10.4% % change Purple line = 65-74 +77% 32 +96% Yellow line = 75-84 Age 75-84 2007 33 5.2% Red line = 85+ 5 4.3% 2030 54 8.8% 6 6.6% % change +62% 33 +84% Age 85+ 2007 17 2.7% 1 1.8% 2030 23 3.8% 1 2.6% % change +34% 50 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in North Dakota as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 3.0% 47 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% State Rank U.S. 65-74 160% 0.3% 50 3.6% 85+ Black 140% 50-64 State Rank U.S. 120% 0.1% 51 8.7% Hispanic 100% 75-84 State Rank U.S. 80% 0.4% 51 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 240 Population & Characteristics Nor th Dakota Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 49 14 48 Persons age 75+ living alone, 2007 38% 4 33% Non-metropolitan population age 65+, 2007/2008 66% 4 20% Bachelor level education or higher age 65+, 2007 11% 51 19% Persons age 60+ raising grandchildren, 2007 0.9% 42 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $25,658 50 $32,158 At/below poverty level age 65+, 2007 12.6% 6 9.5% At/below 200% of poverty level age 65+, 2007 41% 2 32% At/below 300% of poverty level age 65+, 2007 60% 4 51% Women age 75+ at/below poverty level, 2007 20% 1 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 15 17% 18 16% Physical disability 25 30% 24 31% Mobility disability 11 13% 48 18% Self-care disability 5 6% 51 10% Cognitive/mental disability 7 9% 45 12% Any disability (one or more of the five 34 40% 23 41%   listed above) Cognitive/mental disability + any other disability 6 7% 49 11% Persons age 18-64 with disabilities, 2007 Any disability 37 9% 46 11% Cognitive/mental disability + any other disability 11 2.6% 37 3.2% Persons age 65+ with Alzheimer’s disease, 2010 18 19% 1 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 56 34,000 Economic value of family caregiving (millions), 2007 $580 $375,000 Economic value per hour, 2007 $9.74 33 $10.10 Ratio of the economic value of family caregiving to Medicaid 1.9 49 3.7 long-term care spending, 2007 241 Long-Term Care Financing North Dakota Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $515 50 $311,848 Medicaid home and community-based services (HCBS) spending 5% 48 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in North Dakota and the U.S., 2007 North Dakota United States 1% 4% 10% 17% 95% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $178 $279 10 $213 adults with physical disabilities, 2007 Nursing facilities $168 $263 6 $156 HCBS $10 $15 47 $57 Personal care services (PCS) ** $7 $11 25 $34 Aged/disabled waiver services $3 $4 45 $21 Medicaid LTC expenditures for all populations, 2007 $311 $486 9 $323 Institutional services $233 $363 4 $196 HCBS $79 $123 24 $127 Waiver services (all populations) $72 $112 22 $91 Medicaid home health expenditures * $1 $2 40 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $31,253 10 $26,096 Medicaid HCBS expenditures for older people and adults with $5,341 43 $9,459 physical disabilities per person served, 2005 Personal care services ** $3,902 26 $9,666 Aged/disabled waiver services $9,286 23 $9,176 HCBS waiver services (all populations) $17,997 32 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 242 Federal/State/Personal Contributions State Rank U.S. Nor th Dakota Federal Medical Assistance Percentage (FMAP), 2007 64.7% 15 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $7.3 25 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 4.9% 43 8.4% Medicare home health visits per user, 2006 19 48 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 4,990 7.8 16 6.3 Personal care services ** 1,362 2.1 19 2.7 HCBS waiver services 3,628 5.7 11 3.6 Aged/disabled waiver services 497 0.8 44 2.0 Medicaid aged/disabled waiver participants per 9 48 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 521 0.8 39 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 5,926 41 1,440,358 Nursing facility residents per 100 age 65+, 2007 6.4 1 3.8 Nursing facility residents per 100 age 75+, 2007 11.7 1 7.8 Total nursing facility stays, 2006 10,710 45 3,176,119 Residents with Medicaid as primary payer, 2007 55% 47 64% Residents with Medicare as primary payer, 2007 8% 49 14% Residents with “other” as primary payer, 2007 37% 3 22% Residents with dementia, 2007 52% 6 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $160 21 $158 Medicare payment per day for nursing facility care, 2006 $294 34 $305 Average private pay rate per day in nursing facility, 2008 $139 47 $209 Average private pay rate per month in assisted living, 2008 $2,236 48 $3,008 Medicare reimbursement per home health visit, 2006 $124 41 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $29 33 $38 Average private pay daily rate for adult day care, 2008 $73 5 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 243 Long-Term Care Resources North Dakota Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 26 0.28 23 0.22 Adult day facilities, 2001-02 22 0.24 2 0.09 Assisted living and residential care facilities, 2007 111 1.2 15 1.0 Assisted living and residential care units, 2007 3,472 37 11 26 Personal and home care aides, 2007 1,690 18 16 16 Median hourly wage, 2007 $9.24 23 $8.89 Home health aides, 2007 1,890 20 18 22 Median hourly wage, 2007 $9.74 26 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 83 0.89 5 0.43 Nursing facility beds, 2007 6,430 69 2 45 Nursing facility occupancy rate, 2007 92% 4 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4.2 5 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 11% 39 18% residents, 2007 Residents with physical restraints (%), 2007 2% 44 6% Long-term care facility beds per FTE ombudsman, 2006 2,104 25 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 80% 34 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 25 $25 60% 20 47% $20 40% 15 No spending $22 in 2002 Millions of Dollars $15 20% 17% 10 $10 $9 0% $7 5 $5 -4% -20% 0 0 -$2 -40% -$5 -5 -$6 -49% -$10 -60% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -10 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 244 Trends Nor th Dakota Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 380 1,026,374 adults with physical disabilities 2005 1,859 1,376,984 % change +389% 2 +34% Medicaid aged/disabled waiver participants 2000 380 448,167 2005 497 582,342 % change +31% 26 +30% Medicare home health visits per user 2001 23 41 31 2006 19 48 35 % change -19% 50 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 6,277 1,428,117 2007 5,926 1,440,358 % change -6% 41 +1% Nursing facility beds 2002 6,681 1,671,744 2007 6,430 1,699,494 % change -4% 37 +2% Nursing facility occupancy rate 2002 94% 2 85% 2007 92% 4 85% change -2% 30 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $469 $243,497 2007 $515 $311,848 % change +10% 49 +28% Medicaid LTC spending for older people and adults 2002 $180 $54,261 with physical disabilities (millions) 2007 $178 $64,168 % change -1% 47 +18% Medicaid HCBS spending for older people and adults 2002 $5 $10,204 with physical disabilities (millions) 2007 $10 $17,188 % change +92% 23 +68% Medicaid nursing facility spending (millions) 2002 $175 $44,057 2007 $168 $46,980 % change -4% 41 +7% Medicaid HCBS spending for older people and adults 2002 3% 46 19% with physical disabilities, as a percentage of total 2007 5% 48 27% LTC spending change +3% 35 +8% 245 AARP Public Policy Institute Ohio % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 11,467 7 301,621 2030 11,551 9 363,584 % change +1% 45 +21% Age 50-64 2007 2,143 18.7% 12 17.8% 2030 1,950 16.9% 25 16.5% % change -9% 44 +12% Age 65+ 2007 1,545 13.5% 14 12.6% 2030 2,357 20.4% 24 19.7% % change +53% 47 +89% Age 65-74 2007 781 6.8% 15 6.4% 2030 Blue line = 50-64 1,225 10.6% 27 10.4% % change Purple line = 65-74 +57% 48 +96% Yellow line = 75-84 Age 75-84 2007 542 4.7% Red line = 85+ 10 4.3% 2030 809 7.0% 22 6.6% % change +49% 47 +84% Age 85+ 2007 222 75-84 1.9% 85+ 21 1.8% 50-64 65-74 2030 322 2.8% 22 2.6% % change +45% 41 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Ohio as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 10.7% 29 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 85+ State Rank U.S. 160% 0.9% 32 3.6% 65-74 Black 140% State Rank U.S. 120% 8.6% 18 8.7% 50-64 Hispanic 100% State Rank U.S. 75-84 80% 0.9% 39 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 246 Population & Characteristics Population Characteristics State Rank U.S. Ohio Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 36% 10 33% Non-metropolitan population age 65+, 2007/2008 24% 31 20% Bachelor level education or higher age 65+, 2007 15% 39 19% Persons age 60+ raising grandchildren, 2007 1.4% 26 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $30,117 34 $32,158 At/below poverty level age 65+, 2007 8.2% 33 9.5% At/below 200% of poverty level age 65+, 2007 32% 25 32% At/below 300% of poverty level age 65+, 2007 54% 19 51% Women age 75+ at/below poverty level, 2007 11% 35 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 224 15% 34 16% Physical disability 438 30% 24 31% Mobility disability 241 16% 27 18% Self-care disability 142 10% 19 10% Cognitive/mental disability 166 11% 27 12% Any disability (one or more of the five 576 39% 27 41%   listed above) Cognitive/mental disability + any other disability 149 10% 27 11% Persons age 18-64 with disabilities, 2007 Any disability 903 13% 11 11% Cognitive/mental disability + any other disability 262 3.7% 14 3.2% Persons age 65+ with Alzheimer’s disease, 2010 230 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 1,320 34,000 Economic value of family caregiving (millions), 2007 $14,200 $375,000 Economic value per hour, 2007 $9.92 27 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.0 37 3.7 long-term care spending, 2007 247 Long-Term Care Financing Ohio Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $13,007 6 $311,848 Medicaid home and community-based services (HCBS) spending 17% 33 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Ohio and the U.S., 2007 Ohio United States 17% 10% 17% 83% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $3,188 $278 11 $213 adults with physical disabilities, 2007 Nursing facilities $2,643 $230 11 $156 HCBS $545 $48 23 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $545 $48 8 $21 Medicaid LTC expenditures for all populations, 2007 $4,625 $403 13 $323 Institutional services $3,338 $291 7 $196 HCBS $1,286 $112 32 $127 Waiver services (all populations) $1,286 $112 22 $91 Medicaid home health expenditures * $150 $13 11 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $26,836 21 $26,096 Medicaid HCBS expenditures for older people and adults with $11,332 12 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $11,332 14 $9,176 HCBS waiver services (all populations) $18,108 31 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 248 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 59.7% 27 Medicaid personal needs allowance (per month), 2007 *** $40 35 $50 Ohio State-funded HCBS for older people (millions), 2007 $14.7 17 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.8% 21 8.4% Medicare home health visits per user, 2006 28 22 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 52,110 4.5 35 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 52,110 4.5 22 3.6 Aged/disabled waiver services 38,013 3.3 12 2.0 Medicaid aged/disabled waiver participants per 38 22 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 235 0.02 38 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 84,374 7.4 3 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 82,702 4 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.4 8 3.8 Nursing facility residents per 100 age 75+, 2007 10.8 6 7.8 Total nursing facility stays, 2006 185,482 4 3,176,119 Residents with Medicaid as primary payer, 2007 63% 26 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 23% 23 22% Residents with dementia, 2007 48% 18 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $201 7 $158 Medicare payment per day for nursing facility care, 2006 $296 33 $305 Average private pay rate per day in nursing facility, 2008 $191 24 $209 Average private pay rate per month in assisted living, 2008 $2,932 23 $3,008 Medicare reimbursement per home health visit, 2006 $131 37 $134 Average private pay hourly rate for home health aide, 2008 $18 33 $19 Medicare-certified home health aide, 2008 $18 51 $38 Average private pay daily rate for adult day care, 2008 $47 40 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 249 Long-Term Care Resources Ohio Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 409 0.26 23 0.22 Adult day facilities, 2001-02 106 0.07 29 0.09 Assisted living and residential care facilities, 2007 1,205 0.8 23 1.0 Assisted living and residential care units, 2007 44,005 28 23 26 Personal and home care aides, 2007 13,780 9 39 16 Median hourly wage, 2007 $9.15 26 $8.89 Home health aides, 2007 48,350 31 4 22 Median hourly wage, 2007 $9.39 32 $9.62 Medicaid aged/disabled waiver waiting list, 2007 2,107 8 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 983 0.64 10 0.43 Nursing facility beds, 2007 94,459 61 12 45 Nursing facility occupancy rate, 2007 88% 20 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.8 19 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 15% 28 18% residents, 2007 Residents with physical restraints (%), 2007 6% 13 6% Long-term care facility beds per FTE ombudsman, 2006 1,718 28 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 51% 44 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 600 $600 250% $503 400 211% 200% $400 Millions of Dollars 200 $203 150% $200 $143 100% NA 0 $0 59% 50% -$200 6% NA-200 0% -$267 -28% $-400 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -400 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 250 Trends Home & Community-Based Services Year State Rank U.S. Ohio Medicaid HCBS participants, older people and 2000 29,225 1,026,374 adults with physical disabilities 2005 38,013 1,376,984 % change +30% 33 +34% Medicaid aged/disabled waiver participants 2000 29,225 448,167 2005 38,013 582,342 % change +30% 28 +30% Medicare home health visits per user 2001 27 24 31 2006 28 22 35 % change +6% 12 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 79,273 1,428,117 2007 82,702 1,440,358 % change +4% 14 +1% Nursing facility beds 2002 92,014 1,671,744 2007 94,459 1,699,494 % change +3% 21 +2% Nursing facility occupancy rate 2002 86% 30 85% 2007 88% 20 85% change +1% 15 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $9,802 $243,497 2007 $13,007 $311,848 % change +33% 22 +28% Medicaid LTC spending for older people and adults 2002 $2,842 $54,261 with physical disabilities (millions) 2007 $3,188 $64,168 % change +12% 35 +18% Medicaid HCBS spending for older people and adults 2002 $342 $10,204 with physical disabilities (millions) 2007 $545 $17,188 % change +59% 32 +68% Medicaid nursing facility spending (millions) 2002 $2,500 $44,057 2007 $2,643 $46,980 % change +6% 30 +7% Medicaid HCBS spending for older people and adults 2002 12% 27 19% with physical disabilities, as a percentage of total 2007 17% 33 27% LTC spending change +5% 26 +8% 251 AARP Public Policy Institute Oklahoma % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 3,617 28 301,621 2030 3,913 29 363,584 % change +8% 31 +21% Age 50-64 2007 645 17.8% 39 17.8% 2030 632 16.2% 38 16.5% % change -2% 33 +12% Age 65+ 2007 480 13.3% 18 12.6% 2030 758 19.4% 33 19.7% % change +58% 43 +89% Age 65-74 2007 251 6.9% 13 6.4% 2030 Blue line = 50-64 403 10.3% 31 10.4% % change Purple line = 65-74 +61% 44 +96% Yellow line = 75-84 Age 75-84 2007 161 4.5% Red line = 85+ 22 4.3% 2030 255 6.5% 32 6.6% % change +58% 41 +84% Age 85+ 2007 68 1.9% 21 1.8% 2030 100 2.5% 31 2.6% % change +46% 39 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Oklahoma as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 14.6% 23 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% State Rank U.S. 160% 1.0% 28 3.6% 65-74 85+ Black 140% State Rank U.S. 120% 4.7% 27 8.7% 50-64 75-84 Hispanic 100% State Rank U.S. 80% 1.9% 27 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 252 Population & Characteristics Oklahoma Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 46 20 48 Persons age 75+ living alone, 2007 36% 10 33% Non-metropolitan population age 65+, 2007/2008 41% 17 20% Bachelor level education or higher age 65+, 2007 17% 33 19% Persons age 60+ raising grandchildren, 2007 2.2% 9 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $29,327 37 $32,158 At/below poverty level age 65+, 2007 10.1% 17 9.5% At/below 200% of poverty level age 65+, 2007 36% 12 32% At/below 300% of poverty level age 65+, 2007 55% 14 51% Women age 75+ at/below poverty level, 2007 14% 19 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 89 19% 10 16% Physical disability 167 37% 6 31% Mobility disability 80 18% 16 18% Self-care disability 49 11% 13 10% Cognitive/mental disability 63 14% 11 12% Any disability (one or more of the five 212 47% 7 41%   listed above) Cognitive/mental disability + any other disability 54 12% 13 11% Persons age 18-64 with disabilities, 2007 Any disability 341 16% 6 11% Cognitive/mental disability + any other disability 99 4.5% 8 3.2% Persons age 65+ with Alzheimer’s disease, 2010 74 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 380 34,000 Economic value of family caregiving (millions), 2007 $3,700 $375,000 Economic value per hour, 2007 $9.15 42 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.4 31 3.7 long-term care spending, 2007 253 Long-Term Care Financing Oklahoma Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $3,361 27 $311,848 Medicaid home and community-based services (HCBS) spending 27% 18 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Oklahoma and the U.S., 2007 Oklahoma United States 10% 25% 17% 2% 73% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $691 $191 31 $213 adults with physical disabilities, 2007 Nursing facilities $506 $140 30 $156 HCBS $186 $51 20 $57 Personal care services (PCS) ** $11 $3 30 $34 Aged/disabled waiver services $175 $48 8 $21 Medicaid LTC expenditures for all populations, 2007 $1,082 $299 29 $323 Institutional services $633 $175 29 $196 HCBS $449 $124 23 $127 Waiver services (all populations) $439 $121 17 $91 Medicaid home health expenditures * $18 $5 28 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $19,911 47 $26,096 Medicaid HCBS expenditures for older people and adults with $5,943 39 $9,459 physical disabilities per person served, 2005 Personal care services ** $4,702 20 $9,666 Aged/disabled waiver services $6,484 35 $9,176 HCBS waiver services (all populations) $15,287 37 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 254 Federal/State/Personal Contributions State Rank U.S. Oklahoma Federal Medical Assistance Percentage (FMAP), 2007 68.1% 13 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $3.3 40 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 10.7% 5 8.4% Medicare home health visits per user, 2006 55 2 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 27,621 7.8 16 6.3 Personal care services ** 7,000 2 21 2.7 HCBS waiver services 20,621 5.8 10 3.6 Aged/disabled waiver services 16,048 4.5 6 2.0 Medicaid aged/disabled waiver participants per 72 9 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 5,129 1.5 25 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 21,113 25 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.4 18 3.8 Nursing facility residents per 100 age 75+, 2007 9.2 18 7.8 Total nursing facility stays, 2006 37,458 28 3,176,119 Residents with Medicaid as primary payer, 2007 66% 14 64% Residents with Medicare as primary payer, 2007 12% 33 14% Residents with “other” as primary payer, 2007 23% 23 22% Residents with dementia, 2007 42% 40 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $117 44 $158 Medicare payment per day for nursing facility care, 2006 $262 48 $305 Average private pay rate per day in nursing facility, 2008 $141 46 $209 Average private pay rate per month in assisted living, 2008 $2,138 50 $3,008 Medicare reimbursement per home health visit, 2006 $109 48 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $41 16 $38 Average private pay daily rate for adult day care, 2008 $48 38 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 255 Long-Term Care Resources Oklahoma Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 210 0.44 23 0.22 Adult day facilities, 2001-02 25 0.05 38 0.09 Assisted living and residential care facilities, 2007 206 0.4 40 1.0 Assisted living and residential care units, 2007 9,302 19 34 26 Personal and home care aides, 2007 9,610 20 12 16 Median hourly wage, 2007 $8.10 43 $8.89 Home health aides, 2007 7,850 16 31 22 Median hourly wage, 2007 $8.78 43 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 356 0.74 6 0.43 Nursing facility beds, 2007 31,740 66 5 45 Nursing facility occupancy rate, 2007 67% 49 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.6 34 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 20% 16 18% residents, 2007 Residents with physical restraints (%), 2007 11% 2 6% Long-term care facility beds per FTE ombudsman, 2006 1,472 33 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 150 $150 300% $126 254% 100 $100 200% Millions of Dollars $52 50 $50 $39 100% $15 13% 17% 12% $0 0% 0 -$33 -76% -$50 -100% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -50 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 256 Trends Oklahoma Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 16,515 1,026,374 adults with physical disabilities 2005 23,048 1,376,984 % change +40% 28 +34% Medicaid aged/disabled waiver participants 2000 9,042 448,167 2005 16,048 582,342 % change +77% 12 +30% Medicare home health visits per user 2001 49 2 31 2006 55 2 35 % change +14% 7 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 20,895 1,428,117 2007 21,113 1,440,358 % change +1% 25 +1% Nursing facility beds 2002 30,099 1,671,744 2007 31,740 1,699,494 % change +5% 16 +2% Nursing facility occupancy rate 2002 69% 51 85% 2007 67% 49 85% change -3% 38 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $2,297 $243,497 2007 $3,361 $311,848 % change +46% 10 +28% Medicaid LTC spending for older people and adults 2002 $547 $54,261 with physical disabilities (millions) 2007 $691 $64,168 % change +26% 26 +18% Medicaid HCBS spending for older people and adults 2002 $93 $10,204 with physical disabilities (millions) 2007 $186 $17,188 % change +99% 19 +68% Medicaid nursing facility spending (millions) 2002 $454 $44,057 2007 $506 $46,980 % change +12% 27 +7% Medicaid HCBS spending for older people and adults 2002 17% 21 19% with physical disabilities, as a percentage of total 2007 27% 18 27% LTC spending change +10% 14 +8% 257 AARP Public Policy Institute Oregon % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 3,747 27 301,621 2030 4,834 25 363,584 % change +29% 9 +21% Age 50-64 2007 740 19.7% 7 17.8% 2030 814 16.8% 27 16.5% % change +10% 16 +12% Age 65+ 2007 489 13.0% 24 12.6% 2030 882 18.2% 39 19.7% % change +80% 25 +89% Age 65-74 2007 249 6.7% 18 6.4% 2030 Blue line = 50-64 444 9.2% 44 10.4% % change Purple line = 65-74 +78% 31 +96% Yellow line = 75-84 Age 75-84 2007 166 4.4% Red line = 85+ 26 4.3% 2030 316 6.5% 32 6.6% % change +90% 22 +84% Age 85+ 2007 73 2.0% 16 1.8% 2030 122 2.5% 31 2.6% % change +66% 27 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Oregon as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 7.2% 37 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% State Rank U.S. 65-74 200% 2.6% 11 3.6% 85+ Black 170% State Rank U.S. 50-64 140% 1.0% 40 8.7% 75-84 Hispanic 110% State Rank U.S. 80% 2.4% 21 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 258 Population & Characteristics Oregon Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 54 9 48 Persons age 75+ living alone, 2007 35% 16 33% Non-metropolitan population age 65+, 2007/2008 33% 22 20% Bachelor level education or higher age 65+, 2007 22% 13 19% Persons age 60+ raising grandchildren, 2007 1.0% 39 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $33,565 16 $32,158 At/below poverty level age 65+, 2007 8.4% 29 9.5% At/below 200% of poverty level age 65+, 2007 31% 29 32% At/below 300% of poverty level age 65+, 2007 50% 32 51% Women age 75+ at/below poverty level, 2007 12% 28 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 84 18% 13 16% Physical disability 151 32% 16 31% Mobility disability 81 17% 20 18% Self-care disability 50 11% 13 10% Cognitive/mental disability 66 14% 11 12% Any disability (one or more of the five 200 42% 16 41%   listed above) Cognitive/mental disability + any other disability 58 12% 13 11% Persons age 18-64 with disabilities, 2007 Any disability 301 13% 11 11% Cognitive/mental disability + any other disability 86 3.6% 16 3.2% Persons age 65+ with Alzheimer’s disease, 2010 76 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 410 34,000 Economic value of family caregiving (millions), 2007 $4,800 $375,000 Economic value per hour, 2007 $10.91 15 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.5 14 3.7 long-term care spending, 2007 259 Long-Term Care Financing Oregon Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $2,907 31 $311,848 Medicaid home and community-based services (HCBS) spending 56% 2 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Oregon and the U.S., 2007 Oregon United States 10% 41% 17% 44% 73% 15% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $671 $179 35 $213 adults with physical disabilities, 2007 Nursing facilities $292 $78 48 $156 HCBS $379 $101 8 $57 Personal care services (PCS) ** $81 $22 22 $34 Aged/disabled waiver services $275 $73 2 $21 Medicaid LTC expenditures for all populations, 2007 $1,070 $286 33 $323 Institutional services $292 $78 49 $196 HCBS $778 $208 8 $127 Waiver services (all populations) $674 $180 8 $91 Medicaid home health expenditures * $0 $0 48 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $23,713 36 $26,096 Medicaid HCBS expenditures for older people and adults with $7,572 30 $9,459 physical disabilities per person served, 2005 Personal care services ** $1,110 29 $9,666 Aged/disabled waiver services $8,736 24 $9,176 HCBS waiver services (all populations) $15,561 35 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 260 Federal/State/Personal Contributions State Rank U.S. Oregon Federal Medical Assistance Percentage (FMAP), 2007 61.1% 24 Medicaid personal needs allowance (per month), 2007 *** $30 46 $50 State-funded HCBS for older people (millions), 2007 $6.0 30 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 6.2% 36 8.4% Medicare home health visits per user, 2006 18 50 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 42,377 11.7 2 6.3 Personal care services ** 5,086 1.4 24 2.7 HCBS waiver services 37,291 10.3 1 3.6 Aged/disabled waiver services 28,222 7.8 1 2.0 Medicaid aged/disabled waiver participants per 279 1 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 5,983 1.60 4 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 2,245 0.6 44 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 8,208 35 1,440,358 Nursing facility residents per 100 age 65+, 2007 1.7 48 3.8 Nursing facility residents per 100 age 75+, 2007 3.4 49 7.8 Total nursing facility stays, 2006 26,786 33 3,176,119 Residents with Medicaid as primary payer, 2007 61% 32 64% Residents with Medicare as primary payer, 2007 13% 27 14% Residents with “other” as primary payer, 2007 26% 13 22% Residents with dementia, 2007 45% 30 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $173 13 $158 Medicare payment per day for nursing facility care, 2006 $360 4 $305 Average private pay rate per day in nursing facility, 2008 $207 20 $209 Average private pay rate per month in assisted living, 2008 $3,114 18 $3,008 Medicare reimbursement per home health visit, 2006 $179 4 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $46 12 $38 Average private pay daily rate for adult day care, 2008 $83 2 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 261 Long-Term Care Resources Oregon Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 61 0.12 23 0.22 Adult day facilities, 2001-02 20 0.04 43 0.09 Assisted living and residential care facilities, 2007 429 0.9 20 1.0 Assisted living and residential care units, 2007 22,130 45 1 26 Personal and home care aides, 2007 6,130 13 26 16 Median hourly wage, 2007 $9.96 14 $8.89 Home health aides, 2007 9,770 20 18 22 Median hourly wage, 2007 $9.51 31 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 140 0.29 44 0.43 Nursing facility beds, 2007 12,625 26 46 45 Nursing facility occupancy rate, 2007 65% 50 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.9 14 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 16% 22 18% residents, 2007 Residents with physical restraints (%), 2007 4% 28 6% Long-term care facility beds per FTE ombudsman, 2006 6,958 3 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 72% 37 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 150 $150 300% 100 $114 198% 200% $100 Millions of Dollars $69 100% $56 50 $50 $126 40% 24% 18% 0% $0 0 -100% -$11 -100% -$50 -200% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -50 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 262 Trends Oregon Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 31,275 1,026,374 adults with physical disabilities 2005 33,308 1,376,984 % change +7% 45 +34% Medicaid aged/disabled waiver participants 2000 29,205 448,167 2005 28,222 582,342 % change -3% 45 +30% Medicare home health visits per user 2001 18 51 31 2006 18 50 35 % change +3% 16 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 7,910 1,428,117 2007 8,208 1,440,358 % change +4% 14 +1% Nursing facility beds 2002 11,228 1,671,744 2007 12,625 1,699,494 % change +12% 4 +2% Nursing facility occupancy rate 2002 70% 50 85% 2007 65% 50 85% change -5% 44 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $2,590 $243,497 2007 $2,907 $311,848 % change +12% 45 +28% Medicaid LTC spending for older people and adults 2002 $504 $54,261 with physical disabilities (millions) 2007 $671 $64,168 % change +33% 16 +18% Medicaid HCBS spending for older people and adults 2002 $268 $10,204 with physical disabilities (millions) 2007 $379 $17,188 % change +41% 42 +68% Medicaid nursing facility spending (millions) 2002 $236 $44,057 2007 $292 $46,980 % change +24% 20 +7% Medicaid HCBS spending for older people and adults 2002 53% 1 19% with physical disabilities, as a percentage of total 2007 56% 2 27% LTC spending change +3% 35 +8% 263 AARP Public Policy Institute Pennsylvania % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 12,433 6 301,621 2030 12,768 6 363,584 % change +3% 42 +21% Age 50-64 2007 2,384 19.2% 8 17.8% 2030 2,190 17.2% 17 16.5% % change -8% 41 +12% Age 65+ 2007 1,890 15.2% 3 12.6% 2030 2,890 22.6% 11 19.7% % change +53% 47 +89% Age 65-74 2007 896 7.2% 5 6.4% 2030 Blue line = 50-64 1,485 11.6% 12 10.4% % change Purple line = 65-74 +66% 41 +96% Yellow line = 75-84 Age 75-84 2007 692 5.6% Red line = 85+ 2 4.3% 2030 989 7.7% 11 6.6% % change +43% 50 +84% Age 85+ 2007 302 2.4% 5 1.8% 2030 415 3.3% 10 2.6% % change +37% 48 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Pennsylvania as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 9.4% 31 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% State Rank U.S. 85+ 160% 1.2% 24 3.6% 65-74 Black 140% State Rank U.S. 120% 6.8% 21 8.7% 50-64 Hispanic 100% State Rank U.S. 75-84 80% 1.3% 32 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 264 Population & Characteristics Pennsylvania Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 20% 32 20% Bachelor level education or higher age 65+, 2007 15% 39 19% Persons age 60+ raising grandchildren, 2007 1.0% 39 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $28,937 40 $32,158 At/below poverty level age 65+, 2007 8.7% 25 9.5% At/below 200% of poverty level age 65+, 2007 34% 18 32% At/below 300% of poverty level age 65+, 2007 56% 11 51% Women age 75+ at/below poverty level, 2007 12% 28 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 266 15% 34 16% Physical disability 514 29% 30 31% Mobility disability 292 16% 27 18% Self-care disability 162 9% 30 10% Cognitive/mental disability 182 10% 34 12% Any disability (one or more of the five 688 39% 27 41%   listed above) Cognitive/mental disability + any other disability 163 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 931 12% 20 11% Cognitive/mental disability + any other disability 262 3.4% 20 3.2% Persons age 65+ with Alzheimer’s disease, 2010 280 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 1,390 34,000 Economic value of family caregiving (millions), 2007 $15,600 $375,000 Economic value per hour, 2007 $10.39 23 $10.10 Ratio of the economic value of family caregiving to Medicaid 2.5 46 3.7 long-term care spending, 2007 265 Long-Term Care Financing Pennsylvania Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $15,856 4 $311,848 Medicaid home and community-based services (HCBS) spending 11% 39 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Pennsylvania and the U.S., 2007 Pennsylvania United States 11% 10% 17% 89% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $4,322 $348 5 $213 adults with physical disabilities, 2007 Nursing facilities $3,868 $311 3 $156 HCBS $454 $37 26 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $454 $37 11 $21 Medicaid LTC expenditures for all populations, 2007 $6,065 $488 8 $323 Institutional services $4,426 $356 5 $196 HCBS $1,639 $132 19 $127 Waiver services (all populations) $1,639 $132 14 $91 Medicaid home health expenditures * $109 $9 19 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $29,431 12 $26,096 Medicaid HCBS expenditures for older people and adults with $13,468 6 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $13,468 10 $9,176 HCBS waiver services (all populations) $29,201 13 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 266 Federal/State/Personal Contributions State Rank U.S. Pennsylvania Federal Medical Assistance Percentage (FMAP), 2007 54.4% 34 Medicaid personal needs allowance (per month), 2007 *** $45 30 $50 State-funded HCBS for older people (millions), 2007 $182.2 1 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 9.4% 11 8.4% Medicare home health visits per user, 2006 24 35 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 46,247 3.7 39 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 46,247 3.7 28 3.6 Aged/disabled waiver services 20,131 1.6 30 2.0 Medicaid aged/disabled waiver participants per 21 36 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 9,359 0.8 39 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 80,792 5 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.3 20 3.8 Nursing facility residents per 100 age 75+, 2007 8.1 28 7.8 Total nursing facility stays, 2006 178,338 6 3,176,119 Residents with Medicaid as primary payer, 2007 63% 26 64% Residents with Medicare as primary payer, 2007 12% 33 14% Residents with “other” as primary payer, 2007 25% 18 22% Residents with dementia, 2007 47% 20 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $185 11 $158 Medicare payment per day for nursing facility care, 2006 $287 35 $305 Average private pay rate per day in nursing facility, 2008 $247 9 $209 Average private pay rate per month in assisted living, 2008 $3,186 14 $3,008 Medicare reimbursement per home health visit, 2006 $143 23 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $28 36 $38 Average private pay daily rate for adult day care, 2008 $63 16 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 267 Long-Term Care Resources Pennsylvania Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 275 0.15 23 0.22 Adult day facilities, 2001-02 208 0.11 21 0.09 Assisted living and residential care facilities, 2007 1,550 0.8 23 1.0 Assisted living and residential care units, 2007 71,831 38 9 26 Personal and home care aides, 2007 20,650 11 32 16 Median hourly wage, 2007 $9.37 22 $8.89 Home health aides, 2007 50,690 27 6 22 Median hourly wage, 2007 $9.60 27 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 728 0.39 31 0.43 Nursing facility beds, 2007 88,736 47 24 45 Nursing facility occupancy rate, 2007 91% 10 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.9 14 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 11% 39 18% residents, 2007 Residents with physical restraints (%), 2007 4% 28 6% Long-term care facility beds per FTE ombudsman, 2006 2,446 23 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 94% 25 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 400 $400 300% 300 $320 250% 240% $300 $277 Millions of Dollars 200% 200 $200 150% 100% 100 $100 -$51 50% 31% NA 10% $0 NA 0 0% -2% $-100 -$65 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -100 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 268 Trends Pennsylvania Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 6,740 1,026,374 adults with physical disabilities 2005 20,131 1,376,984 % change +199% 4 +34% Medicaid aged/disabled waiver participants 2000 6,740 448,167 2005 20,131 582,342 % change +199% 4 +30% Medicare home health visits per user 2001 25 37 31 2006 24 35 35 % change -4% 29 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 80,395 1,428,117 2007 80,792 1,440,358 % change +0% 28 +1% Nursing facility beds 2002 89,924 1,671,744 2007 88,736 1,699,494 % change -1% 32 +2% Nursing facility occupancy rate 2002 89% 22 85% 2007 91% 10 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $12,134 $243,497 2007 $15,856 $311,848 % change +31% 25 +28% Medicaid LTC spending for older people and adults 2002 $4,067 $54,261 with physical disabilities (millions) 2007 $4,322 $64,168 % change +6% 43 +18% Medicaid HCBS spending for older people and adults 2002 $134 $10,204 with physical disabilities (millions) 2007 $454 $17,188 % change +240% 4 +68% Medicaid nursing facility spending (millions) 2002 $3,933 $44,057 2007 $3,868 $46,980 % change -2% 38 +7% Medicaid HCBS spending for older people and adults 2002 3% 46 19% with physical disabilities, as a percentage of total 2007 11% 39 27% LTC spending change +7% 17 +8% 269 AARP Public Policy Institute Puerto Rico Puerto % of Total Population (thousands) Year Rico Population U.S. All ages 2007 3,942 301,621 2030 363,584 % change +21% Age 50-64 2007 678 17.2% 17.8% 2030 16.5% % change +12% Age 65+ 2007 523 13.3% 12.6% 2030 19.7% % change +89% Age 65-74 2007 295 7.5% 6.4% 2030 10.4% % change +96% Age 75-84 2007 165 4.2% 4.3% 2030 6.6% % change +84% Age 85+ 2007 63 1.6% 1.8% 2030 2.6% % change +74% Race & Ethnicity, Age 65+ Older People of Color (%), 2007 Population of Puerto Rico, by Age, 2007 State U.S. 99.0% 19.3% 17.2% Asian/Pacific Islander State U.S. 7.5% 4.2% 0.2% 3.6% 1.6% Black 69.6% State U.S. 6.8% 8.7% Percentages may not add to 100% due to rounding <50 50-64 65-74 75-84 85+ Hispanic State U.S. 98.7% 6.6% Note: U.S. totals do not include Puerto Rico and the Virgin Islands. 270 Population & Characteristics Puerto Puerto Population Characteristics Rico U.S. Men per 100 women age 85+, 2007 57 48 Persons age 75+ living alone, 2007 24% 33% Non-metropolitan population age 65+, 2007/2008 NA 20% Bachelor level education or higher age 65+, 2007 10% 19% Persons age 60+ raising grandchildren, 2007 3.0% 1.6% Ric o Puerto Income & Poverty Rico U.S. Median household income age 65+, 2007 $13,039 $32,158 At/below poverty level age 65+, 2007 44% 9.5% At/below 200% of poverty level age 65+, 2007 76% 32% At/below 300% of poverty level age 65+, 2007 88% 51% Women age 75+ at/below poverty level, 2007 48% 13% Number Disability Rates (1,000s) Percent U.S. Persons age 65+ with disabilities, 2007 Sensory disability 143 28% 16% Physical disability 245 48% 31% Mobility disability 195 38% 18% Self-care disability 91 18% 10% Cognitive/mental disability 127 25% 12% Any disability (one or more of the five 315 61% 41%   listed above) Cognitive/mental disability + any other disability 121 23% 11% Persons age 18-64 with disabilities, 2007 Any disability 516 22% 11% Cognitive/mental disability + any other disability 170 7.1% 3.2% Persons age 65+ with Alzheimer’s disease, 2010 NA NA 13% (projected) Puerto Per 1,000 HCBS Resources Rico Age 65+ U.S. Medicare-certified home health agencies, 2006 49 0.09 0.22 271 AARP Public Policy Institute Rhode Island % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 1,058 43 301,621 2030 1,153 43 363,584 % change +9% 29 +21% Age 50-64 2007 196 18.5% 19 17.8% 2030 196 17.0% 23 16.5% % change +0% 28 +12% Age 65+ 2007 147 13.9% 10 12.6% 2030 247 21.4% 17 19.7% % change +68% 32 +89% Age 65-74 2007 68 6.4% 32 6.4% 2030 Blue line = 50-64 127 11.0% 20 10.4% % change Purple line = 65-74 +86% 23 +96% Yellow line = 75-84 Age 75-84 2007 53 5.0% Red line = 85+ 8 4.3% 2030 83 7.2% 16 6.6% % change +55% 44 +84% Age 85+ 2007 25 2.4% 5 1.8% 2030 37 3.2% 13 2.6% % change +46% 39 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Rhode Island as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 7.6% 36 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 65-74 State Rank U.S. 160% 1.4% 21 3.6% 85+ Black 140% 50-64 State Rank U.S. 120% 3.0% 30 8.7% Hispanic 100% State Rank U.S. 75-84 80% 3.3% 15 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 272 Population & Characteristics Rhode Island Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 42 48 48 Persons age 75+ living alone, 2007 35% 16 33% Non-metropolitan population age 65+, 2007/2008 0% 45 20% Bachelor level education or higher age 65+, 2007 19% 24 19% Persons age 60+ raising grandchildren, 2007 0.5% 50 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $28,250 42 $32,158 At/below poverty level age 65+, 2007 9.3% 20 9.5% At/below 200% of poverty level age 65+, 2007 34% 18 32% At/below 300% of poverty level age 65+, 2007 53% 22 51% Women age 75+ at/below poverty level, 2007 11% 35 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 21 16% 25 16% Physical disability 39 28% 35 31% Mobility disability 21 15% 35 18% Self-care disability 13 10% 19 10% Cognitive/mental disability 14 10% 34 12% Any disability (one or more of the five 52 38% 34 41%   listed above) Cognitive/mental disability + any other disability 12 9% 34 11% Persons age 18-64 with disabilities, 2007 Any disability 81 12% 20 11% Cognitive/mental disability + any other disability 22 3.3% 21 3.2% Persons age 65+ with Alzheimer’s disease, 2010 24 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 114 34,000 Economic value of family caregiving (millions), 2007 $1,470 $375,000 Economic value per hour, 2007 $11.94 3 $10.10 Ratio of the economic value of family caregiving to Medicaid 2.6 44 3.7 long-term care spending, 2007 273 Long-Term Care Financing Rhode Island Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,755 37 $311,848 Medicaid home and community-based services (HCBS) spending 11% 39 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Rhode Island and the U.S., 2007 Rhode Island United States 11% 10% 17% 89% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $338 $320 7 $213 adults with physical disabilities, 2007 Nursing facilities $300 $284 5 $156 HCBS $38 $36 28 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $38 $36 12 $21 Medicaid LTC expenditures for all populations, 2007 $560 $530 4 $323 Institutional services $308 $291 7 $196 HCBS $252 $239 7 $127 Waiver services (all populations) $252 $239 3 $91 Medicaid home health expenditures * $5 $5 28 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $46,247 2 $26,096 Medicaid HCBS expenditures for older people and adults with $7,648 29 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $7,648 30 $9,176 HCBS waiver services (all populations) $43,032 5 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 274 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 52.4% 37 Rhode Island Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $3.8 38 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 9.5% 10 8.4% Medicare home health visits per user, 2006 25 30 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 5,568 5.2 30 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 5,568 5.2 16 3.6 Aged/disabled waiver services 2,788 2.6 22 2.0 Medicaid aged/disabled waiver participants per 25 35 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 411 0.39 20 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 1,000 0.9 38 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 8,207 36 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.6 6 3.8 Nursing facility residents per 100 age 75+, 2007 10.4 9 7.8 Total nursing facility stays, 2006 16,826 38 3,176,119 Residents with Medicaid as primary payer, 2007 66% 14 64% Residents with Medicare as primary payer, 2007 9% 46 14% Residents with “other” as primary payer, 2007 26% 13 22% Residents with dementia, 2007 47% 20 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $173 13 $158 Medicare payment per day for nursing facility care, 2006 $327 18 $305 Average private pay rate per day in nursing facility, 2008 $248 8 $209 Average private pay rate per month in assisted living, 2008 $3,136 17 $3,008 Medicare reimbursement per home health visit, 2006 $145 20 $134 Average private pay hourly rate for home health aide, 2008 $22 5 $19 Medicare-certified home health aide, 2008 $22 47 $38 Average private pay daily rate for adult day care, 2008 $64 15 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 275 Long-Term Care Resources Rhode Island Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 22 0.15 23 0.22 Adult day facilities, 2001-02 18 0.12 17 0.09 Assisted living and residential care facilities, 2007 63 0.4 40 1.0 Assisted living and residential care units, 2007 3,574 24 28 26 Personal and home care aides, 2007 1,600 11 32 16 Median hourly wage, 2007 $10.68 6 $8.89 Home health aides, 2007 NA NA NA 22 Median hourly wage, 2007 $11.90 3 $9.62 Medicaid aged/disabled waiver waiting list, 2007 111 16 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 88 0.6 14 0.43 Nursing facility beds, 2007 8,877 60 13 45 Nursing facility occupancy rate, 2007 92% 4 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.5 42 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 4% 51 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 1,153 43 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 56% 43 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 60 $60 $57 80% 50 $50 40 60% 58% Millions of Dollars $40 $38 30 $30 40% 36% 20 $20 $14 20% 14% $10 8% 10 $1 NA NA $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sca 276 Trends Rhode Island Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 2,358 1,026,374 adults with physical disabilities 2005 2,788 1,376,984 % change +18% 37 +34% Medicaid aged/disabled waiver participants 2000 2,358 448,167 2005 2,788 582,342 % change +18% 35 +30% Medicare home health visits per user 2001 29 18 31 2006 25 30 35 % change -15% 45 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 8,704 1,428,117 2007 8,207 1,440,358 % change -6% 41 +1% Nursing facility beds 2002 9,575 1,671,744 2007 8,877 1,699,494 % change -7% 45 +2% Nursing facility occupancy rate 2002 91% 11 85% 2007 92% 4 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,387 $243,497 2007 $1,755 $311,848 % change +27% 28 +28% Medicaid LTC spending for older people and adults 2002 $286 $54,261 with physical disabilities (millions) 2007 $338 $64,168 % change +18% 32 +18% Medicaid HCBS spending for older people and adults 2002 $24 $10,204 with physical disabilities (millions) 2007 $38 $17,188 % change +58% 33 +68% Medicaid nursing facility spending (millions) 2002 $262 $44,057 2007 $300 $46,980 % change +14% 25 +7% Medicaid HCBS spending for older people and adults 2002 8% 36 19% with physical disabilities, as a percentage of total 2007 11% 39 27% LTC spending change +3% 35 +8% 277 AARP Public Policy Institute South Carolina % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 4,408 24 301,621 2030 5,149 23 363,584 % change +17% 20 +21% Age 50-64 2007 834 18.9% 10 17.8% 2030 924 17.9% 9 16.5% % change +11% 12 +12% Age 65+ 2007 573 13.0% 24 12.6% 2030 1,134 22.0% 15 19.7% % change +98% 17 +89% Age 65-74 2007 311 7.1% 8 6.4% 2030 Blue line = 50-64 613 11.9% 11 10.4% % change Purple line = 65-74 +97% 18 +96% Yellow line = 75-84 Age 75-84 2007 189 4.3% Red line = 85+ 28 4.3% 2030 380 7.4% 14 6.6% % change +101% 17 +84% Age 85+ 2007 72 1.6% 38 1.8% 2030 141 2.7% 23 2.6% % change +95% 12 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in South Carolina as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 22.6% 12 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 85+ 240% 0.8% 35 3.6% Black 200% 75-84 State Rank U.S. 65-74 160% 20.5% 5 8.7% 50-64 Hispanic 120% State Rank U.S. 80% 1.1% 36 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 278 Population & Characteristics Sou th Carolina Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 33% 33 33% Non-metropolitan population age 65+, 2007/2008 42% 14 20% Bachelor level education or higher age 65+, 2007 19% 24 19% Persons age 60+ raising grandchildren, 2007 1.8% 17 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $29,791 36 $32,158 At/below poverty level age 65+, 2007 12.0% 9 9.5% At/below 200% of poverty level age 65+, 2007 36% 12 32% At/below 300% of poverty level age 65+, 2007 55% 14 51% Women age 75+ at/below poverty level, 2007 17% 6 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 92 17% 18 16% Physical disability 185 33% 14 31% Mobility disability 103 19% 10 18% Self-care disability 64 12% 7 10% Cognitive/mental disability 76 14% 11 12% Any disability (one or more of the five 239 43% 13 41%   listed above) Cognitive/mental disability + any other disability 69 12% 13 11% Persons age 18-64 with disabilities, 2007 Any disability 365 13% 11 11% Cognitive/mental disability + any other disability 110 4.0% 10 3.2% Persons age 65+ with Alzheimer’s disease, 2010 80 13% 31 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 580 34,000 Economic value of family caregiving (millions), 2007 $5,700 $375,000 Economic value per hour, 2007 $8.99 45 $10.10 Ratio of the economic value of family caregiving to Medicaid 5.7 6 3.7 long-term care spending, 2007 279 Long-Term Care Financing South Carolina Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $4,164 25 $311,848 Medicaid home and community-based services (HCBS) spending 22% 25 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in South Carolina and the U.S., 2007 South Carolina United States 10% 21% 17% 1% 78% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $626 $142 42 $213 adults with physical disabilities, 2007 Nursing facilities $490 $111 38 $156 HCBS $136 $31 34 $57 Personal care services (PCS) ** $7 $2 31 $34 Aged/disabled waiver services $129 $29 21 $21 Medicaid LTC expenditures for all populations, 2007 $981 $223 43 $323 Institutional services $647 $147 39 $196 HCBS $334 $76 41 $127 Waiver services (all populations) $327 $74 38 $91 Medicaid home health expenditures * $10 $2 40 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $28,117 14 $26,096 Medicaid HCBS expenditures for older people and adults with $5,813 40 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $5,813 40 $9,176 HCBS waiver services (all populations) $13,295 42 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 280 Federal/State/Personal Contributions State Rank U.S. Sou th Carolina Federal Medical Assistance Percentage (FMAP), 2007 69.5% 10 Medicaid personal needs allowance (per month), 2007 *** $30 46 $50 State-funded HCBS for older people (millions), 2007 $1.2 46 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.0% 31 8.4% Medicare home health visits per user, 2006 26 27 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 20,341 4.8 34 6.3 Personal care services ** NA NA 2.7 HCBS waiver services 20,341 4.8 19 3.6 Aged/disabled waiver services 13,672 3.2 15 2.0 Medicaid aged/disabled waiver participants per 81 8 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 829 0.19 28 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 11,100 2.6 16 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 16,856 29 1,440,358 Nursing facility residents per 100 age 65+, 2007 2.9 40 3.8 Nursing facility residents per 100 age 75+, 2007 6.4 40 7.8 Total nursing facility stays, 2006 36,282 29 3,176,119 Residents with Medicaid as primary payer, 2007 65% 19 64% Residents with Medicare as primary payer, 2007 16% 7 14% Residents with “other” as primary payer, 2007 19% 35 22% Residents with dementia, 2007 56% 2 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $136 36 $158 Medicare payment per day for nursing facility care, 2006 $270 43 $305 Average private pay rate per day in nursing facility, 2008 $158 39 $209 Average private pay rate per month in assisted living, 2008 $2,669 34 $3,008 Medicare reimbursement per home health visit, 2006 $162 9 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $41 16 $38 Average private pay daily rate for adult day care, 2008 $50 35 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 281 Long-Term Care Resources South Carolina Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 67 0.12 23 0.22 Adult day facilities, 2001-02 83 0.14 12 0.09 Assisted living and residential care facilities, 2007 480 0.8 23 1.0 Assisted living and residential care units, 2007 16,279 28 23 26 Personal and home care aides, 2007 4,380 8 41 16 Median hourly wage, 2007 $8.71 36 $8.89 Home health aides, 2007 10,340 18 22 22 Median hourly wage, 2007 $8.78 43 $9.62 Medicaid aged/disabled waiver waiting list, 2007 4,642 6 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 177 0.31 41 0.43 Nursing facility beds, 2007 18,059 32 42 45 Nursing facility occupancy rate, 2007 93% 3 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.9 14 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 9% 43 18% residents, 2007 Residents with physical restraints (%), 2007 7% 7 6% Long-term care facility beds per FTE ombudsman, 2006 1,258 39 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 150 $150 300% 100 250% 239% $100 $99 Millions of Dollars 200% 150% 50 $50 $34 100% $12 $5 $0 50% 36% 0 25% 7% -$18 0% -10% -$50 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -50 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 282 Trends Sou th Carolina Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 14,522 1,026,374 adults with physical disabilities 2005 13,672 1,376,984 % change -6% 48 +34% Medicaid aged/disabled waiver participants 2000 14,522 448,167 2005 13,672 582,342 % change -6% 47 +30% Medicare home health visits per user 2001 27 24 31 2006 26 27 35 % change -4% 29 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 14,290 1,428,117 2007 16,856 1,440,358 % change +18% 1 +1% Nursing facility beds 2002 15,595 1,671,744 2007 18,059 1,699,494 % change +16% 1 +2% Nursing facility occupancy rate 2002 92% 6 85% 2007 93% 3 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $3,385 $243,497 2007 $4,164 $311,848 % change +23% 31 +28% Medicaid LTC spending for older people and adults 2002 $487 $54,261 with physical disabilities (millions) 2007 $626 $64,168 % change +28% 22 +18% Medicaid HCBS spending for older people and adults 2002 $97 $10,204 with physical disabilities (millions) 2007 $136 $17,188 % change +41% 42 +68% Medicaid nursing facility spending (millions) 2002 $390 $44,057 2007 $490 $46,980 % change +25% 16 +7% Medicaid HCBS spending for older people and adults 2002 20% 16 19% with physical disabilities, as a percentage of total 2007 22% 25 27% LTC spending change +2% 42 +8% 283 AARP Public Policy Institute South Dakota % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 796 46 301,621 2030 800 47 363,584 % change +1% 46 +21% Age 50-64 2007 146 18.4% 20 17.8% 2030 133 16.6% 30 16.5% % change -9% 44 +12% Age 65+ 2007 114 14.3% 7 12.6% 2030 185 23.1% 10 19.7% % change +63% 39 +89% Age 65-74 2007 54 6.7% 18 6.4% 2030 Blue line = 50-64 93 11.6% 12 10.4% % change Purple line = 65-74 +73% 35 +96% Yellow line = 75-84 Age 75-84 2007 40 5.0% Red line = 85+ 8 4.3% 2030 64 8.0% 10 6.6% % change +61% 36 +84% Age 85+ 2007 20 2.5% 4 1.8% 2030 28 3.5% 8 2.6% % change +39% 47 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in South Dakota as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 4.6% 44 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% 65-74 State Rank U.S. 85+ 160% 0.3% 50 3.6% 50-64 Black 140% State Rank U.S. 120% 0.2% 48 8.7% 75-84 Hispanic 100% State Rank U.S. 80% 0.7% 46 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 284 Population & Characteristics Sou th Dakota Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 48 16 48 Persons age 75+ living alone, 2007 39% 2 33% Non-metropolitan population age 65+, 2007/2008 65% 5 20% Bachelor level education or higher age 65+, 2007 17% 33 19% Persons age 60+ raising grandchildren, 2007 1.1% 35 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $28,244 43 $32,158 At/below poverty level age 65+, 2007 11.5% 14 9.5% At/below 200% of poverty level age 65+, 2007 36% 12 32% At/below 300% of poverty level age 65+, 2007 58% 8 51% Women age 75+ at/below poverty level, 2007 19% 2 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 18 17% 18 16% Physical disability 29 27% 42 31% Mobility disability 13 12% 51 18% Self-care disability 7 7% 48 10% Cognitive/mental disability 10 9% 45 12% Any disability (one or more of the five 39 38% 34 41%   listed above) Cognitive/mental disability + any other disability 8 8% 44 11% Persons age 18-64 with disabilities, 2007 Any disability 56 12% 20 11% Cognitive/mental disability + any other disability 18 3.8% 11 3.2% Persons age 65+ with Alzheimer’s disease, 2010 19 17% 2 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 87 34,000 Economic value of family caregiving (millions), 2007 $920 $375,000 Economic value per hour, 2007 $9.87 30 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.6 28 3.7 long-term care spending, 2007 285 Long-Term Care Financing South Dakota Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $620 49 $311,848 Medicaid home and community-based services (HCBS) spending 7% 47 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in South Dakota and the U.S., 2007 South Dakota United States 6% 1% 10% 17% 93% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $146 $184 34 $213 adults with physical disabilities, 2007 Nursing facilities $136 $170 23 $156 HCBS $11 $13 48 $57 Personal care services (PCS) ** $1 $2 31 $34 Aged/disabled waiver services $9 $12 40 $21 Medicaid LTC expenditures for all populations, 2007 $249 $313 26 $323 Institutional services $156 $196 22 $196 HCBS $93 $117 28 $127 Waiver services (all populations) $92 $115 19 $91 Medicaid home health expenditures * $7 $9 19 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $21,627 40 $26,096 Medicaid HCBS expenditures for older people and adults with $3,883 49 $9,459 physical disabilities per person served, 2005 Personal care services ** $1,484 28 $9,666 Aged/disabled waiver services $6,061 39 $9,176 HCBS waiver services (all populations) $20,591 27 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 286 Federal/State/Personal Contributions State Rank U.S. Sou th Dakota Federal Medical Assistance Percentage (FMAP), 2007 62.9% 19 Medicaid personal needs allowance (per month), 2007 *** $60 7 $50 State-funded HCBS for older people (millions), 2007 $6.7 29 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 3.7% 50 8.4% Medicare home health visits per user, 2006 20 47 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 4,426 5.7 23 6.3 Personal care services ** 901 1.2 25 2.7 HCBS waiver services 3,525 4.5 22 3.6 Aged/disabled waiver services 992 1.3 35 2.0 Medicaid aged/disabled waiver participants per 17 37 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 1,098 1.38 7 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 4,729 6.1 5 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 6,553 38 1,440,358 Nursing facility residents per 100 age 65+, 2007 5.8 3 3.8 Nursing facility residents per 100 age 75+, 2007 10.9 5 7.8 Total nursing facility stays, 2006 11,586 44 3,176,119 Residents with Medicaid as primary payer, 2007 57% 45 64% Residents with Medicare as primary payer, 2007 7% 50 14% Residents with “other” as primary payer, 2007 36% 4 22% Residents with dementia, 2007 50% 13 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $120 43 $158 Medicare payment per day for nursing facility care, 2006 $352 5 $305 Average private pay rate per day in nursing facility, 2008 $157 42 $209 Average private pay rate per month in assisted living, 2008 $2,191 49 $3,008 Medicare reimbursement per home health visit, 2006 $149 15 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $21 50 $38 Average private pay daily rate for adult day care, 2008 $15 51 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 287 Long-Term Care Resources South Dakota Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 39 0.34 23 0.22 Adult day facilities, 2001-02 6 0.05 38 0.09 Assisted living and residential care facilities, 2007 157 1.4 12 1.0 Assisted living and residential care units, 2007 3,578 32 17 26 Personal and home care aides, 2007 1,470 13 26 16 Median hourly wage, 2007 $8.72 34 $8.89 Home health aides, 2007 870 8 49 22 Median hourly wage, 2007 $9.85 24 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 110 0.97 3 0.43 Nursing facility beds, 2007 6,553 58 14 45 Nursing facility occupancy rate, 2007 NA NA 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.3 49 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 24% 14 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 3,942 10 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 98% 21 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 25 $25 120% $23 20 100% 100% $20 Millions of Dollars 15 80% $15 60% 10 $10 40% 38% $5 $5 $5 5 20% $2 9% 4% 2% $0 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 288 Trends Sou th Dakota Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 1,713 1,026,374 adults with physical disabilities 2005 1,893 1,376,984 % change +11% 44 +34% Medicaid aged/disabled waiver participants 2000 719 448,167 2005 992 582,342 % change +38% 23 +30% Medicare home health visits per user 2001 21 46 31 2006 20 47 35 % change -2% 24 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 6,750 1,428,117 2007 6,553 1,440,358 % change -3% 34 +1% Nursing facility beds 2002 7,336 1,671,744 2007 6,553 1,699,494 % change -11% 49 +2% Nursing facility occupancy rate 2002 92% 6 85% 2007 NA NA 85% change NA NA -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $554 $243,497 2007 $620 $311,848 % change +12% 45 +28% Medicaid LTC spending for older people and adults 2002 $136 $54,261 with physical disabilities (millions) 2007 $146 $64,168 % change +7% 41 +18% Medicaid HCBS spending for older people and adults 2002 $6 $10,204 with physical disabilities (millions) 2007 $11 $17,188 % change +78% 26 +68% Medicaid nursing facility spending (millions) 2002 $130 $44,057 2007 $136 $46,980 % change +4% 31 +7% Medicaid HCBS spending for older people and adults 2002 4% 45 19% with physical disabilities, as a percentage of total 2007 7% 47 27% LTC spending change +3% 35 +8% 289 AARP Public Policy Institute Tennessee % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 6,157 17 301,621 2030 7,381 15 363,584 % change +20% 17 +21% Age 50-64 2007 1,150 18.7% 12 17.8% 2030 1,245 16.9% 25 16.5% % change +8% 17 +12% Age 65+ 2007 793 12.9% 28 12.6% 2030 1,418 19.2% 34 19.7% % change +79% 26 +89% Age 65-74 2007 429 7.0% 10 6.4% 2030 Blue line = 50-64 761 10.3% 31 10.4% % change Purple line = 65-74 +77% 32 +96% Yellow line = 75-84 Age 75-84 2007 261 4.2% Red line = 85+ 33 4.3% 2030 477 6.5% 32 6.6% % change +82% 25 +84% Age 85+ 2007 102 1.7% 33 1.8% 2030 180 2.4% 40 2.6% % change +76% 24 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Tennessee as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 12.5% 25 19.3% Population (% of 2000 Census) Asian/Pacific Islander 230% State Rank U.S. 85+ 200% 0.7% 37 3.6% 65-74 Black 170% 75-84 State Rank U.S. 140% 10.4% 13 8.7% 50-64 Hispanic 110% State Rank U.S. 80% 0.9% 39 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 290 Population & Characteristics Tennessee Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 43 37 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 27% 27 20% Bachelor level education or higher age 65+, 2007 15% 39 19% Persons age 60+ raising grandchildren, 2007 2.1% 11 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $27,740 44 $32,158 At/below poverty level age 65+, 2007 12.0% 9 9.5% At/below 200% of poverty level age 65+, 2007 38% 9 32% At/below 300% of poverty level age 65+, 2007 57% 9 51% Women age 75+ at/below poverty level, 2007 17% 6 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 144 19% 10 16% Physical disability 266 35% 10 31% Mobility disability 153 20% 7 18% Self-care disability 92 12% 7 10% Cognitive/mental disability 113 15% 6 12% Any disability (one or more of the five 347 46% 9 41%   listed above) Cognitive/mental disability + any other disability 100 13% 8 11% Persons age 18-64 with disabilities, 2007 Any disability 582 15% 8 11% Cognitive/mental disability + any other disability 178 4.6% 6 3.2% Persons age 65+ with Alzheimer’s disease, 2010 120 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 780 34,000 Economic value of family caregiving (millions), 2007 $7,800 $375,000 Economic value per hour, 2007 $9.23 41 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.8 24 3.7 long-term care spending, 2007 291 Long-Term Care Financing Tennessee Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $7,107 13 $311,848 Medicaid home and community-based services (HCBS) spending 1% 51 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Tennessee and the U.S., 2007 Tennessee United States 1% 10% 17% 99% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,199 $195 28 $213 adults with physical disabilities, 2007 Nursing facilities $1,183 $192 13 $156 HCBS $16 $3 50 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $16 $3 47 $21 Medicaid LTC expenditures for all populations, 2007 $2,021 $328 24 $323 Institutional services $1,416 $230 16 $196 HCBS $605 $98 36 $127 Waiver services (all populations) $605 $98 27 $91 Medicaid home health expenditures * $0 $0 48 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $27,582 17 $26,096 Medicaid HCBS expenditures for older people and adults with $5,599 42 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $5,599 44 $9,176 HCBS waiver services (all populations) $57,822 1 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 292 Federal/State/Personal Contributions State Rank U.S. Tennessee Federal Medical Assistance Percentage (FMAP), 2007 63.7% 17 Medicaid personal needs allowance (per month), 2007 *** $40 35 $50 State-funded HCBS for older people (millions), 2007 $5.1 32 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 9.1% 12 8.4% Medicare home health visits per user, 2006 41 6 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 6,485 1.1 51 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 6,485 1.1 51 3.6 Aged/disabled waiver services 964 0.2 50 2.0 Medicaid aged/disabled waiver participants per 3 50 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 0 0.00 40 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 12,539 2.1 22 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 33,059 16 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.2 23 3.8 Nursing facility residents per 100 age 75+, 2007 9.1 19 7.8 Total nursing facility stays, 2006 70,818 15 3,176,119 Residents with Medicaid as primary payer, 2007 66% 14 64% Residents with Medicare as primary payer, 2007 16% 7 14% Residents with “other” as primary payer, 2007 18% 39 22% Residents with dementia, 2007 50% 13 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $142 33 $158 Medicare payment per day for nursing facility care, 2006 $261 49 $305 Average private pay rate per day in nursing facility, 2008 $162 35 $209 Average private pay rate per month in assisted living, 2008 $2,857 24 $3,008 Medicare reimbursement per home health visit, 2006 $134 32 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $42 15 $38 Average private pay daily rate for adult day care, 2008 $48 38 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 293 Long-Term Care Resources Tennessee Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 136 0.17 23 0.22 Adult day facilities, 2001-02 28 0.04 43 0.09 Assisted living and residential care facilities, 2007 328 0.4 40 1.0 Assisted living and residential care units, 2007 16,289 21 33 26 Personal and home care aides, 2007 8,900 11 32 16 Median hourly wage, 2007 $8.63 38 $8.89 Home health aides, 2007 10,720 14 37 22 Median hourly wage, 2007 $9.00 40 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 330 0.42 29 0.43 Nursing facility beds, 2007 37,576 47 24 45 Nursing facility occupancy rate, 2007 88% 20 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.6 34 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 16% 22 18% residents, 2007 Residents with physical restraints (%), 2007 7% 7 6% Long-term care facility beds per FTE ombudsman, 2006 3,466 12 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 81% 33 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 400 $400 200% 300 $327 163% $300 150% 125% Millions of Dollars $246 200 $200 100% 100 $100 50% 26% $10 NA NA 0 $0 0% -$19 -7% $-100 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -100 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 294 Trends Tennessee Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 535 1,026,374 adults with physical disabilities 2005 964 1,376,984 % change +80% 15 +34% Medicaid aged/disabled waiver participants 2000 535 448,167 2005 964 582,342 % change +80% 11 +30% Medicare home health visits per user 2001 39 7 31 2006 41 6 35 % change +5% 14 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 34,981 1,428,117 2007 33,059 1,440,358 % change -5% 38 +1% Nursing facility beds 2002 38,980 1,671,744 2007 37,576 1,699,494 % change -4% 37 +2% Nursing facility occupancy rate 2002 90% 18 85% 2007 88% 20 85% change -2% 30 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $5,804 $243,497 2007 $7,107 $311,848 % change +22% 33 +28% Medicaid LTC spending for older people and adults 2002 $943 $54,261 with physical disabilities (millions) 2007 $1,199 $64,168 % change +27% 24 +18% Medicaid HCBS spending for older people and adults 2002 $6 $10,204 with physical disabilities (millions) 2007 $16 $17,188 % change +163% 5 +68% Medicaid nursing facility spending (millions) 2002 $937 $44,057 2007 $1,183 $46,980 % change +26% 13 +7% Medicaid HCBS spending for older people and adults 2002 1% 51 19% with physical disabilities, as a percentage of total 2007 1% 51 27% LTC spending change +1% 45 +8% 295 AARP Public Policy Institute Texas % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 23,904 2 301,621 2030 33,318 2 363,584 % change +39% 4 +21% Age 50-64 2007 3,787 15.8% 50 17.8% 2030 5,002 15.0% 46 16.5% % change +32% 5 +12% Age 65+ 2007 2,394 10.0% 48 12.6% 2030 5,186 15.6% 48 19.7% % change +117% 6 +89% Age 65-74 2007 1,278 5.3% 49 6.4% 2030 Blue line = 50-64 2,838 8.5% 47 10.4% % change Purple line = 65-74 +122% 4 +96% Yellow line = 75-84 Age 75-84 2007 798 3.3% Red line = 85+ 47 4.3% 2030 1,710 5.1% 48 6.6% % change +114% 11 +84% Age 85+ 2007 318 1.3% 46 1.8% 2030 639 1.9% 48 2.6% % change +101% 9 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Texas as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 31.3% 5 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% 85+ State Rank U.S. 240% 2.4% 13 3.6% 65-74 Black 200% State Rank U.S. 50-64 160% 8.7% 17 8.7% 75-84 Hispanic 120% State Rank U.S. 80% 19.8% 2 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 296 Population & Characteristics Texas Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 48 16 48 Persons age 75+ living alone, 2007 30% 44 33% Non-metropolitan population age 65+, 2007/2008 16% 35 20% Bachelor level education or higher age 65+, 2007 19% 24 19% Persons age 60+ raising grandchildren, 2007 2.6% 4 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $31,918 22 $32,158 At/below poverty level age 65+, 2007 12.0% 9 9.5% At/below 200% of poverty level age 65+, 2007 35% 15 32% At/below 300% of poverty level age 65+, 2007 53% 22 51% Women age 75+ at/below poverty level, 2007 16% 11 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 418 18% 13 16% Physical disability 819 36% 8 31% Mobility disability 471 21% 5 18% Self-care disability 306 13% 4 10% Cognitive/mental disability 333 15% 6 12% Any disability (one or more of the five 1,032 45% 11 41%   listed above) Cognitive/mental disability + any other disability 302 13% 8 11% Persons age 18-64 with disabilities, 2007 Any disability 1,621 11% 27 11% Cognitive/mental disability + any other disability 447 3.1% 28 3.2% Persons age 65+ with Alzheimer’s disease, 2010 340 13% 31 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 2,800 34,000 Economic value of family caregiving (millions), 2007 $26,000 $375,000 Economic value per hour, 2007 $8.76 47 $10.10 Ratio of the economic value of family caregiving to Medicaid 5.3 10 3.7 long-term care spending, 2007 297 Long-Term Care Financing Texas Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $20,615 3 $311,848 Medicaid home and community-based services (HCBS) spending 40% 7 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Texas and the U.S., 2007 Texas United States 15% 10% 17% 25% 60% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $3,160 $132 45 $213 adults with physical disabilities, 2007 Nursing facilities $1,887 $79 47 $156 HCBS $1,273 $53 19 $57 Personal care services (PCS) ** $447 $19 23 $34 Aged/disabled waiver services $482 $20 31 $21 Medicaid LTC expenditures for all populations, 2007 $4,709 $197 47 $323 Institutional services $2,836 $119 43 $196 HCBS $1,873 $78 40 $127 Waiver services (all populations) $1,081 $45 48 $91 Medicaid home health expenditures * $227 $9 19 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $19,471 49 $26,096 Medicaid HCBS expenditures for older people and adults with $9,070 21 $9,459 physical disabilities per person served, 2005 Personal care services ** $5,908 16 $9,666 Aged/disabled waiver services $15,382 9 $9,176 HCBS waiver services (all populations) $19,381 29 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 298 Federal/State/Personal Contributions State Rank U.S. Texas Federal Medical Assistance Percentage (FMAP), 2007 60.8% 25 Medicaid personal needs allowance (per month), 2007 *** $60 7 $50 State-funded HCBS for older people (millions), 2007 $4.8 35 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 12.8% 1 8.4% Medicare home health visits per user, 2006 55 2 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 130,871 5.7 23 6.3 Personal care services ** 77,725 3.4 11 2.7 HCBS waiver services 53,146 2.3 42 3.6 Aged/disabled waiver services 38,943 1.7 27 2.0 Medicaid aged/disabled waiver participants per 37 23 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 2,393 0.10 35 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 187,099 8.2 2 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 91,980 3 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.8 28 3.8 Nursing facility residents per 100 age 75+, 2007 8.2 25 7.8 Total nursing facility stays, 2006 180,123 5 3,176,119 Residents with Medicaid as primary payer, 2007 65% 19 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 21% 31 22% Residents with dementia, 2007 43% 37 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $106 48 $158 Medicare payment per day for nursing facility care, 2006 $273 40 $305 Average private pay rate per day in nursing facility, 2008 $160 38 $209 Average private pay rate per month in assisted living, 2008 $2,764 29 $3,008 Medicare reimbursement per home health visit, 2006 $128 40 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $40 18 $38 Average private pay daily rate for adult day care, 2008 $39 47 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 299 Long-Term Care Resources Texas Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 1,700 0.71 23 0.22 Adult day facilities, 2001-02 297 0.12 17 0.09 Assisted living and residential care facilities, 2007 1,433 0.6 30 1.0 Assisted living and residential care units, 2007 45,853 19 34 26 Personal and home care aides, 2007 123,910 52 2 16 Median hourly wage, 2007 $6.63 50 $8.89 Home health aides, 2007 52,200 22 15 22 Median hourly wage, 2007 $7.76 49 $9.62 Medicaid aged/disabled waiver waiting list, 2007 36,412 1 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 1,197 0.5 23 0.43 Nursing facility beds, 2007 125,753 53 18 45 Nursing facility occupancy rate, 2007 73% 45 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.5 42 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 14% 33 18% residents, 2007 Residents with physical restraints (%), 2007 5% 18 6% Long-term care facility beds per FTE ombudsman, 2006 2,774 18 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 300 $300 100% 250 $267 $275 87% $250 80% 200 Millions of Dollars $200 60% 53% 150 $150 $138 40% 100 $100 $76 20% 17% $50 $41 50 9% 4% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 300 Trends Texas Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 102,428 1,026,374 adults with physical disabilities 2005 116,668 1,376,984 % change +14% 41 +34% Medicaid aged/disabled waiver participants 2000 32,144 448,167 2005 38,943 582,342 % change +21% 30 +30% Medicare home health visits per user 2001 41 4 31 2006 55 2 35 % change +33% 2 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 88,925 1,428,117 2007 91,980 1,440,358 % change +3% 18 +1% Nursing facility beds 2002 115,495 1,671,744 2007 125,753 1,699,494 % change +9% 7 +2% Nursing facility occupancy rate 2002 77% 46 85% 2007 73% 45 85% change -4% 43 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $13,389 $243,497 2007 $20,615 $311,848 % change +54% 5 +28% Medicaid LTC spending for older people and adults 2002 $2,768 $54,261 with physical disabilities (millions) 2007 $3,160 $64,168 % change +14% 34 +18% Medicaid HCBS spending for older people and adults 2002 $957 $10,204 with physical disabilities (millions) 2007 $1,273 $17,188 % change +33% 48 +68% Medicaid nursing facility spending (millions) 2002 $1,811 $44,057 2007 $1,887 $46,980 % change +4% 31 +7% Medicaid HCBS spending for older people and adults 2002 35% 6 19% with physical disabilities, as a percentage of total 2007 40% 7 27% LTC spending change +6% 21 +8% 301 AARP Public Policy Institute Utah % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 2,645 34 301,621 2030 3,485 31 363,584 % change +32% 7 +21% Age 50-64 2007 359 13.6% 51 17.8% 2030 494 14.2% 50 16.5% % change +37% 4 +12% Age 65+ 2007 234 8.8% 50 12.6% 2030 461 13.2% 51 19.7% % change +97% 18 +89% Age 65-74 2007 124 4.7% 50 6.4% 2030 Blue line = 50-64 242 6.9% 50 10.4% % change Purple line = 65-74 +96% 19 +96% Yellow line = 75-84 Age 75-84 2007 79 3.0% Red line = 85+ 50 4.3% 2030 159 4.6% 50 6.6% % change +100% 18 +84% Age 85+ 2007 31 1.2% 48 1.8% 2030 59 1.7% 51 2.6% % change +92% 14 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Utah as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 7.8% 35 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% 85+ State Rank U.S. 240% 2.2% 14 3.6% 65-74 Black 200% State Rank U.S. 50-64 160% 0.5% 43 8.7% 75-84 Hispanic 120% State Rank U.S. 80% 4.4% 11 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 302 Population & Characteristics Utah Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 59 5 48 Persons age 75+ living alone, 2007 27% 49 33% Non-metropolitan population age 65+, 2007/2008 NA NA 20% Bachelor level education or higher age 65+, 2007 24% 5 19% Persons age 60+ raising grandchildren, 2007 2.2% 9 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $38,022 7 $32,158 At/below poverty level age 65+, 2007 6.8% 45 9.5% At/below 200% of poverty level age 65+, 2007 24% 48 32% At/below 300% of poverty level age 65+, 2007 46% 39 51% Women age 75+ at/below poverty level, 2007 9% 46 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 38 17% 18 16% Physical disability 64 28% 35 31% Mobility disability 35 16% 27 18% Self-care disability 19 9% 30 10% Cognitive/mental disability 26 11% 27 12% Any disability (one or more of the five 88 39% 27 41%   listed above) Cognitive/mental disability + any other disability 25 11% 20 11% Persons age 18-64 with disabilities, 2007 Any disability 150 9% 46 11% Cognitive/mental disability + any other disability 39 2.4% 43 3.2% Persons age 65+ with Alzheimer’s disease, 2010 32 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 340 34,000 Economic value of family caregiving (millions), 2007 $3,500 $375,000 Economic value per hour, 2007 $9.68 34 $10.10 Ratio of the economic value of family caregiving to Medicaid 9.8 2 3.7 long-term care spending, 2007 303 Long-Term Care Financing Utah Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,405 39 $311,848 Medicaid home and community-based services (HCBS) spending 5% 48 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Utah and the U.S., 2007 Utah United States 4% 1% 10% 17% 95% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $172 $65 51 $213 adults with physical disabilities, 2007 Nursing facilities $163 $62 49 $156 HCBS $9 $3 50 $57 Personal care services (PCS) ** $1 $1 33 $34 Aged/disabled waiver services $8 $3 47 $21 Medicaid LTC expenditures for all populations, 2007 $350 $132 50 $323 Institutional services $221 $84 48 $196 HCBS $129 $49 50 $127 Waiver services (all populations) $127 $48 47 $91 Medicaid home health expenditures * $11 $4 33 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $24,376 32 $26,096 Medicaid HCBS expenditures for older people and adults with $2,357 50 $9,459 physical disabilities per person served, 2005 Personal care services ** $617 30 $9,666 Aged/disabled waiver services $5,805 41 $9,176 HCBS waiver services (all populations) $23,912 22 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 304 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 70.1% 6 Utah Medicaid personal needs allowance (per month), 2007 *** $45 30 $50 State-funded HCBS for older people (millions), 2007 $4.0 37 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 8.6% 14 8.4% Medicare home health visits per user, 2006 52 4 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 6,782 2.7 45 6.3 Personal care services ** 1,755 0.7 30 2.7 HCBS waiver services 5,027 2.0 46 3.6 Aged/disabled waiver services 886 0.4 48 2.0 Medicaid aged/disabled waiver participants per 15 40 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 548 0.21 27 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 2,121 0.8 39 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 5,544 42 1,440,358 Nursing facility residents per 100 age 65+, 2007 2.4 44 3.8 Nursing facility residents per 100 age 75+, 2007 5.0 44 7.8 Total nursing facility stays, 2006 17,591 37 3,176,119 Residents with Medicaid as primary payer, 2007 53% 49 64% Residents with Medicare as primary payer, 2007 20% 1 14% Residents with “other” as primary payer, 2007 27% 11 22% Residents with dementia, 2007 38% 50 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $139 34 $158 Medicare payment per day for nursing facility care, 2006 $307 26 $305 Average private pay rate per day in nursing facility, 2008 $157 42 $209 Average private pay rate per month in assisted living, 2008 $2,433 44 $3,008 Medicare reimbursement per home health visit, 2006 $101 51 $134 Average private pay hourly rate for home health aide, 2008 $21 7 $19 Medicare-certified home health aide, 2008 $27 40 $38 Average private pay daily rate for adult day care, 2008 $37 48 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 305 Long-Term Care Resources Utah Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 59 0.25 23 0.22 Adult day facilities, 2001-02 8 0.03 45 0.09 Assisted living and residential care facilities, 2007 151 0.6 30 1.0 Assisted living and residential care units, 2007 5,256 22 31 26 Personal and home care aides, 2007 NA NA NA 16 Median hourly wage, 2007 $9.22 24 $8.89 Home health aides, 2007 4,350 19 20 22 Median hourly wage, 2007 $9.30 34 $9.62 Medicaid aged/disabled waiver waiting list, 2007 62 20 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 95 0.41 30 0.43 Nursing facility beds, 2007 8,000 34 41 45 Nursing facility occupancy rate, 2007 69% 48 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4.1 7 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 8% 44 18% residents, 2007 Residents with physical restraints (%), 2007 7% 7 6% Long-term care facility beds per FTE ombudsman, 2006 1,421 35 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 82% 32 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 80 $80 120% $67 101%60 100% 95% $60 Millions of Dollars 80% 70% 40 $40 60% 40% $20 20 $20 21% 20% $3 $4 6% $1 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 306 Trends Utah Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 1,126 1,026,374 adults with physical disabilities 2005 2,641 1,376,984 % change +135% 10 +34% Medicaid aged/disabled waiver participants 2000 847 448,167 2005 886 582,342 % change +5% 42 +30% Medicare home health visits per user 2001 49 2 31 2006 52 4 35 % change +6% 12 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 5,092 1,428,117 2007 5,544 1,440,358 % change +9% 4 +1% Nursing facility beds 2002 7,100 1,671,744 2007 8,000 1,699,494 % change +13% 3 +2% Nursing facility occupancy rate 2002 72% 49 85% 2007 69% 48 85% change -2% 30 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,005 $243,497 2007 $1,405 $311,848 % change +40% 15 +28% Medicaid LTC spending for older people and adults 2002 $100 $54,261 with physical disabilities (millions) 2007 $172 $64,168 % change +72% 3 +18% Medicaid HCBS spending for older people and adults 2002 $5 $10,204 with physical disabilities (millions) 2007 $9 $17,188 % change +96% 21 +68% Medicaid nursing facility spending (millions) 2002 $96 $44,057 2007 $163 $46,980 % change +70% 1 +7% Medicaid HCBS spending for older people and adults 2002 5% 43 19% with physical disabilities, as a percentage of total 2007 5% 48 27% LTC spending change +1% 45 +8% 307 AARP Public Policy Institute Vermont % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 621 49 301,621 2030 712 48 363,584 % change +15% 21 +21% Age 50-64 2007 134 21.5% 1 17.8% 2030 122 17.1% 19 16.5% % change -9% 44 +12% Age 65+ 2007 84 13.6% 12 12.6% 2030 174 24.4% 8 19.7% % change +106% 10 +89% Age 65-74 2007 44 7.0% 10 6.4% 2030 Blue line = 50-64 87 12.3% 9 10.4% % change Purple line = 65-74 +100% 14 +96% Yellow line = 75-84 Age 75-84 2007 29 4.6% Red line = 85+ 17 4.3% 2030 62 8.7% 8 6.6% % change +115% 9 +84% Age 85+ 2007 12 1.9% 21 1.8% 2030 25 3.5% 8 2.6% % change +106% 7 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Vermont as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 260% 2.3% 50 19.3% Population (% of 2000 Census) 85+ Asian/Pacific Islander 230% State Rank U.S. 200% 0.6% 41 3.6% 65-74 Black 170% State Rank U.S. 140% 0.3% 46 8.7% 50-64 75-84 Hispanic 110% State Rank U.S. 80% 0.7% 46 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 308 Population & Characteristics Vermont Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 35% 16 33% Non-metropolitan population age 65+, 2007/2008 74% 2 20% Bachelor level education or higher age 65+, 2007 27% 2 19% Persons age 60+ raising grandchildren, 2007 0.5% 50 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $30,784 29 $32,158 At/below poverty level age 65+, 2007 7.5% 44 9.5% At/below 200% of poverty level age 65+, 2007 32% 25 32% At/below 300% of poverty level age 65+, 2007 51% 29 51% Women age 75+ at/below poverty level, 2007 11% 35 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 13 16% 25 16% Physical disability 22 27% 42 31% Mobility disability 11 14% 41 18% Self-care disability 7 8% 40 10% Cognitive/mental disability 8 10% 34 12% Any disability (one or more of the five 30 37% 40 41%   listed above) Cognitive/mental disability + any other disability 6 8% 44 11% Persons age 18-64 with disabilities, 2007 Any disability 49 12% 20 11% Cognitive/mental disability + any other disability 13 3.3% 21 3.2% Persons age 65+ with Alzheimer’s disease, 2010 11 12% 39 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 55 34,000 Economic value of family caregiving (millions), 2007 $680 $375,000 Economic value per hour, 2007 $11.45 7 $10.10 Ratio of the economic value of family caregiving to Medicaid 2.3 47 3.7 long-term care spending, 2007 309 Long-Term Care Financing Vermont Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $1,041 45 $311,848 Medicaid home and community-based services (HCBS) spending 35% 11 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Vermont and the U.S., 2007 Vermont United States 10% 25% 17% 65% 10% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $171 $276 13 $213 adults with physical disabilities, 2007 Nursing facilities $111 $179 20 $156 HCBS $60 $97 9 $57 Personal care services (PCS) ** $17 $28 15 $34 Aged/disabled waiver services $43 $69 3 $21 Medicaid LTC expenditures for all populations, 2007 $293 $471 10 $323 Institutional services $112 $181 26 $196 HCBS $181 $291 4 $127 Waiver services (all populations) $163 $263 1 $91 Medicaid home health expenditures * $7 $11 14 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $26,066 27 $26,096 Medicaid HCBS expenditures for older people and adults with $10,525 14 $9,459 physical disabilities per person served, 2005 Personal care services ** $4,300 24 $9,666 Aged/disabled waiver services $15,998 6 $9,176 HCBS waiver services (all populations) $31,726 10 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 310 Federal/State/Personal Contributions State Rank U.S. Vermont Federal Medical Assistance Percentage (FMAP), 2007 58.9% 28 Medicaid personal needs allowance (per month), 2007 *** $47.66 29 $50 State-funded HCBS for older people (millions), 2007 $5.0 33 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 9.6% 9 8.4% Medicare home health visits per user, 2006 36 9 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 5,343 8.6 11 6.3 Personal care services ** 1,534 2.5 15 2.7 HCBS waiver services 3,809 6.1 8 3.6 Aged/disabled waiver services 1,745 2.8 19 2.0 Medicaid aged/disabled waiver participants per 44 16 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 1,484 2.39 2 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 3,611 5.8 6 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 3,127 48 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.7 32 3.8 Nursing facility residents per 100 age 75+, 2007 7.7 32 7.8 Total nursing facility stays, 2006 6,800 48 3,176,119 Residents with Medicaid as primary payer, 2007 67% 11 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 19% 35 22% Residents with dementia, 2007 52% 6 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $152 24 $158 Medicare payment per day for nursing facility care, 2006 $339 10 $305 Average private pay rate per day in nursing facility, 2008 $232 12 $209 Average private pay rate per month in assisted living, 2008 $2,569 38 $3,008 Medicare reimbursement per home health visit, 2006 $115 47 $134 Average private pay hourly rate for home health aide, 2008 $22 5 $19 Medicare-certified home health aide, 2008 $26 43 $38 Average private pay daily rate for adult day care, 2008 $59 20 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 311 Long-Term Care Resources Vermont Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 13 0.15 23 0.22 Adult day facilities, 2001-02 20 0.24 2 0.09 Assisted living and residential care facilities, 2007 118 1.4 12 1.0 Assisted living and residential care units, 2007 2,610 31 18 26 Personal and home care aides, 2007 NA NA NA 16 Median hourly wage, 2007 NA NA $8.89 Home health aides, 2007 2,300 27 6 22 Median hourly wage, 2007 $10.42 16 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 41 0.49 25 0.43 Nursing facility beds, 2007 3,389 40 33 45 Nursing facility occupancy rate, 2007 92% 4 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.8 19 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 8% 44 18% residents, 2007 Residents with physical restraints (%), 2007 2% 44 6% Long-term care facility beds per FTE ombudsman, 2006 754 51 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 49% 45 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 40 $40 $37 200% 184% 30 $30 150% Millions of Dollars 20 $19 $20 $20 100% 89% $11 50% 10 $10 50% 20% $0 0% 0 -$1 -32% $-10 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -10 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 312 Trends Vermont Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 1,140 1,026,374 adults with physical disabilities 2005 3,279 1,376,984 % change +188% 5 +34% Medicaid aged/disabled waiver participants 2000 1,140 448,167 2005 1,745 582,342 % change +53% 19 +30% Medicare home health visits per user 2001 41 4 31 2006 36 9 35 % change -12% 42 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 3,311 1,428,117 2007 3,127 1,440,358 % change -6% 41 +1% Nursing facility beds 2002 3,679 1,671,744 2007 3,389 1,699,494 % change -8% 47 +2% Nursing facility occupancy rate 2002 90% 18 85% 2007 92% 4 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $665 $243,497 2007 $1,041 $311,848 % change +56% 2 +28% Medicaid LTC spending for older people and adults 2002 $121 $54,261 with physical disabilities (millions) 2007 $171 $64,168 % change +42% 8 +18% Medicaid HCBS spending for older people and adults 2002 $29 $10,204 with physical disabilities (millions) 2007 $60 $17,188 % change +109% 15 +68% Medicaid nursing facility spending (millions) 2002 $92 $44,057 2007 $111 $46,980 % change +20% 22 +7% Medicaid HCBS spending for older people and adults 2002 24% 13 19% with physical disabilities, as a percentage of total 2007 35% 11 27% LTC spending change +11% 12 +8% 313 AARP Public Policy Institute Virgin Islands Virgin % of Total U.S. Population Year Islands Population (thousands) All ages 2000 108,612 281,422 2030 363,584 % change +29% Age 50-64 2000 19,525 18.0% 14.9% 2030 16.5% % change +43% Age 65+ 2000 9,117 8.4% 12.4% 2030 19.7% % change +104% Age 65-74 2000 5,845 5.4% 6.5% 2030 10.4% % change +106% Age 75-84 2000 2,505 2.3% 4.4% 2030 6.6% % change +93% Age 85+ 2000 767 0.7% 1.5% 2030 2.6% % change +127% Race & Ethnicity, Age 65+ Older People of Color (%), 2000 Population of Virgin Islands, by Age, 2000 State U.S. 85.9% 16.3% 18.0% Asian/Pacific Islander 5.4% State U.S. 2.3% NA 2.6% 0.7% Black 73.6% State U.S. 75.4% 8.3% Percentages may not add to 100% due to rounding <50 50-64 65-74 75-84 85+ Hispanic State U.S. 10.6% 4.9% Note: U.S. totals do not include Puerto Rico and the Virgin Islands. Because of data availability, data years for most indicators for the Virgin Islands differ from those in other profiles. 314 Population & Characteristics Virgin Islands Virgin Population Characteristics Islands U.S. Men per 100 women age 85+, 2000 54 41 Persons age 75+ living alone, 2000 30% 35% Virgin Income & Poverty Islands U.S. Median household income age 65+, 2000 $17,515 $23,048 At/below poverty level age 65+, 2000 30% 10% Disability Rates Number Percent U.S. Persons age 65+ with disabilities, 2000 Sensory disability 1,284 14% 14% Physical disability 2,268 25% 28% Mobility disability 1,022 19% 20% Self-care disability 757 8% 10% Cognitive/mental disability 1,678 11% 11% Any disability (one or more of the five 3,424 38% 42%   listed above) Virgin Per 1,000 HCBS Resources Islands Age 65+ U.S. Medicare-certified home health agencies, 2006 2 0.22 0.22 315 AARP Public Policy Institute Virginia % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 7,712 12 301,621 2030 9,825 12 363,584 % change +27% 10 +21% Age 50-64 2007 1,403 18.2% 29 17.8% 2030 1,553 15.8% 42 16.5% % change +11% 12 +12% Age 65+ 2007 910 11.8% 41 12.6% 2030 1,844 18.8% 36 19.7% % change +103% 13 +89% Age 65-74 2007 490 6.4% 32 6.4% 2030 Blue line = 50-64 974 9.9% 36 10.4% % change Purple line = 65-74 +99% 16 +96% Yellow line = 75-84 Age 75-84 2007 302 3.9% Red line = 85+ 41 4.3% 2030 620 6.3% 37 6.6% % change +105% 13 +84% Age 85+ 2007 117 1.5% 45 1.8% 2030 250 2.5% 31 2.6% % change +114% 6 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Virginia as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 20.9% 16 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% 85+ State Rank U.S. 240% 3.3% 9 3.6% 65-74 Black 200% 75-84 State Rank U.S. 160% 15.4% 9 8.7% 50-64 Hispanic 120% State Rank U.S. 80% 2.0% 26 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 316 Population & Characteristics Virginia Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 44 32 48 Persons age 75+ living alone, 2007 36% 10 33% Non-metropolitan population age 65+, 2007/2008 26% 30 20% Bachelor level education or higher age 65+, 2007 23% 11 19% Persons age 60+ raising grandchildren, 2007 1.5% 24 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $36,561 14 $32,158 At/below poverty level age 65+, 2007 9.2% 23 9.5% At/below 200% of poverty level age 65+, 2007 28% 40 32% At/below 300% of poverty level age 65+, 2007 45% 40 51% Women age 75+ at/below poverty level, 2007 15% 16 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 128 15% 34 16% Physical disability 266 31% 17 31% Mobility disability 149 17% 20 18% Self-care disability 87 10% 19 10% Cognitive/mental disability 102 12% 21 12% Any disability (one or more of the five 343 39% 27 41%   listed above) Cognitive/mental disability + any other disability 95 11% 20 11% Persons age 18-64 with disabilities, 2007 Any disability 485 10% 34 11% Cognitive/mental disability + any other disability 123 2.5% 39 3.2% Persons age 65+ with Alzheimer’s disease, 2010 130 13% 31 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 910 34,000 Economic value of family caregiving (millions), 2007 $9,200 $375,000 Economic value per hour, 2007 $9.38 38 $10.10 Ratio of the economic value of family caregiving to Medicaid 5.7 6 3.7 long-term care spending, 2007 317 Long-Term Care Financing Virginia Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $4,968 21 $311,848 Medicaid home and community-based services (HCBS) spending 26% 19 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Virginia and the U.S., 2007 Virginia United States 10% 26% 17% 74% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $979 $127 47 $213 adults with physical disabilities, 2007 Nursing facilities $720 $93 43 $156 HCBS $258 $34 32 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $258 $34 15 $21 Medicaid LTC expenditures for all populations, 2007 $1,602 $208 45 $323 Institutional services $971 $126 41 $196 HCBS $631 $82 39 $127 Waiver services (all populations) $631 $82 33 $91 Medicaid home health expenditures * $5 $1 43 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $24,222 33 $26,096 Medicaid HCBS expenditures for older people and adults with $12,172 9 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $12,172 11 $9,176 HCBS waiver services (all populations) $21,797 25 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 318 Federal/State/Personal Contributions State Rank U.S. Virginia Federal Medical Assistance Percentage (FMAP), 2007 50.0% 40 Medicaid personal needs allowance (per month), 2007 *** $40 35 $50 State-funded HCBS for older people (millions), 2007 $10.6 22 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 7.7% 22 8.4% Medicare home health visits per user, 2006 27 24 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 19,436 2.6 47 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 19,436 2.6 39 3.6 Aged/disabled waiver services 12,424 1.6 30 2.0 Medicaid aged/disabled waiver participants per 45 15 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by NA NA NA 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 3,299 0.4 49 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 28,778 18 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.2 39 3.8 Nursing facility residents per 100 age 75+, 2007 6.9 37 7.8 Total nursing facility stays, 2006 68,224 17 3,176,119 Residents with Medicaid as primary payer, 2007 60% 36 64% Residents with Medicare as primary payer, 2007 17% 3 14% Residents with “other” as primary payer, 2007 22% 28 22% Residents with dementia, 2007 45% 30 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $145 31 $158 Medicare payment per day for nursing facility care, 2006 $282 37 $305 Average private pay rate per day in nursing facility, 2008 $180 29 $209 Average private pay rate per month in assisted living, 2008 $3,013 21 $3,008 Medicare reimbursement per home health visit, 2006 $141 25 $134 Average private pay hourly rate for home health aide, 2008 $17 37 $19 Medicare-certified home health aide, 2008 $32 26 $38 Average private pay daily rate for adult day care, 2008 $52 31 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 319 Long-Term Care Resources Virginia Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 174 0.19 23 0.22 Adult day facilities, 2001-02 47 0.05 38 0.09 Assisted living and residential care facilities, 2007 577 0.6 30 1.0 Assisted living and residential care units, 2007 31,964 35 13 26 Personal and home care aides, 2007 9,100 10 35 16 Median hourly wage, 2007 $7.77 44 $8.89 Home health aides, 2007 12,250 13 41 22 Median hourly wage, 2007 $9.11 37 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 282 0.31 41 0.43 Nursing facility beds, 2007 31,485 35 39 45 Nursing facility occupancy rate, 2007 91% 10 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.7 26 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 17% 20 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 2,465 22 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 71% 39 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 200 $200 150% 150 $158 123% $150 $142 Millions of Dollars 100% 100 74% $100 50% $50 50 $35 $20 16% NA 3% NA $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 320 Trends Virginia Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 10,498 1,026,374 adults with physical disabilities 2005 12,424 1,376,984 % change +18% 37 +34% Medicaid aged/disabled waiver participants 2000 10,498 448,167 2005 12,424 582,342 % change +18% 35 +30% Medicare home health visits per user 2001 28 20 31 2006 27 24 35 % change -4% 29 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 26,508 1,428,117 2007 28,778 1,440,358 % change +9% 4 +1% Nursing facility beds 2002 29,291 1,671,744 2007 31,485 1,699,494 % change +7% 9 +2% Nursing facility occupancy rate 2002 90% 18 85% 2007 91% 10 85% change +1% 15 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $3,469 $243,497 2007 $4,968 $311,848 % change +43% 12 +28% Medicaid LTC spending for older people and adults 2002 $816 $54,261 with physical disabilities (millions) 2007 $979 $64,168 % change +20% 29 +18% Medicaid HCBS spending for older people and adults 2002 $116 $10,204 with physical disabilities (millions) 2007 $258 $17,188 % change +123% 12 +68% Medicaid nursing facility spending (millions) 2002 $700 $44,057 2007 $720 $46,980 % change +3% 33 +7% Medicaid HCBS spending for older people and adults 2002 14% 25 19% with physical disabilities, as a percentage of total 2007 26% 19 27% LTC spending change +12% 9 +8% 321 AARP Public Policy Institute Washington % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 6,468 13 301,621 2030 8,625 14 363,584 % change +33% 6 +21% Age 50-64 2007 1,228 19.0% 9 17.8% 2030 1,358 15.7% 43 16.5% % change +11% 12 +12% Age 65+ 2007 758 11.7% 43 12.6% 2030 1,564 18.1% 40 19.7% % change +106% 10 +89% Age 65-74 2007 394 6.1% 41 6.4% 2030 Blue line = 50-64 806 9.3% 42 10.4% % change Purple line = 65-74 +104% 10 +96% Yellow line = 75-84 Age 75-84 2007 252 3.9% Red line = 85+ 41 4.3% 2030 542 6.3% 37 6.6% % change +115% 9 +84% Age 85+ 2007 111 1.7% 33 1.8% 2030 216 2.5% 31 2.6% % change +94% 13 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Washington as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 11.4% 28 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% State Rank U.S. 85+ 240% 5.8% 5 3.6% 65-74 Black 200% State Rank U.S. 160% 1.9% 37 8.7% 50-64 Hispanic 120% 75-84 State Rank U.S. 80% 2.5% 20 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 322 Population & Characteristics Was hington Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 52 12 48 Persons age 75+ living alone, 2007 34% 24 33% Non-metropolitan population age 65+, 2007/2008 11% 38 20% Bachelor level education or higher age 65+, 2007 24% 5 19% Persons age 60+ raising grandchildren, 2007 1.4% 26 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $36,908 12 $32,158 At/below poverty level age 65+, 2007 7.9% 40 9.5% At/below 200% of poverty level age 65+, 2007 26% 44 32% At/below 300% of poverty level age 65+, 2007 45% 40 51% Women age 75+ at/below poverty level, 2007 11% 35 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 131 18% 13 16% Physical disability 227 31% 17 31% Mobility disability 122 17% 20 18% Self-care disability 75 10% 19 10% Cognitive/mental disability 97 13% 17 12% Any disability (one or more of the five 299 41% 19 41%   listed above) Cognitive/mental disability + any other disability 84 12% 13 11% Persons age 18-64 with disabilities, 2007 Any disability 525 13% 11 11% Cognitive/mental disability + any other disability 153 3.7% 14 3.2% Persons age 65+ with Alzheimer’s disease, 2010 110 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 640 34,000 Economic value of family caregiving (millions), 2007 $7,900 $375,000 Economic value per hour, 2007 $11.43 8 $10.10 Ratio of the economic value of family caregiving to Medicaid 4.3 16 3.7 long-term care spending, 2007 323 Long-Term Care Financing Washington Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $5,700 17 $311,848 Medicaid home and community-based services (HCBS) spending 55% 3 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Washington and the U.S., 2007 Washington United States 10% 30% 17% 45% 24% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,312 $203 25 $213 adults with physical disabilities, 2007 Nursing facilities $595 $92 44 $156 HCBS $717 $111 6 $57 Personal care services (PCS) ** $318 $49 9 $34 Aged/disabled waiver services $399 $62 5 $21 Medicaid LTC expenditures for all populations, 2007 $1,828 $283 34 $323 Institutional services $709 $110 45 $196 HCBS $1,119 $173 12 $127 Waiver services (all populations) $801 $124 15 $91 Medicaid home health expenditures * $27 $4 33 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $22,970 38 $26,096 Medicaid HCBS expenditures for older people and adults with $10,624 13 $9,459 physical disabilities per person served, 2005 Personal care services ** $11,649 8 $9,666 Aged/disabled waiver services $10,016 19 $9,176 HCBS waiver services (all populations) $15,765 34 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 324 Federal/State/Personal Contributions State Rank U.S. Was hington Federal Medical Assistance Percentage (FMAP), 2007 50.1% 39 Medicaid personal needs allowance (per month), 2007 *** $55.45 14 $50 State-funded HCBS for older people (millions), 2007 $14.4 18 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 5.5% 39 8.4% Medicare home health visits per user, 2006 19 48 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 59,762 9.5 6 6.3 Personal care services ** 18,429 2.9 13 2.7 HCBS waiver services 41,333 6.6 7 3.6 Aged/disabled waiver services 31,139 5 5 2.0 Medicaid aged/disabled waiver participants per 138 4 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 6,193 0.96 12 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 3,597 0.6 44 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 19,641 27 1,440,358 Nursing facility residents per 100 age 65+, 2007 2.6 41 3.8 Nursing facility residents per 100 age 75+, 2007 5.4 42 7.8 Total nursing facility stays, 2006 57,490 21 3,176,119 Residents with Medicaid as primary payer, 2007 60% 36 64% Residents with Medicare as primary payer, 2007 17% 3 14% Residents with “other” as primary payer, 2007 24% 21 22% Residents with dementia, 2007 50% 13 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $155 23 $158 Medicare payment per day for nursing facility care, 2006 $341 9 $305 Average private pay rate per day in nursing facility, 2008 $220 14 $209 Average private pay rate per month in assisted living, 2008 $3,033 20 $3,008 Medicare reimbursement per home health visit, 2006 $189 3 $134 Average private pay hourly rate for home health aide, 2008 $21 7 $19 Medicare-certified home health aide, 2008 $68 5 $38 Average private pay daily rate for adult day care, 2008 $55 28 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 325 Long-Term Care Resources Washington Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 59 0.08 23 0.22 Adult day facilities, 2001-02 50 0.07 29 0.09 Assisted living and residential care facilities, 2007 551 0.7 28 1.0 Assisted living and residential care units, 2007 26,829 35 13 26 Personal and home care aides, 2007 16,740 22 7 16 Median hourly wage, 2007 $10.61 7 $8.89 Home health aides, 2007 9,640 13 41 22 Median hourly wage, 2007 $10.23 18 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 247 0.33 38 0.43 Nursing facility beds, 2007 22,688 30 44 45 Nursing facility occupancy rate, 2007 87% 27 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.8 19 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 25% 11 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 2,483 21 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 78% 36 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 200 $250 80% 150 $161 67% $200 60% 56%100 $114 Millions of Dollars $107 $150 40% 36% 50 $100 20% 0 $0 -$14 0% -$50 -50 -$82 -11% -12% -$100 -20% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -100 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 326 Trends Was hington Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 35,692 1,026,374 adults with physical disabilities 2005 49,568 1,376,984 % change +39% 29 +34% Medicaid aged/disabled waiver participants 2000 29,178 448,167 2005 31,139 582,342 % change +7% 41 +30% Medicare home health visits per user 2001 19 48 31 2006 19 48 35 % change +3% 16 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 20,054 1,428,117 2007 19,641 1,440,358 % change -2% 31 +1% Nursing facility beds 2002 23,784 1,671,744 2007 22,688 1,699,494 % change -5% 41 +2% Nursing facility occupancy rate 2002 84% 36 85% 2007 87% 27 85% change +2% 4 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $5,401 $243,497 2007 $5,700 $311,848 % change +6% 50 +28% Medicaid LTC spending for older people and adults 2002 $1,173 $54,261 with physical disabilities (millions) 2007 $1,312 $64,168 % change +12% 35 +18% Medicaid HCBS spending for older people and adults 2002 $496 $10,204 with physical disabilities (millions) 2007 $717 $17,188 % change +44% 40 +68% Medicaid nursing facility spending (millions) 2002 $677 $44,057 2007 $595 $46,980 % change -12% 47 +7% Medicaid HCBS spending for older people and adults 2002 42% 3 19% with physical disabilities, as a percentage of total 2007 55% 3 27% LTC spending change +12% 9 +8% 327 AARP Public Policy Institute West Virginia % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 1,812 37 301,621 2030 1,720 39 363,584 % change -5% 49 +21% Age 50-64 2007 374 20.6% 4 17.8% 2030 354 20.6% 1 16.5% % change -5% 37 +12% Age 65+ 2007 281 15.5% 2 12.6% 2030 426 24.8% 7 19.7% % change +52% 49 +89% Age 65-74 2007 146 8.0% 2 6.4% 2030 Blue line = 50-64 221 12.8% 6 10.4% % change Purple line = 65-74 +52% 50 +96% Yellow line = 75-84 Age 75-84 2007 98 5.4% Red line = 85+ 3 4.3% 2030 152 8.9% 5 6.6% % change +56% 43 +84% Age 85+ 2007 37 2.1% 12 1.8% 2030 53 3.1% 15 2.6% % change +43% 45 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in West Virginia as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 4.1% 46 19.3% Population (% of 2000 Census) Asian/Pacific Islander 180% State Rank U.S. 85+ 160% 0.5% 46 3.6% Black 140% 75-84 State Rank U.S. 120% 2.5% 33 8.7% 65-74 50-64 Hispanic 100% State Rank U.S. 80% 0.6% 49 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 328 Population & Characteristics West Virginia Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 37% 6 33% Non-metropolitan population age 65+, 2007/2008 46% 11 20% Bachelor level education or higher age 65+, 2007 12% 50 19% Persons age 60+ raising grandchildren, 2007 1.9% 15 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $25,795 49 $32,158 At/below poverty level age 65+, 2007 10.4% 16 9.5% At/below 200% of poverty level age 65+, 2007 41% 2 32% At/below 300% of poverty level age 65+, 2007 64% 1 51% Women age 75+ at/below poverty level, 2007 15% 16 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 57 21% 4 16% Physical disability 103 38% 5 31% Mobility disability 58 22% 2 18% Self-care disability 33 12% 7 10% Cognitive/mental disability 38 14% 11 12% Any disability (one or more of the five 130 48% 5 41%   listed above) Cognitive/mental disability + any other disability 36 13% 8 11% Persons age 18-64 with disabilities, 2007 Any disability 222 20% 1 11% Cognitive/mental disability + any other disability 75 6.7% 1 3.2% Persons age 65+ with Alzheimer’s disease, 2010 44 15% 3 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 280 34,000 Economic value of family caregiving (millions), 2007 $2,500 $375,000 Economic value per hour, 2007 $8.23 49 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.0 37 3.7 long-term care spending, 2007 329 Long-Term Care Financing West Virginia Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $2,176 34 $311,848 Medicaid home and community-based services (HCBS) spending 19% 29 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in West Virginia and the U.S., 2007 West Virginia United States 11% 10% 8% 17% 81% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $521 $288 8 $213 adults with physical disabilities, 2007 Nursing facilities $421 $232 10 $156 HCBS $101 $55 17 $57 Personal care services (PCS) ** $42 $23 20 $34 Aged/disabled waiver services $59 $32 17 $21 Medicaid LTC expenditures for all populations, 2007 $788 $435 12 $323 Institutional services $478 $264 11 $196 HCBS $310 $171 13 $127 Waiver services (all populations) $269 $148 13 $91 Medicaid home health expenditures * $28 $15 7 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $32,513 8 $26,096 Medicaid HCBS expenditures for older people and adults with $9,241 19 $9,459 physical disabilities per person served, 2005 Personal care services ** $6,286 15 $9,666 Aged/disabled waiver services $11,953 12 $9,176 HCBS waiver services (all populations) $27,174 16 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 330 Federal/State/Personal Contributions State Rank U.S. West Virginia Federal Medical Assistance Percentage (FMAP), 2007 72.8% 3 Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $1.8 43 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 5.9% 38 8.4% Medicare home health visits per user, 2006 24 35 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 13,126 7.3 19 6.3 Personal care services ** 4,535 2.5 15 2.7 HCBS waiver services 8,591 4.8 19 3.6 Aged/disabled waiver services 4,942 2.7 20 2.0 Medicaid aged/disabled waiver participants per 42 20 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 475 0.26 23 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 1,749 1 35 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 9,977 34 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.6 33 3.8 Nursing facility residents per 100 age 75+, 2007 7.4 34 7.8 Total nursing facility stays, 2006 21,659 35 3,176,119 Residents with Medicaid as primary payer, 2007 72% 6 64% Residents with Medicare as primary payer, 2007 14% 18 14% Residents with “other” as primary payer, 2007 14% 49 22% Residents with dementia, 2007 51% 10 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $170 17 $158 Medicare payment per day for nursing facility care, 2006 $267 46 $305 Average private pay rate per day in nursing facility, 2008 $185 26 $209 Average private pay rate per month in assisted living, 2008 $2,717 33 $3,008 Medicare reimbursement per home health visit, 2006 $146 18 $134 Average private pay hourly rate for home health aide, 2008 $14 49 $19 Medicare-certified home health aide, 2008 $49 11 $38 Average private pay daily rate for adult day care, 2008 $42 46 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 331 Long-Term Care Resources West Virginia Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 63 0.22 23 0.22 Adult day facilities, 2001-02 6 0.02 48 0.09 Assisted living and residential care facilities, 2007 120 0.4 40 1.0 Assisted living and residential care units, 2007 3,510 13 43 26 Personal and home care aides, 2007 4,770 17 17 16 Median hourly wage, 2007 $7.26 47 $8.89 Home health aides, 2007 5,130 18 22 22 Median hourly wage, 2007 $7.35 51 $9.62 Medicaid aged/disabled waiver waiting list, 2007 0 22 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 133 0.47 26 0.43 Nursing facility beds, 2007 11,093 40 33 45 Nursing facility occupancy rate, 2007 90% 13 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.7 26 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 20% 16 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 1,335 38 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 87% 31 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 120 $120 100% 100 $109 93% $100 80% 80 Millions of Dollars $83 65% $80 60% 60 $60 40% 35% 40 $40 21% $20 20% $20 13% 20 $10 $7 $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 332 Trends West Virginia Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 11,031 1,026,374 adults with physical disabilities 2005 9,477 1,376,984 % change -14% 50 +34% Medicaid aged/disabled waiver participants 2000 5,182 448,167 2005 4,942 582,342 % change -5% 46 +30% Medicare home health visits per user 2001 26 31 31 2006 24 35 35 % change -8% 38 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 10,179 1,428,117 2007 9,977 1,440,358 % change -2% 31 +1% Nursing facility beds 2002 11,057 1,671,744 2007 11,093 1,699,494 % change +0% 31 +2% Nursing facility occupancy rate 2002 92% 6 85% 2007 90% 13 85% change -2% 30 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $1,598 $243,497 2007 $2,176 $311,848 % change +36% 19 +28% Medicaid LTC spending for older people and adults 2002 $385 $54,261 with physical disabilities (millions) 2007 $521 $64,168 % change +35% 12 +18% Medicaid HCBS spending for older people and adults 2002 $74 $10,204 with physical disabilities (millions) 2007 $101 $17,188 % change +37% 44 +68% Medicaid nursing facility spending (millions) 2002 $311 $44,057 2007 $421 $46,980 % change +35% 5 +7% Medicaid HCBS spending for older people and adults 2002 19% 17 19% with physical disabilities, as a percentage of total 2007 19% 29 27% LTC spending change +0% 49 +8% 333 AARP Public Policy Institute Wisconsin % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 5,602 20 301,621 2030 6,151 21 363,584 % change +10% 26 +21% Age 50-64 2007 1,040 18.6% 17 17.8% 2030 1,064 17.3% 15 16.5% % change +2% 23 +12% Age 65+ 2007 736 13.1% 22 12.6% 2030 1,312 21.3% 19 19.7% % change +78% 27 +89% Age 65-74 2007 365 6.5% 25 6.4% 2030 Blue line = 50-64 685 11.1% 18 10.4% % change Purple line = 65-74 +88% 22 +96% Yellow line = 75-84 Age 75-84 2007 256 4.6% Red line = 85+ 17 4.3% 2030 444 7.2% 16 6.6% % change +73% 28 +84% Age 85+ 2007 115 2.1% 12 1.8% 2030 183 3.0% 17 2.6% % change +59% 32 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Wisconsin as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 200% 5.3% 40 19.3% 65-74 Population (% of 2000 Census) Asian/Pacific Islander 180% 85+ State Rank U.S. 160% 0.8% 35 3.6% Black 140% 75-84 State Rank U.S. 50-64 120% 2.7% 32 8.7% Hispanic 100% State Rank U.S. 80% 1.3% 32 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 334 Population & Characteristics Wisconsin Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 45 22 48 Persons age 75+ living alone, 2007 37% 6 33% Non-metropolitan population age 65+, 2007/2008 29% 26 20% Bachelor level education or higher age 65+, 2007 16% 37 19% Persons age 60+ raising grandchildren, 2007 0.7% 46 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $30,184 33 $32,158 At/below poverty level age 65+, 2007 8.3% 31 9.5% At/below 200% of poverty level age 65+, 2007 33% 21 32% At/below 300% of poverty level age 65+, 2007 54% 19 51% Women age 75+ at/below poverty level, 2007 13% 24 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 96 14% 43 16% Physical disability 181 26% 46 31% Mobility disability 101 14% 41 18% Self-care disability 56 8% 40 10% Cognitive/mental disability 62 9% 45 12% Any disability (one or more of the five 247 35% 49 41%   listed above) Cognitive/mental disability + any other disability 55 8% 44 11% Persons age 18-64 with disabilities, 2007 Any disability 359 10% 34 11% Cognitive/mental disability + any other disability 91 2.6% 37 3.2% Persons age 65+ with Alzheimer’s disease, 2010 110 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 590 34,000 Economic value of family caregiving (millions), 2007 $6,600 $375,000 Economic value per hour, 2007 $10.32 24 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.1 34 3.7 long-term care spending, 2007 335 Long-Term Care Financing Wisconsin Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $5,037 20 $311,848 Medicaid home and community-based services (HCBS) spending 28% 17 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Wisconsin and the U.S., 2007 Wisconsin United States 12% 10% 16% 17% 72% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $1,373 $245 16 $213 adults with physical disabilities, 2007 Nursing facilities $989 $176 22 $156 HCBS $385 $69 12 $57 Personal care services (PCS) ** $226 $40 12 $34 Aged/disabled waiver services $158 $28 24 $21 Medicaid LTC expenditures for all populations, 2007 $2,058 $367 17 $323 Institutional services $1,139 $203 20 $196 HCBS $919 $164 16 $127 Waiver services (all populations) $693 $124 15 $91 Medicaid home health expenditures * $53 $9 19 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $23,169 37 $26,096 Medicaid HCBS expenditures for older people and adults with $14,089 5 $9,459 physical disabilities per person served, 2005 Personal care services ** $11,511 9 $9,666 Aged/disabled waiver services $15,443 8 $9,176 HCBS waiver services (all populations) $22,623 23 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 336 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 57.5% 32 Wisconsin Medicaid personal needs allowance (per month), 2007 *** $45 30 $50 State-funded HCBS for older people (millions), 2007 $0.0 48 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 4.9% 43 8.4% Medicare home health visits per user, 2006 25 30 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 48,208 8.7 10 6.3 Personal care services ** 11,123 2 21 2.7 HCBS waiver services 37,085 6.7 4 3.6 Aged/disabled waiver services 21,173 3.8 10 2.0 Medicaid aged/disabled waiver participants per 58 12 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 8,542 1.52 5 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 5,903 1.1 33 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 33,483 15 1,440,358 Nursing facility residents per 100 age 65+, 2007 4.5 17 3.8 Nursing facility residents per 100 age 75+, 2007 9.0 20 7.8 Total nursing facility stays, 2006 73,192 14 3,176,119 Residents with Medicaid as primary payer, 2007 62% 30 64% Residents with Medicare as primary payer, 2007 13% 27 14% Residents with “other” as primary payer, 2007 25% 18 22% Residents with dementia, 2007 47% 20 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 $129 40 $158 Medicare payment per day for nursing facility care, 2006 $325 20 $305 Average private pay rate per day in nursing facility, 2008 $198 23 $209 Average private pay rate per month in assisted living, 2008 $3,170 15 $3,008 Medicare reimbursement per home health visit, 2006 $137 28 $134 Average private pay hourly rate for home health aide, 2008 $20 12 $19 Medicare-certified home health aide, 2008 $30 31 $38 Average private pay daily rate for adult day care, 2008 $53 30 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 337 Long-Term Care Resources Wisconsin Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 117 0.16 23 0.22 Adult day facilities, 2001-02 111 0.15 9 0.09 Assisted living and residential care facilities, 2007 1,617 2.2 6 1.0 Assisted living and residential care units, 2007 31,782 43 3 26 Personal and home care aides, 2007 16,310 22 7 16 Median hourly wage, 2007 $9.57 18 $8.89 Home health aides, 2007 17,680 24 12 22 Median hourly wage, 2007 $10.05 21 $9.62 Medicaid aged/disabled waiver waiting list, 2007 11,777 2 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 402 0.55 17 0.43 Nursing facility beds, 2007 38,250 52 19 45 Nursing facility occupancy rate, 2007 88% 20 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 3.7 26 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 31% 7 18% residents, 2007 Residents with physical restraints (%), 2007 2% 44 6% Long-term care facility beds per FTE ombudsman, 2006 3,136 14 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 42% 47 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 400 $400 150% 200 $200 $182 105% $116 100% Millions of Dollars 0 $6 $0 57% -$76 50% -200 -$200 4% 0% -$400 -400 -$476 -33% -33% $-600 -50% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and -600 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 338 Trends Wisconsin Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 24,392 1,026,374 adults with physical disabilities 2005 32,296 1,376,984 % change +32% 32 +34% Medicaid aged/disabled waiver participants 2000 13,884 448,167 2005 21,173 582,342 % change +52% 21 +30% Medicare home health visits per user 2001 25 37 31 2006 25 30 35 % change +0% 21 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 36,886 1,428,117 2007 33,483 1,440,358 % change -9% 48 +1% Nursing facility beds 2002 43,403 1,671,744 2007 38,250 1,699,494 % change -12% 50 +2% Nursing facility occupancy rate 2002 85% 32 85% 2007 88% 20 85% change +3% 1 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $3,914 $243,497 2007 $5,037 $311,848 % change +29% 27 +28% Medicaid LTC spending for older people and adults 2002 $1,728 $54,261 with physical disabilities (millions) 2007 $1,373 $64,168 % change -21% 51 +18% Medicaid HCBS spending for older people and adults 2002 $263 $10,204 with physical disabilities (millions) 2007 $385 $17,188 % change +46% 38 +68% Medicaid nursing facility spending (millions) 2002 $1,465 $44,057 2007 $989 $46,980 % change -33% 51 +7% Medicaid HCBS spending for older people and adults 2002 15% 24 19% with physical disabilities, as a percentage of total 2007 28% 17 27% LTC spending change +13% 7 +8% 339 AARP Public Policy Institute Wyoming % of Total Population (thousands) Year State Population Rank U.S. All ages 2007 523 51 301,621 2030 523 50 363,584 % change +0% 47 +21% Age 50-64 2007 104 19.9% 6 17.8% 2030 94 18.1% 7 16.5% % change -9% 44 +12% Age 65+ 2007 64 12.2% 35 12.6% 2030 139 26.5% 2 19.7% % change +117% 6 +89% Age 65-74 2007 34 6.5% 25 6.4% 2030 Blue line = 50-64 68 13.1% 4 10.4% % change Purple line = 65-74 +100% 14 +96% Yellow line = 75-84 Age 75-84 2007 21 4.1% Red line = 85+ 35 4.3% 2030 51 9.7% 1 6.6% % change +140% 4 +84% Age 85+ 2007 9 1.6% 38 1.8% 2030 19 3.7% 2 2.6% % change +126% 4 +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in Wyoming as a Percentage of Older People of Color (%), 2007 2000 Census, by Age Group, 2000-2030 State Rank U.S. 320% 6.6% 39 19.3% Population (% of 2000 Census) Asian/Pacific Islander 280% 85+ State Rank U.S. 240% 65-74 0.7% 37 3.6% 75-84 Black 200% State Rank U.S. 160% 0.5% 43 8.7% Hispanic 120% 50-64 State Rank U.S. 80% 3.8% 14 6.6% 2000 2005 2010 2015 2020 2025 2030 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. 340 Population & Characteristics Wyoming Population Characteristics State Rank U.S. Men per 100 women age 85+, 2007 51 13 48 Persons age 75+ living alone, 2007 32% 36 33% Non-metropolitan population age 65+, 2007/2008 77% 1 20% Bachelor level education or higher age 65+, 2007 19% 24 19% Persons age 60+ raising grandchildren, 2007 0.6% 49 1.6% Income & Poverty State Rank U.S. Median household income age 65+, 2007 $32,280 21 $32,158 At/below poverty level age 65+, 2007 5.3% 51 9.5% At/below 200% of poverty level age 65+, 2007 31% 29 32% At/below 300% of poverty level age 65+, 2007 52% 26 51% Women age 75+ at/below poverty level, 2007 11% 35 13% Number Disability Rates (1,000s) Percent Rank U.S. Persons age 65+ with disabilities, 2007 Sensory disability 10 18% 13 16% Physical disability 17 29% 30 31% Mobility disability 10 17% 20 18% Self-care disability 6 10% 19 10% Cognitive/mental disability 6 10% 34 12% Any disability (one or more of the five 24 41% 19 41%   listed above) Cognitive/mental disability + any other disability 6 10% 27 11% Persons age 18-64 with disabilities, 2007 Any disability 42 13% 11 11% Cognitive/mental disability + any other disability 11 3.3% 21 3.2% Persons age 65+ with Alzheimer’s disease, 2010 10 14% 13 13% (projected) Family Caregivers State Rank U.S. Family caregivers (thousands), 2007 55 34,000 Economic value of family caregiving (millions), 2007 $580 $375,000 Economic value per hour, 2007 $9.84 31 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.0 37 3.7 long-term care spending, 2007 341 Long-Term Care Financing Wyoming Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2007 $433 51 $311,848 Medicaid home and community-based services (HCBS) spending 14% 35 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in Wyoming and the U.S., 2007 Wyoming United States 14% 10% 17% 86% 73% Percentages may not add to 100% due to rounding Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Rank U.S. Medicaid LTC expenditures for older people and $79 $151 41 $213 adults with physical disabilities, 2007 Nursing facilities $68 $130 32 $156 HCBS $11 $21 41 $57 Personal care services (PCS) ** NA NA NA $34 Aged/disabled waiver services $11 $21 30 $21 Medicaid LTC expenditures for all populations, 2007 $192 $367 17 $323 Institutional services $88 $168 32 $196 HCBS $104 $199 10 $127 Waiver services (all populations) $104 $199 6 $91 Medicaid home health expenditures * $6 $12 12 $13 Expenditures Per Person Served State Rank U.S. Medicaid nursing facility expenditures per person served, 2005 $22,187 39 $26,096 Medicaid HCBS expenditures for older people and adults with $5,755 41 $9,459 physical disabilities per person served, 2005 Personal care services ** NA NA $9,666 Aged/disabled waiver services $5,755 42 $9,176 HCBS waiver services (all populations) $24,465 21 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. ** In 2007, 15 states did not report any PCS spending; the lowest possible rank for this indicator is 36. In 2005, 20 states did not report any PCS participants; the lowest possible rank for this indicator is 31. 342 Federal/State/Personal Contributions State Rank U.S. Federal Medical Assistance Percentage (FMAP), 2007 52.9% 36 Wyoming Medicaid personal needs allowance (per month), 2007 *** $50 16 $50 State-funded HCBS for older people (millions), 2007 $3.2 41 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization State Rank U.S. Medicare beneficiaries receiving home health services, 2006 4.6% 48 8.4% Medicare home health visits per user, 2006 28 22 35 Per 1,000 Medicaid HCBS Utilization State Population Rank U.S. Medicaid HCBS participants, 2005 3,391 6.7 21 6.3 Personal care services ** NA NA NA 2.7 HCBS waiver services 3,391 6.7 4 3.6 Aged/disabled waiver services 1,488 2.9 17 2.0 Medicaid aged/disabled waiver participants per 53 14 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 130 0.25 24 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 565 1.1 33 3.1 Nursing Facility Utilization State Rank U.S. Total nursing facility residents, 2007 2,445 50 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.8 28 3.8 Nursing facility residents per 100 age 75+, 2007 8.2 25 7.8 Total nursing facility stays, 2006 4,952 50 3,176,119 Residents with Medicaid as primary payer, 2007 59% 38 64% Residents with Medicare as primary payer, 2007 11% 37 14% Residents with “other” as primary payer, 2007 30% 8 22% Residents with dementia, 2007 45% 30 46% Long-Term Care Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2007 NA NA $158 Medicare payment per day for nursing facility care, 2006 $298 32 $305 Average private pay rate per day in nursing facility, 2008 $176 32 $209 Average private pay rate per month in assisted living, 2008 $2,449 42 $3,008 Medicare reimbursement per home health visit, 2006 $121 43 $134 Average private pay hourly rate for home health aide, 2008 $19 21 $19 Medicare-certified home health aide, 2008 $29 33 $38 Average private pay daily rate for adult day care, 2008 $60 18 $59 *** 6 states used the minimum allowed PNA of $30 per month; the lowest rank for this indicator is 46. 343 Long-Term Care Resources Wyoming Per 1,000 HCBS Resources State Age 65+ Rank U.S. Medicare-certified home health agencies, 2006 27 0.42 23 0.22 Adult day facilities, 2001-02 12 0.19 7 0.09 Assisted living and residential care facilities, 2007 35 0.5 36 1.0 Assisted living and residential care units, 2007 1,436 22 31 26 Personal and home care aides, 2007 770 12 30 16 Median hourly wage, 2007 $10.02 13 $8.89 Home health aides, 2007 900 14 37 22 Median hourly wage, 2007 $10.25 17 $9.62 Medicaid aged/disabled waiver waiting list, 2007 210 15 89,938 Per 1,000 Nursing Facility Resources State Age 65+ Rank U.S. Total nursing facilities, 2007 39 0.61 13 0.43 Nursing facility beds, 2007 3,052 48 21 45 Nursing facility occupancy rate, 2007 80% 38 85% Quality & Oversight of Nursing Facilities State Rank U.S. Direct care nursing hours per patient day, 2007 4 9 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 24% 14 18% residents, 2007 Residents with physical restraints (%), 2007 3% 34 6% Long-term care facility beds per FTE ombudsman, 2006 893 46 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 100% 1 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service 40 $40 80% 80 $33 30 61% $30 60% Millions of Dollars 54% 60 20 $20 40% 40 $14 29% 25% $10 20% 10 20 $4 $4 NA NA $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and 0 0 Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS Note: The highest data value within each ranking is indicated by a rank of 1. For indicators in which both a total number and a ratio are given for the state value (percent of population, per person in the state, etc), the rank and U.S. values correspond to the ratio column. Sc 344 Trends Wyoming Home & Community-Based Services Year State Rank U.S. Medicaid HCBS participants, older people and 2000 953 1,026,374 adults with physical disabilities 2005 1,488 1,376,984 % change +56% 23 +34% Medicaid aged/disabled waiver participants 2000 953 448,167 2005 1,488 582,342 % change +56% 18 +30% Medicare home health visits per user 2001 29 18 31 2006 28 22 35 % change -1% 23 +13% Nursing Facilities Year State Rank U.S. Nursing facility residents 2002 2,502 1,428,117 2007 2,445 1,440,358 % change -2% 31 +1% Nursing facility beds 2002 3,015 1,671,744 2007 3,052 1,699,494 % change +1% 28 +2% Nursing facility occupancy rate 2002 83% 38 85% 2007 80% 38 85% change -3% 38 -1% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2002 $277 $243,497 2007 $433 $311,848 % change +56% 2 +28% Medicaid LTC spending for older people and adults 2002 $61 $54,261 with physical disabilities (millions) 2007 $79 $64,168 % change +29% 19 +18% Medicaid HCBS spending for older people and adults 2002 $7 $10,204 with physical disabilities (millions) 2007 $11 $17,188 % change +54% 35 +68% Medicaid nursing facility spending (millions) 2002 $54 $44,057 2007 $68 $46,980 % change +25% 16 +7% Medicaid HCBS spending for older people and adults 2002 12% 27 19% with physical disabilities, as a percentage of total 2007 14% 35 27% LTC spending change +2% 42 +8% 345 This page intentionally left blank AARP Public Policy Institute State Data and Rankings Population & Projections Percent Change in Population, Percent Change in Population, People of color age 65+ (%), Age 65+, 2007-2030 Age 85+, 2007-2030 2007 Value Rank Value Rank Value Rank Alabama +66% 34 +61% 30 20.3% 17 Alaska +165% 3 +297% 1 27.5% 6 Arizona +189% 1 +135% 3 16.6% 20 Arkansas +65% 35 +45% 41 12.2% 26 California +107% 9 +98% 10 36.2% 4 Colorado +94% 20 +104% 8 15.3% 22 Connecticut +68% 32 +70% 26 11.6% 27 Delaware +102% 14 +89% 18 16.2% 21 District of Columbia -16% 51 -17% 51 70.8% 2 Florida +151% 4 +91% 15 21.4% 15 Georgia +102% 14 +91% 15 24.6% 11 Hawaii +78% 27 +64% 28 77.5% 1 Idaho +106% 10 +91% 15 5.1% 43 Illinois +56% 44 +51% 35 19.4% 18 Indiana +55% 45 +48% 36 8.5% 33 Iowa +51% 50 +36% 49 2.8% 48 Kansas +65% 35 +45% 41 8.3% 34 Kentucky +64% 38 +48% 36 6.9% 38 Louisiana +81% 24 +84% 23 26.1% 9 Maine +92% 21 +87% 20 1.7% 51 Maryland +87% 23 +98% 10 27.4% 7 Massachusetts +70% 31 +52% 34 8.8% 32 Michigan +63% 39 +58% 33 13.0% 24 Minnesota +88% 22 +61% 30 4.2% 45 Mississippi +74% 29 +45% 41 26.5% 8 Missouri +65% 35 +48% 36 10.0% 30 Montana +102% 14 +88% 19 5.2% 41 Nebraska +59% 42 +40% 46 5.2% 41 Nevada +179% 2 +176% 2 22.4% 13 New Hampshire +113% 8 +87% 20 2.5% 49 New Jersey +73% 30 +72% 25 21.9% 14 New Mexico +122% 5 +123% 5 39.4% 3 New York +54% 46 +62% 29 25.5% 10 North Carolina +97% 18 +87% 20 19.0% 19 North Dakota +63% 39 +34% 50 3.0% 47 Ohio +53% 47 +45% 41 10.7% 29 Oklahoma +58% 43 +46% 39 14.6% 23 Oregon +80% 25 +66% 27 7.2% 37 Pennsylvania +53% 47 +37% 48 9.4% 31 Rhode Island +68% 32 +46% 39 7.6% 36 South Carolina +98% 17 +95% 12 22.6% 12 South Dakota +63% 39 +39% 47 4.6% 44 Tennessee +79% 26 +76% 24 12.5% 25 Texas +117% 6 +101% 9 31.3% 5 Utah +97% 18 +92% 14 7.8% 35 Vermont +106% 10 +106% 7 2.3% 50 Virginia +103% 13 +114% 6 20.9% 16 Washington +106% 10 +94% 13 11.4% 28 West Virginia +52% 49 +43% 45 4.1% 46 Wisconsin +78% 27 +59% 32 5.3% 40 Wyoming +117% 6 +126% 4 6.6% 39 United States +89% +74% 19.3% Note: The highest data value within each ranking is indicated by a rank of 1. This volume contains ranking tables for only a few indicators. A complete set of ranking tables for all indicators may be found in the Executive Summary volume. 348 Population & Characteristics Percent of Age 65+ Persons Age 65+ with Any Economic Value of Family Caregiving, Below Poverty, 2007 D ­ isability, 2007 2007 Value Percent of Value Value Rank (Thousands) Age 65+ Rank (Millions) Per Hour Rank Alabama 11.9% 12 298 50% 2 $5,200 $8.49 48 Alaska 5.4% 50 22 48% 5 $1,050 $13.10 1 Arizona 8.6% 26 313 39% 27 $6,900 $10.50 20 Arkansas 12.1% 7 188 50% 2 $3,500 $8.80 46 California 8.2% 33 1,582 41% 19 $48,000 $11.05 13 Colorado 8.5% 27 175 37% 40 $6,500 $11.04 14 Connecticut 6.4% 48 159 36% 43 $4,900 $12.37 2 Delaware 7.8% 41 42 38% 34 $1,280 $11.31 9 District of Columbia 13.7% 2 25 38% 34 $670 $10.82 16 Florida 9.4% 19 1,157 38% 34 $19,200 $9.89 29 Georgia 12.1% 7 405 45% 11 $13,000 $9.07 44 Hawaii 6.3% 49 69 38% 34 $1,450 $11.92 4 Idaho 8.0% 37 66 40% 23 $1,600 $9.13 43 Illinois 8.5% 27 567 39% 27 $17,100 $10.60 19 Indiana 7.8% 41 303 40% 23 $7,800 $9.91 28 Iowa 7.7% 43 147 36% 43 $3,400 $10.25 25 Kansas 8.1% 36 133 40% 23 $2,700 $9.24 40 Kentucky 12.9% 5 254 49% 4 $5,400 $9.51 37 Louisiana 13.3% 3 236 47% 7 $4,900 $8.13 51 Maine 9.2% 23 79 43% 13 $1,840 $11.18 10 Maryland 8.2% 33 235 37% 40 $6,600 $10.12 26 Massachusetts 9.3% 20 294 36% 43 $8,800 $11.86 5 Michigan 8.0% 37 501 41% 19 $14,400 $10.41 22 Minnesota 8.0% 37 210 35% 49 $7,100 $11.11 12 Mississippi 14.9% 1 182 53% 1 $4,000 $8.18 50 Missouri 9.3% 20 315 42% 16 $6,300 $9.84 31 Montana 10.0% 18 53 42% 16 $1,140 $9.53 36 Nebraska 8.3% 31 79 36% 43 $2,000 $10.48 21 Nevada 6.8% 45 102 36% 43 $3,300 $10.81 17 New Hampshire 6.5% 47 56 36% 43 $1,830 $11.55 6 New Jersey 8.4% 29 384 35% 49 $11,800 $11.16 11 New Mexico 13.3% 3 113 46% 9 $2,100 $9.36 39 New York 11.7% 13 954 39% 27 $25,000 $10.61 18 North Carolina 11.0% 15 458 43% 13 $11,600 $9.63 35 North Dakota 12.6% 6 34 40% 23 $580 $9.74 33 Ohio 8.2% 33 576 39% 27 $14,200 $9.92 27 Oklahoma 10.1% 17 212 47% 7 $3,700 $9.15 42 Oregon 8.4% 29 200 42% 16 $4,800 $10.91 15 Pennsylvania 8.7% 25 688 39% 27 $15,600 $10.39 23 Rhode Island 9.3% 20 52 38% 34 $1,470 $11.94 3 South Carolina 12.0% 9 239 43% 13 $5,700 $8.99 45 South Dakota 11.5% 14 39 38% 34 $920 $9.87 30 Tennessee 12.0% 9 347 46% 9 $7,800 $9.23 41 Texas 12.0% 9 1,032 45% 11 $26,000 $8.76 47 Utah 6.8% 45 88 39% 27 $3,500 $9.68 34 Vermont 7.5% 44 30 37% 40 $680 $11.45 7 Virginia 9.2% 23 343 39% 27 $9,200 $9.38 38 Washington 7.9% 40 299 41% 19 $7,900 $11.43 8 West Virginia 10.4% 16 130 48% 5 $2,500 $8.23 49 Wisconsin 8.3% 31 247 35% 49 $6,600 $10.32 24 Wyoming 5.3% 51 24 41% 19 $580 $9.84 31 United States 9.5% 14,735 41% $375,000 $10.10 Note: The highest data value within each ranking is indicated by a rank of 1. This volume contains ranking tables for only a few indicators. A complete set of ranking tables for all indicators may be found in the Executive Summary volume. 349 Long-Term Care Financing & Utilization Medicaid HCBS for Older People and Medicaid HCBS Expenditures for Older People Medicaid HCBS Participants, 2005 Adults w/ Physical Disabilites, and Adults w/ Physical Disabilites, 2007 ­ % of LTC, 2007 Value Percent of Per 1,000 Value Rank (Thousands) Age 65+ Rank Value Population Rank Alabama 9% 44 $82 $18 45 13,572 3.0 44 Alaska 51% 4 $129 $188 1 6,307 9.4 7 Arizona 40% 7 $262 $41 24 32,348 5.4 28 Arkansas 21% 27 $142 $50 22 27,583 10.0 5 California 51% 4 $3,820 $105 7 394,373 11.0 3 Colorado 22% 25 $144 $30 38 25,575 5.5 26 Connecticut 9% 44 $122 $35 30 18,272 5.2 30 Delaware 10% 43 $18 $20 42 2,642 3.1 43 District of Columbia 34% 12 $88 $149 2 3,306 5.7 23 Florida 14% 35 $374 $20 42 73,131 4.1 37 Georgia 18% 30 $183 $19 44 24,686 2.7 45 Hawaii 17% 33 $46 $36 28 4,363 3.4 41 Idaho 39% 9 $91 $61 15 13,215 9.3 8 Illinois 23% 24 $402 $31 34 68,953 5.4 28 Indiana 5% 48 $46 $7 49 13,484 2.2 49 Iowa 14% 35 $75 $25 39 18,060 6.1 22 Kansas 34% 12 $177 $64 13 23,348 8.5 12 Kentucky 8% 46 $66 $16 46 14,922 3.6 40 Louisiana 24% 22 $160 $37 26 9,414 2.1 50 Maine 26% 19 $82 $62 14 11,922 9.1 9 Maryland 11% 39 $123 $22 40 19,109 3.4 41 Massachusetts 24% 22 $504 $78 11 32,793 5.1 32 Michigan 18% 30 $324 $32 33 72,607 7.2 20 Minnesota 44% 6 $650 $125 5 54,096 10.6 4 Mississippi 11% 39 $90 $31 34 14,540 5.0 33 Missouri 31% 15 $338 $58 16 81,505 14.1 1 Montana 26% 19 $52 $54 18 7,121 7.6 18 Nebraska 18% 30 $72 $41 24 9,732 5.5 26 Nevada 34% 12 $81 $31 34 5,878 2.4 48 New Hampshire 13% 38 $46 $35 30 4,924 3.8 38 New Jersey 20% 28 $445 $51 20 38,243 4.4 36 New Mexico 61% 1 $268 $136 4 15,630 8.2 15 New York 29% 16 $2,729 $141 3 162,387 8.4 13 North Carolina 39% 9 $713 $79 10 72,221 8.3 14 North Dakota 5% 48 $10 $15 47 4,990 7.8 16 Ohio 17% 33 $545 $48 23 52,110 4.5 35 Oklahoma 27% 18 $186 $51 20 27,621 7.8 16 Oregon 56% 2 $379 $101 8 42,377 11.7 2 Pennsylvania 11% 39 $454 $37 26 46,247 3.7 39 Rhode Island 11% 39 $38 $36 28 5,568 5.2 30 South Carolina 22% 25 $136 $31 34 20,341 4.8 34 South Dakota 7% 47 $11 $13 48 4,426 5.7 23 Tennessee 1% 51 $16 $3 50 6,485 1.1 51 Texas 40% 7 $1,273 $53 19 130,871 5.7 23 Utah 5% 48 $9 $3 50 6,782 2.7 45 Vermont 35% 11 $60 $97 9 5,343 8.6 11 Virginia 26% 19 $258 $34 32 19,436 2.6 47 Washington 55% 3 $717 $111 6 59,762 9.5 6 West Virginia 19% 29 $101 $55 17 13,126 7.3 19 Wisconsin 28% 17 $385 $69 12 48,208 8.7 10 Wyoming 14% 35 $11 $21 41 3,391 6.7 21 United States 27% $17,188 $57 1,854,998 6.3 Note: The highest data value within each ranking is indicated by a rank of 1. This volume contains ranking tables for only a few indicators. A complete set of ranking tables for all indicators may be found in the Executive Summary volume. 350 AARP Public Policy Institute Data Documentation Data Documentation Care should be taken when making comparisons to indicators from other publications or earlier editions of Across the States, as data sources, definitions, and methodology may differ. In addition, please note that many indicators are drawn from the American Community Survey (ACS), a national survey administered by the U.S. Census Bureau. As of data year 2006, ACS includes persons living in institutions and group quarters. Of particular note for this book, persons living in nursing facilities are now included in indicators based on the 2007 ACS except where otherwise noted. However, indicators based on data from the 2007 ACS are no longer exactly comparable to those in earlier editions of Across the States, which were based on the 2005 and earlier ACS and thus exclude persons living in institutions and group quarters. The Census Bureau population projections and estimates do include persons living in institutions and other group quarters for all years. Except where noted otherwise, the base for any analysis of survey data is all persons in the sample within the age group specified. Where indicators include both raw measures and amount per capita, or per person of a certain age in the state, U.S. Census Bureau population estimates (see <http://www.census.gov/popest/estimates.php>) for the relevant year are used in the denominator. Long-Term Care & Independent Living Maps Percent of population age 85+, 2007 and 2030. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, Population Division, “State Single Year of Age and Sex Population Estimates: April 1, 2000 to July 1, 2007 - RESIDENT” available at <http://www.census.gov/popest/states/asrh/files/SC- EST2007-AGESEX-RES.csv> (2007 data year) and U.S. Census Bureau, Population Division, “State Interim Population Projections by Age and Sex: 2004 – 2030; File 4. Annual projections by single year of age by sex” available at <http://www.census.gov/population/projections/DownldFile4.xls> (2030 data year). Both data sources were accessed September 2008. Medicaid HCBS Spending for Older People and Adults with Physical Disabilities, as a Percentage of LTC Spending. AARP Public Policy Institute calculations based on data from Brian Burwell, Kate Sredl, and Steve Eiken, “Medicaid Long Term Care Expenditures FY 2007” Thomson Reuters, 2008, available at <http://hcbs.org/moreInfo.php/nb/doc/2374/Medicaid_Long_Term_Care_Expenditures_FY_2007>. For more detail, see “long-term care financing” below. Medicaid HCBS Participants, as a Percentage of Older People and Adults with Physical Disabilities Receiving Medicaid LTC. Source: AARP Public Policy Institute calculations using data from (1) Terence Ng, Charlene Harrington, and Molly O’Malley, “Medicaid Home and Community-Based Service Programs: Data Update” University of California, San Francisco and Kaiser Family Foundation, December 2008, available at <http://www.kff.org/medicaid/7720.cfm> and (2) Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2008, “Table 13.25: Medicaid Persons Served (Beneficiaries), by Type of Service and Area of Residence: Fiscal Year 2005” available at <http://www.cms.hhs.gov/ MedicareMedicaidStatSupp/LT/list.asp#TopOfPage>. For more detail, see “long-term care utilization” below. Percent of nursing facilities that are for-profit. Source: Charlene Harrington, Helen Carrillo, and Brandee Woleslagle Blank, “Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2001 Through 2007,” University of California, San Francisco, 2008, available at <http://198.170.85.250/nursing_homes/nursing_ trends_2007.php>. Nursing facility occupancy rate. Source: Helen Carrillo and Charlene Harrington, Analysis of On-Line Survey Certification and Reporting System (OSCAR) unpublished data from the Centers for Medicare and 352 Data Documentation Medicaid Services, University of California, San Francisco, September 2008. Occupancy rate is computed by dividing the total number of residents (see long-term care utilization, above) by the number of beds. South Dakota data indicated an occupancy rate of 100%: not a single unoccupied bed in the state. We don’t believe this is the case, and thus report the occupancy rate as NA. In prior years, South Dakota has had one of the highest occupancy rates in the country, and if that had continues, the occupancy rate in the state would be 90% to 95%. Medicaid personal needs allowance. Source: National Long-Term Care Ombudsman Resource Center, National Citizens’ Coalition for Nursing Home Reform. The personal needs allowance is the monthly sum that nursing home residents who receive Medicaid may retain from their personal income. Any income above the allowance is applied toward the cost of their care. This allowance is intended for residents to spend at their discretion on items such as telephone expenses, cards to send to family, or hobbies and is not intended to be used for personal items or services that a facility should be providing such as toothpaste, shampoo, or incontinence products. HCBS aged/disabled waiver waiting list. Source: Terence Ng, Charlene Harrington, and Molly O’Malley, “Medicaid Home and Community-Based Service Programs: Data Update” University of California, San Francisco and Kaiser Family Foundation, December 2008, available at <http://www.kff.org/medicaid/7720. cfm>. Waiting lists procedures vary by state, it is not necessarily the case that states with no waiting list or a small waiting list are meeting the needs of all Mediciad beneficiaries wishing to receive services in a home or community-based settings. Federal Medical Assistance Percentage. Source: National Conference of State Legislatures, available at <http://www.ncsl.org/statefed/health/FMAPfy07.htm>. The FMAP is the percentage of Medicaid spending that is paid by the federal government. States Offering PCS Benefit for Adults in State Plan. Sources: AARP Public Policy Institute inquiries and Laura Summer and Emily S. Ihara, “The Medicaid Personal Care Services Benefit: Practices in States that Offer the Optional State Plan Benefit” AARP Public Policy Issue Paper, May 2005. Summer and Ihara identified states offering the personal care services benefit in the state plan as of 2004. Contacting other states which reported personal care spending in 2007, four additional states providing PCS in the state plan in 2007 were identified. States with Green Houses. Source: NCB Capital Impact, “The Green House Project” fact sheet, November 2008. Developed by Dr. William Thomas and rooted in the tradition of the Eden Alternative, a model for cultural change within nursing facilities, The Green House model is intended to de-institutionalize long- term care by eliminating large nursing facilities and creating habilitative, social settings. See also <www. ncbcapitalimpact.org/thegreenhouse>. States Exceeding Federal Requirements for Family and Medical Leave Acts. Source: personal communication with Jeanne Mejeur, National Conference of State Legislatures, October 2008. Refers to states exceeding federal requirements for Family and Medical Leave Acts for adults (several additional states exceed federal requirements for children only). Federal requirements are employers with 50 or more employees must provide 12 weeks of unpaid leave during a 12-month period to •  are for a newborn, adopted, or foster child. c •  are for a family member (parent, under 18 child, dependant adult child, or spouse) with a serious health c condition. •  ttend to the employee’s own serious health condition. a See also <http://www.ncsl.org/print/employ/fam-medleave.pdf>. 353 Data Documentation States Receiving FY 2007-2011 Money Follows the Person Grants. Source: Centers for Medicare and Medicaid Services, “Money Follows the Person (MFP) Rebalance Demonstration,” June 2007. Available at <http://www.cms.hhs.gov/DeficitReductionAct/Downloads/MFP_FactSheet.pdf>. The MFP rebalancing demonstration makes awards to states to achieve the objectives of rebalancing, eliminating barriers to flexible use of Medicaid funds to individuals to receive support in the settings of their choice, continuity of service, and quality assurance and quality improvement with respect to long-term care services under state Medicaid programs. States Receiving FY 2003-2005 Aging and Disability Resource Center Grants. Source: Administration on Aging, “Aging and Disability Resource Center Grant Programs” available at <http://www.aoa.gov/prof/ aging_dis/docs/ADRCmap05.pdf>. These grants were developed to help states create single sources of information and access for all people seeking long term supports and services. States with Cash and Counseling Programs. Cash and Counseling, “Participating States” available at <http://www.cashandcounseling.org/about/participating_states>, accessed November 2008. Cash and Counseling is a national program sponsored by The Robert Wood Johnson Foundation, the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services (ASPE), and the Administration on Aging. The program gives Medicaid beneficiaries with disabilities the option to manage a flexible budget to hire their own personal care aides as well as purchase items or services that help them live independently. States with Own Your Future Programs. Source: National Clearinghouse for Long-Term Care Information, “Own Your Future: State Activities” available at <http://www.longtermcare.gov/LTC/Main_ Site/Planning_LTC/Campaign/index.aspx>, accessed November 2008. The Own Your Future campaign is a joint federal-state initiative to increase awareness about the importance of planning for future long-term care needs. States adopting most recent NAIC model long-term care insurance act. Source: personal communication with Jennifer Cook, National Association of Insurance Commissioners, November 2008. The Model Act was last revised 2007 Proc. 3rd Quarter when changes were made to the new Producer Training Section (Section 9). State Profiles Total population, population by age groups, percentage of population by age groups (2007 and 2030), and percent change. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, Population Division, “State Single Year of Age and Sex Population Estimates: April 1, 2000 to July 1, 2007 - RESIDENT” available at <http://www.census.gov/popest/states/asrh/files/SC-EST2007-AGESEX- RES.csv> (2007 data year) and U.S. Census Bureau, Population Division, “State Interim Population Projections by Age and Sex: 2004 – 2030; File 4. Annual projections by single year of age by sex” available at <http://www.census.gov/population/projections/DownldFile4.xls> (2030 data year). Both data sources were accessed September 2008. Race & Ethnicity. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, Population Division, “State by Age, Sex, Race, and Hispanic Origin” available at <http://www.census.gov/ popest/states/asrh/files/SC-EST2007-alldata6.csv> (6 race groups) and <http://www.census.gov/popest/ states/asrh/files/SC-EST2007-alldata5.csv> (5 race groups). Asian/Pacific Islander and Black populations were calculated using the 5 race groups file, with race variable equal to 4 “Asian alone or in combination” or 5 “Native Hawaiian and other Pacific Islander alone or in combination;” and 2 “Black alone or in combination,” respectively. Hispanic population was calculated using the 6 race groups file, with origin 354 Data Documentation variable equal to 2 “Hispanic or Latino origin.” Minority population was calculated using the 6 race groups file, with origin variable not equal to 2 and/or race variable not equal to 1 “White alone.” Both data sources were accessed September 2008. Note that minority population is not equal to the sum of the three reported minority groups, because there are other minority groups and it is possible for one individual to belong to more than one minority group. Line graph, projected population growth by age group. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, Population Division, “State Interim Population Projections by Age and Sex: 2004 – 2030; File 4. Annual projections by single year of age by sex” available at <http:// www.census.gov/population/projections/DownldFile4.xls>, accessed September 2008. Population and Characteristics Men per 100 women age 85+. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, Population Division, “State Single Year of Age and Sex Population Estimates: April 1, 2000 to July 1, 2007 - RESIDENT” accessed September 2008. Persons age 75+ living alone. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, public use microdata, accessed November 2008. Non-metropolitan population age 65+. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, Current Population Survey 2007 and 2008, public use microdata, accessed November 2008. Refers to the percentage of the 65+ population living outside a metropolitan area. CPS data exclude persons living in institutions. Confidentiality requirements led to some households – including all non- metropolitan households – being classified as “not identifiable” in four states: Colorado, Lousiana, Nevada, and Utah. Values of NA were assigned for this indicator for these states, and the U.S. total is calculated excluding these states. Data from 2007 and 2008 surveys were combined to increase sample size. Bachelor level education or higher age 65+. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table B15001 “Sex by Age by Educational Attainment for the Population 18 Years and Over” generated by AARP Public Policy Institute using American FactFinder <http://factfinder.census.gov> (September 2008). Grandparents age 60+ raising grandchildren. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table B10056 “Sex of Grandparents Living with Own Grandchildren Under 18 Years by Responsibility for Own Grandchildren and Age of Grandparent” generated by AARP Public Policy Institute using American FactFinder <http://factfinder. census.gov> (September 2008) and U.S. Census Bureau, Population Division, “State Single Year of Age and Sex Population Estimates: April 1, 2000 to July 1, 2007 - RESIDENT” available at <http://www.census.gov/ popest/states/asrh/files/SC-EST2007-AGESEX-RES.csv>. The number of grandparents age 60 or older financially responsible for basic needs of grandchildren such as food, shelter, clothing, day care, etc was taken from the first file, and the number of persons age 60 or older was taken from the second file. Median household income age 65+. Source: U.S. Census Bureau, American Community Survey 2007, Table B19049 “Median Household Income in the Past 12 Months (In 2007 Inflation-Adjusted Dollars) by Age of Householder” generated by AARP Public Policy Institute using American FactFinder <http:// factfinder.census.gov> (September 2008). All income variables are computed for the preceding 12 months (the survey is conducted throughout the year, so this reference period could be January 2006 to December 2006, December 2006 to November 2007, or any time in between) and are reported in 2007 inflation- adjusted dollars. 355 Data Documentation At/below poverty level age 65+; Women age 75+ at/below poverty level. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table B17001 “Poverty Status in the Past 12 Months by Sex by Age” generated by AARP Public Policy Institute using American FactFinder <http://factfinder.census.gov> (September 2008). The Census poverty thresholds are similar to, but not exactly the same as, the U.S. Department of Health and Human Services guidelines that are used for eligibility for many social services. For persons age 65+ living alone or with another adult, the thresholds are usually somewhat lower than the guidelines. For example, the poverty threshold for a single adult age 65+ interviewed in July 2007 was $9,944. The 2007 poverty guideline for a single adult was $10,210. At/below 200% and 300% poverty level age 65+. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2005, public use microdata, accessed November 2008. Persons age 65+ with sensory disability. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table C18003 “Sex by Age by Sensory Disability for the Civilian Noninstitutionalized Population 5 Years and Over” generated by AARP Public Policy Institute using American FactFinder <http://factfinder.census.gov> (September 2008). Question asks, “Does this person have any of the following long-lasting conditions: Blindness, deafness, or a severe vision or hearing impairment?” Persons age 65+ with physical disability. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table C18004 “Sex by Age by Physical Disability for the Civilian Noninstitutionalized Population 5 Years and Over” generated by AARP Public Policy Institute using American FactFinder <http://factfinder.census.gov> (September 2008). Question asks, “Does this person have any of the following long-lasting conditions: A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying?” Persons age 65+ with mobility disability. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table C18007 “Sex by Age by Go- Outside-Home Disability for the Civilian Noninstitutionalized Population 16 Years and Over” generated by AARP Public Policy Institute using American FactFinder <http://factfinder.census.gov> (September 2008). Question asks, “Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities: Going outside the home alone to shop or visit a doctor’s office?” Persons age 65+ with self-care disability. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table C18006 “Sex by Age by Self-Care Disability for the Civilian Noninstitutionalized Population 5 Years and Over” generated by AARP Public Policy Institute using American FactFinder <http://factfinder.census.gov> (September 2008). Question asks, “Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities: Dressing, bathing, or getting around inside the home?” Persons age 65+ with cognitive/mental disability. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table C18005 “Sex by Age by Mental Disability for the Civilian Noninstitutionalized Population 5 Years and Over” generated by AARP Public Policy Institute using American FactFinder <http://factfinder.census.gov> (September 2008). Question asks, “Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities: Learning, remembering, or concentrating?” 356 Data Documentation Persons age 65+ with any disability. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, Table C18002 “Sex by Age by Disability Status for the Civilian Noninstitutionalized Population 5 Years and Over” generated by AARP Public Policy Institute using American FactFinder <http://factfinder.census.gov> (September 2008). Includes persons with one or more of the five types of disability – sensory, physical, mobility, self-care, and cognitive/mental – listed separately above. Persons age 65+ with cognitive/mental + any other disability; Persons age 18-64 with disabilities. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2007, public use microdata, accessed November 2008. Cognitive/mental + any other disability indicator includes persons with a cognitive mental disability and one or more the four other types of disability – sensory, physical, mobility, and self-care – listed separately above. The American Community Survey also identifies a work disability for persons under 65. For comparability with the disability rates for persons 65+, this type of disability is not included in the indicators for persons age 18 to 64. As with the other disability indicators (above), these indicators do not include persons living in institutions. Persons age 65+ with Alzheimer’s disease. Source: Total numbers from Table 2: Number of People Age 65+ with Alzheimer’s Disease and Percent Change Between 2000 and 2010, by State, “2008 Alzheimer’s Disease Facts and Figures,” Alzheimer’s Association, 2008. Available at <http://www.alz.org/national/ documents/report_alzfactsfigures2008.pdf>. Data used with permission. Percent of age 65+ from AARP Public Policy Institute calculations using total numbers and denominator data from U.S. Census Bureau, Population Division, “State Interim Population Projections by Age and Sex: 2004 – 2030; File 4. Annual projections by single year of age by sex” available at <http://www.census.gov/population/projections/ DownldFile4.xls>. Family caregivers; Economic value of family caregiving; Economic value per hour; Ratio of economic value to Medicaid LTC spending. Source: Ari Houser and Mary Jo Gibson, “Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update,” AARP Public Policy Insight on the Issues #13, November 2008, available at <http://www.aarp.org/research/housing-mobility/caregiving/i13_caregiving. html>. Ratio of economic value to Medicaid LTC spending was not calculated for Vermont or Arizona in the original source. Using our special calculations of Medicaid LTC spending for these states (see below, under Long-Term Care Financing), comparable data can now be reported for these states. Long-Term Care Financing Total Medicaid expenditures; Pie chart; Expenditures by service. Source: AARP Public Policy Institute calculations based on data from Brian Burwell, Kate Sredl, and Steve Eiken, “Medicaid Long Term Care Expenditures FY 2007” Thomson Reuters, 2008, available at <http://hcbs.org/moreInfo.php/nb/doc/2374/ Medicaid_Long_Term_Care_Expenditures_FY_2007>. Refers to total fee-for-service expenditures for services under the Medicaid program, including both state and federal contributions, not including spending provided through capitated managed care programs. A few states have large managed care programs that pay for long-term care benefits on a capitated basis, so these numbers may underestimate the total amount spent on long-term care for those states. Long-term care services under the Medicaid program include nursing facilities, intermediate care facilities-mental retardation (ICF-MR), and home- and community-based services (HCBS). HCBS includes personal care services, 1915(c) waiver programs, and additional programs in several states. Beginning with the 2008 AARP Public Policy Institute Report, “A Balancing Act: State Long-Term Care Reform” (Kassner et al, available at <http://www.aarp.org/research/longtermcare/ programfunding/2008_10_ltc.html>), we no longer include Medicaid home health in the totals for LTC or HCBS. Medicaid home health expenditures are included on a separate for comparison to earlier editions of Across the States or other sources that include home health in long-term care. 357 Data Documentation In this edition of Across the States, we also follow the conventions of “A Balancing Act” in separating services for older people and adults with physical disabilities from other long-term care populations. Long- term care services for older people and adults with physical disabilities include nursing facilities; personal care services; 1915(c) waiver programs classified serving aged, aged/disabled, or physically disabled populations; and additional programs in several states. Long-term care services for other populations include ICF-MR’s and 1915(c) waiver programs for other populations, primarily persons with mental retardation or developmental disabilities (MR/DD). Additional calculations and data were required for three states: •  ississippi reported total 1915(c) waiver spending but not spending for each individual waiver, thereby M not permitted calculation of the total about. Consistent with the state’s spending in preceding years, we allocated 70% of total waiver spending to waivers for older people and adults with physical disabilities. •  eginning in 2006, the vast majority of Vermont’s Medicaid HCBS was provided through a managed care B program. Data which are consistent with spending figures for 2005 and earlier, and thus with the rest of the country, were obtained from the state (personal communication with Bard Hill, Vermont Agency of Human Services, November 2008). •  or a long-time. Spending and participation data were obtained from the state (personal communication F with Alan Schafer, Arizona Health Care Cost Containment System, November 2008), but matching the state’s services to the categories used for other states could not be done exactly. We used the following mechanisms to achieve as close a match as possible:   HCBS spending in the Arizona Long-Term Care System’s (ALTCS) EPD programs was classified as All personal care services, and all institutional spending in EPD programs was classified as nursing facility services. All HCBS spending in DES-DDD programs was classified as HCBS waiver services for the MR/DD population, and all institutional spending in EPD programs was classified as ICF-MR.   these amounts were added the state’s fee-for-service spending (the state reported some fee-for-service To spending for personal care services and nursing facilties). Where available, these data were obtained directly from the state. For 2002 and 2005, data from Burwell et al were used for fee-for-service spending.   This categorization leaves no services classified as home health or as HCBS waivers for older people and adults with disabilities. Any “equivalent” services would be categorized as “not long-term care” or as personal care services, respectively. Adjustments for these three states are not included in the U.S. total values, as the effect would have been small. Therefore, the U.S. values reported in Across the States are the same as the U.S. totals reported in the original source. Medicaid nursing facility expenditures per person served. Source: Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2008, “Table 13.27: Medicaid Payment per Person Served (Beneficiary), by Type of Service and Area of Residence: Fiscal Year 2005” available at <http:// www.cms.hhs.gov/MedicareMedicaidStatSupp/LT/list.asp#TopOfPage>. Refers to total Medicaid spending for nursing facility care, divided by the total number of beneficiaries receiving Medicaid nursing facility services at any point during the year. Maine did not report data for 2005, so 2004 data are used instead. Arizona data were obtained directly from the state (personal communication with Alan Schafer, Arizona Health Care Cost Containment System, November 2008) and represent total spending per beneficiary-year (not per unique beneficiary) and are therefore somewhat inflated relative to the values reported for the U.S. and for other states. Medicaid HCBS expenditures per person served; Expenditures per person served by service. Source: Terence Ng, Charlene Harrington, and Molly O’Malley, “Medicaid Home and Community-Based Service 358 Data Documentation Programs: Data Update” University of California, San Francisco and Kaiser Family Foundation, December 2008, available at <http://www.kff.org/medicaid/7720.cfm>. Refers to total Medicaid spending for the type of service, divided by the total number of beneficiaries receiving the service at any point during the year. The number of beneficiaries is unduplicated within service or waiver, but not between services. If there are beneficiaries receiving multiple services or services from multiple waivers, then the actual spending per beneficiary will be somewhat higher than reported. Arizona data were obtained directly from the state (personal communication with Alan Schafer, Arizona Health Care Cost Containment System, November 2008) and represent total spending per beneficiary-year (not per unique beneficiary) and are therefore somewhat inflated relative to the values reported for the U.S. and for other states. For more detail on how Arizona’s services were matched to the categories used for other states, see discussion in Medicaid expenditures, above. Federal Medical Assistance Percentage. Source: National Conference of State Legislatures, available at <http://www.ncsl.org/statefed/health/FMAPfy07.htm>. The FMAP is the percentage of Medicaid spending that is paid by the federal government. The FMAP is calculated by the formula: 100% – 45%*[(State per capita income)/(U.S. per capita income)]2, where per capita income is the three year average of data from the National Income and Product Accounts (NIPA), published by the Department of Commerce, and may not be lower than 50%. In 2007, 12 states had the minimum FMAP of 50%, and the amounts ranged from 50% to 76%. Medicaid personal needs allowance. Source: National Long-Term Care Ombudsman Resource Center, National Citizens’ Coalition for Nursing Home Reform. The personal needs allowance is the monthly sum that nursing home residents who receive Medicaid may retain from their personal income. Any income above the allowance is applied toward the cost of their care. This allowance is intended for residents to spend at their discretion on items such as telephone expenses, cards to send to family, or hobbies and is not intended to be used for personal items or services that a facility should be providing such as toothpaste, shampoo, or incontinence products. The U.S. value for this indicator is the median of all state values. State-funded HCBS for older people. Source: Robert Mollica and Kristin Simms-Kastelein, National Academy for State Health Policy, research for AARP Public Policy Institute (publication forthcoming). Refers to spending for home and community-based services funded entire by the state. Does not include the state share of Medicaid or spending at the local level. Long-Term Care Utilization Medicare beneficiaries receiving home health services; Medicare home health visits per user. Source: Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2007, “Table 7.3: Persons Served, Visits, Total Charges, Visit Charges, and Program Payments for Medicare Home Health Agency Services, by Area of Residence: Calendar Year 2006” available at <http://www.cms.hhs.gov/ MedicareMedicaidStatSupp/LT/list.asp#TopOfPage>. Medicaid HCBS and home health participants. Source: AARP Public Policy Institute calculations based on Terence Ng, Charlene Harrington, and Molly O’Malley, “Medicaid Home and Community-Based Service Programs: Data Update” University of California, San Francisco and Kaiser Family Foundation, December 2008, available at <http://www.kff.org/medicaid/7720.cfm>. The number of beneficiaries is unduplicated within service or waiver, but not between services. If there are beneficiaries receiving multiple services or services from multiple waivers, then the actual total number of beneficiaries will be somewhat lower than reported. Arizona data were obtained directly from the state (personal communication with Alan Schafer, Arizona Health Care Cost Containment System, November 2008) and represent total participant-years (not unique participants) and are therefore somewhat deflated relative to the values reported for the U.S. and for 359 Data Documentation other states. For more detail on how Arizona’s services were matched to the categories used for other states, see discussion in Medicaid expenditures, above. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities. Source: AARP Public Policy Institute calculations using data from (1) Terence Ng, Charlene Harrington, and Molly O’Malley, “Medicaid Home and Community-Based Service Programs: Data Update” University of California, San Francisco and Kaiser Family Foundation, December 2008, available at <http://www.kff.org/ medicaid/7720.cfm> and (2) Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2008, “Table 13.25: Medicaid Persons Served (Beneficiaries), by Type of Service and Area of Residence: Fiscal Year 2005” available at <http://www.cms.hhs.gov/MedicareMedicaidStatSupp/LT/list. asp#TopOfPage>. Persons in assisted living / residential care covered by Medicaid or state funding. Source: Robert Mollica, Kristin Sims-Kastelein, and Janet O’Keeffe, “Residential Care and Assisted Living Compendium: 2007,” National Academy for State Health Policy and RTI International, 2008, available at <http://aspe.hhs. gov/daltcp/reports/2007/07alcom.htm>. Refers to persons receiving Medicaid or state public assistance to live in residential care facilities. These facilities may be called by many names, including adult foster care, board and care homes, rest homes, adult care home, domiciliary care homes, personal care homes, community-based residential facilities, and assisted living. Total nursing facility residents; Residents per 100 age 65+; Residents per 100 age 75+. Source: Helen Carrillo and Charlene Harrington, Analysis of On-Line Survey Certification and Reporting System (OSCAR) unpublished data from the Centers for Medicare and Medicaid Services, University of California, San Francisco, September 2008. According to the 2004 National Nursing Home Survey, about 88% of nursing facility residents are 65 or older, and 76% are 75 or older. Therefore, the value of the indicator on residents per 100 age 65+ or age 75+ should not be read as the percentage of persons age 65+ living in nursing facilities. Those numbers would be lower, approximately 3.3% and 5.9% for the nation as a whole. Total nursing facility stays. Source: Centers for Medicare and Medicaid Services, “Nursing Home Data Compendium: 2007 Edition,” available at <http://www.cms.hhs.gov/CertificationandComplianc/12_NHs. asp>. Most nursing facility stays are less than 3 months in duration. Therefore, there are many more distinct stays in a calendar year than there are residents in a nursing facility at any given time. Residents by primary payer; Residents with dementia. Source: Charlene Harrington, Helen Carrillo, and Brandee Woleslagle Blank, “Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2001 Through 2007,” University of California, San Francisco, 2008, available at <http://198.170.85.250/nursing_homes/ nursing_trends_2007.php>. Long-Term Care Costs Medicaid payment rate for nursing facility care. Source: 2008 University of North Texas Survey of 2007 Medicaid NF Reimbursement, funded by the U.S. Department of Housing and Urban Development. Missing data for five states – Hawaii, North Carolina, New Hampshire, New Jersey, and New York – were filled from BDO Seidman, “A Report on Shortfalls in Medicaid Funding for Nursing Home Care,” Report for the American Healthcare Association, September 2007. Missing data remains for Mississippi and Wyoming. U.S. value is the average of state values weighted by estimated number of Medicaid beneficiary-days in nursing facilties. 360 Data Documentation Medicare payment rate for nursing facility care. Source: Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2007, “Table 6.3: Covered Admissions, Covered Days of Care, Covered Charges, and Program Payments for Skilled Nursing Facility Services Used by Medicare Beneficiaries, by Area of Residence: Calendar Year 2006” available at <http://www.cms.hhs.gov/ MedicareMedicaidStatSupp/LT/list.asp#TopOfPage>. Private pay rate in nursing facility; Private pay rate in assisted living; Private pay hourly rate for home health aide and Medicare-certified home health aide; Private pay daily rate for adult day care. Source: Genworth Financial, “Genworth Financial 2008 Cost of Care Survey” available at <http://www.genworth. com/content/genworth/www_genworth_com/web/us/en/products_we_offer/long_term_care_insurance/ long_term_care_overview/what_is_the_cost_of_long_term_care.html>. Rates for nursing facility assume a private room. A semi-private room is somewhat less expensive (for the U.S., $187 per day compared to $209 for a private room). The Medicare-certified home health aide rate is associated with a skilled nursing visit that could include specialized care. The rate for this specialized form of care (and the level of skill required of the caregiver/nurse) skews the average cost very high relative to the non-certified rate. Data reported in Across the States differ slightly from the source for the District of Columbia: the source includes Montgomery County, MD in the calculation of the DC estimate, while we do not. Medicare reimbursement per home health visit. Source: Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2007, “Table 7.3: Persons Served, Visits, Total Charges, Visit Charges, and Program Payments for Medicare Home Health Agency Services, by Area of Residence: Calendar Year 2006” available at <http://www.cms.hhs.gov/MedicareMedicaidStatSupp/LT/list. asp#TopOfPage>. Long-Term Care Resources Medicare-certified home health agencies. Source: AARP Public Policy Institute calculations using data from Centers for Medicare and Medicaid Services, Health Care Information System, “HHA National State Summary for Completed Year 2006.” Denominator data are age 65+ population in 2007 (number of agencies in 2006 divided by most current estimate of age 65+ population). Adult day facilities. Source: Nancy J. Cox, “National Study of Adult Day Services 2001-2002, Partners in Caregiving: The Adult Day Services Program, Wake Forest University School of Medicine, Winston- Salem, NC. Refers to the number of confirmed adult data facilities in the 2001-2002 study period. Adult day facilities provide services on a part-time and/or intermittent basis. Programs include health, social, personal care, and related supportive services to meet the needs of functionally or mentally impaired adults. Denominator data are age 65+ population in 2007 (number of agencies in 2001/2002 divided by most current estimate of age 65+ population). Assisted living and residential care facilities and units. Source: Robert Mollica, Kristin Sims-Kastelein, and Janet O’Keeffe, “Residential Care and Assisted Living Compendium: 2007,” National Academy for State Health Policy and RTI International, 2008, available at <http://aspe.hhs.gov/daltcp/reports/2007/07alcom. htm>. Refers to number of residential care facilities and units in the state. These facilities may be called by many names, including adult foster care, board and care homes, rest homes, adult care home, domiciliary care homes, personal care homes, community-based residential facilities, and assisted living. In some states, the number of facilities and beds was not available or not reported for all types of residential care facilities, which may result in undercounting in those states. Counts of units were not available for any type of facility for Minnesota or New Mexico. 361 Data Documentation Personal and home care aides and home health aides; Median hourly wage. Source: Bureau of Labor Statistics, Occupational Employment Statistics, May 2007 Estimates. Personal and home care aides are occupation code 39-9021 and home health aides are occupation code 31-1011. Complete data were not available for several states: Rhode Island, Utah, and Vermont. Medicaid aged/disabled waiver waiting list. Source: Terence Ng, Charlene Harrington, and Molly O’Malley, “Medicaid Home and Community-Based Service Programs: Data Update” University of California, San Francisco and Kaiser Family Foundation, December 2008, available at <http://www.kff.org/ medicaid/7720.cfm>. Waiting lists procedures vary by state, it is not necessarily the case that states with no waiting list or a small waiting list are meeting the needs of all Mediciad beneficiaries wishing to receive services in a home or community-based settings. Total nursing facilities; Nursing facility beds; Nursing facility occupancy rate. Source: Helen Carrillo and Charlene Harrington, Analysis of On-Line Survey Certification and Reporting System (OSCAR) unpublished data from the Centers for Medicare and Medicaid Services, University of California, San Francisco, September 2008. Occupancy rate is computed by dividing the total number of residents (see long-term care utilization, above) by the number of beds. South Dakota data indicated an occupancy rate of 100%: not a single unoccupied bed in the state. We don’t believe this is the case, and thus report the occupancy rate as NA. In prior years, South Dakota has had one of the highest occupancy rates in the country, and if that had continues, the occupancy rate in the state would be 90% to 95%. Direct care nursing hours per patient day; Facilities with deficiency for actual harm or jeopardy of residents; Residents with physical restraints. Source: Charlene Harrington, Helen Carrillo, and Brandee Woleslagle Blank, “Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2001 Through 2007,” University of California, San Francisco, 2008, available at <http://198.170.85.250/nursing_homes/nursing_ trends_2007.php>. Total nursing hours include RN, LPN/LVN, and CNA hours. State surveyors assess both the process and outcomes of nursing facility care using 185 measures of quality. When a nursing home fails to meet a standard, a deficiency or citation is given for that individual standard. The deficiencies causing actual harm or immediate jeopardy are the most serious. Long-term care facility beds per FTE ombudsman; Nursing facilities visited at least quarterly. Source: U.S. Administration on Aging, 2006 National Ombudsman Report Appendices, Table A-1, available at <http://www.aoa.dhhs.gov/prof/aoaprog/elder_rights/LTCombudsman/National_and_State_Data/2006/2006. aspx>. Long-term care facility beds include both nursing facility beds and beds in board and care facilities. Ombudsmen advocate for resident rights and investigate and respond to complaints. Many states rely heavily upon volunteer ombudsmen (not included in this indicator) to supplement the work of paid staff. Trends Bar chart graphics, change and percentage change in Medicaid LTC by type of service. Source: AARP Public Policy Institute calculations based on data from Brian Burwell, Kate Sredl, and Steve Eiken, “Medicaid Long Term Care Expenditures FY 2007” Thomson Reuters, 2008, available at <http://hcbs. org/moreInfo.php/nb/doc/2374/Medicaid_Long_Term_Care_Expenditures_FY_2007>. Refers to total fee-for-service expenditures for services under the Medicaid program, including both state and federal contributions, not including spending provided through capitated managed care programs. A few states have large managed care programs that pay for long-term care benefits on a capitated basis, so these numbers may underestimate the total amount spent on long-term care for those states. See also notes on these data under long-term care financing, above. 362 Data Documentation Medicaid HCBS participants; Aged/disabled waiver participants. Source: AARP Public Policy calculations based on (1) Terence Ng, Charlene Harrington, and Molly O’Malley, “Medicaid Home and Community-Based Service Programs: Data Update” University of California, San Francisco and Kaiser Family Foundation, December 2008, available at <http://www.kff.org/medicaid/7720.cfm> and (2) year 2000 data on waiver participants (personal communication with Charlene Harrington, September 2008). The number of beneficiaries is unduplicated within service or waiver, but not between services. If there are beneficiaries receiving multiple services or services from multiple waivers, then the actual total number of beneficiaries will be somewhat lower than reported. Medicare home health visits per user. Source: AARP Public Policy calculations based on (1) Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2002, “Table 48: Persons Served, Visits, Total Charges, Visit Charges, and Program Payments for Medicare Home Health Agency Services, by Area of Residence: Calendar Year 2001” and (2) Centers for Medicare and Medicaid Services, Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2007, “Table 7.3: Persons Served, Visits, Total Charges, Visit Charges, and Program Payments for Medicare Home Health Agency Services, by Area of Residence: Calendar Year 2006.” Both available at <http://www.cms.hhs.gov/ MedicareMedicaidStatSupp/LT/list.asp#TopOfPage>. Nursing facility residents, beds, and occupancy rate. Source: Helen Carrillo and Charlene Harrington, Analysis of On-Line Survey Certification and Reporting System (OSCAR) unpublished data from the Centers for Medicare and Medicaid Services, University of California, San Francisco, August 2006. These data show a very slight increase in the number of residents and beds over the 5-year period, with about half of the states increasing and half of the states declining. Data from some other sources, using different methodologies of data collection and analysis, show a decrease in residents over a similar period. But it is important to note that sources agree that the rate of nursing home utilization has gone down; from 2002 to 2007 the older population has increased much faster than the nursing facility resident population: the 85+ population increased 6.5% from 2002 to 2007, while the nursing home population increased by only 0.9% over the same time period. Total Medicaid spending and spending by type of service. Source: AARP Public Policy Institute calculations based on data from Brian Burwell, Kate Sredl, and Steve Eiken, “Medicaid Long Term Care Expenditures FY 2007” Thomson Reuters, 2008, available at <http://hcbs.org/moreInfo.php/nb/doc/2374/ Medicaid_Long_Term_Care_Expenditures_FY_2007>. Refers to total fee-for-service expenditures for services under the Medicaid program, including both state and federal contributions, not including spending provided through capitated managed care programs. A few states have large managed care programs that pay for long-term care benefits on a capitated basis, so these numbers may underestimate the total amount spent on long-term care for those states. See also notes on these data under long-term care financing, above. 363 This page intentionally left blank AARP Public Policy Institute AARP State Offices AARP STATE OFFICES AARP Alabama AARP Connecticut AARP Idaho RSA Tower 21 Oak Street, #104 Eagle Road Professional 201 Monroe Street, #1880 Hartford, CT 06106 Center II Montgomery, AL 36104 Brenda Kelley 3080 Gentry Way, #100 Joan Carter 860-548-3161 Meridian, ID 83642 334-954-3057 John Erlingheuser Jim Wordelman Bill Hawkins 860-548-3165 208-855-4001 204-978-2374 Dede Shelton AARP Delaware 208-855-4005 AARP Alaska One Rodney Square North 3601 “C” Street, #1420 1100 N. Market Street, #1201 AARP Illinois Anchorage, AK 99503 Wilmington, DE 19801 222 N. LaSalle Street, #710 Ken Osterkamp Lucretia Young Chicago, IL 60601 907-762-3301 302-498-6503 Bob Gallo John Luby Brian Posey 312-458-3604 907-762-3314 302-498-6512 Nancy Nelson 217-522-7700 AARP Arizona AARP District of Columbia Collier Center 601 E Street NW, #A1-200 AARP Indiana 201 East Washington St., #1795 Washington 20049 One North Capitol Ave., #1275 Phoenix, AZ 85004-2428 Mimi Castaldi Indianapolis, IN 46204 David Mitchell 202-434-7705 June Lyle 602-262-5191 Louis Davis 317-423-7104 Lupe Solis 202-434-7712 Paul Chase 602-262-5163 317-423-7101 AARP Florida AARP Arkansas 200 W College Avenue, Ste. 304 AARP Iowa 1701 Centerview Drive, #205 Tallahassee, FL 32301 600 E. Court Avenue, Suite C Little Rock, AR 72211 Lori Parham Des Moines, IA 50309 Maria Reynolds Diaz 850-577-5170 Bruce Koeppl 501-217-1621 Jack McRay 515-697-1001 Herb Sanderson 850-577-5187 Anthony Carroll 501-217-1639 515-697-1015 AARP Georgia AARP California 999 Peachtree Street NE, #1100 AARP Kansas 1415 L Street, #960 Atlanta, GA 30309 555 S. Kansas Avenue, #201 Sacramento, CA 95814 Ken Mitchell Topeka, KS 66603 Tom Porter 404-870-3780 Maren Turner 916-556-3030 Kathy Floyd 785-234-1361 Ernie Powell 404-870-3791 Ernest Kutzley 916-556-3021 785-234-1363 AARP Hawaii AARP Colorado 1132 Bishop Street, 19th Floor AARP Kentucky 303 E. 17th Avenue, #510 Honolulu, HI 96813 10401 Linn Station Road, #121 Denver, CO 80203 Barbara Stanton Louisville, KY 40223 Jon Looney 808-545-6001 Phil Peters 303-764-5988 502-394-3422 Kelli Fritts Cathy Murphy 303-764-5991 502-394-3427 Locations and contacts current as of January 2009. 366 AARP STATE OFFICES AARP Louisiana AARP Mississippi AARP New Jersey 301 Main Street, #1012 6360 1-55 North, #160 Forrestal Village One American Place Jackson, MS 39211 101 Rockingham Row Baton Rouge, LA 70825 Sherri Davis Princeton, NJ 08540 Nancy McPherson 601-206-1841 Jim Dieterle 225-376-1141 Walter Howell 609-452-3919 Kerry Everitt 601-206-1851 Douglas Johnston 225-376-1151 609-452-3910 AARP Missouri AARP Maine 700 West 47th Street, #110 AARP New Mexico 1685 Congress Street Kansas City, MO 64112 535 Cerrillos Road, Suite A Portland, ME 04102 Craig Eichelman Santa Fe, NM 87501 Nancy Kelleher 816-360-2200 Stanley Cooper 207-776-6304 Norma Collins 505-946-3601 816-360-2201 Michael Donnelly AARP Maryland 505-946-3603 200 St. Paul Place, Ste. 2510 AARP Montana Baltimore, MD 21202 30 West 14th Street, #301 AARP New York Joseph DeMattos Helena, MT 59601 780 Third Avenue, 33rd Floor 410-895-7601 New York, NY 10017 Henry Greenberg Bob Bartholomew Lois Aronstein 410-895-7613 406-457-4701 212-407-3707 Claudia Clifford David McNally AARP Massachusetts 406-457-4705 518-447-6713 One Beacon Street, #2301 Boston, MA 02108 AARP Nebraska AARP North Carolina Deb Banda 301 S. 13th Street, Suite 201 1511 Sunday Drive, #312 617-305-0561 Lincoln, NE 68508 Raleigh, NC 27607 Jessica Costantino Connie Benjamin Robert Jackson 617-305-0538 402-323-5421 919-508-0265 Mark Intermill Mary Bethel AARP Michigan 402-323-5424 919-508-0297 309 N. Washington Sq., #110 Lansing, MI 48933 AARP Nevada AARP North Dakota Steve Gools 5820 S. Eastern Avenue, #190 107 West Main Avenue, #125 (517) 267-8914 Las Vegas, NV 89119 Bismarck, ND 58501 Felicia Wasson Carla Sloan Janis Cheney 517-267-8917 702-938-3232 701-355-3641 Barry Gold Linda Wurtz AARP Minnesota 702-938-3236 701-355-3642 30 East 7th Street, #1200 St. Paul, MN 55101 AARP New Hampshire AARP Ohio Michelle Kimball 900 Elm Street, #702 17 South High Street, #800 651-726-5641 Manchester, NH 03101 Columbus, OH 43215 Keith Weigel Kelly Clark Jane Taylor 651-726-5643 603-621-1001 (614) 222-1510 Bill Hamilton Ron Bridges 603-621-1005 614-222-1503 Locations and contacts current as of January 2009. 367 AARP STATE OFFICES AARP Oklahoma AARP South Dakota AARP Virginia 126 N. Bryant Avenue 5101 S. Nevada Street, #150 707 East Main Street, #910 Edmond, OK 73034 Sioux Falls, SD 57108 Richmond, VA 23219 Nancy Coffer Sarah Jennings Bill Kallio 405-715-4461 605-362-3042 804-344-3041 Sean Voskuhi Sam Wilson Madge Bush 405-715-4475 605-362-3045 804-344-3059 AARP Oregon AARP Tennessee AARP Washington 9200 SE Sunnybrook Blvd, #410 150 4th Avenue N., #180 9750 Third Avenue NE, #450 Clackamas, OR 97015 Nashville, TN 37219 Seattle, WA 98115 Jerry Cohen Rebecca Kelly Doug Shadel 503-513-7373 615-726-5100 206-517-2316 Rick Bennett Patrick Willard Ingrid McDonald 503-513-7370 615-726-5106 206-517-2324 AARP Pennsylvania AARP Texas AARP West Virginia 30 N. Third Street, #750 98 San Jacinto Blvd, #750 300 Summers Street, #400 Harrisburg, PA 17101 Austin, TX 78701 Charleston, WV 25301 Richard Chevrefils Bob Jackson Frank Bellinetti 717-237-6486 512-480-2434 304-340-4601 Raymond Landis Amanda Fredriksen Angela Vance 717-237-6482 512-480-2425 304-340-4603 AARP Puerto Rico AARP Utah AARP Wisconsin 654 Munoz Rivera Ave, #901 6975 Union Park Center, #320 222 West Washington Ave, #600 San Juan, PR 00918 Midvale, UT 84047 Madison, WI 53703 Jose Acaron Rob Ence D’Anna Bowman 787-296-3001 801-567-2644 608-286-6301 Eddie Olivera Laura Polacheck Gail Sumi 787-296-3008 801-567-2643 608-286-6307 AARP Rhode Island AARP Vermont AARP Wyoming 10 Orms Street, #200 199 Main Street, #225 2020 Carey Avenue, Providence, RI 02904 Burlington, VT 05401 Mezzanine Level Kathleen Connell Gregory Marchildon Cheyenne, WY 82001 401-248 2670 802-951-1306 Tim Summers Stephen Jennings Philene Taormina 307-432-5816 401-248-2655 802-951-1304 AARP South Carolina AARP Virgin Islands 1201 Main Street, #1280 93B Estate Diamond Columbia, SC 29201 St. Croix, VI 00820 Jane Wiley Denyce Singleton 803-765-7375 340-713-2002 Teresa Arnold Ginny Dargan 803-765-7374 340-776-8236 Locations and contacts current as of January 2009. 368