ACROSS THE STATES PROFILES OF LONG-TERM SERVICES AND SUPPORTS 2012 NINTH EDITION ACROSS THE STATES PROFILES OF LONG-TERM SERVICES AND SUPPORTS by Ari Houser Wendy Fox-Grage Kathleen Ujvari ©1994-2012 AARP 2012 NINTH EDITION Table of Contents Acknowledgements............................................................................................................................. 3 Introduction......................................................................................................................................... 5 Overview............................................................................................................................................. 6 Long-Term Care and Independent Living Maps............................................................................... 21 State Long-Term Care and Independent Living Profiles.................................................................. 35 United States National Profile.................................................................................................. 36 . State Profiles (and DC, PR, VI)................................................................................................ 42 Data Documentation....................................................................................................................... 353 AARP State Offices........................................................................................................................ 363 . 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 Truven Health Analytics (formerly Thomson Reuters), Janet Gale at Genworth Financial, Robert Mollica, Vincent Mor at Brown University, Scott Nystrom at REMI, Charlene Harrington at the University of California San Francisco, and Lori Smetanka at the National Ombudsman Resource Center. We also wish to thank our AARP Public Policy Institute colleagues Enid Kassner and Susan Reinhard who reviewed and contributed to this publication. 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 2012: Profiles of Long-Term Services and Supports is the ninth edition of the AARP Public Policy Institute’s state long-term services and supports reference report. Published for the past 18 years, the Across the States series was developed to help inform policy discussions among public and private sector leaders in long-term services and supports throughout the United States. Across the States 2012 presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single reference. This publication presents up-to-date data and is displayed in easy-to-use maps, graphics, tables, and state profiles. Across the States 2012 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, and the nation as a whole. The full report provides a comprehensive 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 services and supports spending for older people and adults with physical disabilities going to home and community-based services. This permits readers to easily see variations among states. Some of the indicators in Across the States 2012 may be found in prior editions. Please exercise caution when making comparisons with information in earlier editions due to 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. Additional indicators on health care spending, health status, and health care utilization for the age 50+ population can be found in another AARP Public Policy Institute report, Quick Health Facts 2010: Selected State Data on Older Americans. Copies of Across the States 2012 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 be found at http://www.aarp.org/acrossthestates. 5 AARP text Public Policy Institute OVERVIEW Across the States 2012: Profiles of Long-Term Services and Supports focuses on comparative state data. Given the aging population, rising demand for long-term services and supports (LTSS), and increasing cost of services, consistent data across all states is essential to understand what is needed to improve the lives of those who need LTSS and their family caregivers. The following key findings were identified from the state and national data.   1:   The age 85 and older population—the age group most likely to need long-term services and supports—is growing at a dramatic rate.   The older population is racially and ethnically diverse and is projected to become 2: even more diverse as our multicultural society ages.     Many older Americans live below 250 percent of the poverty line, and are likely to 3: qualify for need-based long-term services and supports and other publicly funded services.   Family caregivers provided $450 billion worth of unpaid care in 2009, almost four 4: times Medicaid long-term services and supports spending and nearly seven times what people paid privately.     The bulk of Medicaid long-term services and supports dollars still go to nursing 5: facilities rather than home and community-based services.     The number of older people and adults with physical disabilities receiving Medicaid- 6: funded home and community-based services has increased, while the number of nursing facility residents has remained constant.   7:   On average, Medicaid dollars can support roughly three people with home and community-based services for every person in an institution.   8:   At the state level, registered nurse hours per resident day are correlated with better nursing facility quality measures.   9:   The supply of assisted living units is catching up with the total number of nursing facility beds. 6 The age 85 and older population—the age group most likely to need 1: long-term services and supports—is growing at a dramatic rate. Projected Growth in the Older Population in the United States as a Percentage of 2012 Population, by Age Group 350% Population (% of 2012 Population) 300% 85+ 250% 75-84 200% 65-74 150% 50-64 100% 50% 0% 2010 2015 2020 2025 2030 2035 2040 2045 2050 From 2012 to 2050, the population age 65 and older is projected to more than double, to 89 million. The 107 percent growth rate for the 65+ population is more than five times as fast as that of the age 50–64 population and almost twice as fast as that of the population under age 50. A better barometer for the potential demand for long-term services and supports (LTSS) is the growth in the population age 85 and older, which is expected to increase by 69 percent between 2012 and 2032 and more than triple (+224%) between 2012 and 2050. People age 85 or older not only have much higher rates of disability, but they are also much more likely to be widowed and without someone to provide assistance with daily activities. For the next 20 years (2012–2032), the population age 65–84 and the population age 85+ are projected to grow at similar rates (+75% and +69%, respectively). As the baby boomers begin to turn 85, however, the age 85+ population will grow dramatically while growth among those ages 65–84 will level off. Between 2032 and 2050, the age 85+ population will almost double (+92%), while the age 65–84 population will increase by only 6 percent. In 2012, people age 85 or older make up only 2 percent of the U.S. population. The states with the highest percentage growth are Florida and Hawaii, with 3 percent each. In 2050, the national percentage is projected to be 4.8 percent, and all 50 states will exceed 3 percent, with only the District of Columbia, at 2.9 percent, falling shy of that mark. The age 85+ population is projected to more than quadruple in seven states between 2012 and 2050: Alaska (+650%), Nevada (+474%), Georgia (+375%), Colorado (+369%), Utah (+323%), Texas (+318%), and Virginia (+307%). 7 The older population is racially and ethnically diverse and is 2: projected to become even more diverse as our multicultural society ages. Race and Ethnicity, Age 65+, 2010 Black: 8.5% Hispanic: 6.9% ic Islander Pacif : 3. sian/ 6% A ultiracial: r/ M 2.9 the % O People of Color: 20.1% Categories do not sum to total People of Color percentage because individuals may belong to more than one racial/ethnic group. In 2010, one out of every five people age 65+ was nonwhite or Hispanic, a percentage that is increasing and will continue to do so in the future. By 2060, it is projected that 46 percent of the age 65+ population will be people of color. The growing ethnic and racial diversity of the older population has enormous implications for meeting diverse LTSS preferences, addressing the role of paid and unpaid caregivers, providing services with cultural sensitivity, and training the paid LTSS workforce in cultural competence. Aging populations of color outnumber whites in Hawaii (64% Asian/Pacific Islander), Puerto Rico (99% Hispanic), and the District of Columbia (62% black). In New Mexico, California, and Texas—the states with the highest proportion of Hispanics—more than 30 percent of people age 65+ are people of color. This report not only highlights diversity in race and ethnicity among older adults, it also demonstrates great disparities related to poverty, education, disability, and living arrangements. Poverty: Approximately 41 percent of people age 65 or older have incomes at or below 250 percent of poverty (about $27,000 for a single person over age 65 or $36,000 for a family of two), an income level that makes them financially vulnerable and unlikely to be able to pay for LTSS out-. of-pocket. Education: Level of education is one of the strongest predictors of LTSS need as well as of the economic capacity to pay for services. Those with college educations are less likely to need services and more likely to be able to pay for them. About one out of five (21%) people age 65 or older has a bachelor’s degree or higher. 8 Disability: More than one-third (37%) of people age 65 or older have a sensory, physical, mobility, self-care, or cognitive disability that may affect their ability to accomplish common tasks of everyday living. Among the age 65+ population, 9 percent have self-care difficulty and 10 percent have cognitive difficulty, which are the most likely to result in need for LTSS. Living Alone: One-third (34%) of people age 75 or older 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 LTSS. Many older Americans live below 250 percent of the poverty line, and 3: are likely to qualify for need-based long-term services and supports and other publicly funded services. Percent of Adults Below Poverty Line and Below 250% of Poverty Line, by Age, 2010 60 54% 54% 48% 50 42% Percent of Population 40 36% 31% 30 20 23% 10 14% 10% 12% 10% 8% 0 0-24 25-44 45-64 65-74 75-84 85+ Age Below 250% of poverty Below poverty line Older people are less likely to be below the poverty line than younger and working-age people. However, the proportion of older people who have income below 250 percent of the poverty line 1 is much higher than for the working-age population. The percentage of Americans living below 250 percent of the poverty line is as high for the age 85+ population, those most likely to need LTSS, as it is for the age 0–24 population. This will have significant ramifications in the future because of the increasing projected growth of the age 85+ population. 1 250 percent of the federal poverty level is slightly higher than 300 percent of Social Security Income, a moderate level of income under which older people and adults with disabilities can qualify for need-based LTSS and other publicly funded services in most states. 9 Family caregivers provided $450 billion worth of unpaid care in 4: 2009, almost four times Medicaid long-term services and supports spending and nearly seven times what people paid privately. Annual Spending in Billions of Dollars $450 $119 $67 Medicaid Economic Private Pay LTSS & Value of LTSS & Home Health Family Home Health Spending Caregiving Spending in 2009 in 2009 in 2009 In the United States, 42 million caregivers were providing unpaid care to friends and family at any given time during 2009. They provided an average of 18.4 hours of care per week, at an average value of $11.16 per hour. Although Medicaid is the largest payer of LTSS, family caregivers are the foundation of the LTSS system. The estimated economic value of contributions was $450 billion in 2009, almost four times as much as total Medicaid LTSS spending and almost seven times the amount of privately paid LTSS and home health care. The estimated economic value of family caregiving exceeded Medicaid LTSS spending in every state. 2 Family caregivers provide personal care and help with everyday tasks as well as health-related interventions such as administering complex medications. They help to contain health and LTSS costs by providing such care and can even delay or prevent the use of more expensive hospital and nursing home care. Although family caregivers usually undertake these tasks willingly, they often experience high levels of emotional, physical and financial stress. Many of them juggle employment with caregiving responsibilities. 2 AARP Public Policy Institute, Valuing the Invaluable: 2011 Update. The Economic Value of Family Caregiving in 2009 (Washington, DC: AARP Public Policy Institute, June 2011). The $119 billion figure does not include several categories of LTSS spending, among them inpatient mental health services. The $67 billion in the figure is from AARP Public Policy Institute analysis of 2009 National Health Expenditure data. 10 sky blue med blue green blue-green blue-grey States Exceeding Federal Requirements for Family and Medical Leave Acts for Adults, 2008 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 Exceeds Federal Requirements Federal Requirements Only The federal Family and Medical Leave Act of 1993 (FMLA) allows covered employees to take up to 12 weeks of unpaid leave to care for a family member with a serious health condition. States can help adults and family caregivers by exceeding the minimum FMLA requirements—by broadening the range of employers that must comply with the requirements, extending the coverage period beyond 12 weeks, and broadening the definition of “family member.” In 2008, 14 states exceeded the federal minimum FMLA requirements for adults. 11 5: The bulk of Medicaid long-term services and supports dollars still go to nursing facilities rather than home and community-based services. Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in the United States, 2009 25% 64% 11% Nursing Facilities Aged/Disabled Waivers Other HCBS Medicaid is the primary payer of formal LTSS in the United States (46% in 2009). Almost two- thirds (64%) of Medicaid LTSS dollars for older people and adults with physical disabilities went to nursing facility care, even though most people prefer to live at home or in their communities. Medicaid nursing facility spending was $51.4 billion, compared to $28.7 billion for home and community-based services (HCBS) for older people and adults with physical disabilities. Nursing facility care is a mandatory entitlement within the Medicaid program. All individuals who qualify financially for Medicaid and qualify by level of disability for nursing facility care must be allowed to receive nursing facility services. Most HCBS are optional; although all states have mechanisms for providing home and community alternatives to nursing homes, Medicaid-eligible older people and adults with disabilities are not necessarily entitled to such services. All state Medicaid programs in the U.S. cover optional HCBS through federal waivers. Also, many states cover personal care services for adults in the home under their Medicaid state plans. There is great state variation in the funding of Medicaid HCBS. In 2009, the percentage of Medicaid LTSS funds for older adults and adults with physical disabilities going toward HCBS ranged from 10 percent to 65 percent. 12 sky blue med blue green blue-green blue-grey Medicaid HCBS Spending as Percentage of LTSS Spending, for Older People and Adults with Physical Disabilities, 2009 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 <30% 30-44% 45-59% 60%+ Only seven states—New Mexico, Washington, Minnesota, Oregon, Alaska, California, and Texas—and the District of Columbia spent more than 45 percent of their Medicaid LTSS funds on HCBS. On the other end of the range, six states—North Dakota, Delaware, Rhode Island, South Dakota, Alabama, and Maryland—spent 15 percent or less on HCBS. Although small compared with Medicaid budgets, non-Medicaid state-funded programs are another source of HCBS public funding. In 2009, state-only HCBS funding totaled $1.5 billion (about 5% of the amount of Medicaid HCBS expenditures) but was significant in several states. State-funded HCBS programs often serve people who are not Medicaid eligible but are at risk of institutionalization. 3 3 Jenna Walls, Kathleen Gifford, Catherine Rudd, Rex O’Rourke, Martha Roherty, Lindsey Copeland, and Wendy Fox- Grage, Weathering the Storm: The Impact of the Great Recession on Long-Term Services and Supports (Washington, DC: AARP Public Policy Institute, January 2011). 13 The number of older people and adults with physical disabilities 6: receiving Medicaid-funded home and community-based services has increased, while the number of nursing facility residents has remained constant. 3.0 Number of Users (Millions) 2.5 2.0 1.5 1.0 0.5 0.0 2003 2004 2005 2006 2007 2008 Medicaid HCBS Users, Older People and Adults with Physical Disabilities Medicaid Nursing Facility Users Most people with LTSS needs do not live in institutions such as nursing facilities. Most live in their own home, and receive LTSS at home or in their community. There are a wide variety of home and community-based services and supports that can enable people to live as independently as possible. These include personal care, where an aide can help with daily activities; assisted living, which is licensed, supportive group housing usually including meals and assistance with daily activities for people who would otherwise not be able to live in their own homes; adult day services provided in a senior center or other group setting, and many others. The number of older people and adults with physical disabilities receiving HCBS is increasing . at a greater rate than the number of people living in nursing facilities. The number of older . people and adults with physical disabilities receiving Medicaid HCBS (including those receiving home health services) increased 18 percent from 2003 to 2008, to a total of 2.5 million Medicaid beneficiaries receiving these services. 4 From 2003 to 2008, the number of people using Medicaid nursing services actually declined 4 percent, from about 1.7 million to 1.6 million. During the same five-year period, the number of nursing facility residents (all payment sources) also declined slightly from 1.5 million to 1.4 million. 5 4 The total of 2.5 million is not an unduplicated count. There is significant duplication between services, so the true number may be substantially lower, between 1.6 million and 2.5 million. 5 Most nursing facility stays begin or end during the year, so the number of people who spend time in a nursing facility during the year is approximately twice as high as the number of residents on a typical day. 14 $60 Medical Expenditures (Billions) $50 $40 $30 $20 $10 $0 2004 2005 2006 2007 2008 2009 Nursing Facility HCBS for Older People and Adults with Physical Disabilities Across all states, Medicaid HCBS expenditures increased by 70 percent from 2004 to 2009, while Medicaid expenditures for nursing facilities increased by just 12 percent. Nevertheless, total nursing facility expenditures remained nearly twice as high as HCBS expenditures. From 2004 to 2009, all states except Maryland and Mississippi increased Medicaid HCBS expenditures. The largest percentage increases in expenditures were in the District of Columbia, Louisiana, Virginia, and Minnesota, all of which increased HCBS spending by more than 150 percent during the five-year period. 15 On average, Medicaid dollars can support roughly three people 7: with home and community-based services for every person in an institution. Medicaid Long-Term Services and Supports Spending per Person Served, by Service, 2008 Home Health Services $5,495 Aged/Disabled Waiver Services $10,710 Personal Care Services $11,142 Nursing Facility Services $29,533 MR/DD Waiver Services $42,896 ICF-MR Services $123,053 $0 $20 $40 $60 $80 $100 $120 $140 Spending per Person Served (Thousands) The need for LTSS is associated with growing old. However, people of all ages need LTSS. The services and supports needed by these populations—older people, adults with physical disabilities, adults with intellectual disabilities, and others—as well as the costs of these services and supports, are very different. However, for all populations, the typical cost of HCBS is about one-third the cost of institutional care. Per person, nursing facility services are almost three times as costly as HCBS for older people and adults with disabilities. In 2008, Medicaid spending for HCBS—waiver and state plan personal care services (PCS)—for each older person and adult with physical disabilities receiving services averaged $10,957, compared with $29,533 for each person receiving services in a nursing facility. Home health care, which is often used for short-term post-acute care, averaged $5,495 per . person served. Likewise, for people with intellectual disabilities, the cost of institutional services in an Intermediate Care Facility-Mental Retardation (ICF-MR) averaged $123,053 per person, nearly three times the average cost of HCBS ($42,896). States have been shifting Medicaid resources toward HCBS to “balance” Medicaid LTSS spending. In general, states are further ahead in their efforts to deinstitutionalize by closing ICF-MRs and serving more people with intellectual disabilities in the community. 16 At the state level, registered nurse hours per resident day are 8: correlated with better nursing facility quality measures. 35% 3.0 % of Long-Stay NH Residents with a Number of Users (Millions) 30% 2.5 Hospital Admission, 2008 25% 2.0 20% 1.5 15% 1.0 R² = 0.50 10% 0.5 5% 0.0 0.20 0.40 0.60 0.80 1.00 1.20 Direct Care RN Hours per Resident Day, 2010 The number of direct care registered nurse (RN) hours per resident day correlates strongly with incidence of pressure sores, use of physical restraints, and hospital admissions. States with more direct care RN hours tended to have lower rates of pressure sores, lower use of restraints, and fewer hospital admissions. On average, in 2010, nursing facility residents received 3.8 hours of direct nursing care per day, of which 0.64 were RN hours. The states with the most RN hours per resident day are Alaska (for which quality data were not available because of the small number of nursing facilities in the state), Hawaii, Washington, Delaware, Montana, and Utah. These states performed better than the national average in all three quality indicators included in the state profiles (pressure sores, use of restraints, and hospital admissions), except for Utah on its use of physical restraints. North Dakota, Hawaii, Minnesota, and Nebraska have the lowest rates of pressure sores. Kansas, Nebraska, and Wisconsin have the lowest rates of use of physical restraints. Minnesota, Utah, Arizona, and Oregon have the lowest rates of hospital admissions. 17 The supply of assisted living units is catching up with the total 9: number of nursing facility beds. Assisted Living and Nursing Home Supply, 2007 - 2010 1.8 1.70 1.69 1.6 1.4 Unit Supply (Millions) 1.23 1.2 1.05 1.0 0.8 0.6 0.4 0.2 2007 2010 Assisted Living Supply Nursing Facility Supply Depending upon state licensure requirements, assisted living can include a variety of residential care settings, such as adult foster care and personal care homes. Assisted living generally offers services that provide assistance with activities of daily living and instrumental activities of daily living to people in a residential setting. Over the past few years, there has been a dramatic increase in the number of assisted living units across the United States. From 2007 to 2010, supply has increased almost 18 percent, from a total capacity of 1,046,631 units to 1,233,690 units. 6 During the same period, nursing facility bed supply remained constant at about 1.7 million beds. This trend demonstrates consumer preferences for alternatives to nursing facilities. There is almost a sixfold difference in the average supply of assisted living units between the highest five and lowest five states. The average supply in the five highest states (Minnesota, Oregon, Idaho, Wisconsin, and Washington) was 62 units per 1,000 people age 65 or older in the state, compared with 11 units in the five lowest states (District of Columbia, Louisiana, West Virginia, Mississippi, and Nevada). The national average is 31 units. 6 Robert Mollica, Ari Houser, and Kathleen Ujvari, Assisted Living and Residential Care in the States in 2010 (Washington, DC: AARP Public Policy Institute, with support from The SCAN Foundation and The Commonwealth Fund, April 2012). 18 State Variation in Assisted Living Supply 90 Units per 1,000 People Age 65+ 78 80 70 62 60 50 40 30 28 20 11 10 7 0 Number of assisted living and residential care units per 1,000 people age 65+ Highest State Highest 5 states average All states median Lowest 5 states average All Lowest state Assisted living facilities are predominantly private pay, while nursing facilities are largely funded by Medicaid. Only about one-fifth (19%) of assisted living residents have the cost of services covered by Medicaid, compared with almost two-thirds (63%) of nursing facility residents. The national average annual private pay rate for an assisted living unit ($39,135) was slightly more than one-half the cost of a semiprivate room in a nursing facility ($70,445). Conclusion This report provides the latest available data on long-term services and supports in the United States at a time when many states are transforming the delivery and financing of these services. Each state is unique, and the states vary greatly in demographics, service delivery, and financing. This edition 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 services and supports. AARP Public Policy Institute Long-Term Services and Supports Maps sky blue med blue green blue-green blue-grey Long-Term Services and Supports Percent of Population Age 85+, 2012 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 sky blue med blue green blue-green blue-grey < 2% 2.0-2.9% 3.0-3.9% 4.0-4.9% 5%+ Percent of Population Age 85+, 2032 (projected) 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 < 2% 2.0-2.9% 3.0-3.9% 4.0-4.9% 5%+ 22 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Percent of Population Age 85+, 2050 (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 sky blue med blue green blue-green blue-grey < 2% 2.0-2.9% 3.0-3.9% 4.0-4.9% 5%+ People of Color, Percent of Age 65+ Population, 2010 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 < 10% 10-24% 25%+ 23 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Medicaid HCBS Spending as Percentage of LTSS Spending, for Older People and Adults with Physical Disabilities, 2009 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 sky blue med blue green blue-green blue-grey < 30% 30-44% 45-59% 60%+ Medicaid HCBS Spending as Percentage of LTSS Spending, for All Populations, 2009 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 < 30% 30-44% 45-59% 60%+ 24 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Medicaid HCBS Beneficiaries as Percentage of LTSS Users, for Older People and Adults with Physical Disabilities, 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 sky blue med blue green blue-green blue-grey < 50% 50-59% 60-69% 70%+ Data not available Medicaid HCBS Beneficiaries as Percentage of LTSS Users, for All Populations, 2008 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 < 50% 50-59% 60-69% 70%+ Data not available 25 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Annual Cost of Care for Semi-Private Room in a Nursing Facility, 2011 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 sky blue med blue green blue-green blue-grey < $60,000 $60,000-$75,000 $75,000-$100,000 $100,000+ Annual Cost of Home Care (30 Hours per Week), 2011 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 < $27,000 $27,000-$31,000 $31,000-$36,000 $36,000+ 26 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Annual Cost of Assisted Living, 2011 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 sky blue < $35,000 med blue green $35,000-$40,000 blue-green blue-grey $40,000-$50,000 $50,000+ Private Long-Term Care Insurance Policies in Effect per 1,000 Population Age 40+, 2010 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 < 40 40-59 60-99 100+ 27 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Medicaid Presumptive Eligibility for HCBS, 2010 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 sky blue med blue green blue-green blue-grey No Yes Data not available States With or Planning to Implement Medicaid Managed LTSS 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 None Plan to implement in 2012 or 2013 Existing Program (in 2011) 28 sky blue med blue green blue-green blue-grey Long-Term Services and Supports States Exceeding Federal Requirements for Family and Medical Leave Acts for Adults, 2008 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 sky blue med blue green blue-green blue-grey Exceeds Federal Requirements Federal Requirements Only Percentage of State Population in ADRC Coverage Area, June 2012 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 0% 1-49% 50-99% 100% 29 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Medicaid Community Spouse Income Protection: Income Eligibility Allowance, 2009 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 sky blue med blue green blue-green blue-grey Minimum ($1821/mo) Intermediate or Variable ($1821-$2739/mo) Maximum ($2739/mo) Medicaid Community Spouse Asset Protection: Allowable Asset Standards, 2009 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 Minimum ($21,912) Intermediate Amount ($21,912-$109,560) Maximum ($109,560) Data not available 30 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Percent of Long-Stay Nursing Facility Residents with Physical Restraints, 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 sky blue med blue green blue-green blue-grey < 3% 3-4% 5%+ Data not available Percent of High Risk Nursing Facility Residents with Pressure Sores, 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 < 10% 10-12% 13%+ Data not available 31 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Percent of Long-Stay Nursing Facility Residents with a Hospital Admission, 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 sky blue med blue green blue-green blue-grey < 15% 15-20% 21%+ Data not available Percent of Home Health Patients with a Hospital Admission, 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 < 28% 28-31% 32%+ 32 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Nursing Facility Staffing Turnover Rate, 2010 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 sky blue med blue green blue-green blue-grey < 35% 35-49% 50%+ Data not available Percent of Nursing Facilities that are For-Profit, 2010 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% 50-69% 70%+ 33 sky blue med blue green blue-green blue-grey Long-Term Services and Supports Dual Eligibles as a Percent of the Total Medicare Population by State, 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 sky blue med blue green blue-green blue-grey < 15% 15%-19% 20%-24% 25%+ States with Integrated Medicare-Medicaid Programs other than PACE, 2011 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 No Non-PACE Integrated Care Non-PACE Integrated Care 34 AARP Public Policy Institute State Long-Term Care and Independent Living Profiles AARP Public Policy Institute UNITED STATES Value % Change % of Total Population & Projections Year (1,000s) from 2012 Population All ages 2012 315,311 2032 376,660 +19% 2050 434,447 +38% Age 50-64 2012 60,506 19.2% 2032 61,753 +2% 16.4% 2050 72,281 +19% 24.0% Age 65+ 2012 42,941 13.6% 2032 74,728 +74% 19.8% 2050 88,820 +107% 20.4% Age 65-74 2012 23,305 7.4% 2032 38,215 +64% 10.1% 2050 39,451 +69% 9.1% Age 75-84 2012 13,210 4.2% 2032 25,647 +94% 6.8% 2050 28,527 +116% 6.6% Age 85+ 2012 6,426 2.0% 2032 10,867 +69% 2.9% 2050 20,482 +224% 4.8% Projected Growth in the Older Population Older People of Color (%), 2010 in United States as a Percentage of 2012 Population, by Age Group 20.1% 400% Asian/Pacific Islander Population (% of 2012 Population) 350% 85+ 3.6% 300% 250% Black 75-84 200% 8.5% 65-74 150% Hispanic 100% 50-64 50% 6.9% 0% 2010 2020 2030 2040 2050 2060 36 Population & Characteristics UNIT ED STAT ES Living Arrangements Value Men per 100 women age 85+, 2010 48 People age 75+ living alone, 2010 34% People age 60+ with grandchildren in household, 2010 5.5% People age 60+ responsible for raising grandchildren, 2010 1.6% Percent of age 65+ households with someone under 18, 2010 7.0% Income & Poverty Value Median household income age 65+, 2010 $34,381 At/below poverty level age 65+, 2010 9.0% At/below 250% of poverty level age 65+, 2010 42% Women age 75+ at/below poverty level, 2010 12.2% Women age 75+ at/below 250% of poverty level, 2010 54% Bachelor level education or higher age 65+, 2010 21% Value Disability Rates (1,000’s) Percent People age 65+ with disabilities, 2010 Self-care difficulty 3,428 8.8% Cognitive difficulty 3,712 9.5% Any disability 14,352 37% People age 18-64 with disabilities, 2010 Self-care difficulty 3,444 1.8% Cognitive difficulty 7,943 4.2% Any disability 19,048 10.0% Per 1,000 Family Caregivers Value Population Family caregivers, 2009 42,100,000 137 Economic value of family caregiving, 2009 . (total in millions of $) $450,000 $1,460 Economic value per hour, 2009 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.8 Per 1,000 Long-Term Care Insurance Value Age 40+ Private long-term care insurance policies in effect, 2010 6,485,598 45 37 Public LTSS Expenditures United States Medicaid Expenditures Value Total Medicaid expenditures (millions), 2009 $368,330 Medicaid home and community-based services (HCBS). as a % of long-term services and supports (LTSS) spending,. for older people and adults with physical disabilities, 2009 * 36% Medicaid HCBS spending as a % of LTSS spending,. for all populations, 2009 * 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in the U.S., 2009 United States 11% 25% 64% Nursing Facilities Aged/Disabled Waivers Other HCBS Value Per 1,000 LTSS & Home Health Expenditures (millions) Population Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $80,181 $261 Nursing facilities $51,403 $168 HCBS $28,778 $94 Aged/disabled waiver services $8,821 $29 Personal care services (PCS) $14,983 $45 Home health services $4,861 $16 Other HCBS ** $1,165 $4 Medicaid LTSS expenditures for all populations, 2009 $126,816 $413 Institutional services $71,220 $232 HCBS $55,596 $181 Waiver services (all populations) $34,826 $114 Other HCBS (including PCS and home health) $20,770 $68 State-funded HCBS expenditures for older people and. adults with physical disabilities, 2009 $1,481 $4.83 * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. 38 Per 1,000 Medicaid HCBS Participants By Type of Service Population Un it ed States Value Nursing facilities (NF), 2008 1,614,404 5.3 HCBS (older people and adults with PD), 2008 2,499,867 8.2 Aged/disabled waiver services 674,528 2.2 Personal care services (PCS) 902,943 3.0 Home health services 922,396 3.0 Institutional services (NF and ICF-MR), 2008 1,717,794 5.6 HCBS (all populations), 2008 3,066,750 10.1 Waiver services (all populations) 1,241,411 4.1 Other HCBS (including PCS and home health) 1,825,339 6.0 Adults with disabilities self-directing services, 2011 739,711 2.43 Medicaid Participant LTSS Balance Value Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 42 Medicaid HCBS beneficiaries as a % of LTSS users,. for older people and adults with PD, 2008 * 61% Medicaid HCBS beneficiaries as a % of LTSS users,. for all populations, 2008 * 64% Medicaid Expenditures Per Person Served Value Nursing facility services, 2008 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $10,957 Aged/disabled waiver services $10,710 Personal care services $11,142 Home health services $5,495 ICF-MR services, 2008 $123,053 MR/DD waiver services, 2008 $42,896 LTSS Costs Public & Private Payment Rates Value Medicaid payment per day for nursing facility care, 2011 $178 Medicare payment per day for nursing facility care, 2010 $398 Medicare reimbursement per home health visit, 2010 $154 Private pay rate per day in nursing facility, 2011 $193 Private pay rate per month in assisted living, 2011 $3,261 Private pay daily rate for adult day care, 2011 $60 Private pay hourly rate for home health aide, 2011 $19 39 LTSS Resources United States Per 1,000 HCBS Resources Value Age 65+ Assisted living and residential care facilities, 2010 58,938 1.46 Assisted living and residential care units, 2010 1,233,690 31 Personal and home care aides, 2010 686,030 17 Median hourly wage, 2010 $9.44 Home health aides, 2010 982,840 24 Median hourly wage, 2010 $9.89 People receiving ACL congregate meals, 2009 * 1,671,670 42 People receiving ACL home delivered meals, 2009 * 869,304 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $1,423 $36 Per 1,000 Nursing Facility Resources & Utilization Value Age 65+ Total nursing facilities, 2010 16,071 0.40 Nursing facility beds, 2010 1,696,721 42 Nursing facility residents, 2010 1,408,886 35 Nursing facility occupancy rate, 2010 83% Direct care nursing hours per patient day, 2010 3.8 RN hours per patient day, 2010 0.64 Nursing facility staffing turnover, 2010 40% Nursing Facility Resident Characteristics Value Residents with dementia, 2010 46% Nursing facility residents with low care needs, 2008 17% Residents with Medicaid as primary payer, 2010 63% Residents with Medicare as primary payer, 2010 14% Residents with “other” as primary payer, 2010 22% Quality & Oversight of Nursing Facilities Value Residents with physical restraints (%), 2008 4% High risk residents with pressure sores, 2008 12% Long-stay residents with a hospital admission, 2008 21% Long-term care facility beds per FTE ombudsman, 2010 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 76% * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 40 Trends Un it ed States Medicaid HCBS Utilization Year Value Medicaid HCBS participants, older people and adults 2003 1,270,155 with physical disabilities (excluding home health) 2008 1,577,471 % change +24% Nursing Facility Residents Year Value Nursing facility residents 2005 1,460,185 2010 1,408,886 % change -4% Long-Term Care Financing Year Value Total Medicaid spending (millions) 2004 $285,710 2009 $368,330 % change +29% Medicaid LTSS spending for older people and. 2004 $62,811 adults with physical disabilities (millions) 2009 $80,181 % change +28% Medicaid nursing facility spending (millions) 2004 $45,842 2009 $51,403 % change +12% Medicaid HCBS spending for older people and. 2004 $16,969 adults with physical disabilities (millions) 2009 $28,778 % change +70% Medicaid HCBS as a % of LTSS spending, for older. 2004 27% people and adults with physical disabilities 2009 36% change +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $9,000 +$8,853 $9,000 +$8,853 100% 100% +$7,982 +$7,982 $7,200 $7,200 80% 80% +77% +77% +67% +67% +$5,561 +$5,561 $5,400 $5,400 60% 60% +54% +54% +$3,827 +$3,827 $3,600 $3,600 40% 40% $1,800 $1,800 20% 20% +$934 +$934 +12% +12% +8% +8% $0 $0 0% 0% ICF-MR MR/DD ICF-MR MR/DD Nursing HCBS PCS HCBS PCS and Nursing and ICF-MR MR/DD ICF-MR MR/DD Nursing HCBS PCS HCBS PCS and Nursing and Waivers Waivers Facilities 1915(c) other Facilities 1915(c) other Waivers Waivers Facilities 1915(c) other Facilities 1915(c) other Waivers HCBS Waivers HCBS Waivers HCBS Waivers HCBS 41 AARP Public Policy Institute Alabama Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 4,786 23 315,311 2032 5,442 24 376,660 +14% 39 +19% 2050 6,314 24 434,447 +32% 34 +38% Age 50-64 2012 929 19.4% 27 19.2% 2032 893 16.4% 22 16.4% -4% 28 +2% 2050 1,062 16.8% 28 16.6% +14% 33 +19% Age 65+ 2012 701 14.7% 14 13.6% 2032 1,095 20.1% 25 19.8% +56% 45 +74% 2050 1,240 19.6% 37 20.4% +77% 44 +107% Age 65-74 2012 385 8.0% 12 7.4% 2032 549 10.1% 22 10.1% +43% 48 +64% 2050 563 8.9% 37 9.1% +46% 41 +69% Age 75-84 2012 221 4.6% 10 4.2% 2032 380 7.0% 21 6.8% +72% 48 +94% 2050 394 6.2% 33 6.6% +79% 41 +116% Age 85+ 2012 96 2.0% 28 2.0% 2032 166 3.1% 10 2.9% +74% 21 +69% 2050 283 4.5% 38 4.8% +196% 29 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Alabama as a Percentage of State Rank U.S. 2012 Population, by Age Group 19.6% 18 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% 85+ State Rank U.S. 0.5% 40 3.6% 250% 200% Black State Rank U.S. 75-84 150% 17.6% 7 8.5% 65-74 100% Hispanic 50-64 State Rank U.S. 50% 0.6% 46 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Alabama Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 43 45 48 People age 75+ living alone, 2010 34% 28 34% People age 60+ with grandchildren in household, 2010 5.5% 14 5.5% People age 60+ responsible for raising grandchildren, 2010 2.5% 3 1.6% Percent of age 65+ households with someone under 18, 2010 6.6% 17 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $30,763 42 $34,381 At/below poverty level age 65+, 2010 10.7% 9 9.0% At/below 250% of poverty level age 65+, 2010 48% 6 42% Women age 75+ at/below poverty level, 2010 15.4% 6 12.2% Women age 75+ at/below 250% of poverty level, 2010 60% 8 54% Bachelor level education or higher age 65+, 2010 17% 38 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 72 11.3% 2 8.8% Cognitive difficulty 83 13.0% 2 9.5% Any disability 281 44% 2 37% People age 18-64 with disabilities, 2010 Self-care difficulty 76 2.6% 4 1.8% Cognitive difficulty 174 5.9% 4 4.2% Any disability 423 14.4% 5 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 818,000 174 3 137 Economic value of family caregiving, 2009 . (state in millions of $) $7,300 $1,560 18 $1,460 Economic value per hour, 2009 $9.37 51 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 5.2 12 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 74,291 33 42 45 43 Public LTSS Expenditures Alabama Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $4,417 26 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 68.01% 10 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 15% 46 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 30% 46 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Alabama and the U.S., 2009 Alabama United States 25% Percentages may not add 6% to 100% due to rounding 64% 9% 85% Aged/Disabled Waivers 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults $1,103 $232 27 $261 with physical disabilities, 2009 Nursing facilities $938 $197 15 $168 HCBS $165 $35 44 $94 Aged/disabled waiver services $104 $22 31 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $61 $13 15 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $1,479 $311 38 $413 Institutional services $1,040 $219 22 $232 HCBS $439 $92 44 $181 Waiver services (all populations) $378 $79 40 $114 Other HCBS (including PCS and home health) $61 $13 37 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 44 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Alabama State Nursing facilities (NF), 2008 25,671 5.4 26 5.3 HCBS (older people and adults with PD), 2008 16,211 3.4 40 8.2 Aged/disabled waiver services 9,468 2.0 28 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 6,743 1.4 28 3.0 Institutional services (NF and ICF-MR), 2008 25,912 5.5 26 5.6 HCBS (all populations), 2008 21,888 4.6 42 10.1 Waiver services (all populations) 15,145 3.2 34 4.1 Other HCBS (including PCS and home health) 6,743 1.4 42 6.0 Adults with disabilities self-directing services, 2011 89 0.02 49 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 37 29 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 39% 42 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 46% 45 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $32,322 16 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $9,704 22 $10,957 Aged/disabled waiver services $9,704 28 $10,710 Personal care services ** NA NA $11,142 Home health services $3,708 18 $5,495 ICF-MR services, 2008 $144,633 14 $123,053 MR/DD waiver services, 2008 $43,421 24 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $341 48 $398 Medicare reimbursement per home health visit, 2010 $153 35 $154 Private pay rate per day in nursing facility, 2011 $170 39 $193 Private pay rate per month in assisted living, 2011 $2,899 40 $3,261 Private pay daily rate for adult day care, 2011 $35 50 $60 Private pay hourly rate for home health aide, 2011 $16 47 $19 45 LTSS Resources Alabama Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 472 0.72 33 1.46 Assisted living and residential care units, 2010 9,860 15 44 31 Personal and home care aides, 2010 3,800 6 47 17 Median hourly wage, 2010 $8.35 48 $9.44 Home health aides, 2010 9,850 15 37 24 Median hourly wage, 2010 $8.80 47 $9.89 People receiving ACL congregate meals, 2009 * 25,081 39 32 42 People receiving ACL home delivered meals, 2009 * 13,539 21 30 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $23 $36 25 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 4 29 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 233 0.35 33 0.40 Nursing facility beds, 2010 26,880 41 28 42 Nursing facility residents, 2010 23,080 35 26 35 Nursing facility occupancy rate, 2010 86% 24 83% Direct care nursing hours per resident day, 2010 4.2 6 3.8 RN hours per day, 2010 0.56 44 0.64 Nursing facility staffing turnover, 2010 48% 13 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 52% 9 46% Nursing facility residents with low care needs, 2008 19% 20 17% Residents with Medicaid as primary payer, 2010 68% 8 63% Residents with Medicare as primary payer, 2010 14% 26 14% Residents with “other” as primary payer, 2010 19% 36 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 10% 33 12% Long-stay residents with a hospital admission, 2008 23% 11 21% Long-term care facility beds per FTE ombudsman, 2010 1,744 32 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 46 Trends Alabama Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 8,274 1,270,155 with physical disabilities (excluding home health) 2008 9,468 1,577,471 % change +14% 31 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 23,459 1,460,185 2010 23,080 1,408,886 % change -2% 16 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $3,670 $285,710 2009 $4,417 $368,330 % change +20% 42 +29% Medicaid LTSS spending for older people and adults 2004 $869 $62,811 with physical disabilities (millions) 2009 $1,103 $80,181 % change +27% 25 +28% Medicaid nursing facility spending (millions) 2004 $767 $45,842 2009 $938 $51,403 % change +22% 12 +12% Medicaid HCBS spending for older people and adults 2004 $102 $16,969 with physical disabilities (millions) 2009 $165 $28,778 % change +61% 28 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 12% 41 27% people and adults with physical disabilities 2009 15% 46 36% change +3% 39 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $200 80% +$172 70% +67% $160 60% +58% Millions of Dollars +55% $120 50% +$97 40% $80 30% +22% +$38 20% $40 +$24 +10% 10% +$4 $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 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. 47 AARP Public Policy Institute Alaska Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 726 47 315,311 2032 951 47 376,660 +31% 6 +19% 2050 985 47 434,447 +36% 27 +38% Age 50-64 2012 144 19.8% 21 19.2% 2032 146 15.3% 39 16.4% +1% 20 +2% 2050 182 18.5% 7 16.6% +27% 12 +19% Age 65+ 2012 63 8.7% 51 13.6% 2032 156 16.4% 49 19.8% +147% 1 +74% 2050 196 19.9% 33 20.4% +210% 1 +107% Age 65-74 2012 41 5.6% 50 7.4% 2032 83 8.7% 48 green line = 50-64 (WAS BLUE) +64% 10.1% +103% 1 red line = 65-74 (WAS PURPLE) 2050 96 9.8% 2 9.1% +136% 2 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 16 2.3% 51 blue line = 85+ (WAS RED) 4.2% 2032 55 5.8% 48 6.8% +232% 1 +94% 2050 55 5.5% 49 6.6% +231% 1 +116% Age 85+ 2012 6 0.8% 51 2.0% 2032 18 1.9% 49 2.9% +207% 1 +69% 2050 45 4.6% 34 4.8% +650% 1 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Alaska as a Percentage of State Rank U.S. 2012 Population, by Age Group 25.5% 10 20.1% 900% Population (% of 2012 Population) Asian/Pacific Islander 800% State Rank U.S. 700% 85+ 6.3% 4 3.6% 600% Black 500% State Rank U.S. 400% 1.9% 35 8.5% 75-84 300% 65-74 Hispanic 200% State Rank U.S. 100% 50-64 2.1% 24 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Alaska Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 54 9 48 People age 75+ living alone, 2010 30% 43 34% People age 60+ with grandchildren in household, 2010 6.8% 6 5.5% People age 60+ responsible for raising grandchildren, 2010 2.1% 8 1.6% Percent of age 65+ households with someone under 18, 2010 11.0% 3 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $43,987 3 $34,381 At/below poverty level age 65+, 2010 5.7% 51 9.0% At/below 250% of poverty level age 65+, 2010 31% 50 42% Women age 75+ at/below poverty level, 2010 7.2% 51 12.2% Women age 75+ at/below 250% of poverty level, 2010 43% 49 54% Bachelor level education or higher age 65+, 2010 24% 13 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 4 8.3% 21 8.8% Cognitive difficulty 4 8.7% 28 9.5% Any disability 20 39% 12 37% People age 18-64 with disabilities, 2010 Self-care difficulty 7 1.6% 30 1.8% Cognitive difficulty 18 3.9% 32 4.2% Any disability 48 10.8% 22 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 88,000 126 41 137 Economic value of family caregiving, 2009 . (state in millions of $) $1,100 $1,570 16 $1,460 Economic value per hour, 2009 $13.10 3 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 2.9 43 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 8,793 29 48 45 49 Public LTSS Expenditures Alaska Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,070 47 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 51.43% 36 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 56% 5 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 63% 6 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Alaska and the U.S., 2009 Alaska United States 25% Percentages may not add 31% to 100% due to rounding 44% 64% Aged/Disabled Waivers 11% 25% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults $268 $384 6 $261 with physical disabilities, 2009 Nursing facilities $119 $170 24 $168 HCBS $150 $214 4 $94 Aged/disabled waiver services $67 $95 4 $29 Personal care services (PCS) ** $82 $118 4 $45 Home health services $1 $1 44 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $403 $576 6 $413 Institutional services $150 $215 24 $232 HCBS $253 $361 5 $181 Waiver services (all populations) $170 $243 7 $114 Other HCBS (including PCS and home health) $83 $119 7 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $4 $5.58 14 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 50 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Alaska State Nursing facilities (NF), 2008 939 1.4 50 5.3 HCBS (older people and adults with PD), 2008 6,863 10.0 12 8.2 Aged/disabled waiver services 3,049 4.4 10 2.2 Personal care services (PCS) ** 3,520 5.1 7 3.0 Home health services 294 0.4 47 3.0 Institutional services (NF and ICF-MR), 2008 944 1.4 50 5.6 HCBS (all populations), 2008 8,358 12.2 13 10.1 Waiver services (all populations) 4,544 6.6 10 4.1 Other HCBS (including PCS and home health) 3,814 5.5 16 6.0 Adults with disabilities self-directing services, 2011 3,688 5.36 4 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 325 1 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 88% 1 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 90% 1 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $79,078 1 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $18,711 2 $10,957 Aged/disabled waiver services $16,543 5 $10,710 Personal care services ** $20,589 2 $11,142 Home health services $3,256 20 $5,495 ICF-MR services, 2008 $170,340 10 $123,053 MR/DD waiver services, 2008 $59,949 8 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $648 1 $398 Medicare reimbursement per home health visit, 2010 $217 2 $154 Private pay rate per day in nursing facility, 2011 $609 1 $193 Private pay rate per month in assisted living, 2011 $5,500 1 $3,261 Private pay daily rate for adult day care, 2011 $90 6 $60 Private pay hourly rate for home health aide, 2011 $27 1 $19 51 LTSS Resources Alaska Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 229 4.15 5 1.46 Assisted living and residential care units, 2010 1,912 35 14 31 Personal and home care aides, 2010 2,310 42 4 17 Median hourly wage, 2010 $14.38 1 $9.44 Home health aides, 2010 1,570 28 10 24 Median hourly wage, 2010 $14.56 1 $9.89 People receiving ACL congregate meals, 2009 * 7,970 149 4 42 People receiving ACL home delivered meals, 2009 * 2,638 49 6 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $9 $167 1 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 8 21 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 15 0.27 44 0.40 Nursing facility beds, 2010 682 12 51 42 Nursing facility residents, 2010 640 12 51 35 Nursing facility occupancy rate, 2010 94% 1 83% Direct care nursing hours per resident day, 2010 5.4 1 3.8 RN hours per day, 2010 1.51 1 0.64 Nursing facility staffing turnover, 2010 NA NA 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 47% 24 46% Nursing facility residents with low care needs, 2008 NA NA 17% Residents with Medicaid as primary payer, 2010 73% 3 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 12% 49 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 NA NA 4% High risk residents with pressure sores, 2008 NA NA 12% Long-stay residents with a hospital admission, 2008 NA NA 21% Long-term care facility beds per FTE ombudsman, 2010 1,002 46 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 53% 41 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 52 Trends Alaska Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 4,940 1,270,155 with physical disabilities (excluding home health) 2008 6,569 1,577,471 % change +33% 22 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 629 1,460,185 2010 640 1,408,886 % change +2% 6 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $890 $285,710 2009 $1,070 $368,330 % change +20% 42 +29% Medicaid LTSS spending for older people and adults 2004 $218 $62,811 with physical disabilities (millions) 2009 $268 $80,181 % change +23% 31 +28% Medicaid nursing facility spending (millions) 2004 $107 $45,842 2009 $119 $51,403 % change +11% 29 +12% Medicaid HCBS spending for older people and adults 2004 $111 $16,969 with physical disabilities (millions) 2009 $150 $28,778 % change +35% 40 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 51% 3 27% people and adults with physical disabilities 2009 56% 5 36% change +5% 29 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $40 70% +65% +$35 $35 60% +62% $30 Millions of Dollars +$26 50% $25 40% $20 30% $15 +$13 +$12 20% +18% $10 +11% $5 10% +$1 $0 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 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. 53 AARP Public Policy Institute Arizona Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 6,961 14 315,311 2032 9,297 13 376,660 +34% 4 +19% 2050 11,085 12 434,447 +59% 3 +38% Age 50-64 2012 1,190 17.1% 49 19.2% 2032 1,267 13.6% 51 16.4% +6% 11 +2% 2050 1,429 12.9% 50 16.6% +20% 23 +19% Age 65+ 2012 968 13.9% 30 13.6% 2032 1,800 19.4% 31 19.8% +86% 12 +74% 2050 2,161 19.5% 38 20.4% +123% 13 +107% Age 65-74 2012 528 7.6% 24 7.4% green line = 50-64 (WAS BLUE) 2032 865 9.3% 43 10.1% +64% 19 +64% red line = 65-74 (WAS PURPLE) 2050 833 7.5% 50 9.1% +58% 27 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 301 4.3% 26 blue line = 85+ (WAS RED) 4.2% 2032 648 7.0% 21 6.8% +115% 9 +94% 2050 770 6.9% 7 6.6% +156% 8 +116% Age 85+ 2012 140 2.0% 28 2.0% 2032 287 3.1% 10 2.9% +105% 5 +69% 2050 559 5.0% 13 4.8% +299% 8 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Arizona as a Percentage of State Rank U.S. 2012 Population, by Age Group 17.4% 20 20.1% 500% Population (% of 2012 Population) 450% Asian/Pacific Islander 85+ State Rank U.S. 400% 1.8% 17 3.6% 350% 300% Black 250% State Rank U.S. 75-84 200% 1.9% 35 8.5% 150% 65-74 Hispanic 100% 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 11.0% 5 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Arizona Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 58 2 48 People age 75+ living alone, 2010 30% 43 34% People age 60+ with grandchildren in household, 2010 5.2% 18 5.5% People age 60+ responsible for raising grandchildren, 2010 1.8% 17 1.6% Percent of age 65+ households with someone under 18, 2010 6.8% 16 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $37,134 14 $34,381 At/below poverty level age 65+, 2010 7.7% 31 9.0% At/below 250% of poverty level age 65+, 2010 39% 37 42% Women age 75+ at/below poverty level, 2010 9.3% 45 12.2% Women age 75+ at/below 250% of poverty level, 2010 49% 40 54% Bachelor level education or higher age 65+, 2010 25% 10 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 58 6.6% 44 8.8% Cognitive difficulty 68 7.8% 42 9.5% Any disability 287 33% 42 37% People age 18-64 with disabilities, 2010 Self-care difficulty 64 1.7% 24 1.8% Cognitive difficulty 152 4.0% 30 4.2% Any disability 364 9.6% 31 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 855,000 130 35 137 Economic value of family caregiving, 2009 . (state in millions of $) $9,400 $1,430 35 $1,460 Economic value per hour, 2009 $11.50 21 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 6.3 7 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 103,642 36 36 45 55 Public LTSS Expenditures Arizona Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $8,561 12 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 65.75% 14 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 44% 9 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 67% 4 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Arizona and the U.S., 2009 Arizona United States 25% Percentages may not add to 100% due to rounding 44% 56% 64% Aged/Disabled Waivers 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults $794 $125 49 $261 with physical disabilities, 2009 Nursing facilities $447 $70 49 $168 HCBS $347 $55 30 $94 Aged/disabled waiver services NA NA NA $29 Personal care services (PCS) ** $8 $1 32 $45 Home health services $1 $0 48 $16 Other HCBS *** $338 $53 2 $4 Medicaid LTSS expenditures for all populations, 2009 $1,528 $241 47 $413 Institutional services $505 $80 51 $232 HCBS $1,023 $161 24 $181 Waiver services (all populations) NA NA NA $114 Other HCBS (including PCS and home health) $1,023 $161 3 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $16 $2.53 27 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 56 Per 1,000 Medicaid HCBS Participants By Type of Service † Population Rank U.S. Arizona State Nursing facilities (NF), 2008 NA NA NA 5.3 HCBS (older people and adults with PD), 2008 NA NA NA 8.2 Aged/disabled waiver services NA NA NA 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services NA NA NA 3.0 Institutional services (NF and ICF-MR), 2008 NA NA NA 5.6 HCBS (all populations), 2008 34,968 5.6 39 10.1 Waiver services (all populations) NA NA NA 4.1 Other HCBS (including PCS and home health) 34,968 5.6 15 6.0 Adults with disabilities self-directing services, 2011 2,140 0.34 39 2.43 Medicaid Participant LTSS Balance † State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 NA NA 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * NA NA 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * NA NA 64% Medicaid Expenditures Per Person Served † State Rank U.S. Nursing facility services, 2008 $24,154 43 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) NA NA $10,957 Aged/disabled waiver services NA NA $10,710 Personal care services ** NA NA $11,142 Home health services NA NA $5,495 ICF-MR services, 2008 NA NA $123,053 MR/DD waiver services, 2008 NA NA $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $177 21 $178 Medicare payment per day for nursing facility care, 2010 $423 19 $398 Medicare reimbursement per home health visit, 2010 $188 7 $154 Private pay rate per day in nursing facility, 2011 $175 36 $193 Private pay rate per month in assisted living, 2011 $3,000 35 $3,261 Private pay daily rate for adult day care, 2011 $80 8 $60 Private pay hourly rate for home health aide, 2011 $19 31 $19 † Because of Arizona’s unique Medicaid LTSS system, comparable data on participants and expenditures per person served are not available for many service types 57 LTSS Resources Arizona Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 1,925 2.17 11 1.46 Assisted living and residential care units, 2010 28,536 32 18 31 Personal and home care aides, 2010 11,460 13 29 17 Median hourly wage, 2010 $10.05 20 $9.44 Home health aides, 2010 21,280 24 16 24 Median hourly wage, 2010 $10.36 20 $9.89 People receiving ACL congregate meals, 2009 * 12,316 14 48 42 People receiving ACL home delivered meals, 2009 * 11,484 13 46 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $13 $15 51 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 NA NA Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 140 0.16 50 0.40 Nursing facility beds, 2010 16,245 18 49 42 Nursing facility residents, 2010 11,758 13 50 35 Nursing facility occupancy rate, 2010 72% 43 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.71 23 0.64 Nursing facility staffing turnover, 2010 44% 17 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 39% 48 46% Nursing facility residents with low care needs, 2008 15% 29 17% Residents with Medicaid as primary payer, 2010 62% 27 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 23% 19 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 11% 45 21% Long-term care facility beds per FTE ombudsman, 2010 2,374 25 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 58 Trends Arizona Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 NA 1,270,155 with physical disabilities (excluding home health) 2008 NA 1,577,471 % change NA NA +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 12,893 1,460,185 2010 11,758 1,408,886 % change -9% 44 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $4,871 $285,710 2009 $8,561 $368,330 % change +76% 1 +29% Medicaid LTSS spending for older people and adults 2004 NA $62,811 with physical disabilities (millions) 2009 $794 $80,181 % change NA NA +28% Medicaid nursing facility spending (millions) 2004 NA $45,842 2009 $447 $51,403 % change NA NA +12% Medicaid HCBS spending for older people and adults 2004 NA $16,969 with physical disabilities (millions) 2009 $347 $28,778 % change NA NA +70% Medicaid HCBS as a % of LTSS spending, for older 2004 NA NA 27% people and adults with physical disabilities 2009 44% 9 36% change NA NA +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $1 100% $1 90% 80% $1 Millions of Dollars 70% $1 60% $0 50% $0 40% 30% $0 20% $0 10% $0 $0 $0 $0 $0 0% 0% 0% 0% 0% $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 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. 59 AARP Public Policy Institute Arkansas Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 2,978 33 315,311 2032 3,479 32 376,660 +17% 32 +19% 2050 4,071 32 434,447 +37% 25 +38% Age 50-64 2012 556 18.7% 40 19.2% 2032 568 16.3% 24 16.4% +2% 17 +2% 2050 677 16.6% 32 16.6% +22% 18 +19% Age 65+ 2012 446 15.0% 10 13.6% 2032 687 19.7% 28 19.8% +54% 49 +74% 2050 810 19.9% 33 20.4% +82% 35 +107% Age 65-74 2012 245 8.2% 8 7.4% green line = 50-64 (WAS BLUE) 2032 342 9.8% 29 10.1% +39% 50 +64% red line = 65-74 (WAS PURPLE) 2050 378 9.3% 18 9.1% +54% 31 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 137 4.6% 10 blue line = 85+ (WAS RED) 4.2% 2032 239 6.9% 28 6.8% +75% 45 +94% 2050 253 6.2% 33 6.6% +85% 36 +116% Age 85+ 2012 64 2.2% 16 2.0% 2032 106 3.0% 20 2.9% +65% 29 +69% 2050 178 4.4% 41 4.8% +178% 39 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Arkansas as a Percentage of State Rank U.S. 2012 Population, by Age Group 11.3% 28 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.3% 47 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 9.3% 16 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 0.8% 42 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Arkansas Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 47 23 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 4.3% 28 5.5% People age 60+ responsible for raising grandchildren, 2010 2.1% 8 1.6% Percent of age 65+ households with someone under 18, 2010 4.9% 33 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $29,452 48 $34,381 At/below poverty level age 65+, 2010 10.2% 12 9.0% At/below 250% of poverty level age 65+, 2010 49% 5 42% Women age 75+ at/below poverty level, 2010 16.1% 4 12.2% Women age 75+ at/below 250% of poverty level, 2010 63% 4 54% Bachelor level education or higher age 65+, 2010 15% 46 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 37 9.1% 13 8.8% Cognitive difficulty 45 11.1% 7 9.5% Any disability 173 43% 3 37% People age 18-64 with disabilities, 2010 Self-care difficulty 43 2.5% 5 1.8% Cognitive difficulty 99 5.6% 9 4.2% Any disability 255 14.6% 4 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 478,000 165 7 137 Economic value of family caregiving, 2009 . (state in millions of $) $4,500 $1,560 18 $1,460 Economic value per hour, 2009 $9.87 46 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.2 23 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 41,093 30 47 45 61 Public LTSS Expenditures Arkansas Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $3,500 31 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 72.78% 3 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 29% 24 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 30% 46 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Arkansas and the U.S., 2009 Arkansas United States 25% Percentages may not add 16% to 100% due to rounding 71% 64% Aged/Disabled Waivers 13% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $807 $279 17 $261 Nursing facilities $573 $198 14 $168 HCBS $234 $81 19 $94 Aged/disabled waiver services $101 $35 23 $29 Personal care services (PCS) ** $79 $27 18 $45 Home health services $53 $18 10 $16 Other HCBS *** $1 $0 22 $4 Medicaid LTSS expenditures for all populations, 2009 $1,225 $423 20 $413 Institutional services $860 $297 14 $232 HCBS $365 $126 36 $181 Waiver services (all populations) $232 $80 38 $114 Other HCBS (including PCS and home health) $133 $46 19 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $8 $2.66 24 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 62 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Arkansas State Nursing facilities (NF), 2008 27,184 9.5 3 5.3 HCBS (older people and adults with PD), 2008 29,859 10.4 10 8.2 Aged/disabled waiver services 10,173 3.5 14 2.2 Personal care services (PCS) ** 13,923 4.8 8 3.0 Home health services 5,763 2.0 21 3.0 Institutional services (NF and ICF-MR), 2008 29,416 10.2 3 5.6 HCBS (all populations), 2008 33,404 11.6 17 10.1 Waiver services (all populations) 13,718 4.8 23 4.1 Other HCBS (including PCS and home health) 19,686 6.8 11 6.0 Adults with disabilities self-directing services, 2011 4,928 1.71 11 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 37 29 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 52% 25 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 53% 32 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $16,318 51 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $5,136 43 $10,957 Aged/disabled waiver services $6,697 39 $10,710 Personal care services ** $3,996 27 $11,142 Home health services $1,799 34 $5,495 ICF-MR services, 2008 $61,467 50 $123,053 MR/DD waiver services, 2008 $32,074 35 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $334 50 $398 Medicare reimbursement per home health visit, 2010 $127 49 $154 Private pay rate per day in nursing facility, 2011 $143 47 $193 Private pay rate per month in assisted living, 2011 $2,700 46 $3,261 Private pay daily rate for adult day care, 2011 $63 25 $60 Private pay hourly rate for home health aide, 2011 $16 47 $19 63 LTSS Resources Arkansas Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 175 0.42 44 1.46 Assisted living and residential care units, 2010 7,713 18 39 31 Personal and home care aides, 2010 8,940 21 13 17 Median hourly wage, 2010 $8.30 49 $9.44 Home health aides, 2010 8,120 19 27 24 Median hourly wage, 2010 $8.30 51 $9.89 People receiving ACL congregate meals, 2009 * 26,563 64 21 42 People receiving ACL home delivered meals, 2009 * 15,284 37 13 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $20 $48 19 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 15 6 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 246 0.58 11 0.40 Nursing facility beds, 2010 25,690 61 7 42 Nursing facility residents, 2010 18,770 45 14 35 Nursing facility occupancy rate, 2010 73% 42 83% Direct care nursing hours per resident day, 2010 4.1 9 3.8 RN hours per day, 2010 0.41 49 0.64 Nursing facility staffing turnover, 2010 45% 16 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 45% 31 46% Nursing facility residents with low care needs, 2008 24% 5 17% Residents with Medicaid as primary payer, 2010 67% 9 63% Residents with Medicare as primary payer, 2010 11% 44 14% Residents with “other” as primary payer, 2010 21% 30 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 6% 5 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 28% 3 21% Long-term care facility beds per FTE ombudsman, 2010 2,317 27 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 64 Trends Arkansas Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 24,157 1,270,155 with physical disabilities (excluding home health) 2008 24,096 1,577,471 % change +0% 42 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 18,265 1,460,185 2010 18,770 1,408,886 % change +3% 5 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $2,600 $285,710 2009 $3,500 $368,330 % change +35% 17 +29% Medicaid LTSS spending for older people and adults 2004 $684 $62,811 with physical disabilities (millions) 2009 $807 $80,181 % change +18% 38 +28% Medicaid nursing facility spending (millions) 2004 $540 $45,842 2009 $573 $51,403 % change +6% 35 +12% Medicaid HCBS spending for older people and adults 2004 $144 $16,969 with physical disabilities (millions) 2009 $234 $28,778 % change +63% 26 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 21% 23 27% people and adults with physical disabilities 2009 29% 24 36% change +8% 16 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $80 140% +$73 +129% $70 120% +$60 +102% $60 +$57 Millions of Dollars 100% $50 +84% 80% $40 +$33 +$33 60% $30 40% +33% $20 $10 20% +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 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. 65 AARP Public Policy Institute California Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 38,163 1 315,311 2032 45,655 1 376,660 +20% 25 +19% 2050 53,159 1 434,447 +39% 21 +38% Age 50-64 2012 6,885 18.0% 44 19.2% 2032 7,635 16.7% 11 16.4% +11% 7 +2% 2050 8,148 15.3% 46 16.6% +18% 25 +19% Age 65+ 2012 4,556 11.9% 45 13.6% 2032 8,662 19.0% 38 19.8% +90% 8 +74% 2050 10,866 20.4% 21 20.4% +138% 9 +107% Age 65-74 2012 2,471 6.5% 47 7.4% green line = 50-64 (WAS BLUE) 2032 4,514 9.9% 26 10.1% +83% 5 +64% red line = 65-74 (WAS PURPLE) 2050 4,756 8.9% 37 9.1% +92% 9 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 1,391 3.6% 45 blue line = 85+ (WAS RED) 4.2% 2032 2,912 6.4% 41 6.8% +109% 15 +94% 2050 3,545 6.7% 12 6.6% +155% 9 +116% Age 85+ 2012 694 1.8% 38 2.0% 2032 1,236 2.7% 38 2.9% +78% 18 +69% 2050 2,564 4.8% 22 4.8% +270% 11 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in California as a Percentage of State Rank U.S. 2012 Population, by Age Group 38.1% 4 20.1% 450% Population (% of 2012 Population) Asian/Pacific Islander 400% 85+ State Rank U.S. 350% 13.6% 2 3.6% 300% Black 250% 75-84 State Rank U.S. 200% 5.5% 25 8.5% 150% 65-74 Hispanic 100% 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 17.7% 3 6.9% 0% 2010 2020 2030 2040 2050 2060 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 California Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 54 9 48 People age 75+ living alone, 2010 30% 43 34% People age 60+ with grandchildren in household, 2010 9.1% 2 5.5% People age 60+ responsible for raising grandchildren, 2010 1.9% 13 1.6% Percent of age 65+ households with someone under 18, 2010 11.8% 2 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $40,255 8 $34,381 At/below poverty level age 65+, 2010 9.7% 17 9.0% At/below 250% of poverty level age 65+, 2010 40% 35 42% Women age 75+ at/below poverty level, 2010 12.4% 23 12.2% Women age 75+ at/below 250% of poverty level, 2010 50% 39 54% Bachelor level education or higher age 65+, 2010 27% 5 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 449 10.7% 4 8.8% Cognitive difficulty 444 10.6% 13 9.5% Any disability 1,539 37% 21 37% People age 18-64 with disabilities, 2010 Self-care difficulty 355 1.5% 33 1.8% Cognitive difficulty 762 3.3% 44 4.2% Any disability 1,818 7.8% 48 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 4,020,000 109 50 137 Economic value of family caregiving, 2009 . (state in millions of $) $47,000 $1,270 44 $1,460 Economic value per hour, 2009 $12.17 12 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.1 25 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 708,605 44 24 45 67 Public LTSS Expenditures California Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $40,818 2 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 55% 6 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 57% 9 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in California and the U.S., 2009 California United States 25% Percentages may not add 54% to 100% due to rounding 45% 64% Aged/Disabled Waivers 2% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $9,856 $267 18 $261 Nursing facilities $4,430 $120 39 $168 HCBS $5,426 $147 6 $94 Aged/disabled waiver services $149 $4 48 $29 Personal care services (PCS) ** $4,983 $135 3 $45 Home health services $179 $5 31 $16 Other HCBS *** $116 $3 9 $4 Medicaid LTSS expenditures for all populations, 2009 $12,801 $346 34 $413 Institutional services $5,507 $149 41 $232 HCBS $7,293 $197 17 $181 Waiver services (all populations) $2,016 $55 47 $114 Other HCBS (including PCS and home health) $5,277 $143 5 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $182 $4.93 17 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 68 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. California State Nursing facilities (NF), 2008 137,361 3.8 39 5.3 HCBS (older people and adults with PD), 2008 524,639 14.3 2 8.2 Aged/disabled waiver services 16,119 0.4 49 2.2 Personal care services (PCS) ** 422,823 11.6 1 3.0 Home health services 85,697 2.3 18 3.0 Institutional services (NF and ICF-MR), 2008 145,978 4.0 39 5.6 HCBS (all populations), 2008 599,526 16.4 2 10.1 Waiver services (all populations) 91,006 2.5 45 4.1 Other HCBS (including PCS and home health) 508,520 13.9 1 6.0 Adults with disabilities self-directing services, 2011 480,000 13.11 1 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 12 46 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 79% 2 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 80% 3 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,341 31 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $10,184 19 $10,957 Aged/disabled waiver services $8,906 32 $10,710 Personal care services ** $10,232 13 $11,142 Home health services $1,823 33 $5,495 ICF-MR services, 2008 $83,545 40 $123,053 MR/DD waiver services, 2008 $23,564 45 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $171 24 $178 Medicare payment per day for nursing facility care, 2010 $506 2 $398 Medicare reimbursement per home health visit, 2010 $188 7 $154 Private pay rate per day in nursing facility, 2011 $213 20 $193 Private pay rate per month in assisted living, 2011 $3,500 17 $3,261 Private pay daily rate for adult day care, 2011 $77 9 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 69 LTSS Resources California Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 7,471 1.75 14 1.46 Assisted living and residential care units, 2010 211,402 50 6 31 Personal and home care aides, 2010 44,400 10 34 17 Median hourly wage, 2010 $10.23 17 $9.44 Home health aides, 2010 59,750 14 43 24 Median hourly wage, 2010 $10.13 27 $9.89 People receiving ACL congregate meals, 2009 * 163,104 39 32 42 People receiving ACL home delivered meals, 2009 * 54,209 13 46 22 Total ACL congregate and home delivered meal $150 $36 25 expenditures (total in millions of $), 2009 * $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 2 32 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 1,257 0.29 39 0.40 Nursing facility beds, 2010 122,233 29 43 42 Nursing facility residents, 2010 103,434 24 41 35 Nursing facility occupancy rate, 2010 85% 26 83% Direct care nursing hours per resident day, 2010 4.0 14 3.8 RN hours per day, 2010 0.64 34 0.64 Nursing facility staffing turnover, 2010 27% 45 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 39% 48 46% Nursing facility residents with low care needs, 2008 13% 35 17% Residents with Medicaid as primary payer, 2010 66% 13 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 19% 36 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 8% 1 4% High risk residents with pressure sores, 2008 13% 6 12% Long-stay residents with a hospital admission, 2008 20% 18 21% Long-term care facility beds per FTE ombudsman, 2010 3,758 11 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 80% 29 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 70 Trends California Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 303,025 1,270,155 with physical disabilities (excluding home health) 2008 438,942 1,577,471 % change +45% 15 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 107,787 1,460,185 2010 103,434 1,408,886 % change -4% 27 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $30,246 $285,710 2009 $40,818 $368,330 % change +35% 17 +29% Medicaid LTSS spending for older people and adults 2004 $5,972 $62,811 with physical disabilities (millions) 2009 $9,856 $80,181 % change +65% 2 +28% Medicaid nursing facility spending (millions) 2004 $3,084 $45,842 2009 $4,430 $51,403 % change +44% 1 +12% Medicaid HCBS spending for older people and adults 2004 $2,888 $16,969 with physical disabilities (millions) 2009 $5,426 $28,778 % change +88% 15 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 48% 4 27% people and adults with physical disabilities 2009 55% 6 36% change +7% 21 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $3,000 100% +89% +$2,486 90% $2,500 80% 70% Millions of Dollars $2,000 60% +56% +$1,346 +52% $1,500 50% +44% 40% $1,000 +$663 30% $500 20% +$51 10% $0 -$5 0% -1% -$500 -%10 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 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. 71 AARP Public Policy Institute Colorado Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 5,252 22 315,311 2032 6,890 20 376,660 +31% 6 +19% 2050 8,042 19 434,447 +53% 5 +38% Age 50-64 2012 1,021 19.4% 27 19.2% 2032 1,165 16.9% 8 16.4% +14% 4 +2% 2050 1,303 16.2% 38 16.6% +28% 11 +19% Age 65+ 2012 604 11.5% 47 13.6% 2032 1,268 18.4% 43 19.8% +110% 2 +74% 2050 1,649 20.5% 20 20.4% +173% 5 +107% Age 65-74 2012 348 6.6% 46 7.4% green line = 50-64 (WAS BLUE) 2032 661 9.6% 36 10.1% +90% 2 +64% red line = 65-74 (WAS PURPLE) 2050 752 9.4% 13 9.1% +116% 4 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 177 3.4% 46 blue line = 85+ (WAS RED) 4.2% 2032 439 6.4% 41 6.8% +148% 3 +94% 2050 526 6.5% 22 6.6% +197% 5 +116% Age 85+ 2012 79 1.5% 46 2.0% 2032 168 2.4% 46 2.9% +112% 4 +69% 2050 371 4.6% 34 4.8% +369% 4 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Colorado as a Percentage of State Rank U.S. 2012 Population, by Age Group 15.5% 22 20.1% 600% Population (% of 2012 Population) Asian/Pacific Islander 500% State Rank U.S. 85+ 1.8% 17 3.6% 400% Black 300% State Rank U.S. 75-84 2.6% 31 8.5% 200% 65-74 Hispanic State Rank U.S. 100% 50-64 2030 2040 2050 2060 9.9% 6 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Colorado Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 50 14 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 4.8% 23 5.5% People age 60+ responsible for raising grandchildren, 2010 1.6% 24 1.6% Percent of age 65+ households with someone under 18, 2010 5.4% 29 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $37,684 13 $34,381 At/below poverty level age 65+, 2010 8.1% 26 9.0% At/below 250% of poverty level age 65+, 2010 37% 40 42% Women age 75+ at/below poverty level, 2010 11.1% 30 12.2% Women age 75+ at/below 250% of poverty level, 2010 51% 38 54% Bachelor level education or higher age 65+, 2010 30% 2 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 38 7.1% 36 8.8% Cognitive difficulty 42 7.9% 40 9.5% Any disability 185 35% 31 37% People age 18-64 with disabilities, 2010 Self-care difficulty 43 1.4% 39 1.8% Cognitive difficulty 114 3.6% 39 4.2% Any disability 273 8.5% 40 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 576,000 115 47 137 Economic value of family caregiving, 2009 . (state in millions of $) $6,600 $1,310 41 $1,460 Economic value per hour, 2009 $11.93 13 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.8 12 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 122,775 55 12 45 73 Public LTSS Expenditures Colorado Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $3,571 30 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 44% 9 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 58% 8 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Colorado and the U.S., 2009 Colorado United States 25% Percentages may not add 25% to 100% due to rounding 56% 64% Aged/Disabled Waivers 19% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $973 $196 39 $261 Nursing facilities $549 $110 42 $168 HCBS $424 $85 15 $94 Aged/disabled waiver services $182 $37 20 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $176 $35 4 $16 Other HCBS *** $67 $13 4 $4 Medicaid LTSS expenditures for all populations, 2009 $1,374 $276 41 $413 Institutional services $576 $116 46 $232 HCBS $798 $160 27 $181 Waiver services (all populations) $556 $112 28 $114 Other HCBS (including PCS and home health) $242 $49 16 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $22 $4.42 19 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 74 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Colorado State Nursing facilities (NF), 2008 16,320 3.3 44 5.3 HCBS (older people and adults with PD), 2008 28,454 5.8 30 8.2 Aged/disabled waiver services 17,490 3.6 13 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 10,964 2.2 19 3.0 Institutional services (NF and ICF-MR), 2008 16,476 3.4 44 5.6 HCBS (all populations), 2008 40,455 8.3 29 10.1 Waiver services (all populations) 29,491 6.0 13 4.1 Other HCBS (including PCS and home health) 10,964 2.2 34 6.0 Adults with disabilities self-directing services, 2011 19,550 4.00 6 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 107 7 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 64% 14 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 71% 11 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $30,886 20 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $7,895 33 $10,957 Aged/disabled waiver services $7,895 35 $10,710 Personal care services ** NA NA $11,142 Home health services $8,086 5 $5,495 ICF-MR services, 2008 $144,069 15 $123,053 MR/DD waiver services, 2008 $39,340 28 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $191 17 $178 Medicare payment per day for nursing facility care, 2010 $437 10 $398 Medicare reimbursement per home health visit, 2010 $158 29 $154 Private pay rate per day in nursing facility, 2011 $202 23 $193 Private pay rate per month in assisted living, 2011 $3,288 25 $3,261 Private pay daily rate for adult day care, 2011 $60 27 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 75 LTSS Resources Colorado Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 540 0.98 26 1.46 Assisted living and residential care units, 2010 16,664 30 19 31 Personal and home care aides, 2010 10,130 18 20 17 Median hourly wage, 2010 $9.63 26 $9.44 Home health aides, 2010 13,360 24 16 24 Median hourly wage, 2010 $10.38 19 $9.89 People receiving ACL congregate meals, 2009 * 20,442 38 34 42 People receiving ACL home delivered meals, 2009 * 8,030 15 40 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $14 $27 38 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 16 1 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 216 0.39 29 0.40 Nursing facility beds, 2010 20,506 37 33 42 Nursing facility residents, 2010 16,421 30 35 35 Nursing facility occupancy rate, 2010 80% 37 83% Direct care nursing hours per resident day, 2010 3.8 30 3.8 RN hours per day, 2010 0.80 17 0.64 Nursing facility staffing turnover, 2010 48% 13 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 45% 31 46% Nursing facility residents with low care needs, 2008 20% 17 17% Residents with Medicaid as primary payer, 2010 59% 39 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 29% 8 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 9% 39 12% Long-stay residents with a hospital admission, 2008 12% 42 21% Long-term care facility beds per FTE ombudsman, 2010 1,120 44 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 76 Trends Colorado Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 15,634 1,270,155 with physical disabilities (excluding home health) 2008 17,490 1,577,471 % change +12% 35 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 16,669 1,460,185 2010 16,421 1,408,886 % change -1% 13 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $2,685 $285,710 2009 $3,571 $368,330 % change +33% 22 +29% Medicaid LTSS spending for older people and adults 2004 $637 $62,811 with physical disabilities (millions) 2009 $973 $80,181 % change +53% 4 +28% Medicaid nursing facility spending (millions) 2004 $426 $45,842 2009 $549 $51,403 % change +29% 6 +12% Medicaid HCBS spending for older people and adults 2004 $211 $16,969 with physical disabilities (millions) 2009 $424 $28,778 % change +101% 12 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 33% 11 27% people and adults with physical disabilities 2009 44% 9 36% change +11% 10 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $140 120% +110% +$122 +$127 $120 100% +90% $100 +$92 80% +$86 Millions of Dollars $80 60% $60 40% +38% +29% $40 20% $20 0% $0 -20% -$20 -40% -$21 -48% -$40 -60% 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 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. 77 AARP Public Policy Institute Connecticut Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 3,536 29 315,311 2032 3,912 30 376,660 +11% 44 +19% 2050 4,290 31 434,447 +21% 49 +38% Age 50-64 2012 746 21.1% 7 19.2% 2032 647 16.5% 17 16.4% -13% 45 +2% 2050 828 19.3% 4 16.6% +11% 41 +19% Age 65+ 2012 522 14.8% 12 13.6% 2032 884 22.6% 6 19.8% +69% 25 +74% 2050 937 21.8% 5 20.4% +79% 40 +107% Age 65-74 2012 277 7.8% 18 7.4% green line = 50-64 (WAS BLUE) 2032 463 11.8% 2 10.1% +67% 16 +64% red line = 65-74 (WAS PURPLE) 2050 385 9.0% 33 9.1% +39% 46 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 159 4.5% 16 blue line = 85+ (WAS RED) 4.2% 2032 292 7.5% 9 6.8% +84% 32 +94% 2050 305 7.1% 4 6.6% +92% 28 +116% Age 85+ 2012 86 2.4% 8 2.0% 2032 128 3.3% 6 2.9% +49% 40 +69% 2050 248 5.8% 2 4.8% +188% 36 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Connecticut as a Percentage of State Rank U.S. 2012 Population, by Age Group 12.6% 25 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 1.6% 21 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 6.2% 22 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 4.3% 11 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Conne Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 47 23 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 5.2% 18 5.5% People age 60+ responsible for raising grandchildren, 2010 1.2% 36 1.6% Percent of age 65+ households with someone under 18, 2010 6.4% 19 7.0% ctic ut Income & Poverty State Rank U.S. Median household income age 65+, 2010 $39,235 10 $34,381 At/below poverty level age 65+, 2010 6.6% 48 9.0% At/below 250% of poverty level age 65+, 2010 34% 46 42% Women age 75+ at/below poverty level, 2010 8.3% 50 12.2% Women age 75+ at/below 250% of poverty level, 2010 47% 44 54% Bachelor level education or higher age 65+, 2010 26% 6 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 36 7.5% 34 8.8% Cognitive difficulty 39 8.1% 37 9.5% Any disability 159 33% 42 37% People age 18-64 with disabilities, 2010 Self-care difficulty 27 1.2% 47 1.8% Cognitive difficulty 77 3.5% 40 4.2% Any disability 179 8.1% 44 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 486,000 138 24 137 Economic value of family caregiving, 2009 . (state in millions of $) $5,800 $1,650 8 $1,460 Economic value per hour, 2009 $12.50 7 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 1.8 49 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 93,955 52 16 45 79 Public LTSS Expenditures Connecticut Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $5,974 22 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 24% 32 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 44% 21 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Connecticut and the U.S., 2009 Connecticut United States 25% Percentages may not add 15% to 100% due to rounding 76% 64% Aged/Disabled Waivers 9% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,638 $460 3 $261 Nursing facilities $1,240 $348 2 $168 HCBS $398 $112 12 $94 Aged/disabled waiver services $151 $42 15 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $247 $69 2 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $3,437 $965 2 $413 Institutional services $1,921 $539 2 $232 HCBS $1,516 $426 4 $181 Waiver services (all populations) $1,270 $356 1 $114 Other HCBS (including PCS and home health) $247 $69 11 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $68 $19.09 2 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 80 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Conne State Nursing facilities (NF), 2008 39,696 11.2 1 5.3 HCBS (older people and adults with PD), 2008 27,543 7.8 21 8.2 Aged/disabled waiver services 12,386 3.5 14 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 15,157 4.3 8 3.0 Institutional services (NF and ICF-MR), 2008 40,929 11.5 1 5.6 HCBS (all populations), 2008 31,145 8.8 26 10.1 Waiver services (all populations) 15,988 4.5 27 4.1 ctic ut Other HCBS (including PCS and home health) 15,157 4.3 24 6.0 Adults with disabilities self-directing services, 2011 2,429 0.69 31 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 31 36 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 41% 39 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 43% 47 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $33,346 13 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $10,626 17 $10,957 Aged/disabled waiver services $10,626 23 $10,710 Personal care services ** NA NA $11,142 Home health services $9,799 4 $5,495 ICF-MR services, 2008 $190,441 6 $123,053 MR/DD waiver services, 2008 $19,488 48 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $221 4 $178 Medicare payment per day for nursing facility care, 2010 $432 12 $398 Medicare reimbursement per home health visit, 2010 $132 47 $154 Private pay rate per day in nursing facility, 2011 $357 2 $193 Private pay rate per month in assisted living, 2011 $4,488 6 $3,261 Private pay daily rate for adult day care, 2011 $75 11 $60 Private pay hourly rate for home health aide, 2011 $22 8 $19 81 LTSS Resources Connecticut Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 158 0.31 49 1.46 Assisted living and residential care units, 2010 NA NA NA 31 Personal and home care aides, 2010 9,450 19 16 17 Median hourly wage, 2010 $10.37 13 $9.44 Home health aides, 2010 11,410 22 19 24 Median hourly wage, 2010 $13.33 2 $9.89 People receiving ACL congregate meals, 2009 * 15,881 32 39 42 People receiving ACL home delivered meals, 2009 * 6,542 13 46 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $16 $32 30 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 1 36 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 242 0.48 21 0.40 Nursing facility beds, 2010 29,207 58 12 42 Nursing facility residents, 2010 26,186 52 6 35 Nursing facility occupancy rate, 2010 90% 9 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.77 19 0.64 Nursing facility staffing turnover, 2010 22% 48 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 50% 14 46% Nursing facility residents with low care needs, 2008 21% 11 17% Residents with Medicaid as primary payer, 2010 67% 9 63% Residents with Medicare as primary payer, 2010 14% 26 14% Residents with “other” as primary payer, 2010 18% 42 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 10% 33 12% Long-stay residents with a hospital admission, 2008 19% 23 21% Long-term care facility beds per FTE ombudsman, 2010 3,614 13 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 82 Trends Conne Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 10,886 1,270,155 with physical disabilities (excluding home health) 2008 12,386 1,577,471 % change +14% 35 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 27,568 1,460,185 2010 26,186 1,408,886 ctic ut % change -5% 30 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $4,004 $285,710 2009 $5,974 $368,330 % change +49% 5 +29% Medicaid LTSS spending for older people and adults 2004 $1,299 $62,811 with physical disabilities (millions) 2009 $1,638 $80,181 % change +26% 26 +28% Medicaid nursing facility spending (millions) 2004 $1,016 $45,842 2009 $1,240 $51,403 % change +22% 12 +12% Medicaid HCBS spending for older people and adults 2004 $284 $16,969 with physical disabilities (millions) 2009 $398 $28,778 % change +40% 38 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 22% 21 27% people and adults with physical disabilities 2009 24% 32 36% change +2% 42 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $700 160% +$622 $600 140% +135% 120% Millions of Dollars $500 +106% 100% $400 80% $300 +$270 +$224 60% +50% $200 +35% 40% +22% $100 +$50 +$64 20% $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 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. 83 AARP Public Policy Institute Delaware Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 912 45 315,311 2032 1,105 45 376,660 +21% 23 +19% 2050 1,259 45 434,447 +38% 23 +38% Age 50-64 2012 178 19.5% 25 19.2% 2032 176 16.0% 32 16.4% -1% 24 +2% 2050 206 16.4% 36 16.6% +16% 29 +19% Age 65+ 2012 139 15.2% 7 13.6% 2032 233 21.1% 11 19.8% +68% 27 +74% 2050 270 21.4% 10 20.4% +94% 25 +107% Age 65-74 2012 77 8.4% 5 7.4% green line = 50-64 (WAS BLUE) 2032 117 10.6% 14 10.1% +52% 33 +64% red line = 65-74 (WAS PURPLE) 2050 118 9.4% 13 9.1% +54% 31 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 43 4.7% 7 blue line = 85+ (WAS RED) 4.2% 2032 80 7.3% 12 6.8% +87% 27 +94% 2050 87 6.9% 7 6.6% +101% 25 +116% Age 85+ 2012 19 2.1% 23 2.0% 2032 36 3.3% 6 2.9% +91% 13 +69% 2050 65 5.2% 11 4.8% +243% 19 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Delaware as a Percentage of State Rank U.S. 2012 Population, by Age Group 17.1% 21 20.1% 400% Population (% of 2012 Population) Asian/Pacific Islander 350% 85+ State Rank U.S. 300% 1.8% 17 3.6% 250% Black 200% State Rank U.S. 75-84 12.4% 10 8.5% 150% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 1.9% 25 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Delaware Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 48 19 48 People age 75+ living alone, 2010 32% 39 34% People age 60+ with grandchildren in household, 2010 4.4% 27 5.5% People age 60+ responsible for raising grandchildren, 2010 1.7% 22 1.6% Percent of age 65+ households with someone under 18, 2010 5.8% 25 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $40,301 7 $34,381 At/below poverty level age 65+, 2010 7.7% 31 9.0% At/below 250% of poverty level age 65+, 2010 35% 44 42% Women age 75+ at/below poverty level, 2010 10.6% 34 12.2% Women age 75+ at/below 250% of poverty level, 2010 47% 44 54% Bachelor level education or higher age 65+, 2010 22% 20 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 7 5.8% 49 8.8% Cognitive difficulty 10 8.0% 38 9.5% Any disability 39 31% 51 37% People age 18-64 with disabilities, 2010 Self-care difficulty 9 1.7% 24 1.8% Cognitive difficulty 25 4.6% 20 4.2% Any disability 60 10.9% 20 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 138,000 156 9 137 Economic value of family caregiving, 2009 . (state in millions of $) $1,560 $1,760 3 $1,460 Economic value per hour, 2009 $11.77 16 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.7 19 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 17,227 40 29 45 85 Public LTSS Expenditures Delaware Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,213 45 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.21% 37 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 13% 49 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 35% 39 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Delaware and the U.S., 2009 Delaware United States 25% Percentages may not add to 100% due to rounding 4% 88% 64% 8% Aged/Disabled Waivers 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $212 $238 24 $261 Nursing facilities $186 $208 13 $168 HCBS $27 $30 48 $94 Aged/disabled waiver services $18 $20 32 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $8 $9 24 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $341 $382 24 $413 Institutional services $221 $248 18 $232 HCBS $120 $135 34 $181 Waiver services (all populations) $112 $125 24 $114 Other HCBS (including PCS and home health) $8 $9 41 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $2 $1.77 32 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 86 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Delaware State Nursing facilities (NF), 2008 3,713 4.2 35 5.3 HCBS (older people and adults with PD), 2008 2,576 2.9 42 8.2 Aged/disabled waiver services 1,307 1.5 36 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 1,269 1.4 28 3.0 Institutional services (NF and ICF-MR), 2008 3,851 4.4 35 5.6 HCBS (all populations), 2008 4,129 4.7 41 10.1 Waiver services (all populations) 2,860 3.2 34 4.1 Other HCBS (including PCS and home health) 1,269 1.4 42 6.0 Adults with disabilities self-directing services, 2011 35 0.04 48 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 35 33 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 41% 39 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 52% 34 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $48,369 3 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $12,893 10 $10,957 Aged/disabled waiver services $12,893 13 $10,710 Personal care services ** NA NA $11,142 Home health services $3,995 16 $5,495 ICF-MR services, 2008 $215,541 3 $123,053 MR/DD waiver services, 2008 $96,836 1 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $209 8 $178 Medicare payment per day for nursing facility care, 2010 $421 20 $398 Medicare reimbursement per home health visit, 2010 $172 16 $154 Private pay rate per day in nursing facility, 2011 $230 14 $193 Private pay rate per month in assisted living, 2011 $4,626 4 $3,261 Private pay daily rate for adult day care, 2011 $75 11 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 87 LTSS Resources Delaware Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 133 1.03 23 1.46 Assisted living and residential care units, 2010 2,365 18 39 31 Personal and home care aides, 2010 470 4 48 17 Median hourly wage, 2010 $9.82 21 $9.44 Home health aides, 2010 2,000 15 37 24 Median hourly wage, 2010 $11.34 6 $9.89 People receiving ACL congregate meals, 2009 * 19,128 151 3 42 People receiving ACL home delivered meals, 2009 * 3,324 26 23 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $4 $34 28 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 3 30 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 48 0.37 31 0.40 Nursing facility beds, 2010 5,062 39 31 42 Nursing facility residents, 2010 4,242 33 30 35 Nursing facility occupancy rate, 2010 84% 30 83% Direct care nursing hours per resident day, 2010 4.1 9 3.8 RN hours per day, 2010 0.89 5 0.64 Nursing facility staffing turnover, 2010 37% 28 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 48% 20 46% Nursing facility residents with low care needs, 2008 17% 26 17% Residents with Medicaid as primary payer, 2010 58% 41 63% Residents with Medicare as primary payer, 2010 17% 7 14% Residents with “other” as primary payer, 2010 25% 16 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 20% 18 21% Long-term care facility beds per FTE ombudsman, 2010 1,494 35 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 88 Trends Delaware Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 1,293 1,270,155 with physical disabilities (excluding home health) 2008 1,307 1,577,471 % change +1% 41 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 3,872 1,460,185 2010 4,242 1,408,886 % change +10% 1 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $794 $285,710 2009 $1,213 $368,330 % change +53% 3 +29% Medicaid LTSS spending for older people and adults 2004 $182 $62,811 with physical disabilities (millions) 2009 $212 $80,181 % change +17% 39 +28% Medicaid nursing facility spending (millions) 2004 $159 $45,842 2009 $186 $51,403 % change +17% 19 +12% Medicaid HCBS spending for older people and adults 2004 $23 $16,969 with physical disabilities (millions) 2009 $27 $28,778 % change +16% 46 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 13% 38 27% people and adults with physical disabilities 2009 13% 49 36% change +0% 46 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $40 +$38 80% +75% $35 70% $30 +$27 60% Millions of Dollars $25 50% $20 40% $15 30% +24% $10 20% +17% $5 +$3 10% +3% $0 $0 0% -$1 -2% -$5 -10% 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 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. 89 AARP Public Policy Institute District of Columbia Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 624 49 315,311 2032 763 50 376,660 +22% 18 +19% 2050 846 49 434,447 +36% 27 +38% Age 50-64 2012 110 17.6% 48 19.2% 2032 112 14.7% 48 16.4% +2% 17 +2% 2050 97 11.4% 51 16.6% -12% 51 +19% Age 65+ 2012 75 11.9% 45 13.6% 2032 116 15.2% 50 19.8% +56% 45 +74% 2050 125 14.8% 51 20.4% +68% 48 +107% Age 65-74 2012 42 6.8% 45 7.4% green line = 50-64 (WAS BLUE) 2032 63 8.3% 50 10.1% +49% 39 +64% red line = 65-74 (WAS PURPLE) 2050 53 6.3% 51 9.1% +26% 50 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 21 3.4% 46 blue line = 85+ (WAS RED) 4.2% 2032 38 5.0% 50 6.8% +78% 41 +94% 2050 47 5.5% 49 6.6% +119% 16 +116% Age 85+ 2012 11 1.7% 44 2.0% 2032 15 1.9% 49 2.9% +37% 47 +69% 2050 25 2.9% 51 4.8% +132% 49 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in District of Columbia as a Percentage of State Rank U.S. 2012 Population, by Age Group 69.4% 2 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% State Rank U.S. 85+ 2.0% 14 3.6% 200% 75-84 Black 150% State Rank U.S. 65-74 61.9% 1 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 4.0% 13 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Distr Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 43 45 48 People age 75+ living alone, 2010 45% 1 34% People age 60+ with grandchildren in household, 2010 5.3% 17 5.5% People age 60+ responsible for raising grandchildren, 2010 1.9% 13 1.6% ict of Columbia Percent of age 65+ households with someone under 18, 2010 7.6% 15 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $41,128 5 $34,381 At/below poverty level age 65+, 2010 13.1% 1 9.0% At/below 250% of poverty level age 65+, 2010 35% 44 42% Women age 75+ at/below poverty level, 2010 15.3% 7 12.2% Women age 75+ at/below 250% of poverty level, 2010 38% 50 54% Bachelor level education or higher age 65+, 2010 35% 1 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 6 8.7% 17 8.8% Cognitive difficulty 7 9.8% 18 9.5% Any disability 23 34% 35 37% People age 18-64 with disabilities, 2010 Self-care difficulty 4 1.0% 51 1.8% Cognitive difficulty 19 4.6% 20 4.2% Any disability 37 8.7% 38 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 68,000 113 49 137 Economic value of family caregiving, 2009 . (state in millions of $) $760 $1,270 44 $1,460 Economic value per hour, 2009 $11.70 17 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 1.4 51 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 30,069 122 2 45 91 Public LTSS Expenditures District of Columbia Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,626 40 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 70.00% 8 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 46% 8 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 50% 14 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in District of Columbia and the U.S., 2009 District of Columbia United States 25% Percentages may not add 26% to 100% due to rounding 54% 64% Aged/Disabled Waivers 19% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $362 $612 2 $261 Nursing facilities $197 $333 3 $168 HCBS $165 $279 1 $94 Aged/disabled waiver services $70 $118 2 $29 Personal care services (PCS) ** $89 $150 2 $45 Home health services $7 $11 19 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $570 $962 3 $413 Institutional services $283 $478 3 $232 HCBS $287 $484 2 $181 Waiver services (all populations) $191 $323 3 $114 Other HCBS (including PCS and home health) $95 $161 3 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 92 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. 5.8 20 5.3 Distr Nursing facilities (NF), 2008 3,359 HCBS (older people and adults with PD), 2008 8,248 14.2 3 8.2 Aged/disabled waiver services 1,714 3.0 21 2.2 Personal care services (PCS) ** 2,298 4.0 12 3.0 Home health services 4,236 7.3 3 3.0 Institutional services (NF and ICF-MR), 2008 4,017 6.9 14 5.6 ict of Columbia HCBS (all populations), 2008 9,352 16.1 4 10.1 Waiver services (all populations) 2,818 4.9 22 4.1 Other HCBS (including PCS and home health) 6,534 11.3 2 6.0 Adults with disabilities self-directing services, 2011 1 0.00 51 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 51 21 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 71% 11 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 70% 12 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $47,938 4 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $8,456 32 $10,957 Aged/disabled waiver services $14,564 10 $10,710 Personal care services ** $3,900 28 $11,142 Home health services $4,163 15 $5,495 ICF-MR services, 2008 $112,654 23 $123,053 MR/DD waiver services, 2008 $30,409 38 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $261 1 $178 Medicare payment per day for nursing facility care, 2010 $428 16 $398 Medicare reimbursement per home health visit, 2010 $185 10 $154 Private pay rate per day in nursing facility, 2011 $282 7 $193 Private pay rate per month in assisted living, 2011 $4,350 7 $3,261 Private pay daily rate for adult day care, 2011 $104 2 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 93 LTSS Resources District of Columbia Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 22 0.32 48 1.46 Assisted living and residential care units, 2010 509 7 50 31 Personal and home care aides, 2010 1,020 15 25 17 Median hourly wage, 2010 $12.53 2 $9.44 Home health aides, 2010 3,520 51 4 24 Median hourly wage, 2010 $10.64 15 $9.89 People receiving ACL congregate meals, 2009 * 5,159 76 15 42 People receiving ACL home delivered meals, 2009 * 3,926 58 3 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $5 $74 6 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 8 21 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 19 0.28 43 0.40 Nursing facility beds, 2010 2,768 40 29 42 Nursing facility residents, 2010 2,577 37 25 35 Nursing facility occupancy rate, 2010 93% 3 83% Direct care nursing hours per resident day, 2010 4.4 3 3.8 RN hours per day, 2010 0.71 23 0.64 Nursing facility staffing turnover, 2010 24% 47 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 46% 28 46% Nursing facility residents with low care needs, 2008 NA NA 17% Residents with Medicaid as primary payer, 2010 80% 1 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 9% 51 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 17% 1 12% Long-stay residents with a hospital admission, 2008 NA NA 21% Long-term care facility beds per FTE ombudsman, 2010 491 51 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 63% 35 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 94 Trends Distr Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 2,636 1,270,155 with physical disabilities (excluding home health) 2008 4,012 1,577,471 % change +52% 14 +24% Nursing Facility Residents Year State Rank U.S. ict of Columbia Nursing facility residents 2005 2,801 1,460,185 2010 2,577 1,408,886 % change -8% 42 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $1,226 $285,710 2009 $1,626 $368,330 % change +33% 22 +29% Medicaid LTSS spending for older people and adults 2004 $218 $62,811 with physical disabilities (millions) 2009 $362 $80,181 % change +66% 1 +28% Medicaid nursing facility spending (millions) 2004 $188 $45,842 2009 $197 $51,403 % change +5% 36 +12% Medicaid HCBS spending for older people and adults 2004 $30 $16,969 with physical disabilities (millions) 2009 $165 $28,778 % change +451% 1 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 14% 36 27% people and adults with physical disabilities 2009 46% 8 36% change +32% 1 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $140 2500% $120 +$116 +2051% 2000% +1777% $100 Millions of Dollars 1500% $80 +$69 +$66 $60 1000% $40 500% +264% $20 +$9 +5% 0% $0 -9% -$7 -$20 -500% 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 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. 95 AARP Public Policy Institute Florida Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 19,170 4 315,311 2032 24,746 3 376,660 +29% 10 +19% 2050 29,208 3 434,447 +52% 7 +38% Age 50-64 2012 3,657 19.1% 34 19.2% 2032 3,873 15.7% 38 16.4% +6% 11 +2% 2050 4,788 16.4% 36 16.6% +31% 7 +19% Age 65+ 2012 3,445 18.0% 1 13.6% 2032 5,674 22.9% 5 19.8% +65% 31 +74% 2050 6,805 23.3% 1 20.4% +98% 23 +107% Age 65-74 2012 1,761 9.2% 1 7.4% green line = 50-64 (WAS BLUE) 2032 2,721 11.0% 10 10.1% +54% 30 +64% red line = 65-74 (WAS PURPLE) 2050 2,859 9.8% 2 9.1% +62% 25 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 1,103 5.8% 1 blue line = 85+ (WAS RED) 4.2% 2032 2,011 8.1% 4 6.8% +82% 36 +94% 2050 2,254 7.7% 1 6.6% +104% 23 +116% Age 85+ 2012 581 3.0% 1 2.0% 2032 942 3.8% 2 2.9% +62% 30 +69% 2050 1,692 5.8% 2 4.8% +191% 34 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Florida as a Percentage of State Rank U.S. 2012 Population, by Age Group 22.9% 14 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 1.3% 22 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 7.7% 19 8.5% 65-74 50-64 100% Hispanic 2030 2040 State 2050 Rank 2060 U.S. 50% 13.5% 4 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Florida Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 57 5 48 People age 75+ living alone, 2010 30% 43 34% People age 60+ with grandchildren in household, 2010 5.2% 18 5.5% People age 60+ responsible for raising grandchildren, 2010 1.4% 26 1.6% Percent of age 65+ households with someone under 18, 2010 6.2% 22 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $35,024 17 $34,381 At/below poverty level age 65+, 2010 9.9% 13 9.0% At/below 250% of poverty level age 65+, 2010 43% 21 42% Women age 75+ at/below poverty level, 2010 12.6% 21 12.2% Women age 75+ at/below 250% of poverty level, 2010 53% 34 54% Bachelor level education or higher age 65+, 2010 23% 17 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 258 8.0% 24 8.8% Cognitive difficulty 292 9.1% 24 9.5% Any disability 1,096 34% 35 37% People age 18-64 with disabilities, 2010 Self-care difficulty 207 1.8% 21 1.8% Cognitive difficulty 469 4.1% 28 4.2% Any disability 1,115 9.8% 30 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 2,780,000 150 10 137 Economic value of family caregiving, 2009 . (state in millions of $) $29,000 $1,560 18 $1,460 Economic value per hour, 2009 $10.88 31 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 6.8 4 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 330,017 34 39 45 97 Public LTSS Expenditures Florida Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $15,547 5 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 54.98% 32 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 21% 37 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 34% 40 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Florida and the U.S., 2009 Florida United States 25% Percentages may not add 9% to 100% due to rounding 79% 64% Aged/Disabled Waivers 12% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $3,074 $165 44 $261 Nursing facilities $2,423 $130 36 $168 HCBS $650 $35 44 $94 Aged/disabled waiver services $381 $20 32 $29 Personal care services (PCS) ** $57 $3 28 $45 Home health services $169 $9 24 $16 Other HCBS *** $43 $2 11 $4 Medicaid LTSS expenditures for all populations, 2009 $4,379 $235 48 $413 Institutional services $2,879 $154 39 $232 HCBS $1,500 $80 47 $181 Waiver services (all populations) $1,231 $66 43 $114 Other HCBS (including PCS and home health) $269 $14 35 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $57 $3.05 23 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 98 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Florida State Nursing facilities (NF), 2008 77,853 4.2 35 5.3 HCBS (older people and adults with PD), 2008 46,742 2.5 44 8.2 Aged/disabled waiver services 29,316 1.6 32 2.2 Personal care services (PCS) ** 403 0.0 30 3.0 Home health services 17,023 0.9 39 3.0 Institutional services (NF and ICF-MR), 2008 80,860 4.4 35 5.6 HCBS (all populations), 2008 82,578 4.5 43 10.1 Waiver services (all populations) 65,152 3.5 33 4.1 Other HCBS (including PCS and home health) 17,426 0.9 49 6.0 Adults with disabilities self-directing services, 2011 1,984 0.11 46 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 38 28 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 38% 43 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 51% 38 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $30,019 24 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $10,380 18 $10,957 Aged/disabled waiver services $10,305 24 $10,710 Personal care services ** $15,830 7 $11,142 Home health services $4,189 14 $5,495 ICF-MR services, 2008 $109,714 26 $123,053 MR/DD waiver services, 2008 $30,323 39 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $206 11 $178 Medicare payment per day for nursing facility care, 2010 $404 28 $398 Medicare reimbursement per home health visit, 2010 $133 46 $154 Private pay rate per day in nursing facility, 2011 $210 21 $193 Private pay rate per month in assisted living, 2011 $2,663 47 $3,261 Private pay daily rate for adult day care, 2011 $60 27 $60 Private pay hourly rate for home health aide, 2011 $18 37 $19 99 LTSS Resources Florida Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 3,330 1.02 25 1.46 Assisted living and residential care units, 2010 83,761 26 30 31 Personal and home care aides, 2010 14,030 4 48 17 Median hourly wage, 2010 $8.96 35 $9.44 Home health aides, 2010 31,340 10 47 24 Median hourly wage, 2010 $10.00 30 $9.89 People receiving ACL congregate meals, 2009 * 35,287 11 51 42 People receiving ACL home delivered meals, 2009 * 30,455 10 50 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $53 $16 50 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 0 41 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 685 0.21 49 0.40 Nursing facility beds, 2010 82,558 25 46 42 Nursing facility residents, 2010 72,304 22 42 35 Nursing facility occupancy rate, 2010 88% 16 83% Direct care nursing hours per resident day, 2010 4.6 2 3.8 RN hours per day, 2010 0.60 40 0.64 Nursing facility staffing turnover, 2010 28% 44 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 47% 24 46% Nursing facility residents with low care needs, 2008 13% 35 17% Residents with Medicaid as primary payer, 2010 58% 41 63% Residents with Medicare as primary payer, 2010 21% 1 14% Residents with “other” as primary payer, 2010 21% 30 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 5% 9 4% High risk residents with pressure sores, 2008 13% 6 12% Long-stay residents with a hospital admission, 2008 24% 9 21% Long-term care facility beds per FTE ombudsman, 2010 3,248 16 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 100 Trends Florida Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 36,222 1,270,155 with physical disabilities (excluding home health) 2008 29,719 1,577,471 % change -18% 48 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 72,909 1,460,185 2010 72,304 1,408,886 % change -1% 13 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $12,726 $285,710 2009 $15,547 $368,330 % change +22% 39 +29% Medicaid LTSS spending for older people and adults 2004 $2,586 $62,811 with physical disabilities (millions) 2009 $3,074 $80,181 % change +19% 35 +28% Medicaid nursing facility spending (millions) 2004 $2,250 $45,842 2009 $2,423 $51,403 % change +8% 33 +12% Medicaid HCBS spending for older people and adults 2004 $335 $16,969 with physical disabilities (millions) 2009 $650 $28,778 % change +94% 13 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 13% 38 27% people and adults with physical disabilities 2009 21% 37 36% change +8% 16 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $300 200% 180% +176% $250 +$243 160% +$211 Millions of Dollars 140% $200 +$173 120% $150 100% 80% $100 +$72 60% 40% +33% +36% $50 +$19 20% +6% +8% $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 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. 101 AARP Public Policy Institute Georgia Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 10,492 8 315,311 2032 13,833 7 376,660 +32% 5 +19% 2050 16,717 7 434,447 +59% 3 +38% Age 50-64 2012 1,856 17.7% 47 19.2% 2032 2,288 16.5% 17 16.4% +23% 3 +2% 2050 2,756 16.5% 34 16.6% +49% 2 +19% Age 65+ 2012 1,147 10.9% 48 13.6% 2032 2,352 17.0% 48 19.8% +105% 4 +74% 2050 3,163 18.9% 47 20.4% +176% 4 +107% Age 65-74 2012 671 6.4% 48 7.4% green line = 50-64 (WAS BLUE) 2032 1,260 9.1% 44 10.1% +88% 4 +64% red line = 65-74 (WAS PURPLE) 2050 1,461 8.7% 41 9.1% +118% 3 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 335 3.2% 49 blue line = 85+ (WAS RED) 4.2% 2032 778 5.6% 49 6.8% +132% 5 +94% 2050 1,029 6.2% 33 6.6% +207% 3 +116% Age 85+ 2012 142 1.4% 49 2.0% 2032 313 2.3% 47 2.9% +121% 3 +69% 2050 674 4.0% 49 4.8% +375% 3 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Georgia as a Percentage of State Rank U.S. 2012 Population, by Age Group 25.0% 11 20.1% 600% Population (% of 2012 Population) Asian/Pacific Islander 500% State Rank U.S. 85+ 1.9% 15 3.6% 400% Black 300% State Rank U.S. 75-84 20.5% 5 8.5% 200% 65-74 Hispanic 50-64 State Rank U.S. 100% 2030 2040 2050 2060 1.9% 25 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Georgia Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 41 51 48 People age 75+ living alone, 2010 32% 39 34% People age 60+ with grandchildren in household, 2010 6.7% 7 5.5% People age 60+ responsible for raising grandchildren, 2010 2.3% 4 1.6% Percent of age 65+ households with someone under 18, 2010 8.8% 7 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $32,183 34 $34,381 At/below poverty level age 65+, 2010 10.7% 9 9.0% At/below 250% of poverty level age 65+, 2010 45% 12 42% Women age 75+ at/below poverty level, 2010 15.1% 9 12.2% Women age 75+ at/below 250% of poverty level, 2010 56% 26 54% Bachelor level education or higher age 65+, 2010 20% 28 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 98 9.7% 9 8.8% Cognitive difficulty 111 11.1% 7 9.5% Any disability 397 40% 11 37% People age 18-64 with disabilities, 2010 Self-care difficulty 112 1.9% 19 1.8% Cognitive difficulty 242 4.0% 30 4.2% Any disability 615 10.2% 26 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,360,000 139 23 137 Economic value of family caregiving, 2009 . (state in millions of $) $13,100 $1,330 40 $1,460 Economic value per hour, 2009 $10.03 43 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 6.6 5 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 145,914 35 37 45 103 Public LTSS Expenditures Georgia Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $7,461 14 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 65.10% 17 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * † 26% 27 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * † 37% 36 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Georgia and the U.S., 2009 Georgia United States 25% Percentages may not add 6% to 100% due to rounding 74% 64% Aged/Disabled Waivers 11% 20% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures † (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,552 $161 46 $261 Nursing facilities $1,153 $120 39 $168 HCBS $399 $42 39 $94 Aged/disabled waiver services $310 $32 27 $29 Personal care services (PCS) ** $1 $0 35 $45 Home health services $88 $9 24 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $1,998 $208 49 $413 Institutional services $1,264 $131 45 $232 HCBS $734 $76 48 $181 Waiver services (all populations) $645 $67 42 $114 Other HCBS (including PCS and home health) $89 $9 41 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $18 $1.86 31 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. † Because of inconsistencies in 2009 spending data for some services, an average of 2008 and 2009 data is used for Georgia’s Medicaid LTSS expenditures. 104 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Georgia State Nursing facilities (NF), 2008 38,806 4.1 38 5.3 HCBS (older people and adults with PD), 2008 21,115 2.2 47 8.2 Aged/disabled waiver services 15,082 1.6 32 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 6,033 0.6 43 3.0 Institutional services (NF and ICF-MR), 2008 40,469 4.3 38 5.6 HCBS (all populations), 2008 32,680 3.4 49 10.1 Waiver services (all populations) 26,647 2.8 41 4.1 Other HCBS (including PCS and home health) 6,033 0.6 50 6.0 Adults with disabilities self-directing services, 2011 2,849 0.30 41 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 39 26 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 35% 45 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 45% 46 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $27,253 36 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $8,935 28 $10,957 Aged/disabled waiver services $8,935 31 $10,710 Personal care services ** NA NA $11,142 Home health services $835 47 $5,495 ICF-MR services, 2008 $71,121 44 $123,053 MR/DD waiver services, 2008 $13,599 49 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $143 37 $178 Medicare payment per day for nursing facility care, 2010 $354 41 $398 Medicare reimbursement per home health visit, 2010 $166 23 $154 Private pay rate per day in nursing facility, 2011 $160 42 $193 Private pay rate per month in assisted living, 2011 $2,400 51 $3,261 Private pay daily rate for adult day care, 2011 $59 33 $60 Private pay hourly rate for home health aide, 2011 $18 37 $19 105 LTSS Resources Georgia Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 2,224 2.14 12 1.46 Assisted living and residential care units, 2010 30,567 29 22 31 Personal and home care aides, 2010 8,810 8 38 17 Median hourly wage, 2010 $8.63 43 $9.44 Home health aides, 2010 11,990 12 45 24 Median hourly wage, 2010 $8.94 42 $9.89 People receiving ACL congregate meals, 2009 * 14,562 14 48 42 People receiving ACL home delivered meals, 2009 * 14,402 14 44 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $30 $30 32 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 NA NA Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 360 0.35 33 0.40 Nursing facility beds, 2010 39,880 38 32 42 Nursing facility residents, 2010 34,520 33 30 35 Nursing facility occupancy rate, 2010 87% 22 83% Direct care nursing hours per resident day, 2010 3.6 44 3.8 RN hours per day, 2010 0.44 47 0.64 Nursing facility staffing turnover, 2010 42% 22 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 49% 17 46% Nursing facility residents with low care needs, 2008 19% 20 17% Residents with Medicaid as primary payer, 2010 72% 5 63% Residents with Medicare as primary payer, 2010 13% 31 14% Residents with “other” as primary payer, 2010 15% 46 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 5% 9 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 21% 16 21% Long-term care facility beds per FTE ombudsman, 2010 1,755 30 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 98% 22 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 106 Trends Georgia Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 15,418 1,270,155 with physical disabilities (excluding home health) 2008 15,082 1,577,471 % change -2% 44 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 37,804 1,460,185 2010 34,520 1,408,886 % change -9% 44 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $8,859 $285,710 2009 $7,461 $368,330 % change -16% 51 +29% Medicaid LTSS spending for older people and adults 2004 $1,545 $62,811 with physical disabilities (millions) 2009 $1,552 $80,181 % change +0% 46 +28% Medicaid nursing facility spending (millions) 2004 $1,354 $45,842 2009 $1,153 $51,403 % change -15% 50 +12% Medicaid HCBS spending for older people and adults 2004 $191 $16,969 with physical disabilities (millions) 2009 $399 $28,778 % change +109% 10 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 12% 41 27% people and adults with physical disabilities 2009 26% 27 36% change +13% 7 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $200 120% +111% +$163 +104% $150 100% $100 80% Millions of Dollars +$50 +$46 $50 60% $0 40% +18% -$50 20% -$59 -$100 0% -$150 -20% -15% -$200 -40% -$201 +40% -$250 -60% 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 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. 107 AARP Public Policy Institute Hawaii Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 1,309 42 315,311 2032 1,596 40 376,660 +22% 18 +19% 2050 1,782 41 434,447 +36% 27 +38% Age 50-64 2012 250 19.1% 34 19.2% 2032 256 16.1% 31 16.4% +2% 17 +2% 2050 282 15.8% 40 16.6% +13% 37 +19% Age 65+ 2012 206 15.8% 6 13.6% 2032 331 20.7% 19 19.8% +60% 40 +74% 2050 394 22.1% 3 20.4% +91% 27 +107% Age 65-74 2012 103 7.9% 15 7.4% green line = 50-64 (WAS BLUE) 2032 151 9.5% 37 10.1% +47% 41 +64% red line = 65-74 (WAS PURPLE) 2050 174 9.8% 2 9.1% +69% 19 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 65 4.9% 5 blue line = 85+ (WAS RED) 4.2% 2032 118 7.4% 11 6.8% +82% 36 +94% 2050 117 6.6% 18 6.6% +82% 38 +116% Age 85+ 2012 39 3.0% 1 2.0% 2032 62 3.9% 1 2.9% +59% 32 +69% 2050 103 5.8% 2 4.8% +163% 46 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Hawaii as a Percentage of State Rank U.S. 2012 Population, by Age Group 75.8% 1 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% State Rank U.S. 85+ 63.6% 1 3.6% 200% 75-84 Black 150% 65-74 State Rank U.S. 0.6% 43 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 3.4% 15 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Hawa ii Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 60 1 48 People age 75+ living alone, 2010 22% 51 34% People age 60+ with grandchildren in household, 2010 11.4% 1 5.5% People age 60+ responsible for raising grandchildren, 2010 1.8% 17 1.6% Percent of age 65+ households with someone under 18, 2010 16.4% 1 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $51,293 1 $34,381 At/below poverty level age 65+, 2010 6.8% 43 9.0% At/below 250% of poverty level age 65+, 2010 28% 51 42% Women age 75+ at/below poverty level, 2010 11.6% 27 12.2% Women age 75+ at/below 250% of poverty level, 2010 36% 51 54% Bachelor level education or higher age 65+, 2010 24% 13 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 14 7.3% 35 8.8% Cognitive difficulty 19 9.9% 17 9.5% Any disability 63 33% 42 37% People age 18-64 with disabilities, 2010 Self-care difficulty 11 1.4% 39 1.8% Cognitive difficulty 26 3.2% 47 4.2% Any disability 66 8.1% 44 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 169,000 130 35 137 Economic value of family caregiving, 2009 . (state in millions of $) $1,990 $1,540 22 $1,460 Economic value per hour, 2009 $12.33 11 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 7.9 3 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 76,518 116 3 45 109 Public LTSS Expenditures Hawaii Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,339 42 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 54.24% 34 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * † 19% 40 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * † 42% 24 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Hawaii and the U.S., 2009 Hawaii United States 25% Percentages may not add 19% to 100% due to rounding 81% 64% Aged/Disabled Waivers 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures † (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $273 $203 37 $261 Nursing facilities $222 $165 26 $168 HCBS $52 $38 41 $94 Aged/disabled waiver services $51 $38 19 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $1 $0 48 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $399 $296 39 $413 Institutional services $231 $171 37 $232 HCBS $168 $125 37 $181 Waiver services (all populations) $167 $124 25 $114 Other HCBS (including PCS and home health) $1 $0 51 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $6 $4.12 22 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. † Because of inconsistencies in 2009 spending data for some services, 2008 data are used for Hawaii’s Medicaid LTSS expenditures. 110 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Hawa ii State Nursing facilities (NF), 2008 4,863 3.7 40 5.3 HCBS (older people and adults with PD), 2008 4,347 3.3 41 8.2 Aged/disabled waiver services 2,719 2.0 28 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 1,628 1.2 34 3.0 Institutional services (NF and ICF-MR), 2008 4,950 3.7 42 5.6 HCBS (all populations), 2008 7,183 5.4 40 10.1 Waiver services (all populations) 5,555 4.2 30 4.1 Other HCBS (including PCS and home health) 1,628 1.2 47 6.0 Adults with disabilities self-directing services, 2011 2,271 1.70 12 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 56 17 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 47% 35 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 59% 27 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $43,501 5 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $15,853 4 $10,957 Aged/disabled waiver services $15,853 6 $10,710 Personal care services ** NA NA $11,142 Home health services $1,946 32 $5,495 ICF-MR services, 2008 $102,725 30 $123,053 MR/DD waiver services, 2008 $32,833 34 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $233 2 $178 Medicare payment per day for nursing facility care, 2010 $440 9 $398 Medicare reimbursement per home health visit, 2010 $240 1 $154 Private pay rate per day in nursing facility, 2011 $297 5 $193 Private pay rate per month in assisted living, 2011 $3,825 11 $3,261 Private pay daily rate for adult day care, 2011 $64 23 $60 Private pay hourly rate for home health aide, 2011 $25 3 $19 111 LTSS Resources Hawaii Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 659 3.33 7 1.46 Assisted living and residential care units, 2010 4,891 25 31 31 Personal and home care aides, 2010 4,730 24 11 17 Median hourly wage, 2010 $8.77 39 $9.44 Home health aides, 2010 1,330 7 49 24 Median hourly wage, 2010 $10.84 13 $9.89 People receiving ACL congregate meals, 2009 * 4,139 22 44 42 People receiving ACL home delivered meals, 2009 * 3,287 17 36 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $6 $30 32 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 14 8 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 49 0.25 47 0.40 Nursing facility beds, 2010 4,171 21 48 42 Nursing facility residents, 2010 3,854 19 47 35 Nursing facility occupancy rate, 2010 92% 4 83% Direct care nursing hours per resident day, 2010 4.0 14 3.8 RN hours per day, 2010 0.94 3 0.64 Nursing facility staffing turnover, 2010 15% 50 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 55% 1 46% Nursing facility residents with low care needs, 2008 9% 45 17% Residents with Medicaid as primary payer, 2010 67% 9 63% Residents with Medicare as primary payer, 2010 11% 44 14% Residents with “other” as primary payer, 2010 22% 22 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 7% 47 12% Long-stay residents with a hospital admission, 2008 NA NA 21% Long-term care facility beds per FTE ombudsman, 2010 5,686 2 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 98% 22 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 112 Trends Hawa ii Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 1,742 1,270,155 with physical disabilities (excluding home health) 2008 2,719 1,577,471 % change +56% 13 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 3,691 1,460,185 2010 3,854 1,408,886 % change +4% 3 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $935 $285,710 2009 $1,339 $368,330 % change +43% 9 +29% Medicaid LTSS spending for older people and adults 2004 $231 $62,811 with physical disabilities (millions) 2009 $273 $80,181 % change +19% 35 +28% Medicaid nursing facility spending (millions) 2004 $191 $45,842 2009 $222 $51,403 % change +16% 21 +12% Medicaid HCBS spending for older people and adults 2004 $40 $16,969 with physical disabilities (millions) 2009 $52 $28,778 % change +31% 41 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 17% 33 27% people and adults with physical disabilities 2009 19% 40 36% change +2% 42 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $60 80% +72% $50 +$48 60% Millions of Dollars $40 40% +32% +$31 +21% $30 20% +16% $20 %0 +$12 $10 -20% -20% +$2 $0 $0 -40% 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 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. 113 AARP Public Policy Institute Idaho Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 1,625 39 315,311 2032 2,047 39 376,660 +26% 13 +19% 2050 2,393 38 434,447 +47% 10 +38% Age 50-64 2012 292 17.9% 45 19.2% 2032 314 15.3% 39 16.4% +8% 9 +2% 2050 394 16.5% 34 16.6% +35% 5 +19% Age 65+ 2012 207 12.7% 44 13.6% 2032 370 18.1% 45 19.8% +79% 15 +74% 2050 466 19.5% 38 20.4% +125% 12 +107% Age 65-74 2012 116 7.1% 39 7.4% green line = 50-64 (WAS BLUE) 2032 182 8.9% 47 10.1% +57% 26 +64% red line = 65-74 (WAS PURPLE) 2050 217 9.1% 26 9.1% +87% 11 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 62 3.8% 41 blue line = 85+ (WAS RED) 4.2% 2032 133 6.5% 39 6.8% +115% 9 +94% 2050 144 6.0% 40 6.6% +133% 12 +116% Age 85+ 2012 29 1.8% 38 2.0% 2032 55 2.7% 38 2.9% +90% 15 +69% 2050 105 4.4% 41 4.8% +264% 15 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Idaho as a Percentage of State Rank U.S. 2012 Population, by Age Group 5.9% 40 20.1% 450% Population (% of 2012 Population) Asian/Pacific Islander 400% 85+ State Rank U.S. 350% 0.9% 29 3.6% 300% Black 250% State Rank U.S. 200% 75-84 65-74 0.1% 48 8.5% 150% Hispanic 100% 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 3.2% 16 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Idaho Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 56 6 48 People age 75+ living alone, 2010 32% 39 34% People age 60+ with grandchildren in household, 2010 4.2% 31 5.5% People age 60+ responsible for raising grandchildren, 2010 1.8% 17 1.6% Percent of age 65+ households with someone under 18, 2010 5.3% 30 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $33,725 25 $34,381 At/below poverty level age 65+, 2010 7.9% 28 9.0% At/below 250% of poverty level age 65+, 2010 42% 23 42% Women age 75+ at/below poverty level, 2010 12.0% 25 12.2% Women age 75+ at/below 250% of poverty level, 2010 54% 31 54% Bachelor level education or higher age 65+, 2010 20% 28 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 15 7.6% 33 8.8% Cognitive difficulty 18 9.5% 21 9.5% Any disability 74 38% 14 37% People age 18-64 with disabilities, 2010 Self-care difficulty 17 1.8% 21 1.8% Cognitive difficulty 45 4.8% 17 4.2% Any disability 103 11.1% 19 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 210,000 136 30 137 Economic value of family caregiving, 2009 . (state in millions of $) $2,000 $1,300 42 $1,460 Economic value per hour, 2009 $10.03 43 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.9 16 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 23,514 35 37 45 115 Public LTSS Expenditures Idaho Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,295 44 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 69.40% 9 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 43% 12 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 46% 17 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Idaho and the U.S., 2009 Idaho United States 25% Percentages may not add 12% to 100% due to rounding 56% 64% Aged/Disabled Waivers 11% 32% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $278 $179 41 $261 Nursing facilities $157 $101 43 $168 HCBS $120 $77 21 $94 Aged/disabled waiver services $89 $57 9 $29 Personal care services (PCS) ** $23 $15 23 $45 Home health services $9 $6 29 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $422 $272 43 $413 Institutional services $227 $146 42 $232 HCBS $195 $125 37 $181 Waiver services (all populations) $163 $105 31 $114 Other HCBS (including PCS and home health) $32 $20 31 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 116 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Idaho State Nursing facilities (NF), 2008 5,337 3.5 42 5.3 HCBS (older people and adults with PD), 2008 16,459 10.7 9 8.2 Aged/disabled waiver services 8,185 5.3 5 2.2 Personal care services (PCS) ** 3,799 2.5 19 3.0 Home health services 4,475 2.9 12 3.0 Institutional services (NF and ICF-MR), 2008 5,908 3.9 41 5.6 HCBS (all populations), 2008 18,844 12.3 12 10.1 Waiver services (all populations) 10,570 6.9 9 4.1 Other HCBS (including PCS and home health) 8,274 5.4 17 6.0 Adults with disabilities self-directing services, 2011 1,178 0.77 29 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 153 3 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 76% 4 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 76% 6 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $32,519 14 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $8,784 29 $10,957 Aged/disabled waiver services $9,106 30 $10,710 Personal care services ** $8,089 17 $11,142 Home health services $1,673 35 $5,495 ICF-MR services, 2008 $114,706 22 $123,053 MR/DD waiver services, 2008 $27,518 43 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $194 15 $178 Medicare payment per day for nursing facility care, 2010 $395 30 $398 Medicare reimbursement per home health visit, 2010 $153 35 $154 Private pay rate per day in nursing facility, 2011 $200 24 $193 Private pay rate per month in assisted living, 2011 $3,113 29 $3,261 Private pay daily rate for adult day care, 2011 $96 4 $60 Private pay hourly rate for home health aide, 2011 $18 37 $19 117 LTSS Resources Idaho Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 2,515 12.87 1 1.46 Assisted living and residential care units, 2010 11,701 60 3 31 Personal and home care aides, 2010 3,840 20 15 17 Median hourly wage, 2010 $9.22 31 $9.44 Home health aides, 2010 3,770 19 27 24 Median hourly wage, 2010 $8.88 45 $9.89 People receiving ACL congregate meals, 2009 * 14,450 76 15 42 People receiving ACL home delivered meals, 2009 * 3,795 20 32 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $7 $38 22 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 13 13 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 80 0.41 27 0.40 Nursing facility beds, 2010 6,177 32 41 42 Nursing facility residents, 2010 4,377 22 42 35 Nursing facility occupancy rate, 2010 71% 46 83% Direct care nursing hours per resident day, 2010 4.2 6 3.8 RN hours per day, 2010 0.85 10 0.64 Nursing facility staffing turnover, 2010 53% 8 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 44% 37 46% Nursing facility residents with low care needs, 2008 12% 39 17% Residents with Medicaid as primary payer, 2010 62% 27 63% Residents with Medicare as primary payer, 2010 16% 12 14% Residents with “other” as primary payer, 2010 22% 22 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 8% 42 12% Long-stay residents with a hospital admission, 2008 13% 39 21% Long-term care facility beds per FTE ombudsman, 2010 1,142 43 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 118 Trends Idaho Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 9,805 1,270,155 with physical disabilities (excluding home health) 2008 11,984 1,577,471 % change +22% 29 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 4,654 1,460,185 2010 4,377 1,408,886 % change -6% 37 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $958 $285,710 2009 $1,295 $368,330 % change +35% 17 +29% Medicaid LTSS spending for older people and adults 2004 $205 $62,811 with physical disabilities (millions) 2009 $278 $80,181 % change +36% 10 +28% Medicaid nursing facility spending (millions) 2004 $127 $45,842 2009 $157 $51,403 % change +24% 8 +12% Medicaid HCBS spending for older people and adults 2004 $78 $16,969 with physical disabilities (millions) 2009 $120 $28,778 % change +54% 29 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 38% 7 27% people and adults with physical disabilities 2009 43% 12 36% change +5% 29 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $45 100% +$42 +89% 90% $40 80% $35 +67% +$31 70% Millions of Dollars +$30 $30 60% $25 50% $20 40% 30% +24% $15 20% $10 10% $5 +1% 0% $0 $0 -1% $0 -10% 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 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. 119 AARP Public Policy Institute Illinois Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 13,252 5 315,311 2032 15,487 5 376,660 +17% 32 +19% 2050 17,782 5 434,447 +34% 32 +38% Age 50-64 2012 2,525 19.1% 34 19.2% 2032 2,621 16.9% 8 16.4% +4% 14 +2% 2050 2,989 16.8% 28 16.6% +18% 25 +19% Age 65+ 2012 1,696 12.8% 40 13.6% 2032 2,890 18.7% 40 19.8% +70% 22 +74% 2050 3,458 19.4% 43 20.4% +104% 19 +107% Age 65-74 2012 915 6.9% 44 7.4% green line = 50-64 (WAS BLUE) 2032 1,530 9.9% 26 10.1% +67% 16 +64% red line = 65-74 (WAS PURPLE) 2050 1,596 9.0% 33 9.1% +74% 14 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 521 3.9% 38 blue line = 85+ (WAS RED) 4.2% 2032 968 6.2% 45 6.8% +86% 29 +94% 2050 1,103 6.2% 33 6.6% +112% 21 +116% Age 85+ 2012 260 2.0% 28 2.0% 2032 392 2.5% 43 2.9% +51% 39 +69% 2050 759 4.3% 47 4.8% +192% 32 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Illinois as a Percentage of State Rank U.S. 2012 Population, by Age Group 20.2% 17 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 3.3% 10 3.6% 250% 75-84 200% Black State Rank U.S. 65-74 150% 11.2% 12 8.5% 100% 50-64 Hispanic 2030 2040 State 2050 Rank 2060 U.S. 50% 5.2% 10 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Illinois Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 45 39 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 5.4% 16 5.5% People age 60+ responsible for raising grandchildren, 2010 1.3% 30 1.6% Percent of age 65+ households with someone under 18, 2010 6.4% 19 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $34,673 19 $34,381 At/below poverty level age 65+, 2010 8.4% 23 9.0% At/below 250% of poverty level age 65+, 2010 41% 30 42% Women age 75+ at/below poverty level, 2010 11.3% 28 12.2% Women age 75+ at/below 250% of poverty level, 2010 55% 28 54% Bachelor level education or higher age 65+, 2010 20% 28 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 128 8.3% 21 8.8% Cognitive difficulty 123 8.0% 38 9.5% Any disability 544 35% 31 37% People age 18-64 with disabilities, 2010 Self-care difficulty 121 1.5% 33 1.8% Cognitive difficulty 257 3.2% 47 4.2% Any disability 640 8.0% 46 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,660,000 129 38 137 Economic value of family caregiving, 2009 . (state in millions of $) $18,800 $1,460 31 $1,460 Economic value per hour, 2009 $11.83 15 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 6.1 9 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 286,437 49 20 45 121 Public LTSS Expenditures Illinois Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $13,572 7 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.17% 38 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 23% 34 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 30% 46 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Illinois and the U.S., 2009 Illinois United States 25% Percentages may not add 2% to 100% due to rounding 77% 64% Aged/Disabled Waivers 11% 21% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $2,103 $164 45 $261 Nursing facilities $1,616 $126 38 $168 HCBS $486 $38 41 $94 Aged/disabled waiver services $443 $35 23 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $43 $3 36 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $3,498 $273 42 $413 Institutional services $2,439 $191 32 $232 HCBS $1,059 $83 46 $181 Waiver services (all populations) $1,016 $79 40 $114 Other HCBS (including PCS and home health) $43 $3 47 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $228 $17.85 3 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 122 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Illinois State Nursing facilities (NF), 2008 71,848 5.6 23 5.3 HCBS (older people and adults with PD), 2008 186,145 14.6 1 8.2 Aged/disabled waiver services 58,001 4.6 8 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 128,144 10.1 1 3.0 Institutional services (NF and ICF-MR), 2008 81,126 6.4 19 5.6 HCBS (all populations), 2008 208,346 16.3 3 10.1 Waiver services (all populations) 80,202 6.3 11 4.1 Other HCBS (including PCS and home health) 128,144 10.1 5 6.0 Adults with disabilities self-directing services, 2011 8,327 0.65 33 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 81 10 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 72% 8 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 72% 9 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $21,865 48 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $8,503 30 $10,957 Aged/disabled waiver services $8,503 33 $10,710 Personal care services ** NA NA $11,142 Home health services $962 45 $5,495 ICF-MR services, 2008 $61,960 49 $123,053 MR/DD waiver services, 2008 $30,176 40 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $120 42 $178 Medicare payment per day for nursing facility care, 2010 $391 31 $398 Medicare reimbursement per home health visit, 2010 $193 6 $154 Private pay rate per day in nursing facility, 2011 $150 44 $193 Private pay rate per month in assisted living, 2011 $3,490 20 $3,261 Private pay daily rate for adult day care, 2011 $65 21 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 123 LTSS Resources Illinois Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 549 0.34 47 1.46 Assisted living and residential care units, 2010 29,214 18 39 31 Personal and home care aides, 2010 16,060 10 34 17 Median hourly wage, 2010 $9.69 24 $9.44 Home health aides, 2010 36,120 22 19 24 Median hourly wage, 2010 $10.13 27 $9.89 People receiving ACL congregate meals, 2009 * 73,858 46 28 42 People receiving ACL home delivered meals, 2009 * 40,893 26 23 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $58 $36 25 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 2 32 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 802 0.50 19 0.40 Nursing facility beds, 2010 97,312 60 8 42 Nursing facility residents, 2010 75,844 47 10 35 Nursing facility occupancy rate, 2010 78% 41 83% Direct care nursing hours per resident day, 2010 3.4 49 3.8 RN hours per day, 2010 0.64 34 0.64 Nursing facility staffing turnover, 2010 38% 25 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 42% 45 46% Nursing facility residents with low care needs, 2008 31% 1 17% Residents with Medicaid as primary payer, 2010 63% 21 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 22% 22 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 15% 3 12% Long-stay residents with a hospital admission, 2008 25% 6 21% Long-term care facility beds per FTE ombudsman, 2010 3,177 17 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 65% 34 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 124 Trends Illinois Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 46,713 1,270,155 with physical disabilities (excluding home health) 2008 58,001 1,577,471 % change +24% 27 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 79,622 1,460,185 2010 75,844 1,408,886 % change -5% 30 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $10,417 $285,710 2009 $13,572 $368,330 % change +30% 25 +29% Medicaid LTSS spending for older people and adults 2004 $1,985 $62,811 with physical disabilities (millions) 2009 $2,103 $80,181 % change +6% 42 +28% Medicaid nursing facility spending (millions) 2004 $1,576 $45,842 2009 $1,616 $51,403 % change +3% 39 +12% Medicaid HCBS spending for older people and adults 2004 $409 $16,969 with physical disabilities (millions) 2009 $486 $28,778 % change +19% 44 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 21% 23 27% people and adults with physical disabilities 2009 23% 34 36% change +3% 39 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS -200 -150 -100 -50 0 50 100 150 Spending, 2004–2009, by Service Spending, 2004–2009, by Service $150 +$128 40% +37% +19% $100 30% +$70 +21% Millions of Dollars $50 +$41 20% +$7 $0 10% +3% -$50 0% -$100 -10% -$150 -20% -$168 -22% -$200 -30% 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 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. 125 AARP Public Policy Institute Indiana Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 6,473 17 315,311 2032 6,942 19 376,660 +7% 50 +19% 2050 7,939 20 434,447 +23% 47 +38% Age 50-64 2012 1,268 19.6% 24 19.2% 2032 1,156 16.7% 11 16.4% -9% 41 +2% 2050 1,337 16.8% 28 16.6% +5% 45 +19% Age 65+ 2012 887 13.7% 31 13.6% 2032 1,443 20.8% 14 19.8% +63% 36 +74% 2050 1,586 20.0% 31 20.4% +79% 40 +107% Age 65-74 2012 481 7.4% 34 7.4% green line = 50-64 (WAS BLUE) 2032 735 10.6% 14 10.1% +53% 31 +64% red line = 65-74 (WAS PURPLE) 2050 698 8.8% 40 9.1% +45% 42 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 273 4.2% 32 blue line = 85+ (WAS RED) 4.2% 2032 499 7.2% 17 6.8% +83% 34 +94% 2050 508 6.4% 25 6.6% +86% 35 +116% Age 85+ 2012 133 2.1% 23 2.0% 2032 209 3.0% 20 2.9% +57% 35 +69% 2050 379 4.8% 22 4.8% +185% 37 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Indiana as a Percentage of State Rank U.S. 2012 Population, by Age Group 8.5% 35 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.5% 40 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 5.8% 24 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 1.5% 30 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Indiana Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 45 39 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 3.8% 38 5.5% People age 60+ responsible for raising grandchildren, 2010 1.4% 26 1.6% Percent of age 65+ households with someone under 18, 2010 4.1% 41 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $32,172 35 $34,381 At/below poverty level age 65+, 2010 6.8% 43 9.0% At/below 250% of poverty level age 65+, 2010 43% 21 42% Women age 75+ at/below poverty level, 2010 9.5% 44 12.2% Women age 75+ at/below 250% of poverty level, 2010 58% 16 54% Bachelor level education or higher age 65+, 2010 15% 46 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 64 7.9% 26 8.8% Cognitive difficulty 70 8.7% 28 9.5% Any disability 295 37% 21 37% People age 18-64 with disabilities, 2010 Self-care difficulty 79 2.0% 14 1.8% Cognitive difficulty 182 4.6% 20 4.2% Any disability 435 10.9% 20 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 916,000 143 18 137 Economic value of family caregiving, 2009 . (state in millions of $) $9,400 $1,460 31 $1,460 Economic value per hour, 2009 $10.70 32 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.1 25 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 101,381 34 39 45 127 Public LTSS Expenditures Indiana Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $6,263 21 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 65.93% 13 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 16% 44 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 31% 44 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Indiana and the U.S., 2009 Indiana United States 25% Percentages may not add 10% to 100% due to rounding 84% 64% Aged/Disabled Waivers 7% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,428 $221 29 $261 Nursing facilities $1,195 $185 19 $168 HCBS $233 $36 43 $94 Aged/disabled waiver services $95 $15 41 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $138 $21 7 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $2,402 $372 27 $413 Institutional services $1,664 $258 17 $232 HCBS $739 $114 40 $181 Waiver services (all populations) $601 $93 34 $114 Other HCBS (including PCS and home health) $138 $21 29 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $32 $4.94 16 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 128 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Indiana State Nursing facilities (NF), 2008 44,479 6.9 10 5.3 HCBS (older people and adults with PD), 2008 15,602 2.4 45 8.2 Aged/disabled waiver services 7,311 1.1 41 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 8,291 1.3 32 3.0 Institutional services (NF and ICF-MR), 2008 48,785 7.6 11 5.6 HCBS (all populations), 2008 26,323 4.1 46 10.1 Waiver services (all populations) 18,032 2.8 41 4.1 Other HCBS (including PCS and home health) 8,291 1.3 46 6.0 Adults with disabilities self-directing services, 2011 905 0.14 45 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 16 42 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 26% 49 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 35% 49 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $23,625 46 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $8,460 31 $10,957 Aged/disabled waiver services $8,460 34 $10,710 Personal care services ** NA NA $11,142 Home health services $12,762 3 $5,495 ICF-MR services, 2008 $67,259 48 $123,053 MR/DD waiver services, 2008 $44,455 20 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $156 29 $178 Medicare payment per day for nursing facility care, 2010 $364 37 $398 Medicare reimbursement per home health visit, 2010 $154 33 $154 Private pay rate per day in nursing facility, 2011 $183 32 $193 Private pay rate per month in assisted living, 2011 $3,447 21 $3,261 Private pay daily rate for adult day care, 2011 $68 16 $60 Private pay hourly rate for home health aide, 2011 $18 37 $19 129 LTSS Resources Indiana Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 527 0.62 37 1.46 Assisted living and residential care units, 2010 32,875 39 10 31 Personal and home care aides, 2010 12,070 14 27 17 Median hourly wage, 2010 $9.40 30 $9.44 Home health aides, 2010 17,030 20 24 24 Median hourly wage, 2010 $9.90 33 $9.89 People receiving ACL congregate meals, 2009 * 21,281 26 41 42 People receiving ACL home delivered meals, 2009 * 12,119 15 40 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $22 $27 38 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 NA NA Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 522 0.62 8 0.40 Nursing facility beds, 2010 50,246 60 8 42 Nursing facility residents, 2010 39,967 47 10 35 Nursing facility occupancy rate, 2010 80% 37 83% Direct care nursing hours per resident day, 2010 3.7 36 3.8 RN hours per day, 2010 0.65 30 0.64 Nursing facility staffing turnover, 2010 46% 15 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 48% 20 46% Nursing facility residents with low care needs, 2008 20% 17 17% Residents with Medicaid as primary payer, 2010 62% 27 63% Residents with Medicare as primary payer, 2010 17% 7 14% Residents with “other” as primary payer, 2010 21% 30 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 20% 18 21% Long-term care facility beds per FTE ombudsman, 2010 4,279 7 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 10% 50 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 130 Trends Indiana Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 3,688 1,270,155 with physical disabilities (excluding home health) 2008 7,311 1,577,471 % change +98% 8 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 40,841 1,460,185 2010 39,967 1,408,886 % change -2% 16 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $5,052 $285,710 2009 $6,263 $368,330 % change +24% 37 +29% Medicaid LTSS spending for older people and adults 2004 $1,013 $62,811 with physical disabilities (millions) 2009 $1,428 $80,181 % change +41% 8 +28% Medicaid nursing facility spending (millions) 2004 $918 $45,842 2009 $1,195 $51,403 % change +30% 5 +12% Medicaid HCBS spending for older people and adults 2004 $95 $16,969 with physical disabilities (millions) 2009 $233 $28,778 % change +145% 5 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 9% 47 27% people and adults with physical disabilities 2009 16% 44 36% change +7% 21 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $300 +$278 250% +208% $250 200% Millions of Dollars $200 150% $150 +$132 +115% 100% $100 +$64 +$74 50% +36% +30% $50 $0 0% -$32 -9% -$50 -50% 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 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. 131 AARP Public Policy Institute Iowa Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 3,036 30 315,311 2032 3,418 33 376,660 +13% 41 +19% 2050 3,898 33 434,447 +28% 39 +38% Age 50-64 2012 610 20.1% 17 19.2% 2032 514 15.0% 43 16.4% -16% 49 +2% 2050 604 15.5% 44 16.6% -1% 49 +19% Age 65+ 2012 463 15.2% 7 13.6% 2032 710 20.8% 14 19.8% +53% 50 +74% 2050 740 19.0% 46 20.4% +60% 50 +107% Age 65-74 2012 234 7.7% 21 7.4% green line = 50-64 (WAS BLUE) 2032 354 10.4% 18 10.1% +51% 35 +64% red line = 65-74 (WAS PURPLE) 2050 313 8.0% 49 9.1% +34% 48 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 146 4.8% 6 blue line = 85+ (WAS RED) 4.2% 2032 250 7.3% 12 6.8% +71% 50 +94% 2050 237 6.1% 37 6.6% +62% 51 +116% Age 85+ 2012 82 2.7% 3 2.0% 2032 105 3.1% 10 2.9% +28% 50 +69% 2050 190 4.9% 18 4.8% +131% 50 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Iowa as a Percentage of State Rank U.S. 2012 Population, by Age Group 2.5% 49 20.1% 250% Population (% of 2012 Population) Asian/Pacific Islander 85+ State Rank U.S. 200% 0.4% 45 3.6% 75-84 150% Black State Rank U.S. 65-74 100% 0.9% 41 8.5% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 0.7% 43 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Iowa Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 46 31 48 People age 75+ living alone, 2010 38% 5 34% People age 60+ with grandchildren in household, 2010 2.1% 48 5.5% People age 60+ responsible for raising grandchildren, 2010 1.0% 41 1.6% Percent of age 65+ households with someone under 18, 2010 2.1% 51 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $32,487 31 $34,381 At/below poverty level age 65+, 2010 6.7% 47 9.0% At/below 250% of poverty level age 65+, 2010 42% 23 42% Women age 75+ at/below poverty level, 2010 9.9% 42 12.2% Women age 75+ at/below 250% of poverty level, 2010 58% 16 54% Bachelor level education or higher age 65+, 2010 15% 46 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 25 5.9% 47 8.8% Cognitive difficulty 28 6.6% 48 9.5% Any disability 138 32% 48 37% People age 18-64 with disabilities, 2010 Self-care difficulty 28 1.5% 33 1.8% Cognitive difficulty 71 3.8% 35 4.2% Any disability 172 9.3% 33 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 369,000 123 44 137 Economic value of family caregiving, 2009 . (state in millions of $) $4,100 $1,370 38 $1,460 Economic value per hour, 2009 $11.66 19 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.2 37 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 124,729 86 7 45 133 Public LTSS Expenditures Iowa Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $2,983 33 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 63.51% 21 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 29% 24 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 39% 33 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Iowa and the U.S., 2009 Iowa United States 25% Percentages may not add 14% to 100% due to rounding 71% 64% Aged/Disabled Waivers 11% 15% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $660 $218 31 $261 Nursing facilities $467 $154 31 $168 HCBS $194 $64 25 $94 Aged/disabled waiver services $99 $33 26 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $94 $31 5 $16 Other HCBS *** $1 $0 22 $4 Medicaid LTSS expenditures for all populations, 2009 $1,337 $441 18 $413 Institutional services $811 $267 16 $232 HCBS $526 $173 20 $181 Waiver services (all populations) $431 $142 17 $114 Other HCBS (including PCS and home health) $95 $31 24 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $7 $2.20 29 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 134 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Iowa State Nursing facilities (NF), 2008 19,597 6.5 12 5.3 HCBS (older people and adults with PD), 2008 28,333 9.4 14 8.2 Aged/disabled waiver services 15,103 5.0 6 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 13,230 4.4 7 3.0 Institutional services (NF and ICF-MR), 2008 21,881 7.3 12 5.6 HCBS (all populations), 2008 40,185 13.3 7 10.1 Waiver services (all populations) 26,955 8.9 4 4.1 Other HCBS (including PCS and home health) 13,230 4.4 22 6.0 Adults with disabilities self-directing services, 2011 3,095 1.03 24 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 77 13 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 59% 17 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 65% 18 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $24,294 42 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $5,772 41 $10,957 Aged/disabled waiver services $5,772 43 $10,710 Personal care services ** NA NA $11,142 Home health services $8,075 6 $5,495 ICF-MR services, 2008 $125,416 20 $123,053 MR/DD waiver services, 2008 $26,531 44 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $144 35 $178 Medicare payment per day for nursing facility care, 2010 $429 15 $398 Medicare reimbursement per home health visit, 2010 $138 43 $154 Private pay rate per day in nursing facility, 2011 $145 45 $193 Private pay rate per month in assisted living, 2011 $3,182 28 $3,261 Private pay daily rate for adult day care, 2011 $52 41 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 135 LTSS Resources Iowa Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 475 1.05 21 1.46 Assisted living and residential care units, 2010 21,360 47 7 31 Personal and home care aides, 2010 4,070 9 37 17 Median hourly wage, 2010 $9.80 23 $9.44 Home health aides, 2010 11,440 25 13 24 Median hourly wage, 2010 $10.18 24 $9.89 People receiving ACL congregate meals, 2009 * 43,377 96 9 42 People receiving ACL home delivered meals, 2009 * 13,433 30 19 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $18 $41 20 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 16 1 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 460 1.01 1 0.40 Nursing facility beds, 2010 32,365 71 1 42 Nursing facility residents, 2010 25,783 57 2 35 Nursing facility occupancy rate, 2010 80% 37 83% Direct care nursing hours per resident day, 2010 3.5 47 3.8 RN hours per day, 2010 0.64 34 0.64 Nursing facility staffing turnover, 2010 30% 40 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 49% 17 46% Nursing facility residents with low care needs, 2008 26% 4 17% Residents with Medicaid as primary payer, 2010 47% 51 63% Residents with Medicare as primary payer, 2010 8% 50 14% Residents with “other” as primary payer, 2010 45% 1 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 8% 42 12% Long-stay residents with a hospital admission, 2008 17% 30 21% Long-term care facility beds per FTE ombudsman, 2010 5,265 5 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 0% 51 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 136 Trends Iowa Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 7,349 1,270,155 with physical disabilities (excluding home health) 2008 15,103 1,577,471 % change +106% 6 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 28,367 1,460,185 2010 25,783 1,408,886 % change -9% 44 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $2,283 $285,710 2009 $2,983 $368,330 % change +31% 24 +29% Medicaid LTSS spending for older people and adults 2004 $542 $62,811 with physical disabilities (millions) 2009 $660 $80,181 % change +22% 34 +28% Medicaid nursing facility spending (millions) 2004 $426 $45,842 2009 $467 $51,403 % change +10% 31 +12% Medicaid HCBS spending for older people and adults 2004 $116 $16,969 with physical disabilities (millions) 2009 $194 $28,778 % change +67% 22 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 21% 23 27% people and adults with physical disabilities 2009 29% 24 36% change +8% 16 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $160 120% +$140 $140 +99% 100% $120 Millions of Dollars +82% 80% $100 +$80 $80 60% $60 +42% +$49 40% +35% +$41 $40 +$28 20% $20 +10% $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 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. 137 AARP Public Policy Institute Kansas Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 2,855 34 315,311 2032 3,243 35 376,660 +14% 39 +19% 2050 3,662 35 434,447 +28% 39 +38% Age 50-64 2012 550 19.3% 31 19.2% 2032 482 14.9% 46 16.4% -12% 44 +2% 2050 572 15.6% 41 16.6% +4% 47 +19% Age 65+ 2012 391 13.7% 31 13.6% 2032 645 19.9% 26 19.8% +65% 31 +74% 2050 708 19.3% 44 20.4% +81% 37 +107% Age 65-74 2012 204 7.1% 39 7.4% green line = 50-64 (WAS BLUE) 2032 319 9.8% 29 10.1% +57% 26 +64% red line = 65-74 (WAS PURPLE) 2050 305 8.3% 47 9.1% +50% 40 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 122 4.3% 26 blue line = 85+ (WAS RED) 4.2% 2032 230 7.1% 20 6.8% +89% 26 +94% 2050 221 6.0% 40 6.6% +82% 38 +116% Age 85+ 2012 66 2.3% 10 2.0% 2032 96 3.0% 20 2.9% +46% 42 +69% 2050 182 5.0% 13 4.8% +176% 40 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Kansas as a Percentage of State Rank U.S. 2012 Population, by Age Group 8.8% 33 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% 85+ State Rank U.S. 1.0% 27 3.6% 200% 75-84 Black 150% State Rank U.S. 65-74 3.9% 28 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 2.6% 19 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Kansas Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 48 19 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 3.6% 40 5.5% People age 60+ responsible for raising grandchildren, 2010 1.3% 30 1.6% Percent of age 65+ households with someone under 18, 2010 4.2% 40 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $34,653 20 $34,381 At/below poverty level age 65+, 2010 7.7% 31 9.0% At/below 250% of poverty level age 65+, 2010 40% 35 42% Women age 75+ at/below poverty level, 2010 10.3% 37 12.2% Women age 75+ at/below 250% of poverty level, 2010 53% 34 54% Bachelor level education or higher age 65+, 2010 21% 21 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 28 7.8% 29 8.8% Cognitive difficulty 34 9.4% 23 9.5% Any disability 136 38% 14 37% People age 18-64 with disabilities, 2010 Self-care difficulty 34 2.0% 14 1.8% Cognitive difficulty 73 4.2% 25 4.2% Any disability 178 10.3% 25 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 414,000 147 12 137 Economic value of family caregiving, 2009 . (state in millions of $) $4,100 $1,460 31 $1,460 Economic value per hour, 2009 $10.41 37 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.0 28 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 96,305 75 8 45 139 Public LTSS Expenditures Kansas Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $2,456 35 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 60.38% 28 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 39% 16 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 55% 11 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Kansas and the U.S., 2009 Kansas United States 25% Percentages may not add 3% to 100% due to rounding 60% 64% Aged/Disabled Waivers 36% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $617 $218 31 $261 Nursing facilities $373 $132 35 $168 HCBS $243 $86 14 $94 Aged/disabled waiver services $223 $79 6 $29 Personal care services (PCS) ** $3 $1 32 $45 Home health services $13 $5 31 $16 Other HCBS *** $5 $2 11 $4 Medicaid LTSS expenditures for all populations, 2009 $1,056 $373 26 $413 Institutional services $477 $169 38 $232 HCBS $579 $204 16 $181 Waiver services (all populations) $558 $197 11 $114 Other HCBS (including PCS and home health) $21 $7 44 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $8 $2.65 25 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 140 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Kansas State Nursing facilities (NF), 2008 15,549 5.5 25 5.3 HCBS (older people and adults with PD), 2008 20,801 7.4 23 8.2 Aged/disabled waiver services 16,567 5.9 4 2.2 Personal care services (PCS) ** 89 0.0 30 3.0 Home health services 4,145 1.5 27 3.0 Institutional services (NF and ICF-MR), 2008 16,176 5.8 25 5.6 HCBS (all populations), 2008 33,423 11.9 15 10.1 Waiver services (all populations) 29,189 10.4 2 4.1 Other HCBS (including PCS and home health) 4,234 1.5 40 6.0 Adults with disabilities self-directing services, 2011 3,416 1.22 21 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 107 7 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 57% 21 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 67% 15 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $23,026 47 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $11,874 14 $10,957 Aged/disabled waiver services $11,938 21 $10,710 Personal care services ** $14,011 8 $11,142 Home health services $2,916 25 $5,495 ICF-MR services, 2008 $100,801 31 $123,053 MR/DD waiver services, 2008 $36,224 30 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $150 32 $178 Medicare payment per day for nursing facility care, 2010 $420 22 $398 Medicare reimbursement per home health visit, 2010 $147 38 $154 Private pay rate per day in nursing facility, 2011 $144 46 $193 Private pay rate per month in assisted living, 2011 $3,518 16 $3,261 Private pay daily rate for adult day care, 2011 $63 25 $60 Private pay hourly rate for home health aide, 2011 $18 37 $19 141 LTSS Resources Kansas Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 280 0.74 32 1.46 Assisted living and residential care units, 2010 8,363 22 36 31 Personal and home care aides, 2010 12,080 32 7 17 Median hourly wage, 2010 $8.87 37 $9.44 Home health aides, 2010 7,910 21 22 24 Median hourly wage, 2010 $9.92 32 $9.89 People receiving ACL congregate meals, 2009 * 25,785 69 18 42 People receiving ACL home delivered meals, 2009 * 11,934 32 18 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $18 $49 17 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 6 26 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 351 0.93 4 0.40 Nursing facility beds, 2010 23,425 62 6 42 Nursing facility residents, 2010 19,294 51 7 35 Nursing facility occupancy rate, 2010 82% 32 83% Direct care nursing hours per resident day, 2010 3.8 30 3.8 RN hours per day, 2010 0.65 30 0.64 Nursing facility staffing turnover, 2010 61% 5 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 46% 28 46% Nursing facility residents with low care needs, 2008 23% 7 17% Residents with Medicaid as primary payer, 2010 54% 47 63% Residents with Medicare as primary payer, 2010 10% 46 14% Residents with “other” as primary payer, 2010 36% 3 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 1% 48 4% High risk residents with pressure sores, 2008 10% 33 12% Long-stay residents with a hospital admission, 2008 22% 12 21% Long-term care facility beds per FTE ombudsman, 2010 3,434 15 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 142 Trends Kansas Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 10,442 1,270,155 with physical disabilities (excluding home health) 2008 16,656 1,577,471 % change +60% 11 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 20,685 1,460,185 2010 19,294 1,408,886 % change -7% 41 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $1,921 $285,710 2009 $2,456 $368,330 % change +28% 29 +29% Medicaid LTSS spending for older people and adults 2004 $465 $62,811 with physical disabilities (millions) 2009 $617 $80,181 % change +33% 14 +28% Medicaid nursing facility spending (millions) 2004 $327 $45,842 2009 $373 $51,403 % change +14% 24 +12% Medicaid HCBS spending for older people and adults 2004 $138 $16,969 with physical disabilities (millions) 2009 $243 $28,778 % change +76% 21 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 30% 13 27% people and adults with physical disabilities 2009 39% 16 36% change +10% 12 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $140 120% +107% $120 +$115 100% +$100 $100 80% Millions of Dollars $80 60% +50% $60 40% +$46 $40 20% +14% $20 0% -2% $0 -20% -32% -$1 -$20 -$10 -40% 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 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. 143 AARP Public Policy Institute Kentucky Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 4,363 26 315,311 2032 4,808 25 376,660 +10% 47 +19% 2050 5,427 26 434,447 +24% 46 +38% Age 50-64 2012 869 19.9% 20 19.2% 2032 800 16.6% 13 16.4% -8% 39 +2% 2050 902 16.6% 32 16.6% +4% 47 +19% Age 65+ 2012 619 14.2% 23 13.6% 2032 1,002 20.8% 14 19.8% +62% 38 +74% 2050 1,099 20.2% 28 20.4% +78% 42 +107% Age 65-74 2012 347 7.9% 15 7.4% green line = 50-64 (WAS BLUE) 2032 508 10.6% 14 10.1% +46% 44 +64% red line = 65-74 (WAS PURPLE) 2050 492 9.1% 26 9.1% +42% 44 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 189 4.3% 26 blue line = 85+ (WAS RED) 4.2% 2032 350 7.3% 12 6.8% +86% 29 +94% 2050 353 6.5% 22 6.6% +87% 34 +116% Age 85+ 2012 83 1.9% 33 2.0% 2032 144 3.0% 20 2.9% +74% 21 +69% 2050 253 4.7% 30 4.8% +204% 27 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Kentucky as a Percentage of State Rank U.S. 2012 Population, by Age Group 6.5% 38 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.5% 40 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 4.7% 26 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 0.6% 46 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Kentucky Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 44 43 48 People age 75+ living alone, 2010 37% 9 34% People age 60+ with grandchildren in household, 2010 3.9% 32 5.5% People age 60+ responsible for raising grandchildren, 2010 1.9% 13 1.6% Percent of age 65+ households with someone under 18, 2010 4.9% 33 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $27,920 49 $34,381 At/below poverty level age 65+, 2010 11.2% 6 9.0% At/below 250% of poverty level age 65+, 2010 51% 3 42% Women age 75+ at/below poverty level, 2010 15.9% 5 12.2% Women age 75+ at/below 250% of poverty level, 2010 63% 4 54% Bachelor level education or higher age 65+, 2010 14% 50 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 57 10.2% 8 8.8% Cognitive difficulty 62 11.1% 7 9.5% Any disability 233 42% 7 37% People age 18-64 with disabilities, 2010 Self-care difficulty 76 2.8% 3 1.8% Cognitive difficulty 179 6.7% 2 4.2% Any disability 423 15.9% 2 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 735,000 170 4 137 Economic value of family caregiving, 2009 . (state in millions of $) $7,100 $1,640 9 $1,460 Economic value per hour, 2009 $10.03 43 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 5.1 13 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 66,822 32 44 45 145 Public LTSS Expenditures Kentucky Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $5,371 24 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 70.96% 6 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 19% 40 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 31% 44 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Kentucky and the U.S., 2009 Kentucky United States 25% Percentages may not add 11% to 100% due to rounding 81% 64% Aged/Disabled Waivers 8% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,027 $238 24 $261 Nursing facilities $828 $192 16 $168 HCBS $199 $46 34 $94 Aged/disabled waiver services $83 $19 36 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $116 $27 6 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $1,476 $342 36 $413 Institutional services $1,017 $235 20 $232 HCBS $460 $107 42 $181 Waiver services (all populations) $344 $80 38 $114 Other HCBS (including PCS and home health) $116 $27 26 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $34 $7.78 9 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 146 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Kentucky State Nursing facilities (NF), 2008 27,701 6.5 12 5.3 HCBS (older people and adults with PD), 2008 28,363 6.6 27 8.2 Aged/disabled waiver services 10,217 2.4 24 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 18,146 4.2 11 3.0 Institutional services (NF and ICF-MR), 2008 28,378 6.6 16 5.6 HCBS (all populations), 2008 31,617 7.4 34 10.1 Waiver services (all populations) 13,471 3.1 37 4.1 Other HCBS (including PCS and home health) 18,146 4.2 25 6.0 Adults with disabilities self-directing services, 2011 4,332 1.01 25 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 37 29 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 51% 27 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 53% 32 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,157 34 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $3,393 48 $10,957 Aged/disabled waiver services $3,393 48 $10,710 Personal care services ** NA NA $11,142 Home health services $2,750 26 $5,495 ICF-MR services, 2008 $88,394 37 $123,053 MR/DD waiver services, 2008 $67,486 6 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $349 43 $398 Medicare reimbursement per home health visit, 2010 $157 30 $154 Private pay rate per day in nursing facility, 2011 $185 30 $193 Private pay rate per month in assisted living, 2011 $2,948 39 $3,261 Private pay daily rate for adult day care, 2011 $59 33 $60 Private pay hourly rate for home health aide, 2011 $18 37 $19 147 LTSS Resources Kentucky Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 459 0.79 30 1.46 Assisted living and residential care units, 2010 15,411 27 27 31 Personal and home care aides, 2010 4,090 7 42 17 Median hourly wage, 2010 $8.67 41 $9.44 Home health aides, 2010 4,270 7 49 24 Median hourly wage, 2010 $10.14 26 $9.89 People receiving ACL congregate meals, 2009 * 18,934 33 38 42 People receiving ACL home delivered meals, 2009 * 8,734 15 40 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $15 $27 38 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 6 26 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 289 0.50 19 0.40 Nursing facility beds, 2010 26,181 45 21 42 Nursing facility residents, 2010 23,574 41 18 35 Nursing facility occupancy rate, 2010 90% 9 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.63 37 0.64 Nursing facility staffing turnover, 2010 55% 6 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 50% 14 46% Nursing facility residents with low care needs, 2008 9% 45 17% Residents with Medicaid as primary payer, 2010 65% 16 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 19% 36 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 5% 9 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 24% 9 21% Long-term care facility beds per FTE ombudsman, 2010 905 48 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 148 Trends Kentucky Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 15,690 1,270,155 with physical disabilities (excluding home health) 2008 10,217 1,577,471 % change -35% 49 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 23,465 1,460,185 2010 23,574 1,408,886 % change +0% 8 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $4,309 $285,710 2009 $5,371 $368,330 % change +25% 34 +29% Medicaid LTSS spending for older people and adults 2004 $796 $62,811 with physical disabilities (millions) 2009 $1,027 $80,181 % change +29% 16 +28% Medicaid nursing facility spending (millions) 2004 $629 $45,842 2009 $828 $51,403 % change +32% 4 +12% Medicaid HCBS spending for older people and adults 2004 $167 $16,969 with physical disabilities (millions) 2009 $199 $28,778 % change +19% 44 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 21% 23 27% people and adults with physical disabilities 2009 19% 40 36% change -2% 47 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $250 90% 80% +78% +$199 $200 70% Millions of Dollars 60% $150 50% +$107 40% +37% $100 30% 20% +32% $50 +9% +$22 10% +$10 $0 0% -6% -$6 -10% -$50 -20% 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 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. 149 AARP Public Policy Institute Louisiana Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 4,413 25 315,311 2032 4,776 26 376,660 +8% 48 +19% 2050 5,320 27 434,447 +21% 49 +38% Age 50-64 2012 860 19.5% 25 19.2% 2032 777 16.3% 24 16.4% -10% 42 +2% 2050 963 18.1% 10 16.6% +12% 39 +19% Age 65+ 2012 600 13.6% 34 13.6% 2032 964 20.2% 24 19.8% +61% 39 +74% 2050 1,080 20.3% 25 20.4% +80% 38 +107% Age 65-74 2012 331 7.5% 28 7.4% green line = 50-64 (WAS BLUE) 2032 484 10.1% 22 10.1% +46% 44 +64% red line = 65-74 (WAS PURPLE) 2050 509 9.6% 8 9.1% +54% 31 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 186 4.2% 32 blue line = 85+ (WAS RED) 4.2% 2032 336 7.0% 21 6.8% +81% 39 +94% 2050 319 6.0% 40 6.6% +72% 45 +116% Age 85+ 2012 83 1.9% 33 2.0% 2032 143 3.0% 20 2.9% +74% 21 +69% 2050 252 4.7% 30 4.8% +205% 26 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Louisiana as a Percentage of State Rank U.S. 2012 Population, by Age Group 26.4% 8 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.9% 29 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 22.3% 3 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 2.3% 22 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Louisiana Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 47 23 48 People age 75+ living alone, 2010 34% 28 34% People age 60+ with grandchildren in household, 2010 6.2% 11 5.5% People age 60+ responsible for raising grandchildren, 2010 3.0% 1 1.6% Percent of age 65+ households with someone under 18, 2010 8.4% 9 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $29,788 47 $34,381 At/below poverty level age 65+, 2010 11.5% 5 9.0% At/below 250% of poverty level age 65+, 2010 50% 4 42% Women age 75+ at/below poverty level, 2010 15.2% 8 12.2% Women age 75+ at/below 250% of poverty level, 2010 61% 6 54% Bachelor level education or higher age 65+, 2010 17% 38 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 58 10.8% 3 8.8% Cognitive difficulty 65 12.1% 3 9.5% Any disability 232 43% 3 37% People age 18-64 with disabilities, 2010 Self-care difficulty 67 2.4% 7 1.8% Cognitive difficulty 161 5.8% 5 4.2% Any disability 378 13.6% 7 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 627,000 140 22 137 Economic value of family caregiving, 2009 . $1,460 (state in millions of $) $5,700 $1,270 44 $11.16 Economic value per hour, 2009 $9.53 50 3.8 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 2.9 43 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 57,721 28 49 45 151 Public LTSS Expenditures Louisiana Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $6,581 20 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 67.61% 11 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 32% 22 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 36% 38 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Louisiana and the U.S., 2009 Louisiana United States 25% Percentages may not add 26% to 100% due to rounding 68% 64% Aged/Disabled Waivers 6% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,103 $246 20 $261 Nursing facilities $746 $166 25 $168 HCBS $358 $80 20 $94 Aged/disabled waiver services $71 $16 39 $29 Personal care services (PCS) ** $246 $55 10 $45 Home health services $36 $8 27 $16 Other HCBS *** $4 $1 15 $4 Medicaid LTSS expenditures for all populations, 2009 $2,110 $470 15 $413 Institutional services $1,343 $299 13 $232 HCBS $767 $171 21 $181 Waiver services (all populations) $481 $107 30 $114 Other HCBS (including PCS and home health) $286 $64 13 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 152 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Louisiana State Nursing facilities (NF), 2008 28,846 6.5 12 5.3 HCBS (older people and adults with PD), 2008 27,838 6.3 29 8.2 Aged/disabled waiver services 4,615 1.0 42 2.2 Personal care services (PCS) ** 11,532 2.6 17 3.0 Home health services 11,691 2.6 16 3.0 Institutional services (NF and ICF-MR), 2008 34,294 7.7 10 5.6 HCBS (all populations), 2008 36,172 8.2 32 10.1 Waiver services (all populations) 12,949 2.9 38 4.1 Other HCBS (including PCS and home health) 23,223 5.2 20 6.0 Adults with disabilities self-directing services, 2011 2,235 0.50 35 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 16 42 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 49% 32 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 51% 38 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $24,887 40 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $3,518 46 $10,957 Aged/disabled waiver services $12,308 18 $10,710 Personal care services ** $16,833 5 $11,142 Home health services $3,124 22 $5,495 ICF-MR services, 2008 $87,358 39 $123,053 MR/DD waiver services, 2008 $45,281 19 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $322 51 $398 Medicare reimbursement per home health visit, 2010 $143 40 $154 Private pay rate per day in nursing facility, 2011 $137 48 $193 Private pay rate per month in assisted living, 2011 $3,065 34 $3,261 Private pay daily rate for adult day care, 2011 $59 33 $60 Private pay hourly rate for home health aide, 2011 $16 47 $19 153 LTSS Resources Louisiana Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 138 0.25 50 1.46 Assisted living and residential care units, 2010 5,860 10 49 31 Personal and home care aides, 2010 16,600 30 8 17 Median hourly wage, 2010 $8.41 46 $9.44 Home health aides, 2010 12,240 22 19 24 Median hourly wage, 2010 $8.81 46 $9.89 People receiving ACL congregate meals, 2009 * 18,823 34 36 42 People receiving ACL home delivered meals, 2009 * 20,851 38 12 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $27 $49 17 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 11 16 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 288 0.51 18 0.40 Nursing facility beds, 2010 35,645 64 4 42 Nursing facility residents, 2010 25,778 46 12 35 Nursing facility occupancy rate, 2010 72% 43 83% Direct care nursing hours per resident day, 2010 3.4 49 3.8 RN hours per day, 2010 0.38 50 0.64 Nursing facility staffing turnover, 2010 43% 19 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 42% 45 46% Nursing facility residents with low care needs, 2008 31% 1 17% Residents with Medicaid as primary payer, 2010 73% 3 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 15% 46 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 8% 1 4% High risk residents with pressure sores, 2008 17% 1 12% Long-stay residents with a hospital admission, 2008 32% 2 21% Long-term care facility beds per FTE ombudsman, 2010 2,309 28 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 154 Trends Louisiana Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 2,397 1,270,155 with physical disabilities (excluding home health) 2008 16,147 1,577,471 % change +574% 1 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 29,840 1,460,185 2010 25,778 1,408,886 % change -14% 51 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $5,107 $285,710 2009 $6,581 $368,330 % change +29% 27 +29% Medicaid LTSS spending for older people and adults 2004 $671 $62,811 with physical disabilities (millions) 2009 $1,103 $80,181 % change +64% 3 +28% Medicaid nursing facility spending (millions) 2004 $601 $45,842 2009 $746 $51,403 % change +24% 8 +12% Medicaid HCBS spending for older people and adults 2004 $70 $16,969 with physical disabilities (millions) 2009 $358 $28,778 % change +412% 2 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 10% 44 27% people and adults with physical disabilities 2009 32% 22 36% change +22% 3 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $300 1000% +$257 900% +878% $250 800% Millions of Dollars 700% $200 +$188 600% $150 +$145 500% 400% $100 300% +$49 200% $50 +$31 100% +85% +75% +12% +24% $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 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. 155 AARP Public Policy Institute Maine Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 1,332 41 315,311 2032 1,582 41 376,660 +19% 27 +19% 2050 1,827 40 434,447 +37% 25 +38% Age 50-64 2012 307 23.1% 2 19.2% 2032 263 16.6% 13 16.4% -14% 48 +2% 2050 359 19.6% 3 16.6% +17% 28 +19% Age 65+ 2012 223 16.8% 2 13.6% 2032 371 23.4% 3 19.8% +66% 30 +74% 2050 397 21.7% 8 20.4% +78% 42 +107% Age 65-74 2012 121 9.1% 2 7.4% green line = 50-64 (WAS BLUE) 2032 183 11.6% 5 10.1% +51% 35 +64% red line = 65-74 (WAS PURPLE) 2050 172 9.4% 13 9.1% +42% 44 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 69 5.2% 2 blue line = 85+ (WAS RED) 4.2% 2032 132 8.3% 2 6.8% +90% 25 +94% 2050 124 6.8% 11 6.6% +79% 41 +116% Age 85+ 2012 33 2.4% 8 2.0% 2032 56 3.5% 3 2.9% +71% 26 +69% 2050 101 5.5% 6 4.8% +211% 24 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Maine as a Percentage of State Rank U.S. 2012 Population, by Age Group 1.6% 51 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.2% 49 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 0.2% 47 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 0.5% 51 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Maine Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 47 23 48 People age 75+ living alone, 2010 33% 35 34% People age 60+ with grandchildren in household, 2010 2.4% 45 5.5% People age 60+ responsible for raising grandchildren, 2010 0.7% 46 1.6% Percent of age 65+ households with someone under 18, 2010 3.7% 43 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $30,644 44 $34,381 At/below poverty level age 65+, 2010 9.5% 19 9.0% At/below 250% of poverty level age 65+, 2010 47% 8 42% Women age 75+ at/below poverty level, 2010 11.2% 29 12.2% Women age 75+ at/below 250% of poverty level, 2010 60% 8 54% Bachelor level education or higher age 65+, 2010 21% 21 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 14 6.7% 43 8.8% Cognitive difficulty 20 9.8% 18 9.5% Any disability 78 38% 14 37% People age 18-64 with disabilities, 2010 Self-care difficulty 16 1.9% 19 1.8% Cognitive difficulty 48 5.8% 5 4.2% Any disability 104 12.4% 9 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 191,000 145 14 137 Economic value of family caregiving, 2009 . . . . (state in millions of $) $2,300 $1,730 5 $1,460 Economic value per hour, 2009 $12.50 7 $11.16 Ratio of the economic value of family caregiving. . . to Medicaid long-term care spending, 2009 3.2 37 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 219,330 308 1 45 157 Public LTSS Expenditures MAine Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $2,589 34 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 64.99% 18 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 25% 29. 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 52% 12 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Maine and the U.S., 2009 Maine United States 25% Percentages may not add to 100% due to rounding 17% 75% 64% Aged/Disabled Waivers 8% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $335 $252 19 $261 Nursing facilities $252 $190 17 $168 HCBS $82 $62 26 $94 Aged/disabled waiver services $27 $20 32 $29 Personal care services (PCS) ** $51 $39 13 $45 Home health services $4 $3 36 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $874 $658 4 $413 Institutional services $422 $317 10 $232 HCBS $453 $340 7 $181 Waiver services (all populations) $397 $299 4 $114 Other HCBS (including PCS and home health) $56 $42 21 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $16 $12.19 5 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 158 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Maine State Nursing facilities (NF), 2008 10,285 7.7 7 5.3 HCBS (older people and adults with PD), 2008 13,464 10.1 11 8.2 Aged/disabled waiver services 1,635 1.2 40 2.2 Personal care services (PCS) ** 8,963 6.7 3 3.0 Home health services 2,866 2.2 19 3.0 Institutional services (NF and ICF-MR), 2008 10,504 7.9 8 5.6 HCBS (all populations), 2008 17,368 13.1 8 10.1 Waiver services (all populations) 5,539 4.2 30 4.1 Other HCBS (including PCS and home health) 11,829 8.9 9 6.0 Adults with disabilities self-directing services, 2011 930 0.70 30 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 16 42 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 57% 21 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 62% 24 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $23,988 44 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $7,499 36 $10,957 Aged/disabled waiver services $14,163 11 $10,710 Personal care services ** $6,284 22 $11,142 Home health services $2,688 27 $5,495 ICF-MR services, 2008 $137,218 19 $123,053 MR/DD waiver services, 2008 $77,736 3 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $178 20 $178 Medicare payment per day for nursing facility care, 2010 $424 18 $398 Medicare reimbursement per home health visit, 2010 $167 21 $154 Private pay rate per day in nursing facility, 2011 $260 9 $193 Private pay rate per month in assisted living, 2011 $4,625 5 $3,261 Private pay daily rate for adult day care, 2011 $92 5 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 159 LTSS Resources Maine Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 686 3.25 8 1.46 Assisted living and residential care units, 2010 8,958 42 9 31 Personal and home care aides, 2010 5,520 26 9 17 Median hourly wage, 2010 $9.82 21 $9.44 Home health aides, 2010 4,810 23 18 24 Median hourly wage, 2010 $10.52 18 $9.89 People receiving ACL congregate meals, 2009 * 8,668 42 29 42 People receiving ACL home delivered meals, 2009 * 4,929 24 28 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $6 $30 32 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 9 20 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 109 0.52 16 0.40 Nursing facility beds, 2010 7,130 34 38 42 Nursing facility residents, 2010 6,414 30 35 35 Nursing facility occupancy rate, 2010 90% 9 83% Direct care nursing hours per resident day, 2010 4.4 3 3.8 RN hours per day, 2010 1.00 2 0.64 Nursing facility staffing turnover, 2010 35% 37 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 55% 1 46% Nursing facility residents with low care needs, 2008 2% 49 17% Residents with Medicaid as primary payer, 2010 66% 13 63% Residents with Medicare as primary payer, 2010 16% 12 14% Residents with “other” as primary payer, 2010 18% 42 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 8% 42 12% Long-stay residents with a hospital admission, 2008 17% 30 21% Long-term care facility beds per FTE ombudsman, 2010 1,921 29 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 160 Trends Maine Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 8,435 1,270,155 with physical disabilities (excluding home health) 2008 10,598 1,577,471 % change +26% 25 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 6,746 1,460,185 2010 6,414 1,408,886 % change -5% 30 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $2,034 $285,710 2009 $2,589 $368,330 % change +27% 31 +29% Medicaid LTSS spending for older people and adults 2004 $321 $62,811 with physical disabilities (millions) 2009 $335 $80,181 % change +4% 44 +28% Medicaid nursing facility spending (millions) 2004 $244 $45,842 2009 $252 $51,403 % change +3% 39 +12% Medicaid HCBS spending for older people and adults 2004 $77 $16,969 with physical disabilities (millions) 2009 $82 $28,778 % change +8% 48 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 24% 17 27% people and adults with physical disabilities 2009 25% 29 36% change +1% 44 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $200 100% +88% $180 +$173 $160 80% Millions of Dollars $140 60% $120 $100 40% $80 $60 20% +15% $40 +7% +3% $20 +$8 +$7 0% +$4 $0 -5% -$1 -20% -$20 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 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. 161 AARP Public Policy Institute Maryland Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 5,928 19 315,311 2032 7,419 17 376,660 +25% 14 +19% 2050 8,489 17 434,447 +43% 14 +38% Age 50-64 2012 1,184 20.0% 19 19.2% 2032 1,227 16.5% 17 16.4% +4% 14 +2% 2050 1,486 17.5% 20 16.6% +26% 14 +19% Age 65+ 2012 766 12.9% 38 13.6% 2032 1,440 19.4% 31 19.8% +88% 10 +74% 2050 1,735 20.4% 21 20.4% +127% 10 +107% Age 65-74 2012 428 7.2% 37 7.4% green line = 50-64 (WAS BLUE) 2032 760 10.2% 20 10.1% +77% 9 +64% red line = 65-74 (WAS PURPLE) 2050 772 9.1% 26 9.1% +80% 12 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 231 3.9% 38 blue line = 85+ (WAS RED) 4.2% 2032 475 6.4% 41 6.8% +106% 17 +94% 2050 543 6.4% 25 6.6% +135% 11 +116% Age 85+ 2012 106 1.8% 38 2.0% 2032 205 2.8% 34 2.9% +92% 12 +69% 2050 419 4.9% 18 4.8% +294% 9 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Maryland as a Percentage of State Rank U.S. 2012 Population, by Age Group 28.8% 6 20.1% 450% Population (% of 2012 Population) Asian/Pacific Islander 400% 85+ State Rank U.S. 350% 4.2% 8 3.6% 300% Black 250% 75-84 State Rank U.S. 200% 21.4% 4 8.5% 150% 65-74 Hispanic 100% 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 2.3% 22 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Maryland Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 46 31 48 People age 75+ living alone, 2010 33% 35 34% People age 60+ with grandchildren in household, 2010 6.6% 9 5.5% People age 60+ responsible for raising grandchildren, 2010 1.6% 24 1.6% Percent of age 65+ households with someone under 18, 2010 9.1% 6 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $44,712 2 $34,381 At/below poverty level age 65+, 2010 7.7% 31 9.0% At/below 250% of poverty level age 65+, 2010 32% 49 42% Women age 75+ at/below poverty level, 2010 12.0% 25 12.2% Women age 75+ at/below 250% of poverty level, 2010 44% 48 54% Bachelor level education or higher age 65+, 2010 28% 4 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 54 7.8% 29 8.8% Cognitive difficulty 58 8.4% 33 9.5% Any disability 231 34% 35 37% People age 18-64 with disabilities, 2010 Self-care difficulty 52 1.4% 39 1.8% Cognitive difficulty 116 3.2% 47 4.2% Any disability 298 8.2% 42 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 769,000 135 31 137 Economic value of family caregiving, 2009 . (state in millions of $) $8,100 $1,420 37 $1,460 Economic value per hour, 2009 $11.03 29 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.3 22 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 164,752 60 11 45 163 Public LTSS Expenditures Maryland Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $6,702 19 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 15% 46 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 37% 36 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Maryland and the U.S., 2009 Maryland United States 25% Percentages may not add 6% to 100% due to rounding 85% 64% 9% Aged/Disabled Waivers 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,248 $218 31 $261 Nursing facilities $1,062 $185 19 $168 HCBS $187 $33 46 $94 Aged/disabled waiver services $113 $20 32 $29 Personal care services (PCS) ** $35 $6 26 $45 Home health services $39 $7 28 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $2,133 $372 27 $413 Institutional services $1,349 $235 20 $232 HCBS $784 $137 33 $181 Waiver services (all populations) $711 $124 25 $114 Other HCBS (including PCS and home health) $74 $13 37 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $13 $2.20 29 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 164 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Maryland State Nursing facilities (NF), 2008 24,714 4.3 34 5.3 HCBS (older people and adults with PD), 2008 12,123 2.1 48 8.2 Aged/disabled waiver services 3,998 0.7 45 2.2 Personal care services (PCS) ** 4,416 0.8 28 3.0 Home health services 3,709 0.7 42 3.0 Institutional services (NF and ICF-MR), 2008 25,061 4.4 35 5.6 HCBS (all populations), 2008 24,552 4.3 44 10.1 Waiver services (all populations) 16,427 2.9 38 4.1 Other HCBS (including PCS and home health) 8,125 1.4 42 6.0 Adults with disabilities self-directing services, 2011 7,175 1.26 20 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 16 42 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 33% 47 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 49% 42 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $41,167 6 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $13,510 7 $10,957 Aged/disabled waiver services $22,455 1 $10,710 Personal care services ** $5,412 25 $11,142 Home health services $627 49 $5,495 ICF-MR services, 2008 $158,901 12 $123,053 MR/DD waiver services, 2008 $46,780 18 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $223 3 $178 Medicare payment per day for nursing facility care, 2010 $408 27 $398 Medicare reimbursement per home health visit, 2010 $199 5 $154 Private pay rate per day in nursing facility, 2011 $227 15 $193 Private pay rate per month in assisted living, 2011 $3,300 24 $3,261 Private pay daily rate for adult day care, 2011 $75 11 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 165 LTSS Resources Maryland Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 1,803 2.54 9 1.46 Assisted living and residential care units, 2010 20,226 28 25 31 Personal and home care aides, 2010 5,480 8 38 17 Median hourly wage, 2010 $10.37 13 $9.44 Home health aides, 2010 10,450 15 37 24 Median hourly wage, 2010 $11.24 7 $9.89 People receiving ACL congregate meals, 2009 * 28,248 41 30 42 People receiving ACL home delivered meals, 2009 * 5,525 8 51 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $16 $24 43 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 14 8 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 231 0.33 36 0.40 Nursing facility beds, 2010 28,546 40 29 42 Nursing facility residents, 2010 24,820 35 26 35 Nursing facility occupancy rate, 2010 87% 22 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.67 27 0.64 Nursing facility staffing turnover, 2010 38% 25 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 42% 45 46% Nursing facility residents with low care needs, 2008 11% 41 17% Residents with Medicaid as primary payer, 2010 61% 33 63% Residents with Medicare as primary payer, 2010 17% 7 14% Residents with “other” as primary payer, 2010 22% 22 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 13% 6 12% Long-stay residents with a hospital admission, 2008 21% 16 21% Long-term care facility beds per FTE ombudsman, 2010 1,254 41 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 85% 26 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 166 Trends Maryland Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 7,887 1,270,155 with physical disabilities (excluding home health) 2008 8,414 1,577,471 % change +7% 39 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 25,269 1,460,185 2010 24,820 1,408,886 % change -2% 16 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $4,730 $285,710 2009 $6,702 $368,330 % change +42% 11 +29% Medicaid LTSS spending for older people and adults 2004 $1,079 $62,811 with physical disabilities (millions) 2009 $1,248 $80,181 % change +16% 40 +28% Medicaid nursing facility spending (millions) 2004 $864 $45,842 2009 $1,062 $51,403 % change +23% 10 +12% Medicaid HCBS spending for older people and adults 2004 $215 $16,969 with physical disabilities (millions) 2009 $187 $28,778 % change -13% 49 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 20% 28 27% people and adults with physical disabilities 2009 15% 46 36% change -5% 49 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $300 80% +73% +$250 +59% $250 60% +$198 $200 Millions of Dollars 40% $150 +23% 20% $100 0% $50 +$42 -20% $0 -$16 -27% -$50 -40% -$70 -49% -$100 -60% 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 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. 167 AARP Public Policy Institute Massachusetts Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 6,766 15 315,311 2032 8,100 15 376,660 +20% 25 +19% 2050 9,188 16 434,447 +36% 27 +38% Age 50-64 2012 1,385 20.5% 12 19.2% 2032 1,397 17.3% 2 16.4% +1% 20 +2% 2050 1,683 18.3% 9 16.6% +22% 18 +19% Age 65+ 2012 959 14.2% 23 13.6% 2032 1,690 20.9% 13 19.8% +76% 16 +74% 2050 1,979 21.5% 9 20.4% +106% 16 +107% Age 65-74 2012 508 7.5% 28 7.4% green line = 50-64 (WAS BLUE) 2032 900 11.1% 8 10.1% +77% 9 +64% red line = 65-74 (WAS PURPLE) 2050 876 9.5% 11 9.1% +72% 15 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 294 4.3% 26 blue line = 85+ (WAS RED) 4.2% 2032 562 6.9% 28 6.8% +91% 23 +94% 2050 644 7.0% 5 6.6% +119% 16 +116% Age 85+ 2012 157 2.3% 10 2.0% 2032 228 2.8% 34 2.9% +46% 42 +69% 2050 459 5.0% 13 4.8% +193% 31 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Massachusetts as a Percentage of State Rank U.S. 2012 Population, by Age Group 10.4% 30 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 2.8% 11 3.6% 250% 75-84 200% Black State Rank U.S. 65-74 150% 3.9% 28 8.5% 100% 50-64 Hispanic 2030 2040 State 2050 Rank 2060 U.S. 50% 3.0% 18 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Massa chuSe tts Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 45 39 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 4.8% 23 5.5% People age 60+ responsible for raising grandchildren, 2010 0.8% 44 1.6% Percent of age 65+ households with someone under 18, 2010 6.5% 18 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $35,683 16 $34,381 At/below poverty level age 65+, 2010 8.7% 22 9.0% At/below 250% of poverty level age 65+, 2010 39% 37 42% Women age 75+ at/below poverty level, 2010 12.2% 24 12.2% Women age 75+ at/below 250% of poverty level, 2010 53% 34 54% Bachelor level education or higher age 65+, 2010 26% 6 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 67 7.7% 32 8.8% Cognitive difficulty 71 8.2% 35 9.5% Any disability 285 33% 42 37% People age 18-64 with disabilities, 2010 Self-care difficulty 59 1.4% 39 1.8% Cognitive difficulty 163 3.9% 32 4.2% Any disability 354 8.4% 41 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 858,000 130 35 137 Economic value of family caregiving, 2009 . (state in millions of $) $10,900 $1,660 7 $1,460 Economic value per hour, 2009 $13.33 1 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 2.9 43 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 159,155 50 18 45 169 Public LTSS Expenditures Massachusetts Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $12,196 8 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 35% 17 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 47% 15 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Massachusetts and the U.S., 2009 Massachusetts United States 25% Percentages may not add 32% to 100% due to rounding 65% 64% Aged/Disabled Waivers 11% 3% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $2,681 $411 4 $261 Nursing facilities $1,746 $268 6 $168 HCBS $935 $143 7 $94 Aged/disabled waiver services $77 $12 43 $29 Personal care services (PCS) ** $632 $97 6 $45 Home health services $101 $16 12 $16 Other HCBS *** $124 $19 3 $4 Medicaid LTSS expenditures for all populations, 2009 $3,749 $575 7 $413 Institutional services $1,984 $304 11 $232 HCBS $1,766 $271 9 $181 Waiver services (all populations) $908 $139 19 $114 Other HCBS (including PCS and home health) $858 $132 6 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $136 $20.94 1 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 170 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Massa chuse tts State Nursing facilities (NF), 2008 53,232 8.2 6 5.3 HCBS (older people and adults with PD), 2008 44,381 6.9 25 8.2 Aged/disabled waiver services 9,828 1.5 36 2.2 Personal care services (PCS) ** 16,900 2.6 17 3.0 Home health services 17,653 2.7 13 3.0 Institutional services (NF and ICF-MR), 2008 54,271 8.4 6 5.6 HCBS (all populations), 2008 57,662 8.9 25 10.1 Waiver services (all populations) 23,109 3.6 32 4.1 Other HCBS (including PCS and home health) 34,553 5.3 18 6.0 Adults with disabilities self-directing services, 2011 19,460 3.01 8 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 18 41 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 45% 37 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 52% 34 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $35,462 10 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $13,295 8 $10,957 Aged/disabled waiver services $4,156 46 $10,710 Personal care services ** $18,610 4 $11,142 Home health services $4,853 11 $5,495 ICF-MR services, 2008 $206,175 4 $123,053 MR/DD waiver services, 2008 $48,810 14 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $197 13 $178 Medicare payment per day for nursing facility care, 2010 $443 7 $398 Medicare reimbursement per home health visit, 2010 $141 41 $154 Private pay rate per day in nursing facility, 2011 $320 3 $193 Private pay rate per month in assisted living, 2011 $4,950 2 $3,261 Private pay daily rate for adult day care, 2011 $60 27 $60 Private pay hourly rate for home health aide, 2011 $25 3 $19 171 LTSS Resources Massachusetts Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 437 0.48 40 1.46 Assisted living and residential care units, 2010 25,681 28 25 31 Personal and home care aides, 2010 16,030 18 20 17 Median hourly wage, 2010 $11.90 3 $9.44 Home health aides, 2010 17,080 19 27 24 Median hourly wage, 2010 $12.54 3 $9.89 People receiving ACL congregate meals, 2009 * 26,086 29 40 42 People receiving ACL home delivered meals, 2009 * 45,642 51 5 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $54 $60 12 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 2 32 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 436 0.48 21 0.40 Nursing facility beds, 2010 48,780 54 15 42 Nursing facility residents, 2010 43,066 48 9 35 Nursing facility occupancy rate, 2010 88% 16 83% Direct care nursing hours per resident day, 2010 4.0 14 3.8 RN hours per day, 2010 0.79 18 0.64 Nursing facility staffing turnover, 2010 26% 46 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 53% 7 46% Nursing facility residents with low care needs, 2008 15% 29 17% Residents with Medicaid as primary payer, 2010 63% 21 63% Residents with Medicare as primary payer, 2010 14% 26 14% Residents with “other” as primary payer, 2010 23% 19 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 10% 33 12% Long-stay residents with a hospital admission, 2008 16% 32 21% Long-term care facility beds per FTE ombudsman, 2010 1,440 36 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 172 Trends Massa chuse tts Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 16,569 1,270,155 with physical disabilities (excluding home health) 2008 26,728 1,577,471 % change +61% 10 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 45,974 1,460,185 2010 43,066 1,408,886 % change -6% 37 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $8,628 $285,710 2009 $12,196 $368,330 % change +41% 12 +29% Medicaid LTSS spending for older people and adults 2004 $2,075 $62,811 with physical disabilities (millions) 2009 $2,681 $80,181 % change +29% 16 +28% Medicaid nursing facility spending (millions) 2004 $1,612 $45,842 2009 $1,746 $51,403 % change +8% 33 +12% Medicaid HCBS spending for older people and adults 2004 $464 $16,969 with physical disabilities (millions) 2009 $935 $28,778 % change +102% 11 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 22% 21 27% people and adults with physical disabilities 2009 35% 17 36% change +13% 7 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $500 250% +233% +$417 $400 200% Millions of Dollars $300 +$270 150% 100% +95% $200 +$134 +49% $100 50% +$54 +8% $0 0% -$100 -50% +60% -$138 -100% -$200 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 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. 173 AARP Public Policy Institute Michigan Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 9,715 10 315,311 2032 9,789 12 376,660 +1% 51 +19% 2050 10,827 13 434,447 +11% 51 +38% Age 50-64 2012 2,066 21.3% 4 19.2% 2032 1,621 16.6% 13 16.4% -22% 51 +2% 2050 1,953 18.0% 12 16.6% -5% 50 +19% Age 65+ 2012 1,436 14.8% 12 13.6% 2032 2,289 23.4% 3 19.8% +59% 41 +74% 2050 2,265 20.9% 16 20.4% +58% 51 +107% Age 65-74 2012 785 8.1% 9 7.4% green line = 50-64 (WAS BLUE) 2032 1,156 11.8% 2 10.1% +47% 41 +64% red line = 65-74 (WAS PURPLE) 2050 934 8.6% 45 9.1% +19% 51 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 440 4.5% 16 blue line = 85+ (WAS RED) 4.2% 2032 800 8.2% 3 6.8% +82% 36 +94% 2050 742 6.9% 7 6.6% +68% 48 +116% Age 85+ 2012 211 2.2% 16 2.0% 2032 333 3.4% 5 2.9% +58% 33 +69% 2050 588 5.4% 7 4.8% +179% 38 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Michigan as a Percentage of State Rank U.S. 2012 Population, by Age Group 13.5% 24 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 85+ 250% State Rank U.S. 1.2% 24 3.6% 200% 75-84 Black 150% State Rank U.S. 65-74 9.7% 14 8.5% 100% Hispanic 50-64 50% 2030 2040 State 2050 Rank 2060 U.S. 1.5% 30 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 47 23 48 People age 75+ living alone, 2010 36% 11 34% Michigan People age 60+ with grandchildren in household, 2010 3.9% 32 5.5% People age 60+ responsible for raising grandchildren, 2010 1.2% 36 1.6% Percent of age 65+ households with someone under 18, 2010 5.3% 30 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $33,381 28 $34,381 At/below poverty level age 65+, 2010 8.0% 27 9.0% At/below 250% of poverty level age 65+, 2010 42% 23 42% Women age 75+ at/below poverty level, 2010 10.8% 33 12.2% Women age 75+ at/below 250% of poverty level, 2010 57% 23 54% Bachelor level education or higher age 65+, 2010 18% 35 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 113 8.5% 19 8.8% Cognitive difficulty 128 9.7% 20 9.5% Any disability 496 37% 21 37% People age 18-64 with disabilities, 2010 Self-care difficulty 139 2.3% 9 1.8% Cognitive difficulty 314 5.1% 13 4.2% Any disability 715 11.7% 13 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,440,000 145 14 137 Economic value of family caregiving, 2009 . (state in millions of $) $15,500 $1,560 18 $1,460 Economic value per hour, 2009 $11.23 27 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 6.5 6 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 180,912 38 33 45 175 Public LTSS Expenditures Michigan Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $10,635 10 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 63.19% 23 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 22% 36 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 33% 41 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Michigan and the U.S., 2009 Michigan United States 25% Percentages may not add to 100% due to rounding 16% 78% 64% Aged/Disabled Waivers 6% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,972 $199 38 $261 Nursing facilities $1,547 $156 29 $168 HCBS $426 $43 36 $94 Aged/disabled waiver services $118 $12 43 $29 Personal care services (PCS) ** $268 $27 18 $45 Home health services $26 $3 36 $16 Other HCBS *** $13 $1 15 $4 Medicaid LTSS expenditures for all populations, 2009 $2,557 $258 46 $413 Institutional services $1,714 $173 35 $232 HCBS $844 $85 45 $181 Waiver services (all populations) $536 $54 48 $114 Other HCBS (including PCS and home health) $307 $31 24 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 176 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. Nursing facilities (NF), 2008 46,964 4.7 31 5.3 HCBS (older people and adults with PD), 2008 74,047 7.4 23 8.2 Aged/disabled waiver services 9,498 1.0 42 2.2 Personal care services (PCS) ** 58,653 5.9 5 3.0 Michigan Home health services 5,896 0.6 43 3.0 Institutional services (NF and ICF-MR), 2008 47,098 4.7 32 5.6 HCBS (all populations), 2008 82,580 8.3 29 10.1 Waiver services (all populations) 18,031 1.8 47 4.1 Other HCBS (including PCS and home health) 64,549 6.5 12 6.0 Adults with disabilities self-directing services, 2011 9,355 0.94 27 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 20 40 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 61% 15 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 64% 19 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $32,319 17 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $5,296 42 $10,957 Aged/disabled waiver services $9,504 29 $10,710 Personal care services ** $4,614 26 $11,142 Home health services $685 48 $5,495 ICF-MR services, 2008 $163,811 11 $123,053 MR/DD waiver services, 2008 $48,251 17 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $208 10 $178 Medicare payment per day for nursing facility care, 2010 $382 33 $398 Medicare reimbursement per home health visit, 2010 $186 9 $154 Private pay rate per day in nursing facility, 2011 $220 17 $193 Private pay rate per month in assisted living, 2011 $3,000 35 $3,261 Private pay daily rate for adult day care, 2011 $76 10 $60 Private pay hourly rate for home health aide, 2011 $19 31 $19 177 LTSS Resources Michigan Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 3,181 2.33 10 1.46 Assisted living and residential care units, 2010 39,849 29 22 31 Personal and home care aides, 2010 11,360 8 38 17 Median hourly wage, 2010 $9.55 28 $9.44 Home health aides, 2010 34,980 26 12 24 Median hourly wage, 2010 $9.48 38 $9.89 People receiving ACL congregate meals, 2009 * 64,208 48 27 42 People receiving ACL home delivered meals, 2009 * 49,744 37 13 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $51 $38 22 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 0 41 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 434 0.32 37 0.40 Nursing facility beds, 2010 47,412 35 37 42 Nursing facility residents, 2010 40,082 29 38 35 Nursing facility occupancy rate, 2010 85% 26 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.70 26 0.64 Nursing facility staffing turnover, 2010 37% 28 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 55% 1 46% Nursing facility residents with low care needs, 2008 16% 27 17% Residents with Medicaid as primary payer, 2010 62% 27 63% Residents with Medicare as primary payer, 2010 19% 2 14% Residents with “other” as primary payer, 2010 19% 36 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 19% 23 21% Long-term care facility beds per FTE ombudsman, 2010 4,233 9 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 59% 38 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 178 Trends Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 62,495 1,270,155 with physical disabilities (excluding home health) 2008 68,151 1,577,471 % change +9% 37 +24% Michigan Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 42,039 1,460,185 2010 40,082 1,408,886 % change -5% 30 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $8,326 $285,710 2009 $10,635 $368,330 % change +28% 29 +29% Medicaid LTSS spending for older people and adults 2004 $2,002 $62,811 with physical disabilities (millions) 2009 $1,972 $80,181 % change -1% 47 +28% Medicaid nursing facility spending (millions) 2004 $1,704 $45,842 2009 $1,547 $51,403 % change -9% 47 +12% Medicaid HCBS spending for older people and adults 2004 $299 $16,969 with physical disabilities (millions) 2009 $426 $28,778 % change +42% 36 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 15% 35 27% people and adults with physical disabilities 2009 22% 36 36% change +7% 21 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $100 100% +87% +$72 +$55 80% $50 +$33 60% Millions of Dollars 40% +30% $0 20% +8% -$24 -$50 0% -20% -9% -$100 -40% -60% -$150 +$157 -80% -$200 -100% +88% 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 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. 179 AARP Public Policy Institute Minnesota Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 5,401 21 315,311 2032 6,227 22 376,660 +15% 37 +19% 2050 7,103 22 434,447 +32% 34 +38% Age 50-64 2012 1,093 20.2% 15 19.2% 2032 1,028 16.5% 17 16.4% -6% 34 +2% 2050 1,145 16.1% 39 16.6% +5% 45 +19% Age 65+ 2012 720 13.3% 37 13.6% 2032 1,322 21.2% 10 19.8% +84% 13 +74% 2050 1,511 21.3% 12 20.4% +110% 15 +107% Age 65-74 2012 386 7.1% 39 7.4% green line = 50-64 (WAS BLUE) 2032 691 11.1% 8 10.1% +79% 7 +64% red line = 65-74 (WAS PURPLE) 2050 659 9.3% 18 9.1% +71% 17 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 218 4.0% 37 blue line = 85+ (WAS RED) 4.2% 2032 452 7.3% 12 6.8% +107% 16 +94% 2050 476 6.7% 12 6.6% +118% 19 +116% Age 85+ 2012 116 2.1% 23 2.0% 2032 179 2.9% 30 2.9% +55% 36 +69% 2050 376 5.3% 8 4.8% +224% 21 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Minnesota as a Percentage of State Rank U.S. 2012 Population, by Age Group 5.0% 43 20.1% 400% Population (% of 2012 Population) Asian/Pacific Islander 350% State Rank U.S. 85+ 300% 1.7% 20 3.6% 250% Black 75-84 State Rank U.S. 200% 65-74 1.5% 38 8.5% 150% 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 0.9% 40 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Living Arrangements State Rank U.S. Minnesota Men per 100 women age 85+, 2010 47 23 48 People age 75+ living alone, 2010 38% 5 34% People age 60+ with grandchildren in household, 2010 2.4% 45 5.5% People age 60+ responsible for raising grandchildren, 2010 0.8% 44 1.6% Percent of age 65+ households with someone under 18, 2010 2.9% 47 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $34,397 22 $34,381 At/below poverty level age 65+, 2010 8.3% 24 9.0% At/below 250% of poverty level age 65+, 2010 41% 30 42% Women age 75+ at/below poverty level, 2010 13.4% 16 12.2% Women age 75+ at/below 250% of poverty level, 2010 59% 13 54% Bachelor level education or higher age 65+, 2010 21% 21 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 45 6.9% 37 8.8% Cognitive difficulty 43 6.6% 48 9.5% Any disability 209 32% 48 37% People age 18-64 with disabilities, 2010 Self-care difficulty 46 1.4% 39 1.8% Cognitive difficulty 126 3.8% 35 4.2% Any disability 266 8.0% 46 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 679,000 129 38 137 Economic value of family caregiving, 2009 . (state in millions of $) $8,200 $1,570 16 $1,460 Economic value per hour, 2009 $12.70 5 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 2.4 46 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 180,578 73 9 45 181 Public LTSS Expenditures Minnesota Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $7,425 15 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 60% 3 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 68% 3 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Minnesota and the U.S., 2009 Minnesota United States 25% Percentages may not add 28% 40% to 100% due to rounding 64% Aged/Disabled Waivers 11% PCS and other HCBS 32% Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $2,166 $410 5 $261 Nursing facilities $871 $165 26 $168 HCBS $1,295 $245 3 $94 Aged/disabled waiver services $683 $129 1 $29 Personal care services (PCS) ** $505 $96 7 $45 Home health services $107 $20 8 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $3,430 $649 5 $413 Institutional services $1,099 $208 28 $232 HCBS $2,331 $441 3 $181 Waiver services (all populations) $1,719 $325 2 $114 Other HCBS (including PCS and home health) $612 $116 8 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $30 $5.76 13 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 182 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. Nursing facilities (NF), 2008 29,124 5.6 23 5.3 Minnesota HCBS (older people and adults with PD), 2008 74,107 14.1 4 8.2 Aged/disabled waiver services 40,724 7.8 1 2.2 Personal care services (PCS) ** 20,759 4.0 12 3.0 Home health services 12,624 2.4 17 3.0 Institutional services (NF and ICF-MR), 2008 32,035 6.1 22 5.6 HCBS (all populations), 2008 90,225 17.2 1 10.1 Waiver services (all populations) 56,842 10.8 1 4.1 Other HCBS (including PCS and home health) 33,383 6.4 13 6.0 Adults with disabilities self-directing services, 2011 5,736 1.09 22 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 140 5 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 72% 8 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 74% 7 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,341 31 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $13,279 9 $10,957 Aged/disabled waiver services $14,998 9 $10,710 Personal care services ** $9,906 14 $11,142 Home health services $1,993 31 $5,495 ICF-MR services, 2008 $68,762 46 $123,053 MR/DD waiver services, 2008 $63,802 7 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $165 26 $178 Medicare payment per day for nursing facility care, 2010 $432 12 $398 Medicare reimbursement per home health visit, 2010 $174 15 $154 Private pay rate per day in nursing facility, 2011 $185 30 $193 Private pay rate per month in assisted living, 2011 $3,100 30 $3,261 Private pay daily rate for adult day care, 2011 $66 19 $60 Private pay hourly rate for home health aide, 2011 $26 2 $19 183 LTSS Resources Minnesota Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 5,768 8.42 2 1.46 Assisted living and residential care units, 2010 53,712 78 1 31 Personal and home care aides, 2010 41,600 61 2 17 Median hourly wage, 2010 $10.92 5 $9.44 Home health aides, 2010 36,920 54 1 24 Median hourly wage, 2010 $10.97 11 $9.89 People receiving ACL congregate meals, 2009 * 56,989 84 11 42 People receiving ACL home delivered meals, 2009 * 13,798 20 32 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $20 $29 35 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 13 13 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 390 0.57 12 0.40 Nursing facility beds, 2010 32,292 47 19 42 Nursing facility residents, 2010 29,173 43 15 35 Nursing facility occupancy rate, 2010 90% 9 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.71 23 0.64 Nursing facility staffing turnover, 2010 37% 28 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 44% 37 46% Nursing facility residents with low care needs, 2008 19% 20 17% Residents with Medicaid as primary payer, 2010 56% 43 63% Residents with Medicare as primary payer, 2010 10% 46 14% Residents with “other” as primary payer, 2010 34% 6 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 7% 47 12% Long-stay residents with a hospital admission, 2008 8% 48 21% Long-term care facility beds per FTE ombudsman, 2010 7,569 1 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 63% 35 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 184 Trends Minnesota Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 30,174 1,270,155 with physical disabilities (excluding home health) 2008 61,483 1,577,471 % change +104% 7 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 33,651 1,460,185 2010 29,173 1,408,886 % change -13% 49 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $5,404 $285,710 2009 $7,425 $368,330 % change +37% 14 +29% Medicaid LTSS spending for older people and adults 2004 $1,414 $62,811 with physical disabilities (millions) 2009 $2,166 $80,181 % change +53% 4 +28% Medicaid nursing facility spending (millions) 2004 $907 $45,842 2009 $871 $51,403 % change -4% 44 +12% Medicaid HCBS spending for older people and adults 2004 $507 $16,969 with physical disabilities (millions) 2009 $1,295 $28,778 % change +155% 4 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 36% 9 27% people and adults with physical disabilities 2009 60% 3 36% change +24% 2 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $500 250% +$452 200% +196% $400 +$336 Millions of Dollars $300 150% +122% $200 100% +$128 $100 50% +16% $0 0% -$7 -4% -4% -$36 -$100 -50% 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 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. 185 AARP Public Policy Institute Mississippi Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 2,988 32 315,311 2032 3,320 34 376,660 +11% 44 +19% 2050 3,777 34 434,447 +26% 43 +38% Age 50-64 2012 551 18.4% 43 19.2% 2032 529 15.9% 34 16.4% -4% 28 +2% 2050 665 17.6% 18 16.6% +21% 22 +19% Age 65+ 2012 406 13.6% 34 13.6% 2032 641 19.3% 35 19.8% +58% 43 +74% 2050 737 19.5% 38 20.4% +82% 35 +107% Age 65-74 2012 223 7.5% 28 7.4% green line = 50-64 (WAS BLUE) 2032 322 9.7% 33 10.1% +44% 46 +64% red line = 65-74 (WAS PURPLE) 2050 344 9.1% 26 9.1% +54% 31 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 126 4.2% 32 blue line = 85+ (WAS RED) 4.2% 2032 224 6.7% 35 6.8% +78% 41 +94% 2050 228 6.0% 40 6.6% +81% 40 +116% Age 85+ 2012 57 1.9% 33 2.0% 2032 95 2.9% 30 2.9% +67% 28 +69% 2050 165 4.4% 41 4.8% +189% 35 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Mississippi as a Percentage of State Rank U.S. 2012 Population, by Age Group 26.0% 9 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.4% 45 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 24.4% 2 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 0.6% 46 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Living Arrangements State Rank U.S. Mississ Men per 100 women age 85+, 2010 42 50 48 People age 75+ living alone, 2010 32% 39 34% People age 60+ with grandchildren in household, 2010 6.3% 10 5.5% People age 60+ responsible for raising grandchildren, 2010 3.0% 1 1.6% Percent of age 65+ households with someone under 18, 2010 8.3% 11 7.0% ippi Income & Poverty State Rank U.S. Median household income age 65+, 2010 $27,529 50 $34,381 At/below poverty level age 65+, 2010 11.9% 4 9.0% At/below 250% of poverty level age 65+, 2010 54% 1 42% Women age 75+ at/below poverty level, 2010 16.6% 3 12.2% Women age 75+ at/below 250% of poverty level, 2010 64% 1 54% Bachelor level education or higher age 65+, 2010 17% 38 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 43 11.7% 1 8.8% Cognitive difficulty 51 13.9% 1 9.5% Any disability 168 45% 1 37% People age 18-64 with disabilities, 2010 Self-care difficulty 53 3.0% 2 1.8% Cognitive difficulty 111 6.2% 3 4.2% Any disability 267 15.0% 3 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 565,000 191 1 137 Economic value of family caregiving, 2009 . (state in millions of $) $5,200 $1,780 2 $1,460 Economic value per hour, 2009 $9.70 48 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.4 21 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 40,847 31 46 45 187 Public LTSS Expenditures Mississippi Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $3,813 28 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 75.67% 1 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 16% 44 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 14% 51 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Mississippi and the U.S., 2009 Mississippi United States 25% Percentages may not add to 100% due to rounding 1% 84% 64% Aged/Disabled Waivers 15% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $864 $292 13 $261 Nursing facilities $727 $246 9 $168 HCBS $136 $46 34 $94 Aged/disabled waiver services $131 $44 14 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $5 $2 42 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $1,245 $421 21 $413 Institutional services $1,066 $360 7 $232 HCBS $179 $60 50 $181 Waiver services (all populations) $174 $59 45 $114 Other HCBS (including PCS and home health) $5 $2 49 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 188 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. Nursing facilities (NF), 2008 21,734 7.4 8 5.3 Mississ HCBS (older people and adults with PD), 2008 20,249 6.9 25 8.2 Aged/disabled waiver services 12,361 4.2 11 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 7,888 2.7 13 3.0 Institutional services (NF and ICF-MR), 2008 24,877 8.4 6 5.6 HCBS (all populations), 2008 22,924 7.8 33 10.1 Waiver services (all populations) 15,036 5.1 19 4.1 ippi Other HCBS (including PCS and home health) 7,888 2.7 30 6.0 Adults with disabilities self-directing services, 2011 3,750 1.27 19 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 57 16 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 48% 33 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 48% 43 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $32,490 15 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $7,572 35 $10,957 Aged/disabled waiver services $7,572 38 $10,710 Personal care services ** NA NA $11,142 Home health services $923 46 $5,495 ICF-MR services, 2008 $89,852 34 $123,053 MR/DD waiver services, 2008 $20,774 47 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $353 42 $398 Medicare reimbursement per home health visit, 2010 $156 32 $154 Private pay rate per day in nursing facility, 2011 $189 28 $193 Private pay rate per month in assisted living, 2011 $2,949 38 $3,261 Private pay daily rate for adult day care, 2011 $64 23 $60 Private pay hourly rate for home health aide, 2011 $16 47 $19 189 LTSS Resources Mississippi Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 176 0.46 43 1.46 Assisted living and residential care units, 2010 5,079 13 47 31 Personal and home care aides, 2010 NA NA NA 17 Median hourly wage, 2010 $8.37 47 $9.44 Home health aides, 2010 6,520 17 31 24 Median hourly wage, 2010 $8.53 49 $9.89 People receiving ACL congregate meals, 2009 * 5,300 14 48 42 People receiving ACL home delivered meals, 2009 * 15,098 40 10 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $8 $22 44 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 3 30 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 206 0.54 15 0.40 Nursing facility beds, 2010 18,771 49 17 42 Nursing facility residents, 2010 16,526 43 15 35 Nursing facility occupancy rate, 2010 88% 16 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.58 43 0.64 Nursing facility staffing turnover, 2010 30% 40 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 50% 14 46% Nursing facility residents with low care needs, 2008 21% 11 17% Residents with Medicaid as primary payer, 2010 75% 2 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 10% 50 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 6% 5 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 33% 1 21% Long-term care facility beds per FTE ombudsman, 2010 1,370 39 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 190 Trends Mississ Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 10,888 1,270,155 with physical disabilities (excluding home health) 2008 12,361 1,577,471 % change +14% 31 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 16,851 1,460,185 2010 16,526 1,408,886 ippi % change -2% 16 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $3,426 $285,710 2009 $3,813 $368,330 % change +11% 49 +29% Medicaid LTSS spending for older people and adults 2004 $635 $62,811 with physical disabilities (millions) 2009 $864 $80,181 % change +36% 10 +28% Medicaid nursing facility spending (millions) 2004 $563 $45,842 2009 $727 $51,403 % change +29% 6 +12% Medicaid HCBS spending for older people and adults 2004 $71 $16,969 with physical disabilities (millions) 2009 $136 $28,778 % change +91% 14 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 11% 43 27% people and adults with physical disabilities 2009 16% 44 36% change +5% 29 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $180 120% +$164 $160 100% +96% $140 Millions of Dollars $120 80% $100 -$91 60% $80 +49% +$64 $60 40% +29% +29% $40 20% +14% $20 +$10 +$1 $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 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. 191 AARP Public Policy Institute Missouri Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 6,128 18 315,311 2032 7,158 18 376,660 +17% 32 +19% 2050 8,189 18 434,447 +34% 32 +38% Age 50-64 2012 1,209 19.7% 23 19.2% 2032 1,158 16.2% 27 16.4% -4% 28 +2% 2050 1,405 17.2% 22 16.6% +16% 29 +19% Age 65+ 2012 883 14.4% 20 13.6% 2032 1,453 20.3% 23 19.8% +65% 31 +74% 2050 1,661 20.3% 25 20.4% +88% 31 +107% Age 65-74 2012 477 7.8% 18 7.4% green line = 50-64 (WAS BLUE) 2032 738 10.3% 19 10.1% +55% 29 +64% red line = 65-74 (WAS PURPLE) 2050 751 9.2% 20 9.1% +57% 29 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 272 4.4% 18 blue line = 85+ (WAS RED) 4.2% 2032 502 7.0% 21 6.8% +84% 32 +94% 2050 518 6.3% 30 6.6% +90% 29 +116% Age 85+ 2012 133 2.2% 16 2.0% 2032 213 3.0% 20 2.9% +60% 31 +69% 2050 392 4.8% 22 4.8% +194% 30 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Missouri as a Percentage of State Rank U.S. 2012 Population, by Age Group 10.2% 31 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.8% 33 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 7.4% 20 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 1.1% 36 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Living Arrangements State Rank U.S. Missouri Men per 100 women age 85+, 2010 46 31 48 People age 75+ living alone, 2010 36% 11 34% People age 60+ with grandchildren in household, 2010 3.9% 32 5.5% People age 60+ responsible for raising grandchildren, 2010 1.4% 26 1.6% Percent of age 65+ households with someone under 18, 2010 4.5% 38 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $31,324 41 $34,381 At/below poverty level age 65+, 2010 9.1% 21 9.0% At/below 250% of poverty level age 65+, 2010 45% 12 42% Women age 75+ at/below poverty level, 2010 13.2% 18 12.2% Women age 75+ at/below 250% of poverty level, 2010 59% 13 54% Bachelor level education or higher age 65+, 2010 17% 38 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 68 8.4% 20 8.8% Cognitive difficulty 77 9.5% 21 9.5% Any disability 311 39% 12 37% People age 18-64 with disabilities, 2010 Self-care difficulty 88 2.4% 7 1.8% Cognitive difficulty 186 5.1% 13 4.2% Any disability 440 12.0% 11 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 865,000 144 16 137 Economic value of family caregiving, 2009 . (state in millions of $) $8,900 $1,480 29 $1,460 Economic value per hour, 2009 $10.70 32 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.7 19 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 155,771 55 12 45 193 Public LTSS Expenditures Missouri Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $7,676 13 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 64.51% 19 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 34% 19 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 41% 29 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Missouri and the U.S., 2009 Missouri United States 25% Percentages may not add 25% to 100% due to rounding 66% 64% Aged/Disabled Waivers 11% 9% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,311 $220 30 $261 Nursing facilities $869 $146 32 $168 HCBS $442 $74 22 $94 Aged/disabled waiver services $113 $19 36 $29 Personal care services (PCS) ** $318 $53 11 $45 Home health services $5 $1 44 $16 Other HCBS *** $5 $1 15 $4 Medicaid LTSS expenditures for all populations, 2009 $2,135 $358 29 $413 Institutional services $1,265 $212 26 $232 HCBS $870 $146 29 $181 Waiver services (all populations) $541 $91 35 $114 Other HCBS (including PCS and home health) $329 $55 15 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $9 $1.43 35 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 194 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. Nursing facilities (NF), 2008 38,466 6.5 12 5.3 Missouri HCBS (older people and adults with PD), 2008 75,096 12.7 5 8.2 Aged/disabled waiver services 19,620 3.3 18 2.2 Personal care services (PCS) ** 49,333 8.3 2 3.0 Home health services 6,143 1.0 37 3.0 Institutional services (NF and ICF-MR), 2008 39,427 6.7 15 5.6 HCBS (all populations), 2008 84,110 14.2 6 10.1 Waiver services (all populations) 28,634 4.8 23 4.1 Other HCBS (including PCS and home health) 55,476 9.4 8 6.0 Adults with disabilities self-directing services, 2011 15,270 2.58 9 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 51 21 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 66% 12 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 68% 14 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $21,832 49 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $5,868 40 $10,957 Aged/disabled waiver services $5,148 45 $10,710 Personal care services ** $6,154 24 $11,142 Home health services $969 44 $5,495 ICF-MR services, 2008 $111,027 25 $123,053 MR/DD waiver services, 2008 $44,194 21 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $133 38 $178 Medicare payment per day for nursing facility care, 2010 $347 45 $398 Medicare reimbursement per home health visit, 2010 $168 18 $154 Private pay rate per day in nursing facility, 2011 $134 49 $193 Private pay rate per month in assisted living, 2011 $2,420 50 $3,261 Private pay daily rate for adult day care, 2011 $70 14 $60 Private pay hourly rate for home health aide, 2011 $19 31 $19 195 LTSS Resources Missouri Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 603 0.72 33 1.46 Assisted living and residential care units, 2010 21,333 25 31 31 Personal and home care aides, 2010 17,250 21 13 17 Median hourly wage, 2010 $8.75 40 $9.44 Home health aides, 2010 13,440 16 34 24 Median hourly wage, 2010 $9.15 41 $9.89 People receiving ACL congregate meals, 2009 * 78,108 94 10 42 People receiving ACL home delivered meals, 2009 * 36,949 45 9 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $44 $53 13 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 16 1 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 526 0.63 7 0.40 Nursing facility beds, 2010 53,600 64 4 42 Nursing facility residents, 2010 38,504 46 12 35 Nursing facility occupancy rate, 2010 72% 43 83% Direct care nursing hours per resident day, 2010 3.7 36 3.8 RN hours per day, 2010 0.49 46 0.64 Nursing facility staffing turnover, 2010 67% 4 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 44% 37 46% Nursing facility residents with low care needs, 2008 22% 8 17% Residents with Medicaid as primary payer, 2010 61% 33 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 27% 9 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 22% 12 21% Long-term care facility beds per FTE ombudsman, 2010 4,246 8 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 56% 39 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 196 Trends Missouri Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 68,700 1,270,155 with physical disabilities (excluding home health) 2008 68,953 1,577,471 % change +0% 42 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 38,443 1,460,185 2010 38,504 1,408,886 % change +0% 8 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $6,155 $285,710 2009 $7,676 $368,330 % change +25% 34 +29% Medicaid LTSS spending for older people and adults 2004 $1,103 $62,811 with physical disabilities (millions) 2009 $1,311 $80,181 % change +19% 35 +28% Medicaid nursing facility spending (millions) 2004 $795 $45,842 2009 $869 $51,403 % change +9% 32 +12% Medicaid HCBS spending for older people and adults 2004 $308 $16,969 with physical disabilities (millions) 2009 $442 $28,778 % change +43% 33 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 28% 14 27% people and adults with physical disabilities 2009 34% 19 36% change +6% 25 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $200 60% +55% +49% +$151 $150 40% +$109 +28% Millions of Dollars $100 +$74 20% +9% $50 +$25 0% $0 -20% -$50 -$100 -40% -41% -$104 -$150 -60% 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 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. 197 AARP Public Policy Institute Montana Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 1,017 44 315,311 2032 1,326 43 376,660 +30% 8 +19% 2050 1,511 43 434,447 +49% 8 +38% Age 50-64 2012 217 21.3% 4 19.2% 2032 203 15.3% 39 16.4% -6% 34 +2% 2050 291 19.3% 4 16.6% +34% 6 +19% Age 65+ 2012 154 15.2% 7 13.6% 2032 263 19.8% 27 19.8% +70% 22 +74% 2050 307 20.3% 25 20.4% +99% 22 +107% Age 65-74 2012 85 8.3% 6 7.4% green line = 50-64 (WAS BLUE) 2032 126 9.5% 37 10.1% +49% 39 +64% red line = 65-74 (WAS PURPLE) 2050 145 9.6% 8 9.1% +71% 17 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 47 4.6% 10 blue line = 85+ (WAS RED) 4.2% 2032 97 7.3% 12 6.8% +106% 17 +94% 2050 89 5.9% 44 6.6% +89% 31 +116% Age 85+ 2012 23 2.2% 16 2.0% 2032 39 3.0% 20 2.9% +73% 24 +69% 2050 73 4.8% 22 4.8% +222% 22 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Montana as a Percentage of State Rank U.S. 2012 Population, by Age Group 5.0% 43 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.5% 40 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 0.1% 48 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 0.9% 40 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Montana Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 54 9 48 People age 75+ living alone, 2010 38% 5 34% People age 60+ with grandchildren in household, 2010 2.8% 42 5.5% People age 60+ responsible for raising grandchildren, 2010 1.2% 36 1.6% Percent of age 65+ households with someone under 18, 2010 3.5% 44 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $32,423 32 $34,381 At/below poverty level age 65+, 2010 7.0% 41 9.0% At/below 250% of poverty level age 65+, 2010 41% 30 42% Women age 75+ at/below poverty level, 2010 13.4% 16 12.2% Women age 75+ at/below 250% of poverty level, 2010 58% 16 54% Bachelor level education or higher age 65+, 2010 21% 21 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 9 6.6% 44 8.8% Cognitive difficulty 11 7.7% 44 9.5% Any disability 52 37% 21 37% People age 18-64 with disabilities, 2010 Self-care difficulty 9 1.4% 39 1.8% Cognitive difficulty 25 4.1% 28 4.2% Any disability 64 10.5% 23 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 131,000 134 32 137 Economic value of family caregiving, 2009 . (state in millions of $) $1,390 $1,430 35 $1,460 Economic value per hour, 2009 $11.16 28 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.1 25 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 26,686 54 14 45 199 Public LTSS Expenditures Montana Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $876 48 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 67.42% 12 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 34% 19 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 47% 15 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Montana and the U.S., 2009 Montana United States 25% Percentages may not add 20% to 100% due to rounding 66% 64% Aged/Disabled Waivers 11% 14% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $240 $243 21 $261 Nursing facilities $158 $161 28 $168 HCBS $81 $83 18 $94 Aged/disabled waiver services $33 $34 25 $29 Personal care services (PCS) ** $36 $36 15 $45 Home health services $12 $12 18 $16 Other HCBS *** $0 $0 22 $4 Medicaid LTSS expenditures for all populations, 2009 $353 $358 29 $413 Institutional services $186 $189 33 $232 HCBS $166 $169 22 $181 Waiver services (all populations) $118 $120 27 $114 Other HCBS (including PCS and home health) $48 $49 16 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 200 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Montana State Nursing facilities (NF), 2008 5,163 5.3 27 5.3 HCBS (older people and adults with PD), 2008 5,690 5.8 30 8.2 Aged/disabled waiver services 2,205 2.3 25 2.2 Personal care services (PCS) ** 3,093 3.2 15 3.0 Home health services 392 0.4 47 3.0 Institutional services (NF and ICF-MR), 2008 5,228 5.4 28 5.6 HCBS (all populations), 2008 8,105 8.3 29 10.1 Waiver services (all populations) 4,620 4.7 25 4.1 Other HCBS (including PCS and home health) 3,485 3.6 28 6.0 Adults with disabilities self-directing services, 2011 4,832 4.95 5 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 43 25 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 52% 25 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 61% 26 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $29,937 25 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $10,988 16 $10,957 Aged/disabled waiver services $13,350 12 $10,710 Personal care services ** $9,304 15 $11,142 Home health services $1,101 41 $5,495 ICF-MR services, 2008 $182,088 9 $123,053 MR/DD waiver services, 2008 $33,671 33 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $174 23 $178 Medicare payment per day for nursing facility care, 2010 $402 29 $398 Medicare reimbursement per home health visit, 2010 $170 17 $154 Private pay rate per day in nursing facility, 2011 $183 32 $193 Private pay rate per month in assisted living, 2011 $3,100 30 $3,261 Private pay daily rate for adult day care, 2011 $70 14 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 201 LTSS Resources Montana Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 256 1.74 16 1.46 Assisted living and residential care units, 2010 5,246 36 11 31 Personal and home care aides, 2010 2,480 17 23 17 Median hourly wage, 2010 $9.65 25 $9.44 Home health aides, 2010 3,740 25 13 24 Median hourly wage, 2010 $10.06 29 $9.89 People receiving ACL congregate meals, 2009 * 24,835 172 2 42 People receiving ACL home delivered meals, 2009 * 7,100 49 6 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $10 $70 10 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 0 41 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 89 0.60 9 0.40 Nursing facility beds, 2010 7,010 48 18 42 Nursing facility residents, 2010 4,928 33 30 35 Nursing facility occupancy rate, 2010 70% 47 83% Direct care nursing hours per resident day, 2010 4.1 9 3.8 RN hours per day, 2010 0.88 6 0.64 Nursing facility staffing turnover, 2010 51% 11 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 43% 43 46% Nursing facility residents with low care needs, 2008 20% 17 17% Residents with Medicaid as primary payer, 2010 56% 43 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 32% 7 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 8% 42 12% Long-stay residents with a hospital admission, 2008 13% 39 21% Long-term care facility beds per FTE ombudsman, 2010 799 50 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 202 Trends Montana Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 4,292 1,270,155 with physical disabilities (excluding home health) 2008 5,298 1,577,471 % change +23% 28 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 5,370 1,460,185 2010 4,928 1,408,886 % change -8% 42 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $653 $285,710 2009 $876 $368,330 % change +34% 20 +29% Medicaid LTSS spending for older people and adults 2004 $185 $62,811 with physical disabilities (millions) 2009 $240 $80,181 % change +29% 16 +28% Medicaid nursing facility spending (millions) 2004 $140 $45,842 2009 $158 $51,403 % change +13% 26 +12% Medicaid HCBS spending for older people and adults 2004 $45 $16,969 with physical disabilities (millions) 2009 $81 $28,778 % change +80% 18 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 24% 17 27% people and adults with physical disabilities 2009 34% 19 36% change +10% 12 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $30 120% +$27 +99% $25 +$24 100% $20 80% +$18 Millions of Dollars +59% 60% +48% $15 +$12 40% $10 20% +13% $5 0% $0 -20% -$5 -40% -37% -$7 -$10 -60% 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 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. 203 AARP Public Policy Institute Nebraska Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 1,851 38 315,311 2032 2,243 37 376,660 +21% 23 +19% 2050 2,633 37 434,447 +42% 16 +38% Age 50-64 2012 352 19.0% 38 19.2% 2032 331 14.7% 48 16.4% -6% 34 +2% 2050 403 15.3% 46 16.6% +14% 33 +19% Age 65+ 2012 253 13.7% 31 13.6% 2032 417 18.6% 41 19.8% +65% 31 +74% 2050 479 18.2% 49 20.4% +89% 30 +107% Age 65-74 2012 130 7.0% 43 7.4% green line = 50-64 (WAS BLUE) 2032 210 9.4% 40 10.1% +62% 22 +64% red line = 65-74 (WAS PURPLE) 2050 215 8.2% 48 9.1% +66% 22 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 81 4.4% 18 blue line = 85+ (WAS RED) 4.2% 2032 147 6.6% 37 6.8% +83% 34 +94% 2050 149 5.7% 47 6.6% +85% 36 +116% Age 85+ 2012 43 2.3% 10 2.0% 2032 59 2.6% 42 2.9% +38% 46 +69% 2050 114 4.3% 47 4.8% +167% 42 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Nebraska as a Percentage of State Rank U.S. 2012 Population, by Age Group 5.1% 42 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% 85+ State Rank U.S. 0.5% 40 3.6% 200% 65-74 Black 150% State Rank U.S. 75-84 2.1% 33 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 1.9% 25 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 65-74 50-64 204 75-84 Population & Characteristics Nebraska Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 48 19 48 People age 75+ living alone, 2010 36% 11 34% People age 60+ with grandchildren in household, 2010 2.6% 44 5.5% People age 60+ responsible for raising grandchildren, 2010 1.3% 30 1.6% Percent of age 65+ households with someone under 18, 2010 4.4% 39 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $32,745 30 $34,381 At/below poverty level age 65+, 2010 7.5% 37 9.0% At/below 250% of poverty level age 65+, 2010 42% 23 42% Women age 75+ at/below poverty level, 2010 12.7% 20 12.2% Women age 75+ at/below 250% of poverty level, 2010 57% 23 54% Bachelor level education or higher age 65+, 2010 18% 35 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 16 6.8% 41 8.8% Cognitive difficulty 17 7.3% 46 9.5% Any disability 85 36% 27 37% People age 18-64 with disabilities, 2010 Self-care difficulty 19 1.7% 24 1.8% Cognitive difficulty 39 3.5% 40 4.2% Any disability 104 9.4% 32 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 219,000 122 45 137 Economic value of family caregiving, 2009 . (state in millions of $) $2,200 $1,250 49 $1,460 Economic value per hour, 2009 $10.70 32 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.4 34 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 83,702 101 6 45 205 Public LTSS Expenditures Nebraska Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,633 39 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 60.56% 27 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 25% 29 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 38% 34 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Nebraska and the U.S., 2009 Nebraska United States 25% Percentages may not add 9% to 100% due to rounding 75% 64% Aged/Disabled Waivers 11% 16% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $423 $233 26 $261 Nursing facilities $318 $175 22 $168 HCBS $105 $58 29 $94 Aged/disabled waiver services $66 $37 20 $29 Personal care services (PCS) ** $16 $9 24 $45 Home health services $23 $13 15 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $718 $396 22 $413 Institutional services $445 $245 19 $232 HCBS $273 $151 28 $181 Waiver services (all populations) $234 $129 23 $114 Other HCBS (including PCS and home health) $39 $21 29 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $2 $1.12 37 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 206 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Nebraska State Nursing facilities (NF), 2008 10,815 6.0 19 5.3 HCBS (older people and adults with PD), 2008 15,419 8.6 18 8.2 Aged/disabled waiver services 5,909 3.3 18 2.2 Personal care services (PCS) ** 1,832 1.0 25 3.0 Home health services 7,678 4.3 8 3.0 Institutional services (NF and ICF-MR), 2008 11,454 6.4 19 5.6 HCBS (all populations), 2008 19,546 10.9 18 10.1 Waiver services (all populations) 10,036 5.6 16 4.1 Other HCBS (including PCS and home health) 9,510 5.3 18 6.0 Adults with disabilities self-directing services, 2011 2,346 1.31 17 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 55 18 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 59% 17 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 63% 21 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $27,296 35 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $9,388 23 $10,957 Aged/disabled waiver services $9,987 27 $10,710 Personal care services ** $7,453 19 $11,142 Home health services $4,966 10 $5,495 ICF-MR services, 2008 $106,731 28 $123,053 MR/DD waiver services, 2008 $35,988 31 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $144 35 $178 Medicare payment per day for nursing facility care, 2010 $415 24 $398 Medicare reimbursement per home health visit, 2010 $165 25 $154 Private pay rate per day in nursing facility, 2011 $175 36 $193 Private pay rate per month in assisted living, 2011 $2,803 41 $3,261 Private pay daily rate for adult day care, 2011 $50 42 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 207 LTSS Resources Nebraska Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 387 1.56 17 1.46 Assisted living and residential care units, 2010 11,356 46 8 31 Personal and home care aides, 2010 1,830 7 42 17 Median hourly wage, 2010 $10.28 16 $9.44 Home health aides, 2010 2,340 9 48 24 Median hourly wage, 2010 $10.30 23 $9.89 People receiving ACL congregate meals, 2009 * 18,060 74 17 42 People receiving ACL home delivered meals, 2009 * 7,966 33 17 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $15 $61 11 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 16 1 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 233 0.94 3 0.40 Nursing facility beds, 2010 16,275 66 3 42 Nursing facility residents, 2010 13,037 53 4 35 Nursing facility occupancy rate, 2010 80% 37 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.67 27 0.64 Nursing facility staffing turnover, 2010 40% 23 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 44% 37 46% Nursing facility residents with low care needs, 2008 22% 8 17% Residents with Medicaid as primary payer, 2010 53% 49 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 36% 3 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 1% 48 4% High risk residents with pressure sores, 2008 7% 47 12% Long-stay residents with a hospital admission, 2008 18% 28 21% Long-term care facility beds per FTE ombudsman, 2010 5,321 4 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 47% 43 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 208 Trends Nebraska Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 6,211 1,270,155 with physical disabilities (excluding home health) 2008 7,741 1,577,471 % change +25% 26 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 13,575 1,460,185 2010 13,037 1,408,886 % change -4% 27 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $1,456 $285,710 2009 $1,633 $368,330 % change +12% 48 +29% Medicaid LTSS spending for older people and adults 2004 $442 $62,811 with physical disabilities (millions) 2009 $423 $80,181 % change -4% 49 +28% Medicaid nursing facility spending (millions) 2004 $360 $45,842 2009 $318 $51,403 % change -12% 48 +12% Medicaid HCBS spending for older people and adults 2004 $82 $16,969 with physical disabilities (millions) 2009 $105 $28,778 % change +28% 43 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 19% 30 27% people and adults with physical disabilities 2009 25% 29 36% change +6% 25 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $60 50 $50 +$47 +40% 40 $40 +29% Millions of Dollars $30 30 +25% $20 +$15 $10 +$6 +$8 20 $0 +10% 10 -$10 -$20 0 -$30 -10 -$40 -12% -$50 -$42 -20 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 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. 209 AARP Public Policy Institute Nevada Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 2,797 35 315,311 2032 3,902 31 376,660 +40% 1 +19% 2050 4,647 30 434,447 +66% 2 +38% Age 50-64 2012 498 17.8% 46 19.2% 2032 636 16.3% 24 16.4% +27% 2 +2% 2050 726 15.6% 41 16.6% +46% 3 +19% Age 65+ 2012 359 12.8% 40 13.6% 2032 746 19.1% 37 19.8% +107% 3 +74% 2050 1,017 21.9% 4 20.4% +183% 3 +107% Age 65-74 2012 214 7.6% 24 7.4% green line = 50-64 (WAS BLUE) 2032 366 9.4% 40 10.1% +71% 13 +64% red line = 65-74 (WAS PURPLE) 2050 449 9.7% 6 9.1% +110% 5 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 105 3.8% 41 blue line = 85+ (WAS RED) 4.2% 2032 264 6.8% 32 6.8% +151% 2 +94% 2050 335 7.2% 3 6.6% +218% 2 +116% Age 85+ 2012 41 1.5% 46 2.0% 2032 116 3.0% 20 2.9% +184% 2 +69% 2050 234 5.0% 13 4.8% +474% 2 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Nevada as a Percentage of State Rank U.S. 2012 Population, by Age Group 23.8% 12 20.1% 800% Population (% of 2012 Population) Asian/Pacific Islander 700% State Rank U.S. 600% 7.4% 3 3.6% 85+ 500% Black 400% State Rank U.S. 75-84 6.0% 23 8.5% 300% 65-74 200% Hispanic State Rank U.S. 50-64 2030 2040 2050 2060 100% 8.8% 8 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Nevada Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 58 2 48 People age 75+ living alone, 2010 30% 43 34% People age 60+ with grandchildren in household, 2010 7.2% 4 5.5% People age 60+ responsible for raising grandchildren, 2010 2.2% 5 1.6% Percent of age 65+ households with someone under 18, 2010 9.6% 4 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $38,951 12 $34,381 At/below poverty level age 65+, 2010 7.6% 36 9.0% At/below 250% of poverty level age 65+, 2010 38% 39 42% Women age 75+ at/below poverty level, 2010 10.1% 41 12.2% Women age 75+ at/below 250% of poverty level, 2010 49% 40 54% Bachelor level education or higher age 65+, 2010 20% 28 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 25 7.8% 29 8.8% Cognitive difficulty 25 7.8% 42 9.5% Any disability 110 34% 35 37% People age 18-64 with disabilities, 2010 Self-care difficulty 29 1.7% 24 1.8% Cognitive difficulty 56 3.3% 44 4.2% Any disability 152 9.1% 34 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 364,000 138 24 137 Economic value of family caregiving, 2009 . (state in millions of $) $4,000 $1,510 27 $1,460 Economic value per hour, 2009 $11.48 23 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 11.9 1 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 34,417 28 49 45 211 Public LTSS Expenditures Nevada Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,383 41 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.16% 39 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 34% 19 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 42% 24 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Nevada and the U.S., 2009 Nevada United States 25% Percentages may not add 29% to 100% due to rounding 66% 64% Aged/Disabled Waivers 5% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $246 $92 50 $261 Nursing facilities $162 $60 50 $168 HCBS $84 $31 47 $94 Aged/disabled waiver services $12 $5 46 $29 Personal care services (PCS) ** $68 $25 20 $45 Home health services $3 $1 44 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $378 $141 51 $413 Institutional services $221 $82 50 $232 HCBS $157 $59 51 $181 Waiver services (all populations) $85 $32 49 $114 Other HCBS (including PCS and home health) $72 $27 26 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $28 $10.43 6 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 212 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Nevada State Nursing facilities (NF), 2008 4,842 1.8 49 5.3 HCBS (older people and adults with PD), 2008 9,572 3.6 39 8.2 Aged/disabled waiver services 2,654 1.0 42 2.2 Personal care services (PCS) ** 6,205 2.3 22 3.0 Home health services 713 0.3 49 3.0 Institutional services (NF and ICF-MR), 2008 4,971 1.9 49 5.6 HCBS (all populations), 2008 11,258 4.2 45 10.1 Waiver services (all populations) 4,340 1.6 49 4.1 Other HCBS (including PCS and home health) 6,918 2.6 32 6.0 Adults with disabilities self-directing services, 2011 1,238 0.47 36 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 55 18 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 66% 12 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 69% 13 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $33,912 12 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $9,325 24 $10,957 Aged/disabled waiver services $4,083 47 $10,710 Personal care services ** $11,567 10 $11,142 Home health services $4,694 13 $5,495 ICF-MR services, 2008 $145,041 13 $123,053 MR/DD waiver services, 2008 $39,587 27 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $184 19 $178 Medicare payment per day for nursing facility care, 2010 $456 5 $398 Medicare reimbursement per home health visit, 2010 $179 13 $154 Private pay rate per day in nursing facility, 2011 $210 21 $193 Private pay rate per month in assisted living, 2011 $2,750 43 $3,261 Private pay daily rate for adult day care, 2011 $65 21 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 213 LTSS Resources Nevada Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 392 1.20 20 1.46 Assisted living and residential care units, 2010 4,408 14 46 31 Personal and home care aides, 2010 4,400 13 29 17 Median hourly wage, 2010 $10.41 11 $9.44 Home health aides, 2010 4,830 15 37 24 Median hourly wage, 2010 $10.58 17 $9.89 People receiving ACL congregate meals, 2009 * 15,813 50 25 42 People receiving ACL home delivered meals, 2009 * 5,832 18 35 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $6 $21 46 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 15 6 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 51 0.16 50 0.40 Nursing facility beds, 2010 5,892 18 49 42 Nursing facility residents, 2010 4,744 15 48 35 Nursing facility occupancy rate, 2010 81% 36 83% Direct care nursing hours per resident day, 2010 3.8 30 3.8 RN hours per day, 2010 0.82 13 0.64 Nursing facility staffing turnover, 2010 44% 17 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 35% 51 46% Nursing facility residents with low care needs, 2008 14% 31 17% Residents with Medicaid as primary payer, 2010 56% 43 63% Residents with Medicare as primary payer, 2010 18% 5 14% Residents with “other” as primary payer, 2010 26% 13 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 5% 9 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 19% 23 21% Long-term care facility beds per FTE ombudsman, 2010 1,081 45 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 214 Trends Nevada Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 4,277 1,270,155 with physical disabilities (excluding home health) 2008 8,859 1,577,471 % change +107% 5 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 4,461 1,460,185 2010 4,744 1,408,886 % change +6% 2 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $1,034 $285,710 2009 $1,383 $368,330 % change +34% 20 +29% Medicaid LTSS spending for older people and adults 2004 $192 $62,811 with physical disabilities (millions) 2009 $246 $80,181 % change +28% 21 +28% Medicaid nursing facility spending (millions) 2004 $141 $45,842 2009 $162 $51,403 % change +15% 23 +12% Medicaid HCBS spending for older people and adults 2004 $50 $16,969 with physical disabilities (millions) 2009 $84 $28,778 % change +66% 23 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 26% 15 27% people and adults with physical disabilities 2009 34% 19 36% change +8% 16 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $60 300% +$52 $50 250% +238% Millions of Dollars $40 200% $30 +$29 150% +$21 $20 100% +68% $10 50% +$4 +15% +57% $0 0% -$10 -$6 -50% -26% 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 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. 215 AARP Public Policy Institute New Hampshire Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 1,345 40 315,311 2032 1,581 42 376,660 +18% 30 +19% 2050 1,765 42 434,447 +31% 36 +38% Age 50-64 2012 301 22.4% 3 19.2% 2032 262 16.6% 13 16.4% -13% 45 +2% 2050 354 20.1% 1 16.6% +18% 25 +19% Age 65+ 2012 197 14.6% 17 13.6% 2032 372 23.5% 2 19.8% +89% 9 +74% 2050 401 22.7% 2 20.4% +104% 19 +107% Age 65-74 2012 109 8.1% 9 7.4% green line = 50-64 (WAS BLUE) 2032 194 12.3% 1 10.1% +78% 8 +64% red line = 65-74 (WAS PURPLE) 2050 166 9.4% 13 9.1% +52% 38 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 59 4.4% 18 blue line = 85+ (WAS RED) 4.2% 2032 127 8.0% 5 6.8% +114% 11 +94% 2050 131 7.4% 2 6.6% +120% 14 +116% Age 85+ 2012 28 2.1% 23 2.0% 2032 50 3.2% 8 2.9% +77% 19 +69% 2050 104 5.9% 1 4.8% +267% 13 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in New Hampshire as a Percentage of State Rank U.S. 2012 Population, by Age Group 3.0% 48 20.1% 400% Population (% of 2012 Population) Asian/Pacific Islander 350% State Rank U.S. 85+ 300% 0.6% 38 3.6% 250% Black 75-84 State Rank U.S. 200% 0.3% 45 8.5% 150% 65-74 Hispanic 100% 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 1.2% 35 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Hamps hire Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 48 19 48 People age 75+ living alone, 2010 34% 28 34% People age 60+ with grandchildren in household, 2010 3.3% 41 5.5% People age 60+ responsible for raising grandchildren, 2010 0.6% 49 1.6% Percent of age 65+ households with someone under 18, 2010 4.0% 42 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $37,119 15 $34,381 At/below poverty level age 65+, 2010 6.1% 49 9.0% At/below 250% of poverty level age 65+, 2010 36% 41 42% Women age 75+ at/below poverty level, 2010 10.3% 37 12.2% Women age 75+ at/below 250% of poverty level, 2010 52% 37 54% Bachelor level education or higher age 65+, 2010 25% 10 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 10 5.9% 47 8.8% Cognitive difficulty 10 6.1% 51 9.5% Any disability 54 32% 48 37% People age 18-64 with disabilities, 2010 Self-care difficulty 13 1.6% 30 1.8% Cognitive difficulty 35 4.2% 25 4.2% Any disability 77 9.1% 34 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 183,000 138 24 137 Economic value of family caregiving, 2009 . (state in millions of $) $2,200 $1,680 6 $1,460 Economic value per hour, 2009 $12.67 6 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.9 29 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 32,516 48 21 45 217 Public LTSS Expenditures New Hampshire Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,328 43 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 18% 42 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 41% 29 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in New Hampshire and the U.S., 2009 New Hampshire United States 25% Percentages may not add 4% to 100% due to rounding 82% 64% Aged/Disabled Waivers 14% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $382 $290 14 $261 Nursing facilities $315 $239 10 $168 HCBS $68 $51 33 $94 Aged/disabled waiver services $53 $41 16 $29 Personal care services (PCS) ** $6 $5 27 $45 Home health services $8 $6 29 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $607 $461 17 $413 Institutional services $357 $271 15 $232 HCBS $250 $190 18 $181 Waiver services (all populations) $236 $179 12 $114 Other HCBS (including PCS and home health) $14 $11 40 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $12 $9.25 7 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 218 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. New Hamps hire State Nursing facilities (NF), 2008 6,840 5.2 28 5.3 HCBS (older people and adults with PD), 2008 6,015 4.6 36 8.2 Aged/disabled waiver services 3,454 2.6 23 2.2 Personal care services (PCS) ** 21 0.0 30 3.0 Home health services 2,540 1.9 23 3.0 Institutional services (NF and ICF-MR), 2008 6,874 5.2 30 5.6 HCBS (all populations), 2008 9,088 6.9 35 10.1 Waiver services (all populations) 6,527 5.0 21 4.1 Other HCBS (including PCS and home health) 2,561 1.9 36 6.0 Adults with disabilities self-directing services, 2011 1,770 1.35 16 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 50 23 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 47% 35 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 57% 29 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $30,823 21 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $12,827 11 $10,957 Aged/disabled waiver services $12,781 14 $10,710 Personal care services ** $20,496 3 $11,142 Home health services $1,173 40 $5,495 ICF-MR services, 2008 $88,394 37 $123,053 MR/DD waiver services, 2008 $48,447 15 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $195 14 $178 Medicare payment per day for nursing facility care, 2010 $434 11 $398 Medicare reimbursement per home health visit, 2010 $163 27 $154 Private pay rate per day in nursing facility, 2011 $263 8 $193 Private pay rate per month in assisted living, 2011 $3,906 10 $3,261 Private pay daily rate for adult day care, 2011 $60 27 $60 Private pay hourly rate for home health aide, 2011 $24 5 $19 219 LTSS Resources New Hampshire Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 149 0.83 29 1.46 Assisted living and residential care units, 2010 4,899 27 27 31 Personal and home care aides, 2010 3,460 19 16 17 Median hourly wage, 2010 $10.49 10 $9.44 Home health aides, 2010 2,290 13 44 24 Median hourly wage, 2010 $10.84 13 $9.89 People receiving ACL congregate meals, 2009 * 14,441 82 13 42 People receiving ACL home delivered meals, 2009 * 10,980 63 2 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $14 $77 4 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 8 21 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 80 0.45 24 0.40 Nursing facility beds, 2010 7,742 43 25 42 Nursing facility residents, 2010 6,920 39 20 35 Nursing facility occupancy rate, 2010 89% 13 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.83 11 0.64 Nursing facility staffing turnover, 2010 33% 38 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 55% 1 46% Nursing facility residents with low care needs, 2008 19% 20 17% Residents with Medicaid as primary payer, 2010 64% 17 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 21% 30 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 8% 42 12% Long-stay residents with a hospital admission, 2008 14% 35 21% Long-term care facility beds per FTE ombudsman, 2010 2,471 23 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 26% 49 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 220 Trends New Hamps hire Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 2,625 1,270,155 with physical disabilities (excluding home health) 2008 3,475 1,577,471 % change +32% 23 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 7,062 1,460,185 2010 6,920 1,408,886 % change -2% 16 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $1,141 $285,710 2009 $1,328 $368,330 % change +16% 46 +29% Medicaid LTSS spending for older people and adults 2004 $293 $62,811 with physical disabilities (millions) 2009 $382 $80,181 % change +31% 15 +28% Medicaid nursing facility spending (millions) 2004 $255 $45,842 2009 $315 $51,403 % change +23% 10 +12% Medicaid HCBS spending for older people and adults 2004 $38 $16,969 with physical disabilities (millions) 2009 $68 $28,778 % change +80% 18 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 13% 38 27% people and adults with physical disabilities 2009 18% 42 36% change +5% 29 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $70 120% +$59 +104% $60 100% Millions of Dollars $50 +$44 80% $40 60% $30 +$27 +42% 40% +36% $20 +23% +24% $10 20% +$1 +$3 $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 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. 221 AARP Public Policy Institute New Jersey Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 8,771 11 315,311 2032 10,044 11 376,660 +15% 37 +19% 2050 11,370 11 434,447 +30% 37 +38% Age 50-64 2012 1,789 20.4% 13 19.2% 2032 1,733 17.3% 2 16.4% -3% 27 +2% 2050 2,032 17.9% 14 16.6% +14% 33 +19% Age 65+ 2012 1,258 14.3% 22 13.6% 2032 2,157 21.5% 9 19.8% +72% 20 +74% 2050 2,437 21.4% 10 20.4% +94% 25 +107% Age 65-74 2012 672 7.7% 21 7.4% green line = 50-64 (WAS BLUE) 2032 1,142 11.4% 6 10.1% +70% 14 +64% red line = 65-74 (WAS PURPLE) 2050 1,042 9.2% 20 9.1% +55% 30 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 390 4.4% 18 blue line = 85+ (WAS RED) 4.2% 2032 707 7.0% 21 6.8% +81% 39 +94% 2050 797 7.0% 5 6.6% +104% 23 +116% Age 85+ 2012 195 2.2% 16 2.0% 2032 308 3.1% 10 2.9% +58% 33 +69% 2050 597 5.3% 8 4.8% +206% 25 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in New Jersey as a Percentage of State Rank U.S. 2012 Population, by Age Group 23.2% 13 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 4.8% 7 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 9.7% 14 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 8.1% 9 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Jersey Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 46 31 48 People age 75+ living alone, 2010 34% 28 34% People age 60+ with grandchildren in household, 2010 6.7% 7 5.5% People age 60+ responsible for raising grandchildren, 2010 1.2% 36 1.6% Percent of age 65+ households with someone under 18, 2010 8.4% 9 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $41,452 4 $34,381 At/below poverty level age 65+, 2010 7.2% 39 9.0% At/below 250% of poverty level age 65+, 2010 34% 46 42% Women age 75+ at/below poverty level, 2010 9.1% 47 12.2% Women age 75+ at/below 250% of poverty level, 2010 45% 47 54% Bachelor level education or higher age 65+, 2010 23% 17 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 95 8.3% 21 8.8% Cognitive difficulty 95 8.3% 34 9.5% Any disability 375 33% 42 37% People age 18-64 with disabilities, 2010 Self-care difficulty 74 1.3% 46 1.8% Cognitive difficulty 163 3.0% 50 4.2% Any disability 398 7.3% 51 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,190,000 137 28 137 Economic value of family caregiving, 2009 . (state in millions of $) $13,200 $1,520 25 $1,460 Economic value per hour, 2009 $11.59 20 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.5 31 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 184,611 43 26 45 223 Public LTSS Expenditures New Jersey Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $9,928 11 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 21% 37 36% Medicaid HCBS spending as a % of LTSS spending, for all 26% 50 populations, 2009 * 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in New Jersey and the U.S., 2009 New Jersey United States 25% Percentages may not add 15% to 100% due to rounding 79% 64% Aged/Disabled Waivers 6% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $2,509 $287 16 $261 Nursing facilities $1,984 $227 11 $168 HCBS $524 $60 28 $94 Aged/disabled waiver services $152 $17 38 $29 Personal care services (PCS) ** $344 $39 13 $45 Home health services $27 $3 36 $16 Other HCBS *** $1 $0 22 $4 Medicaid LTSS expenditures for all populations, 2009 $4,457 $509 13 $413 Institutional services $3,311 $378 5 $232 HCBS $1,146 $131 35 $181 Waiver services (all populations) $774 $88 37 $114 Other HCBS (including PCS and home health) $372 $43 20 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $43 $4.93 17 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 224 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. New Jersey State Nursing facilities (NF), 2008 44,595 5.1 30 5.3 HCBS (older people and adults with PD), 2008 46,663 5.4 32 8.2 Aged/disabled waiver services 11,345 1.3 38 2.2 Personal care services (PCS) ** 20,623 2.4 21 3.0 Home health services 14,695 1.7 25 3.0 Institutional services (NF and ICF-MR), 2008 48,038 5.5 26 5.6 HCBS (all populations), 2008 60,322 6.9 35 10.1 Waiver services (all populations) 25,004 2.9 38 4.1 Other HCBS (including PCS and home health) 35,318 4.1 26 6.0 Adults with disabilities self-directing services, 2011 2,587 0.30 41 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 25 39 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 51% 27 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 56% 30 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $40,908 7 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $12,226 13 $10,957 Aged/disabled waiver services $12,384 17 $10,710 Personal care services ** $12,140 9 $11,142 Home health services $3,337 19 $5,495 ICF-MR services, 2008 $184,533 8 $123,053 MR/DD waiver services, 2008 $31,281 36 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $209 8 $178 Medicare payment per day for nursing facility care, 2010 $464 3 $398 Medicare reimbursement per home health visit, 2010 $180 12 $154 Private pay rate per day in nursing facility, 2011 $289 6 $193 Private pay rate per month in assisted living, 2011 $4,938 3 $3,261 Private pay daily rate for adult day care, 2011 $87 7 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 225 LTSS Resources New Jersey Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 302 0.25 50 1.46 Assisted living and residential care units, 2010 20,420 17 43 31 Personal and home care aides, 2010 9,600 8 38 17 Median hourly wage, 2010 $11.24 4 $9.44 Home health aides, 2010 29,550 25 13 24 Median hourly wage, 2010 $10.61 16 $9.89 People receiving ACL congregate meals, 2009 * 41,035 35 35 42 People receiving ACL home delivered meals, 2009 * 32,579 28 20 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $44 $38 22 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 7 24 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 365 0.31 38 0.40 Nursing facility beds, 2010 51,514 43 25 42 Nursing facility residents, 2010 45,837 39 20 35 Nursing facility occupancy rate, 2010 89% 13 83% Direct care nursing hours per resident day, 2010 3.7 36 3.8 RN hours per day, 2010 0.76 20 0.64 Nursing facility staffing turnover, 2010 29% 42 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 44% 37 46% Nursing facility residents with low care needs, 2008 19% 20 17% Residents with Medicaid as primary payer, 2010 63% 21 63% Residents with Medicare as primary payer, 2010 18% 5 14% Residents with “other” as primary payer, 2010 19% 36 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 15% 3 12% Long-stay residents with a hospital admission, 2008 27% 4 21% Long-term care facility beds per FTE ombudsman, 2010 2,891 20 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 42% 46 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 226 Trends New Jersey Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 26,618 1,270,155 with physical disabilities (excluding home health) 2008 31,968 1,577,471 % change +20% 30 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 45,566 1,460,185 2010 45,837 1,408,886 % change +1% 7 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $7,982 $285,710 2009 $9,928 $368,330 % change +24% 37 +29% Medicaid LTSS spending for older people and adults 2004 $1,943 $62,811 with physical disabilities (millions) 2009 $2,509 $80,181 % change +29% 16 +28% Medicaid nursing facility spending (millions) 2004 $1,480 $45,842 2009 $1,984 $51,403 % change +34% 3 +12% Medicaid HCBS spending for older people and adults 2004 $463 $16,969 with physical disabilities (millions) 2009 $524 $28,778 % change +13% 47 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 24% 17 27% people and adults with physical disabilities 2009 21% 37 36% change -3% 48 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $600 50% +47% +$505 45% $500 +38% 40% Millions of Dollars 35% +34% $400 30% +28% $300 25% 20% $200 +$164 15% +$144 10% $100 +$49 5% +3% +$12 $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 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. 227 AARP Public Policy Institute New Mexico Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 2,066 36 315,311 2032 2,572 36 376,660 +24% 16 +19% 2050 2,924 36 434,447 +41% 17 +38% Age 50-64 2012 391 18.9% 39 19.2% 2032 387 15.0% 43 16.4% -1% 24 +2% 2050 452 15.5% 44 16.6% +16% 29 +19% Age 65+ 2012 289 14.0% 29 13.6% 2032 498 19.4% 31 19.8% +73% 19 +74% 2050 584 20.0% 31 20.4% +102% 21 +107% Age 65-74 2012 158 7.6% 24 7.4% green line = 50-64 (WAS BLUE) 2032 241 9.4% 40 10.1% +52% 33 +64% red line = 65-74 (WAS PURPLE) 2050 261 8.9% 37 9.1% +65% 23 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 90 4.3% 26 blue line = 85+ (WAS RED) 4.2% 2032 178 6.9% 28 6.8% +98% 20 +94% 2050 178 6.1% 37 6.6% +98% 27 +116% Age 85+ 2012 41 2.0% 28 2.0% 2032 79 3.1% 10 2.9% +94% 10 +69% 2050 145 5.0% 13 4.8% +255% 16 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in New Mexico as a Percentage of State Rank U.S. 2012 Population, by Age Group 39.6% 3 20.1% 400% Population (% of 2012 Population) Asian/Pacific Islander 350% State Rank U.S. 85+ 300% 0.9% 29 3.6% 250% Black State Rank U.S. 200% 75-84 1.5% 38 8.5% 150% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 31.4% 1 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Mex ic o Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 55 7 48 People age 75+ living alone, 2010 29% 49 34% People age 60+ with grandchildren in household, 2010 5.5% 14 5.5% People age 60+ responsible for raising grandchildren, 2010 2.1% 8 1.6% Percent of age 65+ households with someone under 18, 2010 8.0% 12 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $33,447 27 $34,381 At/below poverty level age 65+, 2010 12.0% 3 9.0% At/below 250% of poverty level age 65+, 2010 47% 8 42% Women age 75+ at/below poverty level, 2010 15.1% 9 12.2% Women age 75+ at/below 250% of poverty level, 2010 58% 16 54% Bachelor level education or higher age 65+, 2010 25% 10 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 26 9.6% 10 8.8% Cognitive difficulty 29 10.9% 11 9.5% Any disability 112 41% 9 37% People age 18-64 with disabilities, 2010 Self-care difficulty 28 2.3% 9 1.8% Cognitive difficulty 60 4.8% 17 4.2% Any disability 140 11.3% 16 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 287,000 143 18 137 Economic value of family caregiving, 2009 . (state in millions of $) $3,100 $1,530 24 $1,460 Economic value per hour, 2009 $11.25 26 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.3 35 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 32,664 34 39 45 229 Public LTSS Expenditures New Mexico Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $3,257 32 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 71.35% 5 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * † 65% 1 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * † 75% 1 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in New Mexico and the U.S., 2009 New Mexico United States 25% Percentages may not add 48% to 100% due to rounding 64% Aged/Disabled Waivers 35% 11% PCS and other HCBS 16% Nursing Facilities Total Per Person LTSS & Home Health Expenditures † (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $491 $241 22 $261 Nursing facilities $174 $85 47 $168 HCBS $317 $156 5 $94 Aged/disabled waiver services $81 $40 17 $29 Personal care services (PCS) ** $226 $111 5 $45 Home health services $1 $0 48 $16 Other HCBS *** $10 $5 8 $4 Medicaid LTSS expenditures for all populations, 2009 $797 $391 23 $413 Institutional services $201 $99 47 $232 HCBS $596 $293 8 $181 Waiver services (all populations) $359 $176 13 $114 Other HCBS (including PCS and home health) $236 $116 8 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. † Because of inconsistencies in 2009 spending data for some services, 2008 data are used for New Mexico’s Medicaid LTSS expenditures. 230 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. New Mex ic o State Nursing facilities (NF), 2008 6,021 3.0 46 5.3 HCBS (older people and adults with PD), 2008 16,336 8.1 19 8.2 Aged/disabled waiver services 3,575 1.8 30 2.2 Personal care services (PCS) ** 12,365 6.1 4 3.0 Home health services 396 0.2 50 3.0 Institutional services (NF and ICF-MR), 2008 6,291 3.1 46 5.6 HCBS (all populations), 2008 21,575 10.7 21 10.1 Waiver services (all populations) 8,814 4.4 29 4.1 Other HCBS (including PCS and home health) 12,761 6.3 14 6.0 Adults with disabilities self-directing services, 2011 4,400 2.19 10 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 59 15 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 73% 7 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 77% 4 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,767 27 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $3,457 47 $10,957 Aged/disabled waiver services $15,416 8 $10,710 Personal care services ** $16,471 6 $11,142 Home health services $1,077 42 $5,495 ICF-MR services, 2008 $78,659 41 $123,053 MR/DD waiver services, 2008 $48,447 15 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $377 36 $398 Medicare reimbursement per home health visit, 2010 $154 33 $154 Private pay rate per day in nursing facility, 2011 $183 32 $193 Private pay rate per month in assisted living, 2011 $3,491 19 $3,261 Private pay daily rate for adult day care, 2011 $68 16 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 231 LTSS Resources New Mexico Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 254 0.93 27 1.46 Assisted living and residential care units, 2010 7,800 29 22 31 Personal and home care aides, 2010 16,340 60 3 17 Median hourly wage, 2010 $8.84 38 $9.44 Home health aides, 2010 8,100 30 9 24 Median hourly wage, 2010 $8.90 44 $9.89 People receiving ACL congregate meals, 2009 * 32,806 123 6 42 People receiving ACL home delivered meals, 2009 * 10,371 39 11 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $19 $73 7 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 NA NA Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 74 0.27 44 0.40 Nursing facility beds, 2010 7,112 26 45 42 Nursing facility residents, 2010 5,853 21 45 35 Nursing facility occupancy rate, 2010 82% 32 83% Direct care nursing hours per resident day, 2010 3.4 49 3.8 RN hours per day, 2010 0.65 30 0.64 Nursing facility staffing turnover, 2010 70% 3 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 46% 28 46% Nursing facility residents with low care needs, 2008 21% 11 17% Residents with Medicaid as primary payer, 2010 64% 17 63% Residents with Medicare as primary payer, 2010 13% 31 14% Residents with “other” as primary payer, 2010 23% 19 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 5% 9 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 14% 35 21% Long-term care facility beds per FTE ombudsman, 2010 1,317 40 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 232 Trends New Mex ic o Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 11,204 1,270,155 with physical disabilities (excluding home health) 2008 15,940 1,577,471 % change +42% 17 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 6,163 1,460,185 2010 5,853 1,408,886 % change -5% 30 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $2,241 $285,710 2009 $3,257 $368,330 % change +45% 8 +29% Medicaid LTSS spending for older people and adults 2004 $400 $62,811 with physical disabilities (millions) 2009 $491 $80,181 % change +23% 31 +28% Medicaid nursing facility spending (millions) 2004 $180 $45,842 2009 $174 $51,403 % change -3% 42 +12% Medicaid HCBS spending for older people and adults 2004 $220 $16,969 with physical disabilities (millions) 2009 $317 $28,778 % change +44% 31 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 55% 1 27% people and adults with physical disabilities 2009 65% 1 36% change +10% 12 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $90 100% +$80 +89% $80 $70 80% +$59 Millions of Dollars $60 60% $50 $40 +$38 +41% 40% +33% $30 $20 20% $10 +10% +$2 $0 0% -$10 -$6 -3% -$20 -20% 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 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. 233 AARP Public Policy Institute New York Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 19,595 3 315,311 2032 22,147 4 376,660 +13% 41 +19% 2050 24,594 4 434,447 +26% 43 +38% Age 50-64 2012 3,949 20.2% 15 19.2% 2032 3,904 17.6% 1 16.4% -1% 24 +2% 2050 4,458 18.1% 10 16.6% +13% 37 +19% Age 65+ 2012 2,782 14.2% 23 13.6% 2032 4,525 20.4% 22 19.8% +63% 36 +74% 2050 5,155 21.0% 14 20.4% +85% 33 +107% Age 65-74 2012 1,491 7.6% 24 7.4% green line = 50-64 (WAS BLUE) 2032 2,408 10.9% 11 10.1% +61% 23 +64% red line = 65-74 (WAS PURPLE) 2050 2,377 9.7% 6 9.1% +59% 26 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 860 4.4% 18 blue line = 85+ (WAS RED) 4.2% 2032 1,490 6.7% 35 6.8% +73% 47 +94% 2050 1,630 6.6% 18 6.6% +89% 31 +116% Age 85+ 2012 431 2.2% 16 2.0% 2032 627 2.8% 34 2.9% +46% 42 +69% 2050 1,148 4.7% 30 4.8% +167% 42 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in New York as a Percentage of State Rank U.S. 2012 Population, by Age Group 27.0% 7 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% 85+ State Rank U.S. 5.0% 6 3.6% 200% 65-74 Black 150% State Rank U.S. 75-84 12.1% 11 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 9.6% 7 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 65-74 50-64 234 75-84 Population & Characteristics New York Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 46 31 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 6.2% 11 5.5% People age 60+ responsible for raising grandchildren, 2010 1.3% 30 1.6% Percent of age 65+ households with someone under 18, 2010 8.7% 8 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $34,518 21 $34,381 At/below poverty level age 65+, 2010 10.9% 8 9.0% At/below 250% of poverty level age 65+, 2010 42% 23 42% Women age 75+ at/below poverty level, 2010 14.0% 12 12.2% Women age 75+ at/below 250% of poverty level, 2010 54% 31 54% Bachelor level education or higher age 65+, 2010 23% 17 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 222 8.8% 16 8.8% Cognitive difficulty 226 9.0% 25 9.5% Any disability 858 34% 35 37% People age 18-64 with disabilities, 2010 Self-care difficulty 180 1.5% 33 1.8% Cognitive difficulty 402 3.3% 44 4.2% Any disability 1,012 8.2% 42 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 2,800,000 143 18 137 Economic value of family caregiving, 2009 . (state in millions of $) $32,000 $1,630 10 $1,460 Economic value per hour, 2009 $11.85 14 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 1.5 50 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 348,203 38 33 45 235 Public LTSS Expenditures New York Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $49,719 1 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 41% 14 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 46% 17 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in New York and the U.S., 2009 New York United States 25% Percentages may not add 41% to 100% due to rounding 59% 64% Aged/Disabled Waivers 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $13,053 $676 1 $261 Nursing facilities $7,675 $398 1 $168 HCBS $5,377 $279 1 $94 Aged/disabled waiver services $40 $2 49 $29 Personal care services (PCS) ** $3,332 $173 1 $45 Home health services $1,848 $96 1 $16 Other HCBS *** $157 $8 6 $4 Medicaid LTSS expenditures for all populations, 2009 $22,236 $1,152 1 $413 Institutional services $11,977 $620 1 $232 HCBS $10,258 $531 1 $181 Waiver services (all populations) $4,921 $255 5 $114 Other HCBS (including PCS and home health) $5,337 $276 2 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $115 $5.96 12 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 236 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. New York State Nursing facilities (NF), 2008 212,714 11.1 2 5.3 HCBS (older people and adults with PD), 2008 212,020 11.0 8 8.2 Aged/disabled waiver services 24,140 1.3 38 2.2 Personal care services (PCS) ** 78,494 4.1 10 3.0 Home health services 109,386 5.7 6 3.0 Institutional services (NF and ICF-MR), 2008 221,828 11.5 1 5.6 HCBS (all populations), 2008 276,868 14.4 5 10.1 Waiver services (all populations) 88,988 4.6 26 4.1 Other HCBS (including PCS and home health) 187,880 9.8 6 6.0 Adults with disabilities self-directing services, 2011 10,252 0.53 34 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 11 47 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 50% 29 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 56% 30 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $34,175 11 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $23,177 1 $10,957 Aged/disabled waiver services $1,484 49 $10,710 Personal care services ** $29,848 1 $11,142 Home health services $16,846 2 $5,495 ICF-MR services, 2008 $384,582 1 $123,053 MR/DD waiver services, 2008 $77,992 2 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $220 6 $178 Medicare payment per day for nursing facility care, 2010 $417 23 $398 Medicare reimbursement per home health visit, 2010 $131 48 $154 Private pay rate per day in nursing facility, 2011 $315 4 $193 Private pay rate per month in assisted living, 2011 $3,660 13 $3,261 Private pay daily rate for adult day care, 2011 $48 47 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 237 LTSS Resources New York Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 1,000 0.38 45 1.46 Assisted living and residential care units, 2010 40,670 15 44 31 Personal and home care aides, 2010 101,530 39 5 17 Median hourly wage, 2010 $10.29 15 $9.44 Home health aides, 2010 137,830 52 3 24 Median hourly wage, 2010 $10.36 20 $9.89 People receiving ACL congregate meals, 2009 * 147,255 57 23 42 People receiving ACL home delivered meals, 2009 * 58,362 23 29 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $189 $73 7 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 11 16 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 646 0.25 47 0.40 Nursing facility beds, 2010 119,184 45 21 42 Nursing facility residents, 2010 109,909 42 17 35 Nursing facility occupancy rate, 2010 92% 4 83% Direct care nursing hours per resident day, 2010 3.7 36 3.8 RN hours per day, 2010 0.62 38 0.64 Nursing facility staffing turnover, 2010 20% 49 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 49% 17 46% Nursing facility residents with low care needs, 2008 13% 35 17% Residents with Medicaid as primary payer, 2010 71% 7 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 17% 44 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 13% 6 12% Long-stay residents with a hospital admission, 2008 20% 18 21% Long-term care facility beds per FTE ombudsman, 2010 3,934 10 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 79% 30 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 238 Trends New York Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 105,289 1,270,155 with physical disabilities (excluding home health) 2008 102,634 1,577,471 % change -3% 45 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 113,278 1,460,185 2010 109,909 1,408,886 % change -3% 24 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $41,452 $285,710 2009 $49,719 $368,330 % change +20% 42 +29% Medicaid LTSS spending for older people and adults 2004 $10,215 $62,811 with physical disabilities (millions) 2009 $13,053 $80,181 % change +28% 21 +28% Medicaid nursing facility spending (millions) 2004 $6,487 $45,842 2009 $7,675 $51,403 % change +18% 18 +12% Medicaid HCBS spending for older people and adults 2004 $3,728 $16,969 with physical disabilities (millions) 2009 $5,377 $28,778 % change +44% 31 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 36% 9 27% people and adults with physical disabilities 2009 41% 14 36% change +5% 29 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $1,800 +$1,702 60% +47% $1,600 +41% +$1,391 40% $1,400 +$1,188 +17% +18% Millions of Dollars $1,200 20% $1,000 0% $800 -20% $600 +$474 $400 -40% $200 -60% -56% $0 -$52 -80% -$200 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 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. 239 AARP Public Policy Institute North Carolina Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 9,848 9 315,311 2032 12,265 9 376,660 +25% 14 +19% 2050 14,537 8 434,447 +48% 9 +38% Age 50-64 2012 1,839 18.7% 40 19.2% 2032 1,949 15.9% 34 16.4% +6% 11 +2% 2050 2,274 15.6% 41 16.6% +24% 16 +19% Age 65+ 2012 1,321 13.4% 36 13.6% 2032 2,331 19.0% 38 19.8% +76% 16 +74% 2050 2,811 19.3% 44 20.4% +113% 14 +107% Age 65-74 2012 743 7.5% 28 7.4% green line = 50-64 (WAS BLUE) 2032 1,185 9.7% 33 10.1% +60% 24 +64% red line = 65-74 (WAS PURPLE) 2050 1,226 8.4% 46 9.1% +65% 23 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 402 4.1% 36 blue line = 85+ (WAS RED) 4.2% 2032 800 6.5% 39 6.8% +99% 19 +94% 2050 934 6.4% 25 6.6% +132% 13 +116% Age 85+ 2012 176 1.8% 38 2.0% 2032 347 2.8% 34 2.9% +97% 9 +69% 2050 651 4.5% 38 4.8% +269% 12 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in North Carolina as a Percentage of State Rank U.S. 2012 Population, by Age Group 19.3% 19 20.1% 450% Population (% of 2012 Population) Asian/Pacific Islander 400% 85+ State Rank U.S. 350% 0.9% 29 3.6% 300% Black 250% State Rank U.S. 200% 75-84 15.8% 8 8.5% 150% 65-74 Hispanic 100% 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 1.3% 33 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Carolina Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 43 45 48 People age 75+ living alone, 2010 34% 28 34% People age 60+ with grandchildren in household, 2010 4.6% 26 5.5% People age 60+ responsible for raising grandchildren, 2010 1.8% 17 1.6% Percent of age 65+ households with someone under 18, 2010 5.5% 26 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $31,694 37 $34,381 At/below poverty level age 65+, 2010 9.9% 13 9.0% At/below 250% of poverty level age 65+, 2010 45% 12 42% Women age 75+ at/below poverty level, 2010 14.1% 11 12.2% Women age 75+ at/below 250% of poverty level, 2010 57% 23 54% Bachelor level education or higher age 65+, 2010 20% 28 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 111 9.2% 12 8.8% Cognitive difficulty 125 10.4% 14 9.5% Any disability 460 38% 14 37% People age 18-64 with disabilities, 2010 Self-care difficulty 124 2.1% 13 1.8% Cognitive difficulty 272 4.6% 20 4.2% Any disability 673 11.4% 14 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,180,000 126 41 137 Economic value of family caregiving, 2009 . (state in millions of $) $11,700 $1,250 49 $1,460 Economic value per hour, 2009 $10.37 38 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.5 31 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 183,514 41 28 45 241 Public LTSS Expenditures North Carolina Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $11,490 9 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 65.13% 16 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 43% 12 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 43% 22 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in North Carolina and the U.S., 2009 North Carolina United States 25% Percentages may not add 30% to 100% due to rounding 57% 64% Aged/Disabled Waivers 11% 12% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $2,256 $239 23 $261 Nursing facilities $1,292 $137 34 $168 HCBS $964 $102 13 $94 Aged/disabled waiver services $277 $29 28 $29 Personal care services (PCS) ** $526 $56 9 $45 Home health services $161 $17 11 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $3,576 $378 25 $413 Institutional services $2,046 $216 23 $232 HCBS $1,530 $162 23 $181 Waiver services (all populations) $844 $89 36 $114 Other HCBS (including PCS and home health) $687 $73 10 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $39 $4.14 21 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 242 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Nor th Carolina State Nursing facilities (NF), 2008 41,234 4.4 32 5.3 HCBS (older people and adults with PD), 2008 104,983 11.3 7 8.2 Aged/disabled waiver services 14,579 1.6 32 2.2 Personal care services (PCS) ** 50,017 5.4 6 3.0 Home health services 40,387 4.3 8 3.0 Institutional services (NF and ICF-MR), 2008 45,419 4.9 31 5.6 HCBS (all populations), 2008 115,793 12.4 11 10.1 Waiver services (all populations) 25,389 2.7 43 4.1 Other HCBS (including PCS and home health) 90,404 9.7 7 6.0 Adults with disabilities self-directing services, 2011 70 0.01 50 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 35 33 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 72% 8 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 72% 9 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $26,210 37 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $8,975 27 $10,957 Aged/disabled waiver services $18,037 3 $10,710 Personal care services ** $6,333 21 $11,142 Home health services $3,251 21 $5,495 ICF-MR services, 2008 $111,333 24 $123,053 MR/DD waiver services, 2008 $43,520 23 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $356 39 $398 Medicare reimbursement per home health visit, 2010 $178 14 $154 Private pay rate per day in nursing facility, 2011 $183 32 $193 Private pay rate per month in assisted living, 2011 $2,800 42 $3,261 Private pay daily rate for adult day care, 2011 $48 47 $60 Private pay hourly rate for home health aide, 2011 $19 31 $19 243 LTSS Resources North Carolina Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 1,277 1.03 23 1.46 Assisted living and residential care units, 2010 42,458 34 15 31 Personal and home care aides, 2010 11,880 10 34 17 Median hourly wage, 2010 $9.03 33 $9.44 Home health aides, 2010 67,190 54 1 24 Median hourly wage, 2010 $9.25 40 $9.89 People receiving ACL congregate meals, 2009 * 28,369 23 43 42 People receiving ACL home delivered meals, 2009 * 19,631 16 38 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $24 $20 48 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 6 26 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 431 0.35 33 0.40 Nursing facility beds, 2010 44,230 36 34 42 Nursing facility residents, 2010 37,736 30 35 35 Nursing facility occupancy rate, 2010 85% 26 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.65 30 0.64 Nursing facility staffing turnover, 2010 43% 19 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 45% 31 46% Nursing facility residents with low care needs, 2008 12% 39 17% Residents with Medicaid as primary payer, 2010 67% 9 63% Residents with Medicare as primary payer, 2010 16% 12 14% Residents with “other” as primary payer, 2010 17% 44 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 19% 23 21% Long-term care facility beds per FTE ombudsman, 2010 2,368 26 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 63% 35 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 244 Trends Nor th Carolina Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 44,628 1,270,155 with physical disabilities (excluding home health) 2008 64,596 1,577,471 % change +45% 15 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 38,421 1,460,185 2010 37,736 1,408,886 % change -2% 16 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $8,380 $285,710 2009 $11,490 $368,330 % change +37% 14 +29% Medicaid LTSS spending for older people and adults 2004 $1,790 $62,811 with physical disabilities (millions) 2009 $2,256 $80,181 % change +26% 26 +28% Medicaid nursing facility spending (millions) 2004 $1,118 $45,842 2009 $1,292 $51,403 % change +16% 21 +12% Medicaid HCBS spending for older people and adults 2004 $672 $16,969 with physical disabilities (millions) 2009 $964 $28,778 % change +43% 33 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 38% 7 27% people and adults with physical disabilities 2009 43% 12 36% change +5% 29 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service 300$ 120% +$257 250$ 100% +96% +$223 Millions of Dollars 200$ 80% +$174 150$ 60% +48% 100$ 40% +33% +$72 +$69 50$ 20% +16% +16% 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 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. 245 AARP Public Policy Institute North Dakota Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 673 48 315,311 2032 851 48 376,660 +27% 11 +19% 2050 947 48 434,447 +41% 17 +38% Age 50-64 2012 130 19.3% 31 19.2% 2032 120 14.1% 50 16.4% -8% 39 +2% 2050 167 17.7% 16 16.6% +29% 9 +19% Age 65+ 2012 98 14.6% 17 13.6% 2032 156 18.3% 44 19.8% +59% 41 +74% 2050 179 18.9% 47 20.4% +83% 34 +107% Age 65-74 2012 48 7.1% 39 7.4% green line = 50-64 (WAS BLUE) 2032 78 9.1% 44 10.1% +63% 20 +64% red line = 65-74 (WAS PURPLE) 2050 85 9.0% 33 9.1% +78% 13 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 32 4.7% 7 blue line = 85+ (WAS RED) 4.2% 2032 56 6.6% 37 6.8% +77% 43 +94% 2050 53 5.6% 48 6.6% +66% 49 +116% Age 85+ 2012 18 2.7% 3 2.0% 2032 21 2.5% 43 2.9% +17% 51 +69% 2050 42 4.4% 41 4.8% +127% 51 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in North Dakota as a Percentage of State Rank U.S. 2012 Population, by Age Group 3.2% 47 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% State Rank U.S. 65-74 0.0% 50 3.6% 200% 85+ Black 150% 75-84 State Rank U.S. 0.0% 50 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 0.7% 73 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 65-74 50-64 246 75-84 Population & Characteristics Nor th Dakota Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 49 15 48 People age 75+ living alone, 2010 37% 9 34% People age 60+ with grandchildren in household, 2010 1.4% 51 5.5% People age 60+ responsible for raising grandchildren, 2010 0.6% 49 1.6% Percent of age 65+ households with someone under 18, 2010 2.8% 49 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $30,669 43 $34,381 At/below poverty level age 65+, 2010 12.1% 2 9.0% At/below 250% of poverty level age 65+, 2010 45% 12 42% Women age 75+ at/below poverty level, 2010 20.6% 1 12.2% Women age 75+ at/below 250% of poverty level, 2010 64% 1 54% Bachelor level education or higher age 65+, 2010 15% 46 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 5 4.9% 50 8.8% Cognitive difficulty 6 6.5% 50 9.5% Any disability 32 35% 31 37% People age 18-64 with disabilities, 2010 Self-care difficulty 5 1.1% 50 1.8% Cognitive difficulty 12 2.8% 51 4.2% Any disability 32 7.6% 49 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 75,000 115 47 137 Economic value of family caregiving, 2009 . (state in millions of $) $830 $1,290 43 $1,460 Economic value per hour, 2009 $11.68 18 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 2.3 47 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 32,337 103 5 45 247 Public LTSS Expenditures North Dakota Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $590 50 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 63.01% 24 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 10% 51 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 29% 49 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in North Dakota and the U.S., 2009 North Dakota United States 25% Percentages may not add to 100% due to rounding 9% 90% 64% Aged/Disabled Waivers 2% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $192 $289 15 $261 Nursing facilities $172 $259 7 $168 HCBS $20 $29 49 $94 Aged/disabled waiver services $3 $5 46 $29 Personal care services (PCS) ** $14 $21 21 $45 Home health services $1 $2 42 $16 Other HCBS *** $1 $1 15 $4 Medicaid LTSS expenditures for all populations, 2009 $370 $557 8 $413 Institutional services $263 $396 4 $232 HCBS $107 $161 24 $181 Waiver services (all populations) $91 $137 20 $114 Other HCBS (including PCS and home health) $16 $24 28 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $1 $1.20 36 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 248 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Nor th Dakota State Nursing facilities (NF), 2008 5,505 8.4 5 5.3 HCBS (older people and adults with PD), 2008 3,079 4.7 35 8.2 Aged/disabled waiver services 361 0.5 47 2.2 Personal care services (PCS) ** 1,853 2.8 16 3.0 Home health services 865 1.3 32 3.0 Institutional services (NF and ICF-MR), 2008 6,160 9.4 4 5.6 HCBS (all populations), 2008 6,614 10.1 22 10.1 Waiver services (all populations) 3,896 5.9 14 4.1 Other HCBS (including PCS and home health) 2,718 4.1 26 6.0 Adults with disabilities self-directing services, 2011 432 0.66 32 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 7 49 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 36% 44 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 52% 34 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $30,907 19 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $1,067 49 $10,957 Aged/disabled waiver services $6,543 40 $10,710 Personal care services ** $6,675 20 $11,142 Home health services $6,648 8 $5,495 ICF-MR services, 2008 $107,602 27 $123,053 MR/DD waiver services, 2008 $21,949 46 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $206 11 $178 Medicare payment per day for nursing facility care, 2010 $383 32 $398 Medicare reimbursement per home health visit, 2010 $140 42 $154 Private pay rate per day in nursing facility, 2011 $188 29 $193 Private pay rate per month in assisted living, 2011 $2,500 49 $3,261 Private pay daily rate for adult day care, 2011 $67 18 $60 Private pay hourly rate for home health aide, 2011 $23 6 $19 249 LTSS Resources North Dakota Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 181 1.85 13 1.46 Assisted living and residential care units, 2010 3,562 36 11 31 Personal and home care aides, 2010 NA NA NA 17 Median hourly wage, 2010 $10.08 18 $9.44 Home health aides, 2010 1,950 20 24 24 Median hourly wage, 2010 $11.05 10 $9.89 People receiving ACL congregate meals, 2009 * 13,910 144 5 42 People receiving ACL home delivered meals, 2009 * 5,364 56 4 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $9 $89 3 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 13 13 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 88 0.90 5 0.40 Nursing facility beds, 2010 6,536 67 2 42 Nursing facility residents, 2010 5,722 58 1 35 Nursing facility occupancy rate, 2010 88% 16 83% Direct care nursing hours per resident day, 2010 4.1 9 3.8 RN hours per day, 2010 0.72 22 0.64 Nursing facility staffing turnover, 2010 29% 42 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 54% 6 46% Nursing facility residents with low care needs, 2008 19% 20 17% Residents with Medicaid as primary payer, 2010 53% 49 63% Residents with Medicare as primary payer, 2010 7% 51 14% Residents with “other” as primary payer, 2010 39% 2 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 7% 47 12% Long-stay residents with a hospital admission, 2008 13% 39 21% Long-term care facility beds per FTE ombudsman, 2010 3,555 14 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 82% 27 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 250 Trends Nor th Dakota Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 986 1,270,155 with physical disabilities (excluding home health) 2008 2,214 1,577,471 % change +125% 4 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 5,944 1,460,185 2010 5,722 1,408,886 % change -4% 27 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $490 $285,710 2009 $590 $368,330 % change +20% 42 +29% Medicaid LTSS spending for older people and adults 2004 $175 $62,811 with physical disabilities (millions) 2009 $192 $80,181 % change +10% 41 +28% Medicaid nursing facility spending (millions) 2004 $164 $45,842 2009 $172 $51,403 % change +5% 36 +12% Medicaid HCBS spending for older people and adults 2004 $11 $16,969 with physical disabilities (millions) 2009 $20 $28,778 % change +84% 17 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 6% 49 27% people and adults with physical disabilities 2009 10% 51 36% change +4% 37 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $40 400% +356% $35 +$34 350% $30 300% +$25 Millions of Dollars $25 250% $20 200% $15 +$8 +$13 150% $10 100% +63% +47% $5 50% +5% $0 0% -$5 -$4 -50% -52% -$10 -100% 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 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. 251 AARP Public Policy Institute Ohio Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 11,554 7 315,311 2032 12,452 8 376,660 +8% 48 +19% 2050 14,103 9 434,447 +22% 48 +38% Age 50-64 2012 2,392 20.7% 9 19.2% 2032 2,127 17.1% 6 16.4% -11% 43 +2% 2050 2,540 18.0% 12 16.6% +6% 44 +19% Age 65+ 2012 1,703 14.7% 14 13.6% 2032 2,685 21.6% 8 19.8% +58% 43 +74% 2050 2,900 20.6% 18 20.4% +70% 47 +107% Age 65-74 2012 907 7.9% 15 7.4% green line = 50-64 (WAS BLUE) 2032 1,362 10.9% 11 10.1% +50% 38 +64% red line = 65-74 (WAS PURPLE) 2050 1,300 9.2% 20 9.1% +43% 43 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 536 4.6% 10 blue line = 85+ (WAS RED) 4.2% 2032 936 7.5% 9 6.8% +75% 45 +94% 2050 912 6.5% 22 6.6% +70% 47 +116% Age 85+ 2012 260 2.3% 10 2.0% 2032 388 3.1% 10 2.9% +49% 40 +69% 2050 688 4.9% 18 4.8% +165% 45 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Ohio as a Percentage of State Rank U.S. 2012 Population, by Age Group 10.9% 29 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% State Rank U.S. 85+ 0.8% 33 3.6% 200% 65-74 Black 150% State Rank U.S. 75-84 8.5% 17 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 1.0% 37 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 65-74 50-64 252 75-84 Population & Characteristics Living Arrangements State Rank U.S. Ohio Men per 100 women age 85+, 2010 46 31 48 People age 75+ living alone, 2010 36% 11 34% People age 60+ with grandchildren in household, 2010 3.9% 32 5.5% People age 60+ responsible for raising grandchildren, 2010 1.3% 30 1.6% Percent of age 65+ households with someone under 18, 2010 4.8% 35 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $31,798 36 $34,381 At/below poverty level age 65+, 2010 7.7% 31 9.0% At/below 250% of poverty level age 65+, 2010 44% 17 42% Women age 75+ at/below poverty level, 2010 10.4% 36 12.2% Women age 75+ at/below 250% of poverty level, 2010 59% 13 54% Bachelor level education or higher age 65+, 2010 17% 38 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 123 7.9% 26 8.8% Cognitive difficulty 137 8.8% 27 9.5% Any disability 569 36% 27 37% People age 18-64 with disabilities, 2010 Self-care difficulty 140 2.0% 14 1.8% Cognitive difficulty 350 4.9% 16 4.2% Any disability 804 11.4% 14 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,660,000 144 16 137 Economic value of family caregiving, 2009 . (state in millions of $) $17,500 $1,520 25 $1,460 Economic value per hour, 2009 $11.03 29 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.5 31 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 216,142 39 31 45 253 Public LTSS Expenditures Ohio Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $14,080 6 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 63.42% 22 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 24% 32 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 33% 41 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Ohio and the U.S., 2009 Ohio United States 25% Percentages may not add 6% to 100% due to rounding 76% 64% Aged/Disabled Waivers 11% 18% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $3,382 $293 12 $261 Nursing facilities $2,565 $222 12 $168 HCBS $818 $71 23 $94 Aged/disabled waiver services $607 $53 10 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $188 $16 12 $16 Other HCBS *** $22 $2 11 $4 Medicaid LTSS expenditures for all populations, 2009 $5,691 $494 14 $413 Institutional services $3,839 $333 8 $232 HCBS $1,852 $161 24 $181 Waiver services (all populations) $1,642 $142 17 $114 Other HCBS (including PCS and home health) $210 $18 32 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $12 1.00 38 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 254 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. Nursing facilities (NF), 2008 83,530 7.3 9 5.3 HCBS (older people and adults with PD), 2008 76,001 6.6 27 8.2 Ohio Aged/disabled waiver services 44,693 3.9 12 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 31,308 2.7 13 3.0 Institutional services (NF and ICF-MR), 2008 91,274 7.9 8 5.6 HCBS (all populations), 2008 96,932 8.4 27 10.1 Waiver services (all populations) 65,624 5.7 15 4.1 Other HCBS (including PCS and home health) 31,308 2.7 30 6.0 Adults with disabilities self-directing services, 2011 1,082 0.09 47 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 54 20 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 48% 33 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 52% 34 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $30,535 22 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $12,612 12 $10,957 Aged/disabled waiver services $12,612 15 $10,710 Personal care services ** NA NA $11,142 Home health services $4,787 12 $5,495 ICF-MR services, 2008 $96,287 32 $123,053 MR/DD waiver services, 2008 $40,889 25 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $177 21 $178 Medicare payment per day for nursing facility care, 2010 $378 34 $398 Medicare reimbursement per home health visit, 2010 $146 39 $154 Private pay rate per day in nursing facility, 2011 $190 27 $193 Private pay rate per month in assisted living, 2011 $3,325 23 $3,261 Private pay daily rate for adult day care, 2011 $50 42 $60 Private pay hourly rate for home health aide, 2011 $18 37 $19 255 LTSS Resources Ohio Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 1,378 0.85 28 1.46 Assisted living and residential care units, 2010 49,405 30 19 31 Personal and home care aides, 2010 12,140 7 42 17 Median hourly wage, 2010 $9.48 29 $9.44 Home health aides, 2010 67,140 41 5 24 Median hourly wage, 2010 $9.36 39 $9.89 People receiving ACL congregate meals, 2009 * 54,401 34 36 42 People receiving ACL home delivered meals, 2009 * 33,901 21 30 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $51 $32 30 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 7 24 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 980 0.60 9 0.40 Nursing facility beds, 2010 93,445 57 14 42 Nursing facility residents, 2010 79,658 49 8 35 Nursing facility occupancy rate, 2010 85% 26 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.66 29 0.64 Nursing facility staffing turnover, 2010 37% 28 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 45% 31 46% Nursing facility residents with low care needs, 2008 14% 31 17% Residents with Medicaid as primary payer, 2010 63% 21 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 25% 16 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 5% 9 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 19% 23 21% Long-term care facility beds per FTE ombudsman, 2010 1,682 33 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 54% 40 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 256 Trends Medicaid HCBS Utilization Year State Rank U.S. Ohio Medicaid HCBS participants, older people and adults 2003 31,903 1,270,155 with physical disabilities (excluding home health) 2008 44,693 1,577,471 % change +40% 19 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 82,209 1,460,185 2010 79,658 1,408,886 % change -3% 24 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $11,516 $285,710 2009 $14,080 $368,330 % change +22% 39 +29% Medicaid LTSS spending for older people and adults 2004 $3,299 $62,811 with physical disabilities (millions) 2009 $3,382 $80,181 % change +3% 45 +28% Medicaid nursing facility spending (millions) 2004 $2,726 $45,842 2009 $2,565 $51,403 % change -6% 45 +12% Medicaid HCBS spending for older people and adults 2004 $573 $16,969 with physical disabilities (millions) 2009 $818 $28,778 % change +43% 33 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 17% 33 27% people and adults with physical disabilities 2009 24% 32 36% change +7% 21 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $700 140% +125% $600 +$575 120% $500 100% Millions of Dollars $400 80% $300 +$184 60% $200 +43% +41% 40% $100 +$61 20% $0 -$100 0% -6% -$200 -$164 -20% -$161 -18% -$300 -40% 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 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. 257 AARP Public Policy Institute Oklahoma Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 3,777 28 315,311 2032 4,244 28 376,660 +12% 43 +19% 2050 4,784 29 434,447 +27% 42 +38% Age 50-64 2012 703 18.6% 42 19.2% 2032 671 15.8% 36 16.4% -5% 31 +2% 2050 805 16.8% 28 16.6% +14% 33 +19% Age 65+ 2012 535 14.2% 23 13.6% 2032 836 19.7% 28 19.8% +56% 45 +74% 2050 965 20.2% 28 20.4% +80% 38 +107% Age 65-74 2012 291 7.7% 21 7.4% green line = 50-64 (WAS BLUE) 2032 411 9.7% 33 10.1% +41% 49 +64% red line = 65-74 (WAS PURPLE) 2050 448 9.4% 13 9.1% +54% 31 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 167 4.4% 18 blue line = 85+ (WAS RED) 4.2% 2032 294 6.9% 28 6.8% +77% 43 +94% 2050 292 6.1% 37 6.6% +75% 44 +116% Age 85+ 2012 77 2.0% 28 2.0% 2032 131 3.1% 10 2.9% +70% 27 +69% 2050 226 4.7% 30 4.8% +192% 32 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Oklahoma as a Percentage of State Rank U.S. 2012 Population, by Age Group 14.8% 23 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 1.1% 25 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 4.3% 27 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 1.7% 29 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Oklahoma Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 49 15 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 3.9% 32 5.5% People age 60+ responsible for raising grandchildren, 2010 1.7% 22 1.6% Percent of age 65+ households with someone under 18, 2010 4.8% 35 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $31,486 39 $34,381 At/below poverty level age 65+, 2010 9.3% 20 9.0% At/below 250% of poverty level age 65+, 2010 46% 10 42% Women age 75+ at/below poverty level, 2010 12.9% 19 12.2% Women age 75+ at/below 250% of poverty level, 2010 58% 16 54% Bachelor level education or higher age 65+, 2010 18% 35 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 45 9.1% 13 8.8% Cognitive difficulty 51 10.3% 15 9.5% Any disability 212 43% 3 37% People age 18-64 with disabilities, 2010 Self-care difficulty 52 2.3% 9 1.8% Cognitive difficulty 129 5.7% 8 4.2% Any disability 323 14.3% 6 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 596,000 162 8 137 Economic value of family caregiving, 2009 . (state in millions of $) $6,000 $1,610 12 $1,460 Economic value per hour, 2009 $10.44 36 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 5.0 15 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 56,960 33 45 45 259 Public LTSS Expenditures Oklahoma Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $3,936 27 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 64.43% 20 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 32% 22 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 42% 24 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Oklahoma and the U.S., 2009 Oklahoma United States 25% Percentages may not add to 100% due to rounding 4% 68% 64% Aged/Disabled Waivers 11% 28% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $783 $211 34 $261 Nursing facilities $530 $142 33 $168 HCBS $254 $68 24 $94 Aged/disabled waiver services $222 $60 8 $29 Personal care services (PCS) ** $12 $3 28 $45 Home health services $19 $5 31 $16 Other HCBS *** $1 $0 22 $4 Medicaid LTSS expenditures for all populations, 2009 $1,298 $349 33 $413 Institutional services $759 $204 30 $232 HCBS $539 $145 30 $181 Waiver services (all populations) $508 $137 20 $114 Other HCBS (including PCS and home health) $31 $8 43 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $3 $0.69 39 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 260 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Oklahoma State Nursing facilities (NF), 2008 21,376 5.8 20 5.3 HCBS (older people and adults with PD), 2008 34,015 9.3 15 8.2 Aged/disabled waiver services 25,687 7.0 3 2.2 Personal care services (PCS) ** 3,327 0.9 26 3.0 Home health services 5,001 1.4 28 3.0 Institutional services (NF and ICF-MR), 2008 23,127 6.3 21 5.6 HCBS (all populations), 2008 39,720 10.8 20 10.1 Waiver services (all populations) 31,392 8.6 5 4.1 Other HCBS (including PCS and home health) 8,328 2.3 33 6.0 Adults with disabilities self-directing services, 2011 953 0.26 43 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 120 6 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 61% 15 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 63% 21 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $24,444 41 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $7,085 37 $10,957 Aged/disabled waiver services $7,605 37 $10,710 Personal care services ** $3,077 29 $11,142 Home health services $2,147 29 $5,495 ICF-MR services, 2008 $68,021 47 $123,053 MR/DD waiver services, 2008 $52,103 12 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $127 40 $178 Medicare payment per day for nursing facility care, 2010 $344 46 $398 Medicare reimbursement per home health visit, 2010 $127 49 $154 Private pay rate per day in nursing facility, 2011 $130 50 $193 Private pay rate per month in assisted living, 2011 $2,748 45 $3,261 Private pay daily rate for adult day care, 2011 $60 27 $60 Private pay hourly rate for home health aide, 2011 $19 31 $19 261 LTSS Resources Oklahoma Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 248 0.49 39 1.46 Assisted living and residential care units, 2010 12,540 25 31 31 Personal and home care aides, 2010 7,870 15 25 17 Median hourly wage, 2010 $8.52 45 $9.44 Home health aides, 2010 8,810 17 31 24 Median hourly wage, 2010 $9.69 36 $9.89 People receiving ACL congregate meals, 2009 * 26,158 52 24 42 People receiving ACL home delivered meals, 2009 * 12,510 25 27 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $21 $41 20 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 0 41 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 330 0.65 6 0.40 Nursing facility beds, 2010 30,083 59 10 42 Nursing facility residents, 2010 19,878 39 20 35 Nursing facility occupancy rate, 2010 66% 49 83% Direct care nursing hours per resident day, 2010 3.6 44 3.8 RN hours per day, 2010 0.37 51 0.64 Nursing facility staffing turnover, 2010 71% 2 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 43% 43 46% Nursing facility residents with low care needs, 2008 28% 3 17% Residents with Medicaid as primary payer, 2010 66% 13 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 22% 22 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 6% 5 4% High risk residents with pressure sores, 2008 15% 3 12% Long-stay residents with a hospital admission, 2008 26% 5 21% Long-term care facility beds per FTE ombudsman, 2010 1,530 34 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 262 Trends Oklahoma Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 21,401 1,270,155 with physical disabilities (excluding home health) 2008 29,014 1,577,471 % change +36% 21 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 22,777 1,460,185 2010 19,878 1,408,886 % change -13% 49 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $2,574 $285,710 2009 $3,936 $368,330 % change +53% 3 +29% Medicaid LTSS spending for older people and adults 2004 $584 $62,811 with physical disabilities (millions) 2009 $783 $80,181 % change +34% 13 +28% Medicaid nursing facility spending (millions) 2004 $463 $45,842 2009 $530 $51,403 % change +14% 24 +12% Medicaid HCBS spending for older people and adults 2004 $121 $16,969 with physical disabilities (millions) 2009 $254 $28,778 % change +110% 9 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 21% 23 27% people and adults with physical disabilities 2009 32% 22 36% change +12% 9 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $160 200% +$141 +172% $140 $120 150% Millions of Dollars $100 100% $80 +$67 +$67 $60 50% +31% $40 +14% +5% $20 +$6 0% $0 -20% $-20 -$8 -50% 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 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. 263 AARP Public Policy Institute Oregon Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 3,950 27 315,311 2032 4,689 27 376,660 +19% 27 +19% 2050 5,462 25 434,447 +38% 23 +38% Age 50-64 2012 804 20.4% 13 19.2% 2032 811 17.3% 2 16.4% +1% 20 +2% 2050 937 17.1% 23 16.6% +16% 29 +19% Age 65+ 2012 569 14.4% 20 13.6% 2032 970 20.7% 19 19.8% +70% 22 +74% 2050 1,166 21.3% 12 20.4% +105% 18 +107% Age 65-74 2012 318 8.0% 12 7.4% green line = 50-64 (WAS BLUE) 2032 468 10.0% 25 10.1% +47% 41 +64% red line = 65-74 (WAS PURPLE) 2050 535 9.8% 2 9.1% +68% 21 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 167 4.2% 32 blue line = 85+ (WAS RED) 4.2% 2032 356 7.6% 6 6.8% +113% 12 +94% 2050 366 6.7% 12 6.6% +119% 16 +116% Age 85+ 2012 84 2.1% 23 2.0% 2032 145 3.1% 10 2.9% +73% 24 +69% 2050 264 4.8% 22 4.8% +214% 23 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Oregon as a Percentage of State Rank U.S. 2012 Population, by Age Group 7.2% 37 20.1% 400% Population (% of 2012 Population) Asian/Pacific Islander 350% State Rank U.S. 85+ 300% 2.2% 13 3.6% 250% 75-84 Black State Rank U.S. 200% 0.9% 41 8.5% 150% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 2.4% 21 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Oregon Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 52 12 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 3.9% 32 5.5% People age 60+ responsible for raising grandchildren, 2010 1.4% 26 1.6% Percent of age 65+ households with someone under 18, 2010 5.5% 26 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $34,901 18 $34,381 At/below poverty level age 65+, 2010 7.9% 28 9.0% At/below 250% of poverty level age 65+, 2010 42% 23 42% Women age 75+ at/below poverty level, 2010 9.6% 43 12.2% Women age 75+ at/below 250% of poverty level, 2010 54% 31 54% Bachelor level education or higher age 65+, 2010 24% 13 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 49 9.4% 11 8.8% Cognitive difficulty 60 11.4% 6 9.5% Any disability 198 38% 14 37% People age 18-64 with disabilities, 2010 Self-care difficulty 49 2.0% 14 1.8% Cognitive difficulty 129 5.3% 12 4.2% Any disability 287 11.9% 12 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 463,000 121 46 137 Economic value of family caregiving, 2009 . (state in millions of $) $5,500 $1,440 34 $1,460 Economic value per hour, 2009 $12.43 9 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.2 23 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 86,657 47 22 45 265 Public LTSS Expenditures Oregon Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $3,594 29 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 62.74% 25 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 59% 4 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 74% 2 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Oregon and the U.S., 2009 Oregon United States 25% Percentages may not add 9% 41% to 100% due to rounding 64% Aged/Disabled Waivers 11% 50% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $744 $195 40 $261 Nursing facilities $304 $80 48 $168 HCBS $439 $115 11 $94 Aged/disabled waiver services $370 $97 3 $29 Personal care services (PCS) ** $28 $7 25 $45 Home health services $1 $0 48 $16 Other HCBS *** $40 $11 5 $4 Medicaid LTSS expenditures for all populations, 2009 $1,289 $338 37 $413 Institutional services $329 $86 48 $232 HCBS $960 $252 11 $181 Waiver services (all populations) $891 $234 8 $114 Other HCBS (including PCS and home health) $69 $18 32 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $6 $1.59 33 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 266 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Oregon State Nursing facilities (NF), 2008 10,189 2.7 47 5.3 HCBS (older people and adults with PD), 2008 33,804 9.0 17 8.2 Aged/disabled waiver services 27,403 7.3 2 2.2 Personal care services (PCS) ** 3,389 0.9 26 3.0 Home health services 3,012 0.8 40 3.0 Institutional services (NF and ICF-MR), 2008 10,229 2.7 47 5.6 HCBS (all populations), 2008 44,688 11.9 15 10.1 Waiver services (all populations) 38,287 10.2 3 4.1 Other HCBS (including PCS and home health) 6,401 1.7 38 6.0 Adults with disabilities self-directing services, 2011 23,512 6.24 3 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 269 2 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 77% 3 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 81% 2 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $31,766 18 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $9,312 25 $10,957 Aged/disabled waiver services $10,283 25 $10,710 Personal care services ** $1,463 31 $11,142 Home health services $350 50 $5,495 ICF-MR services, 2008 $281,470 2 $123,053 MR/DD waiver services, 2008 $40,590 26 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $221 4 $178 Medicare payment per day for nursing facility care, 2010 $454 6 $398 Medicare reimbursement per home health visit, 2010 $216 3 $154 Private pay rate per day in nursing facility, 2011 $220 17 $193 Private pay rate per month in assisted living, 2011 $3,500 17 $3,261 Private pay daily rate for adult day care, 2011 $97 3 $60 Private pay hourly rate for home health aide, 2011 $22 8 $19 267 LTSS Resources Oregon Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 3,792 7.08 3 1.46 Assisted living and residential care units, 2010 33,171 62 2 31 Personal and home care aides, 2010 9,590 18 20 17 Median hourly wage, 2010 $10.52 9 $9.44 Home health aides, 2010 8,640 16 34 24 Median hourly wage, 2010 $9.85 34 $9.89 People receiving ACL congregate meals, 2009 * 42,398 81 14 42 People receiving ACL home delivered meals, 2009 * 14,152 27 22 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $14 $27 38 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 16 1 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 138 0.26 46 0.40 Nursing facility beds, 2010 12,293 23 47 42 Nursing facility residents, 2010 7,567 14 49 35 Nursing facility occupancy rate, 2010 62% 51 83% Direct care nursing hours per resident day, 2010 4.4 3 3.8 RN hours per day, 2010 0.81 15 0.64 Nursing facility staffing turnover, 2010 36% 33 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 44% 37 46% Nursing facility residents with low care needs, 2008 13% 35 17% Residents with Medicaid as primary payer, 2010 61% 33 63% Residents with Medicare as primary payer, 2010 14% 26 14% Residents with “other” as primary payer, 2010 25% 16 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 4% 15 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 11% 45 21% Long-term care facility beds per FTE ombudsman, 2010 5,409 3 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 81% 28 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 268 Trends Oregon Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 34,210 1,270,155 with physical disabilities (excluding home health) 2008 30,792 1,577,471 % change -10% 46 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 8,347 1,460,185 2010 7,567 1,408,886 % change -9% 44 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $2,626 $285,710 2009 $3,594 $368,330 % change +37% 14 +29% Medicaid LTSS spending for older people and adults 2004 $582 $62,811 with physical disabilities (millions) 2009 $744 $80,181 % change +28% 21 +28% Medicaid nursing facility spending (millions) 2004 $270 $45,842 2009 $304 $51,403 % change +13% 26 +12% Medicaid HCBS spending for older people and adults 2004 $312 $16,969 with physical disabilities (millions) 2009 $439 $28,778 % change +41% 37 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 54% 2 27% people and adults with physical disabilities 2009 59% 4 36% change +5% 29 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $250 90% +$225 80% +77% $200 70% Millions of Dollars 60% $150 50% +44% +$112 40% $100 30% +26% $50 20% +$35 +13% +$15 10% +$7 0% $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 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. 269 AARP Public Policy Institute Pennsylvania Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 12,828 6 315,311 2032 15,193 6 376,660 +18% 30 +19% 2050 17,309 6 434,447 +35% 31 +38% Age 50-64 2012 2,669 20.8% 8 19.2% 2032 2,510 16.5% 17 16.4% -6% 34 +2% 2050 3,261 18.8% 6 16.6% +22% 18 +19% Age 65+ 2012 2,036 15.9% 4 13.6% 2032 3,156 20.8% 14 19.8% +55% 48 +74% 2050 3,528 20.4% 21 20.4% +73% 46 +107% Age 65-74 2012 1,036 8.1% 9 7.4% green line = 50-64 (WAS BLUE) 2032 1,613 10.6% 14 10.1% +56% 28 +64% red line = 65-74 (WAS PURPLE) 2050 1,591 9.2% 20 9.1% +54% 31 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 650 5.1% 4 blue line = 85+ (WAS RED) 4.2% 2032 1,088 7.2% 17 6.8% +67% 51 +94% 2050 1,113 6.4% 25 6.6% +71% 46 +116% Age 85+ 2012 349 2.7% 3 2.0% 2032 455 3.0% 20 2.9% +30% 49 +69% 2050 824 4.8% 22 4.8% +136% 48 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Pennsylvania as a Percentage of State Rank U.S. 2012 Population, by Age Group 10.0% 32 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% State Rank U.S. 85+ 1.3% 22 3.6% 200% 65-74 Black 150% State Rank U.S. 75-84 6.7% 21 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 1.5% 30 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 65-74 50-64 270 75-84 Population & Characteristics Pennsylvania Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 45 39 48 People age 75+ living alone, 2010 36% 11 34% People age 60+ with grandchildren in household, 2010 3.8% 38 5.5% People age 60+ responsible for raising grandchildren, 2010 1.0% 41 1.6% Percent of age 65+ households with someone under 18, 2010 4.8% 35 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $31,364 40 $34,381 At/below poverty level age 65+, 2010 7.9% 28 9.0% At/below 250% of poverty level age 65+, 2010 44% 17 42% Women age 75+ at/below poverty level, 2010 11.0% 32 12.2% Women age 75+ at/below 250% of poverty level, 2010 58% 16 54% Bachelor level education or higher age 65+, 2010 17% 38 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 149 7.9% 26 8.8% Cognitive difficulty 162 8.6% 31 9.5% Any disability 677 36% 27 37% People age 18-64 with disabilities, 2010 Self-care difficulty 136 1.7% 24 1.8% Cognitive difficulty 370 4.7% 19 4.2% Any disability 824 10.5% 23 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,850,000 147 12 137 Economic value of family caregiving, 2009 . (state in millions of $) $19,900 $1,580 15 $1,460 Economic value per hour, 2009 $11.27 25 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.1 40 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 255,389 40 29 45 271 Public LTSS Expenditures Pennsylvania Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $17,129 4 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 54.81% 33 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 18% 42 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 32% 43 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Pennsylvania and the U.S., 2009 Pennsylvania United States 25% Percentages may not add 5% 82% to 100% due to rounding 64% Aged/Disabled Waivers 11% 13% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $4,394 $347 7 $261 Nursing facilities $3,606 $285 4 $168 HCBS $789 $62 26 $94 Aged/disabled waiver services $569 $45 12 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $130 $10 23 $16 Other HCBS *** $90 $7 7 $4 Medicaid LTSS expenditures for all populations, 2009 $6,855 $541 10 $413 Institutional services $4,630 $365 6 $232 HCBS $2,225 $176 19 $181 Waiver services (all populations) $2,006 $158 15 $114 Other HCBS (including PCS and home health) $219 $17 34 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $220 $17.34 4 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 272 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Pennsylvania State Nursing facilities (NF), 2008 77,931 6.2 16 5.3 HCBS (older people and adults with PD), 2008 52,489 4.2 38 8.2 Aged/disabled waiver services 26,714 2.1 26 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 25,775 2.0 21 3.0 Institutional services (NF and ICF-MR), 2008 81,945 6.5 17 5.6 HCBS (all populations), 2008 82,724 6.6 38 10.1 Waiver services (all populations) 56,949 4.5 27 4.1 Other HCBS (including PCS and home health) 25,775 2.0 35 6.0 Adults with disabilities self-directing services, 2011 19,157 1.52 15 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 34 35 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 40% 41 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 50% 40 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $37,867 8 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $18,218 3 $10,957 Aged/disabled waiver services $18,218 2 $10,710 Personal care services ** NA NA $11,142 Home health services $7,268 7 $5,495 ICF-MR services, 2008 $140,236 18 $123,053 MR/DD waiver services, 2008 $50,294 13 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $212 7 $178 Medicare payment per day for nursing facility care, 2010 $378 34 $398 Medicare reimbursement per home health visit, 2010 $165 25 $154 Private pay rate per day in nursing facility, 2011 $245 12 $193 Private pay rate per month in assisted living, 2011 $3,000 35 $3,261 Private pay daily rate for adult day care, 2011 $54 39 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 273 LTSS Resources Pennsylvania Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 2,054 1.05 21 1.46 Assisted living and residential care units, 2010 70,300 36 11 31 Personal and home care aides, 2010 25,330 13 29 17 Median hourly wage, 2010 $10.08 18 $9.44 Home health aides, 2010 65,660 33 7 24 Median hourly wage, 2010 $9.96 31 $9.89 People receiving ACL congregate meals, 2009 * 79,154 41 30 42 People receiving ACL home delivered meals, 2009 * 32,795 17 36 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $65 $33 29 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 NA NA Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 724 0.37 31 0.40 Nursing facility beds, 2010 89,317 45 21 42 Nursing facility residents, 2010 81,190 41 18 35 Nursing facility occupancy rate, 2010 91% 6 83% Direct care nursing hours per resident day, 2010 3.8 30 3.8 RN hours per day, 2010 0.74 21 0.64 Nursing facility staffing turnover, 2010 39% 24 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 47% 24 46% Nursing facility residents with low care needs, 2008 10% 43 17% Residents with Medicaid as primary payer, 2010 62% 27 63% Residents with Medicare as primary payer, 2010 12% 34 14% Residents with “other” as primary payer, 2010 26% 13 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 18% 28 21% Long-term care facility beds per FTE ombudsman, 2010 2,516 22 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 98% 22 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 274 Trends Pennsylvania Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 15,368 1,270,155 with physical disabilities (excluding home health) 2008 26,714 1,577,471 % change +74% 9 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 80,886 1,460,185 2010 81,190 1,408,886 % change +0% 8 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $14,178 $285,710 2009 $17,129 $368,330 % change +21% 41 +29% Medicaid LTSS spending for older people and adults 2004 $4,458 $62,811 with physical disabilities (millions) 2009 $4,394 $80,181 % change -1% 47 +28% Medicaid nursing facility spending (millions) 2004 $4,135 $45,842 2009 $3,606 $51,403 % change -13% 49 +12% Medicaid HCBS spending for older people and adults 2004 $323 $16,969 with physical disabilities (millions) 2009 $789 $28,778 % change +144% 6 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 7% 48 27% people and adults with physical disabilities 2009 18% 42 36% change +11% 10 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $500 250% $400 +$356 +216% +$316 $300 200% Millions of Dollars $200 +$150 +$114 150% $100 +125% $0 100% $-100 $-200 50% +34% $-300 +22% $-400 0% $-500 -13% $-600 -$530 -50% 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 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. 275 AARP Public Policy Institute Puerto Rico Puerto Rico % of Total % Change Population Year (1,000s) Population U.S. from 2000 U.S. All ages 2000 c 2010 3,726 -2% +10% Age 50-64 2000 579 15.2% 14.9% 2010 682 18.3% 19.0% +18% +40% Age 65+ 2000 425 11.2% 12.4% 2010 542 14.5% 13.0% +27% +15% Age 65-74 2000 241 6.3% 6.5% 2010 312 8.4% 7.0% +29% +18% Age 75-84 2000 136 3.6% 4.4% 2010 168 4.5% 4.2% +23% +6% Age 85+ 2000 48 1.3% 1.5% 2010 63 1.7% 1.8% +31% +30% Older People of Color (%), 2010 Population of Puerto Rico, by Age, 2010 State U.S. 99.3% 20.1% 18.3% Asian/Pacific Islander 8.4% State U.S. 4.5% 0.2% 3.6% 67.1% 1.7% Black State U.S. Percentages may not add to 100% due to rounding 7.3% 8.5% <50 50-64 65-74 75-84 85+ Hispanic State U.S. 99.2% 6.9% 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. 276 Population & Characteristics Puerto Puerto Living Arrangements Rico U.S. Men per 100 women age 85+, 2010 59 48 People age 75+ living alone, 2010 26% 34% People age 60+ with grandchildren in household, 2010 7.0% 5.5% People age 60+ responsible for raising grandchildren, 2010 2.9% 1.6% Percent of age 65+ households with someone under age 18, 2010 9.6% 7.0% Ric o Puerto Income & Poverty Rico U.S. Median household income age 65+, 2010 $14,852 $34,381 At/below poverty level age 65+, 2010 39.6% 9.0% At/below 250% of poverty level age 65+, 2010 83% 42% Women age 75+ at/below poverty level, 2010 44.8% 12.2% Women age 75+ at/below 250% of poverty level, 2010 86% 54% Bachelor level education or higher age 65+, 2010 12% 21% Number Disability Rates (1,000s) Percent U.S. People age 65+ with disabilities, 2010 Self-care difficulty 71 13.2% 8.8% Cognitive difficulty 103 19.1% 9.5% Any disability 280 52% 37% People age 16-64 with disabilities, 2010 Self-care difficulty 60 2.7% 1.8% Cognitive difficulty 170 7.5% 4.2% Any disability 379 16.8% 10.0% 277 AARP Public Policy Institute Rhode Island Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 1,066 43 315,311 2032 1,297 44 376,660 +22% 18 +19% 2050 1,502 44 434,447 +41% 17 +38% Age 50-64 2012 220 20.7% 9 19.2% 2032 210 16.2% 27 16.4% -5% 31 +2% 2050 265 17.6% 18 16.6% +20% 23 +19% Age 65+ 2012 160 15.0% 10 13.6% 2032 270 20.8% 14 19.8% +68% 27 +74% 2050 306 20.4% 21 20.4% +91% 27 +107% Age 65-74 2012 83 7.8% 18 7.4% green line = 50-64 (WAS BLUE) 2032 140 10.8% 13 10.1% +69% 15 +64% red line = 65-74 (WAS PURPLE) 2050 130 8.7% 41 9.1% +58% 27 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 49 4.6% 10 blue line = 85+ (WAS RED) 4.2% 2032 91 7.0% 21 6.8% +86% 29 +94% 2050 99 6.6% 18 6.6% +101% 25 +116% Age 85+ 2012 29 2.7% 3 2.0% 2032 39 3.0% 20 2.9% +37% 47 +69% 2050 77 5.1% 12 4.8% +170% 41 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Rhode Island as a Percentage of State Rank U.S. 2012 Population, by Age Group 8.6% 34 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 1.1% 25 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 65-74 2.5% 32 8.5% 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 3.8% 14 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Rhode Island Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 44 43 48 People age 75+ living alone, 2010 39% 3 34% People age 60+ with grandchildren in household, 2010 4.7% 25 5.5% People age 60+ responsible for raising grandchildren, 2010 1.3% 30 1.6% Percent of age 65+ households with someone under 18, 2010 6.0% 24 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $33,192 29 $34,381 At/below poverty level age 65+, 2010 8.2% 25 9.0% At/below 250% of poverty level age 65+, 2010 42% 23 42% Women age 75+ at/below poverty level, 2010 10.2% 40 12.2% Women age 75+ at/below 250% of poverty level, 2010 56% 26 54% Bachelor level education or higher age 65+, 2010 21% 21 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 10 6.9% 37 8.8% Cognitive difficulty 11 7.9% 40 9.5% Any disability 53 37% 21 37% People age 18-64 with disabilities, 2010 Self-care difficulty 11 1.7% 24 1.8% Cognitive difficulty 37 5.6% 9 4.2% Any disability 75 11.2% 17 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 148,000 141 21 137 Economic value of family caregiving, 2009 . (state in millions of $) $1,880 $1,790 1 $1,460 Economic value per hour, 2009 $13.27 2 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.3 35 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 20,432 39 31 45 279 Public LTSS Expenditures Rhode Island Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,891 37 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 52.63% 35 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * † 13% 49 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * † 46% 17 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Rhode Island and the U.S., 2009 Rhode Island United States 25% Percentages may not add 1% 87% to 100% due to rounding 64% 13% Aged/Disabled Waivers 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures † (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $343 $326 9 $261 Nursing facilities $298 $283 5 $168 HCBS $45 $43 36 $94 Aged/disabled waiver services $43 $40 17 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $3 $3 36 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $583 $553 9 $413 Institutional services $317 $301 12 $232 HCBS $266 $252 11 $181 Waiver services (all populations) $263 $250 6 $114 Other HCBS (including PCS and home health) $3 $3 47 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $5 $4.41 20 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. † Because of inconsistencies in 2009 spending data for some services, 2008 data are used for Rhode Island’s Medicaid LTSS expenditures. 280 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. 9,815 9.3 4 5.3 Rhode Island Nursing facilities (NF), 2008 HCBS (older people and adults with PD), 2008 5,013 4.8 34 8.2 Aged/disabled waiver services 3,577 3.4 17 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 1,436 1.4 28 3.0 Institutional services (NF and ICF-MR), 2008 9,862 9.3 5 5.6 HCBS (all populations), 2008 8,893 8.4 27 10.1 Waiver services (all populations) 7,457 7.1 8 4.1 Other HCBS (including PCS and home health) 1,436 1.4 42 6.0 Adults with disabilities self-directing services, 2011 1,642 1.56 14 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 36 32 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 34% 46 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 47% 44 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $52,105 2 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $10,025 21 $10,957 Aged/disabled waiver services $10,025 26 $10,710 Personal care services ** NA NA $11,142 Home health services $2,115 30 $5,495 ICF-MR services, 2008 $189,654 7 $123,053 MR/DD waiver services, 2008 $69,470 5 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $194 15 $178 Medicare payment per day for nursing facility care, 2010 $427 17 $398 Medicare reimbursement per home health visit, 2010 $168 18 $154 Private pay rate per day in nursing facility, 2011 $258 10 $193 Private pay rate per month in assisted living, 2011 $4,213 8 $3,261 Private pay daily rate for adult day care, 2011 $66 19 $60 Private pay hourly rate for home health aide, 2011 $23 6 $19 281 LTSS Resources Rhode ISland Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 73 0.48 40 1.46 Assisted living and residential care units, 2010 3,829 25 31 31 Personal and home care aides, 2010 1,120 7 42 17 Median hourly wage, 2010 $10.79 7 $9.44 Home health aides, 2010 5,540 36 6 24 Median hourly wage, 2010 $12.16 4 $9.89 People receiving ACL congregate meals, 2009 * 7,347 49 26 42 People receiving ACL home delivered meals, 2009 * 2,255 15 40 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $4 $27 38 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 0 41 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 86 0.57 12 0.40 Nursing facility beds, 2010 8,814 58 12 42 Nursing facility residents, 2010 7,998 53 4 35 Nursing facility occupancy rate, 2010 91% 6 83% Direct care nursing hours per resident day, 2010 3.7 36 3.8 RN hours per day, 2010 0.86 8 0.64 Nursing facility staffing turnover, 2010 36% 33 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 51% 12 46% Nursing facility residents with low care needs, 2008 24% 5 17% Residents with Medicaid as primary payer, 2010 64% 17 63% Residents with Medicare as primary payer, 2010 9% 49 14% Residents with “other” as primary payer, 2010 26% 13 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 12% 42 21% Long-term care facility beds per FTE ombudsman, 2010 1,420 38 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 68% 33 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 282 Trends Rhode Island Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 2,613 1,270,155 with physical disabilities (excluding home health) 2008 3,577 1,577,471 % change +37% 20 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 8,383 1,460,185 2010 7,998 1,408,886 % change -5% 30 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $1,642 $285,710 2009 $1,891 $368,330 % change +15% 47 +29% Medicaid LTSS spending for older people and adults 2004 $326 $62,811 with physical disabilities (millions) 2009 $343 $80,181 % change +5% 43 +28% Medicaid nursing facility spending (millions) 2004 $293 $45,842 2009 $298 $51,403 % change +2% 41 +12% Medicaid HCBS spending for older people and adults 2004 $33 $16,969 with physical disabilities (millions) 2009 $45 $28,778 % change +38% 39 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 10% 44 27% people and adults with physical disabilities 2009 13% 49 36% change +3% 39 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $40 50% +45% +$35 $35 40% $30 30% Millions of Dollars $25 20% $20 +19% 10% +14% $15 +$13 +2% 0% $10 +$5 -10% $5 +$1 $0 -20% -$1 -21% $-5 -30% 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 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. 283 AARP Public Policy Institute South Carolina Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 4,728 24 315,311 2032 5,626 23 376,660 +19% 27 +19% 2050 6,572 23 434,447 +39% 21 +38% Age 50-64 2012 910 19.3% 31 19.2% 2032 909 16.2% 27 16.4% +0% 23 +2% 2050 1,114 17.0% 26 16.6% +22% 18 +19% Age 65+ 2012 693 14.7% 14 13.6% 2032 1,155 20.5% 21 19.8% +67% 29 +74% 2050 1,354 20.6% 18 20.4% +95% 24 +107% Age 65-74 2012 393 8.3% 6 7.4% green line = 50-64 (WAS BLUE) 2032 565 10.1% 22 10.1% +44% 46 +64% red line = 65-74 (WAS PURPLE) 2050 607 9.2% 20 9.1% +54% 31 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 209 4.4% 18 blue line = 85+ (WAS RED) 4.2% 2032 408 7.2% 17 6.8% +95% 21 +94% 2050 431 6.6% 18 6.6% +106% 22 +116% Age 85+ 2012 90 1.9% 33 2.0% 2032 182 3.2% 8 2.9% +101% 6 +69% 2050 316 4.8% 22 4.8% +250% 17 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in South Carolina as a Percentage of State Rank U.S. 2012 Population, by Age Group 22.2% 15 20.1% 400% Population (% of 2012 Population) Asian/Pacific Islander 350% State Rank U.S. 85+ 300% 1.0% 27 3.6% 250% 75-84 Black State Rank U.S. 200% 19.7% 6 8.5% 150% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 1.0% 37 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Carolina Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 43 45 48 People age 75+ living alone, 2010 34% 28 34% People age 60+ with grandchildren in household, 2010 4.9% 22 5.5% People age 60+ responsible for raising grandchildren, 2010 2.1% 8 1.6% Percent of age 65+ households with someone under 18, 2010 6.2% 22 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $31,691 38 $34,381 At/below poverty level age 65+, 2010 9.8% 16 9.0% At/below 250% of poverty level age 65+, 2010 46% 10 42% Women age 75+ at/below poverty level, 2010 13.6% 15 12.2% Women age 75+ at/below 250% of poverty level, 2010 58% 16 54% Bachelor level education or higher age 65+, 2010 21% 21 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 55 8.9% 15 8.8% Cognitive difficulty 68 11.0% 10 9.5% Any disability 237 38% 14 37% People age 18-64 with disabilities, 2010 Self-care difficulty 65 2.3% 9 1.8% Cognitive difficulty 146 5.1% 13 4.2% Any disability 352 12.4% 9 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 770,000 169 5 137 Economic value of family caregiving, 2009 . (state in millions of $) $7,400 $1,620 11 $1,460 Economic value per hour, 2009 $10.04 42 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 6.3 7 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 92,292 42 27 45 285 Public LTSS Expenditures South Carolina Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $5,097 25 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 70.32% 7 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 28% 26 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 38% 34 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in South Carolina and the U.S., 2009 South Carolina United States 25% Percentages may not add 5% 72% to 100% due to rounding 64% Aged/Disabled Waivers 23% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $712 $155 47 $261 Nursing facilities $513 $112 41 $168 HCBS $199 $43 36 $94 Aged/disabled waiver services $165 $36 22 $29 Personal care services (PCS) ** $10 $2 30 $45 Home health services $12 $3 36 $16 Other HCBS *** $12 $3 9 $4 Medicaid LTSS expenditures for all populations, 2009 $1,281 $279 40 $413 Institutional services $789 $172 36 $232 HCBS $492 $107 42 $181 Waiver services (all populations) $458 $100 33 $114 Other HCBS (including PCS and home health) $34 $7 44 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 286 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Sou th Carolina State Nursing facilities (NF), 2008 16,288 3.6 41 5.3 HCBS (older people and adults with PD), 2008 22,885 5.1 33 8.2 Aged/disabled waiver services 14,922 3.3 18 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 7,963 1.8 24 3.0 Institutional services (NF and ICF-MR), 2008 17,917 4.0 39 5.6 HCBS (all populations), 2008 31,099 6.9 35 10.1 Waiver services (all populations) 23,136 5.1 19 4.1 Other HCBS (including PCS and home health) 7,963 1.8 37 6.0 Adults with disabilities self-directing services, 2011 1,786 0.39 37 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 91 9 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 58% 19 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 63% 21 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,361 30 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $7,734 34 $10,957 Aged/disabled waiver services $7,734 36 $10,710 Personal care services ** NA NA $11,142 Home health services $3,721 17 $5,495 ICF-MR services, 2008 $89,608 35 $123,053 MR/DD waiver services, 2008 $36,602 29 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $154 30 $178 Medicare payment per day for nursing facility care, 2010 $348 44 $398 Medicare reimbursement per home health visit, 2010 $182 11 $154 Private pay rate per day in nursing facility, 2011 $175 36 $193 Private pay rate per month in assisted living, 2011 $3,070 33 $3,261 Private pay daily rate for adult day care, 2011 $49 46 $60 Private pay hourly rate for home health aide, 2011 $17 45 $19 287 LTSS Resources South Carolina Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 480 0.76 31 1.46 Assisted living and residential care units, 2010 16,930 27 27 31 Personal and home care aides, 2010 6,910 11 33 17 Median hourly wage, 2010 $8.91 36 $9.44 Home health aides, 2010 11,730 18 30 24 Median hourly wage, 2010 $9.80 35 $9.89 People receiving ACL congregate meals, 2009 * 10,871 18 45 42 People receiving ACL home delivered meals, 2009 * 12,389 20 32 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $17 $28 36 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 1 36 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 186 0.29 39 0.40 Nursing facility beds, 2010 18,966 30 42 42 Nursing facility residents, 2010 17,261 27 40 35 Nursing facility occupancy rate, 2010 91% 6 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.60 40 0.64 Nursing facility staffing turnover, 2010 36% 33 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 55% 1 46% Nursing facility residents with low care needs, 2008 9% 45 17% Residents with Medicaid as primary payer, 2010 62% 27 63% Residents with Medicare as primary payer, 2010 17% 7 14% Residents with “other” as primary payer, 2010 20% 34 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 6% 5 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 20% 18 21% Long-term care facility beds per FTE ombudsman, 2010 1,749 31 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 74% 32 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 288 Trends Sou th Carolina Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 13,633 1,270,155 with physical disabilities (excluding home health) 2008 14,922 1,577,471 % change +9% 37 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 16,596 1,460,185 2010 17,261 1,408,886 % change +4% 3 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $3,944 $285,710 2009 $5,097 $368,330 % change +29% 27 +29% Medicaid LTSS spending for older people and adults 2004 $574 $62,811 with physical disabilities (millions) 2009 $712 $80,181 % change +24% 30 +28% Medicaid nursing facility spending (millions) 2004 $462 $45,842 2009 $513 $51,403 % change +11% 29 +12% Medicaid HCBS spending for older people and adults 2004 $112 $16,969 with physical disabilities (millions) 2009 $199 $28,778 % change +77% 20 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 20% 28 27% people and adults with physical disabilities 2009 28% 26 36% change +8% 16 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $140 90% +84% $120 +$116 80% 70% +68% $100 Millions of Dollars 60% +$75 +52% $80 50% $60 +$51 40% $40 30% 20% $20 +$12 +11% 10% $0 0% -$8 -10% -5% $-20 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 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. 289 AARP Public Policy Institute South Dakota Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 847 46 315,311 2032 1,053 46 376,660 +24% 16 +19% 2050 1,211 46 434,447 +43% 14 +38% Age 50-64 2012 165 19.4% 27 19.2% 2032 156 14.8% 47 16.4% -5% 31 +2% 2050 207 17.1% 23 16.6% +26% 14 +19% Age 65+ 2012 124 14.6% 17 13.6% 2032 204 19.3% 35 19.8% +64% 35 +74% 2050 237 19.5% 38 20.4% +91% 27 +107% Age 65-74 2012 63 7.5% 28 7.4% green line = 50-64 (WAS BLUE) 2032 100 9.5% 37 10.1% +58% 25 +64% red line = 65-74 (WAS PURPLE) 2050 109 9.0% 33 9.1% +72% 15 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 39 4.6% 10 blue line = 85+ (WAS RED) 4.2% 2032 73 7.0% 21 6.8% +87% 27 +94% 2050 70 5.8% 45 6.6% +79% 41 +116% Age 85+ 2012 22 2.6% 7 2.0% 2032 30 2.9% 30 2.9% +39% 45 +69% 2050 58 4.8% 22 4.8% +166% 44 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in South Dakota as a Percentage of State Rank U.S. 2012 Population, by Age Group 4.9% 45 20.1% 300% Population (% of 2012 Population) 85+ Asian/Pacific Islander 250% State Rank U.S. 75-84 0.0% 50 3.6% 200% Black 150% State Rank U.S. 65-74 0.0% 50 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 0.7% 43 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 65-74 50-64 290 75-84 Population & Characteristics Sou th Dakota Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 49 15 48 People age 75+ living alone, 2010 40% 2 34% People age 60+ with grandchildren in household, 2010 1.6% 50 5.5% People age 60+ responsible for raising grandchildren, 2010 0.7% 46 1.6% Percent of age 65+ households with someone under 18, 2010 2.2% 50 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $29,950 46 $34,381 At/below poverty level age 65+, 2010 11.1% 7 9.0% At/below 250% of poverty level age 65+, 2010 45% 12 42% Women age 75+ at/below poverty level, 2010 19.0% 2 12.2% Women age 75+ at/below 250% of poverty level, 2010 61% 6 54% Bachelor level education or higher age 65+, 2010 17% 38 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 8 6.8% 41 8.8% Cognitive difficulty 8 7.4% 45 9.5% Any disability 40 36% 27 37% People age 18-64 with disabilities, 2010 Self-care difficulty 7 1.4% 39 1.8% Cognitive difficulty 18 3.7% 37 4.2% Any disability 43 8.9% 36 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 101,000 124 43 137 Economic value of family caregiving, 2009 . (state in millions of $) $1,030 $1,270 44 $1,460 Economic value per hour, 2009 $10.70 32 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.7 30 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 42,904 113 4 45 291 Public LTSS Expenditures South Dakota Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $715 49 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 62.72% 26 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 14% 48 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 40% 31 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in South Dakota and the U.S., 2009 South Dakota United States 25% Percentages may not add 86% to 100% due to rounding 6% 64% Aged/Disabled Waivers 8% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $165 $205 36 $261 Nursing facilities $142 $176 21 $168 HCBS $23 $29 49 $94 Aged/disabled waiver services $13 $16 39 $29 Personal care services (PCS) ** $2 $2 30 $45 Home health services $9 $11 19 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $286 $354 31 $413 Institutional services $170 $211 27 $232 HCBS $116 $143 32 $181 Waiver services (all populations) $105 $130 22 $114 Other HCBS (including PCS and home health) $10 $13 37 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 292 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Sou th Dakota State Nursing facilities (NF), 2008 5,533 6.9 10 5.3 HCBS (older people and adults with PD), 2008 7,333 9.2 16 8.2 Aged/disabled waiver services 1,472 1.8 30 2.2 Personal care services (PCS) ** 996 1.2 24 3.0 Home health services 4,865 6.1 4 3.0 Institutional services (NF and ICF-MR), 2008 5,715 7.2 13 5.6 HCBS (all populations), 2008 10,211 12.8 10 10.1 Waiver services (all populations) 4,350 5.4 17 4.1 Other HCBS (including PCS and home health) 5,861 7.3 10 6.0 Adults with disabilities self-directing services, 2011 1,036 1.30 18 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 27 37 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 57% 21 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 64% 19 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $24,983 38 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $3,894 45 $10,957 Aged/disabled waiver services $5,332 44 $10,710 Personal care services ** $1,770 30 $11,142 Home health services $979 43 $5,495 ICF-MR services, 2008 $119,182 21 $123,053 MR/DD waiver services, 2008 $30,089 41 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $130 39 $178 Medicare payment per day for nursing facility care, 2010 $430 14 $398 Medicare reimbursement per home health visit, 2010 $166 23 $154 Private pay rate per day in nursing facility, 2011 $167 41 $193 Private pay rate per month in assisted living, 2011 $2,750 43 $3,261 Private pay daily rate for adult day care, 2011 $50 42 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 293 LTSS Resources South Dakota Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 205 1.75 14 1.46 Assisted living and residential care units, 2010 3,989 34 15 31 Personal and home care aides, 2010 1,590 14 27 17 Median hourly wage, 2010 $9.22 31 $9.44 Home health aides, 2010 560 5 51 24 Median hourly wage, 2010 $11.21 8 $9.89 People receiving ACL congregate meals, 2009 * 11,808 102 8 42 People receiving ACL home delivered meals, 2009 * 3,188 28 20 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $8 $73 7 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 11 16 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 111 0.95 2 0.40 Nursing facility beds, 2010 6,936 59 10 42 Nursing facility residents, 2010 6,544 56 3 35 Nursing facility occupancy rate, 2010 94% 1 83% Direct care nursing hours per resident day, 2010 3.5 47 3.8 RN hours per day, 2010 0.83 11 0.64 Nursing facility staffing turnover, 2010 43% 19 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 52% 9 46% Nursing facility residents with low care needs, 2008 21% 11 17% Residents with Medicaid as primary payer, 2010 55% 46 63% Residents with Medicare as primary payer, 2010 10% 46 14% Residents with “other” as primary payer, 2010 36% 3 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 10% 33 12% Long-stay residents with a hospital admission, 2008 16% 32 21% Long-term care facility beds per FTE ombudsman, 2010 3,620 12 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 44% 45 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 294 Trends Sou th Dakota Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 2,195 1,270,155 with physical disabilities (excluding home health) 2008 2,468 1,577,471 % change +12% 35 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 6,752 1,460,185 2010 6,544 1,408,886 % change -3% 24 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $569 $285,710 2009 $715 $368,330 % change +26% 33 +29% Medicaid LTSS spending for older people and adults 2004 $131 $62,811 with physical disabilities (millions) 2009 $165 $80,181 % change +26% 26 +28% Medicaid nursing facility spending (millions) 2004 $118 $45,842 2009 $142 $51,403 % change +20% 16 +12% Medicaid HCBS spending for older people and adults 2004 $13 $16,969 with physical disabilities (millions) 2009 $23 $28,778 % change +85% 16 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 10% 44 27% people and adults with physical disabilities 2009 14% 48 36% change +4% 37 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $30 120% +110% +$25 $25 +$24 100% Millions of Dollars $20 80% +62% $15 60% $10 40% +36% +$7 +$5 +24% +$4 +20% $5 20% $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 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. 295 AARP Public Policy Institute Tennessee Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 6,521 16 315,311 2032 7,942 16 376,660 +22% 18 +19% 2050 9,547 15 434,447 +46% 11 +38% Age 50-64 2012 1,265 19.4% 27 19.2% 2032 1,352 17.0% 7 16.4% +7% 10 +2% 2050 1,632 17.1% 23 16.6% +29% 9 +19% Age 65+ 2012 924 14.2% 23 13.6% 2032 1,559 19.6% 30 19.8% +69% 25 +74% 2050 1,903 19.9% 33 20.4% +106% 16 +107% Age 65-74 2012 520 8.0% 12 7.4% green line = 50-64 (WAS BLUE) 2032 788 9.9% 26 10.1% +51% 35 +64% red line = 65-74 (WAS PURPLE) 2050 877 9.2% 20 9.1% +69% 19 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 281 4.3% 26 blue line = 85+ (WAS RED) 4.2% 2032 538 6.8% 32 6.8% +91% 23 +94% 2050 605 6.3% 30 6.6% +115% 20 +116% Age 85+ 2012 122 1.9% 33 2.0% 2032 233 2.9% 30 2.9% +91% 13 +69% 2050 421 4.4% 41 4.8% +245% 18 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Tennessee as a Percentage of State Rank U.S. 2012 Population, by Age Group 12.4% 26 20.1% 450% Population (% of 2012 Population) Asian/Pacific Islander 400% State Rank U.S. 350% 85+ 0.7% 35 3.6% 300% Black 250% 75-84 State Rank U.S. 200% 10.1% 13 8.5% 150% 65-74 50-64 Hispanic 100% 2030 2040 State 2050 Rank 2060 U.S. 50% 1.0% 37 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Tennessee Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 43 45 48 People age 75+ living alone, 2010 33% 35 34% People age 60+ with grandchildren in household, 2010 5.0% 21 5.5% People age 60+ responsible for raising grandchildren, 2010 2.0% 12 1.6% Percent of age 65+ households with someone under 18, 2010 6.3% 21 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $30,160 45 $34,381 At/below poverty level age 65+, 2010 9.7% 17 9.0% At/below 250% of poverty level age 65+, 2010 48% 6 42% Women age 75+ at/below poverty level, 2010 13.9% 13 12.2% Women age 75+ at/below 250% of poverty level, 2010 60% 8 54% Bachelor level education or higher age 65+, 2010 16% 45 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 89 10.7% 4 8.8% Cognitive difficulty 99 11.9% 4 9.5% Any disability 348 42% 7 37% People age 18-64 with disabilities, 2010 Self-care difficulty 97 2.5% 5 1.8% Cognitive difficulty 230 5.8% 5 4.2% Any disability 530 13.5% 8 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,130,000 180 2 137 Economic value of family caregiving, 2009 . (state in millions of $) $11,000 $1,750 4 $1,460 Economic value per hour, 2009 $10.20 41 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 5.1 13 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 131,025 44 24 45 297 Public LTSS Expenditures Tennessee Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $7,393 16 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 65.57% 15 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 26% 27 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 42% 24 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Tennessee and the U.S., 2009 Tennessee United States 25% Percentages may not add 19% 74% to 100% due to rounding 64% Aged/Disabled Waivers 6% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,312 $208 35 $261 Nursing facilities $975 $155 30 $168 HCBS $337 $53 31 $94 Aged/disabled waiver services $84 $13 42 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $242 $38 3 $16 Other HCBS *** $11 $2 11 $4 Medicaid LTSS expenditures for all populations, 2009 $2,160 $343 35 $413 Institutional services $1,244 $197 31 $232 HCBS $916 $145 30 $181 Waiver services (all populations) $663 $105 31 $114 Other HCBS (including PCS and home health) $253 $40 22 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $9 $1.49 34 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 298 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. TEnnessee State Nursing facilities (NF), 2008 32,471 5.2 28 5.3 HCBS (older people and adults with PD), 2008 14,069 2.3 46 8.2 Aged/disabled waiver services 3,204 0.5 47 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 10,865 1.7 25 3.0 Institutional services (NF and ICF-MR), 2008 33,688 5.4 28 5.6 HCBS (all populations), 2008 21,183 3.4 49 10.1 Waiver services (all populations) 10,318 1.7 48 4.1 Other HCBS (including PCS and home health) 10,865 1.7 38 6.0 Adults with disabilities self-directing services, 2011 1,186 0.19 44 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 10 48 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 30% 48 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 39% 48 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,367 29 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $5,928 39 $10,957 Aged/disabled waiver services $5,928 42 $10,710 Personal care services ** NA NA $11,142 Home health services $17,045 1 $5,495 ICF-MR services, 2008 $196,136 5 $123,053 MR/DD waiver services, 2008 $70,968 4 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $145 34 $178 Medicare payment per day for nursing facility care, 2010 $342 47 $398 Medicare reimbursement per home health visit, 2010 $157 30 $154 Private pay rate per day in nursing facility, 2011 $170 39 $193 Private pay rate per month in assisted living, 2011 $3,080 32 $3,261 Private pay daily rate for adult day care, 2011 $50 42 $60 Private pay hourly rate for home health aide, 2011 $17 45 $19 299 LTSS Resources Tennessee Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 317 0.37 46 1.46 Assisted living and residential care units, 2010 15,375 18 39 31 Personal and home care aides, 2010 10,610 12 32 17 Median hourly wage, 2010 $8.65 42 $9.44 Home health aides, 2010 13,230 15 37 24 Median hourly wage, 2010 $9.67 37 $9.89 People receiving ACL congregate meals, 2009 * 13,507 16 46 42 People receiving ACL home delivered meals, 2009 * 10,341 12 49 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $18 $21 46 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 1 36 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 330 0.39 29 0.40 Nursing facility beds, 2010 37,928 44 24 42 Nursing facility residents, 2010 32,487 38 24 35 Nursing facility occupancy rate, 2010 86% 24 83% Direct care nursing hours per resident day, 2010 3.7 36 3.8 RN hours per day, 2010 0.53 45 0.64 Nursing facility staffing turnover, 2010 36% 33 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 51% 12 46% Nursing facility residents with low care needs, 2008 14% 31 17% Residents with Medicaid as primary payer, 2010 63% 21 63% Residents with Medicare as primary payer, 2010 16% 12 14% Residents with “other” as primary payer, 2010 22% 22 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 7% 3 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 25% 6 21% Long-term care facility beds per FTE ombudsman, 2010 4,355 6 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 52% 42 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 300 Trends Tennessee Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 515 1,270,155 with physical disabilities (excluding home health) 2008 3,204 1,577,471 % change +522% 2 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 33,163 1,460,185 2010 32,487 1,408,886 % change -2% 16 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $7,055 $285,710 2009 $7,393 $368,330 % change +5% 50 +29% Medicaid LTSS spending for older people and adults 2004 NA $62,811 with physical disabilities (millions) 2009 $1,312 $80,181 % change NA NA +28% Medicaid nursing facility spending (millions) 2004 $1,006 $45,842 2009 $975 $51,403 % change -3% 42 +12% Medicaid HCBS spending for older people and adults 2004 NA $16,969 with physical disabilities (millions) 2009 $337 $28,778 % change NA NA +70% Medicaid HCBS as a % of LTSS spending, for older 2004 NA NA 27% people and adults with physical disabilities 2009 26% 27 36% change NA NA +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $350 +$327 1400% +1237% $300 1200% $250 1000% Millions of Dollars $200 800% $150 600% $100 +$77 400% $50 +$40 200% +130% $0 +18% 0% $0 0% -3% $-50 -$31 -200% 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 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. 301 AARP Public Policy Institute Texas Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 25,783 2 315,311 2032 31,365 2 376,660 +22% 18 +19% 2050 36,298 2 434,447 +41% 17 +38% Age 50-64 2012 4,381 17.0% 50 19.2% 2032 5,011 16.0% 32 16.4% +14% 4 +2% 2050 5,428 15.0% 48 16.6% +24% 16 +19% Age 65+ 2012 2,823 10.9% 48 13.6% 2032 5,490 17.5% 46 19.8% +94% 6 +74% 2050 7,074 19.5% 38 20.4% +151% 6 +107% Age 65-74 2012 1,577 6.1% 49 7.4% green line = 50-64 (WAS BLUE) 2032 2,854 9.1% 44 10.1% +81% 6 +64% red line = 65-74 (WAS PURPLE) 2050 3,159 8.7% 41 9.1% +100% 7 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 859 3.3% 48 blue line = 85+ (WAS RED) 4.2% 2032 1,860 5.9% 47 6.8% +117% 8 +94% 2050 2,296 6.3% 30 6.6% +167% 6 +116% Age 85+ 2012 387 1.5% 46 2.0% 2032 776 2.5% 43 2.9% +100% 8 +69% 2050 1,619 4.5% 38 4.8% +318% 6 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Texas as a Percentage of State Rank U.S. 2012 Population, by Age Group 32.5% 5 20.1% 500% Population (% of 2012 Population) 450% Asian/Pacific Islander 85+ State Rank U.S. 400% 2.6% 12 3.6% 350% 300% 75-84 Black 250% State Rank U.S. 200% 8.5% 17 8.5% 65-74 150% Hispanic 100% 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 20.6% 2 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Texas Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 49 15 48 People age 75+ living alone, 2010 30% 43 34% People age 60+ with grandchildren in household, 2010 7.4% 3 5.5% People age 60+ responsible for raising grandchildren, 2010 2.2% 5 1.6% Percent of age 65+ households with someone under 18, 2010 9.4% 5 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $34,178 23 $34,381 At/below poverty level age 65+, 2010 10.7% 9 9.0% At/below 250% of poverty level age 65+, 2010 44% 17 42% Women age 75+ at/below poverty level, 2010 13.7% 14 12.2% Women age 75+ at/below 250% of poverty level, 2010 55% 28 54% Bachelor level education or higher age 65+, 2010 21% 21 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 271 10.7% 4 8.8% Cognitive difficulty 275 10.8% 12 9.5% Any disability 1,029 41% 9 37% People age 18-64 with disabilities, 2010 Self-care difficulty 309 2.0% 14 1.8% Cognitive difficulty 602 3.9% 32 4.2% Any disability 1,549 10.1% 28 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 3,420,000 138 24 137 Economic value of family caregiving, 2009 . (state in millions of $) $34,000 $1,370 38 $1,460 Economic value per hour, 2009 $10.35 40 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 5.6 11 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 381,754 37 35 45 303 Public LTSS Expenditures Texas Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $24,121 3 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 58.73% 30 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 50% 7 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 46% 17 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Texas and the U.S., 2009 Texas United States 25% Percentages may not add 36% 50% to 100% due to rounding 64% Aged/Disabled Waivers 11% PCS and other HCBS 13% Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $4,269 $172 42 $261 Nursing facilities $2,152 $87 45 $168 HCBS $2,117 $85 15 $94 Aged/disabled waiver services $559 $23 30 $29 Personal care services (PCS) ** $1,256 $51 12 $45 Home health services $272 $11 19 $16 Other HCBS *** $30 $1 15 $4 Medicaid LTSS expenditures for all populations, 2009 $6,465 $261 45 $413 Institutional services $3,490 $141 43 $232 HCBS $2,975 $120 39 $181 Waiver services (all populations) $1,417 $57 46 $114 Other HCBS (including PCS and home health) $1,558 $63 14 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $13 $0.52 40 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 304 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Texas State Nursing facilities (NF), 2008 102,111 4.2 35 5.3 HCBS (older people and adults with PD), 2008 289,935 11.9 6 8.2 Aged/disabled waiver services 39,536 1.6 32 2.2 Personal care services (PCS) ** 51,567 2.1 23 3.0 Home health services 198,832 8.2 2 3.0 Institutional services (NF and ICF-MR), 2008 114,213 4.7 32 5.6 HCBS (all populations), 2008 314,728 12.9 9 10.1 Waiver services (all populations) 64,329 2.6 44 4.1 Other HCBS (including PCS and home health) 250,399 10.3 3 6.0 Adults with disabilities self-directing services, 2011 7,964 0.33 40 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 39 26 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 74% 6 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 73% 8 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $18,963 50 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $10,065 20 $10,957 Aged/disabled waiver services $12,506 16 $10,710 Personal care services ** $8,193 16 $11,142 Home health services $2,349 28 $5,495 ICF-MR services, 2008 $78,237 42 $123,053 MR/DD waiver services, 2008 $35,502 32 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $126 41 $178 Medicare payment per day for nursing facility care, 2010 $356 39 $398 Medicare reimbursement per home health visit, 2010 $138 43 $154 Private pay rate per day in nursing facility, 2011 $127 51 $193 Private pay rate per month in assisted living, 2011 $3,210 27 $3,261 Private pay daily rate for adult day care, 2011 $30 51 $60 Private pay hourly rate for home health aide, 2011 $18 37 $19 305 LTSS Resources Texas Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 1,601 0.61 38 1.46 Assisted living and residential care units, 2010 50,782 19 38 31 Personal and home care aides, 2010 101,960 39 5 17 Median hourly wage, 2010 $8.16 50 $9.44 Home health aides, 2010 86,350 33 7 24 Median hourly wage, 2010 $8.64 48 $9.89 People receiving ACL congregate meals, 2009 * 66,617 26 41 42 People receiving ACL home delivered meals, 2009 * 64,857 26 23 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $70 $28 36 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 14 8 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 1,255 0.48 21 0.40 Nursing facility beds, 2010 133,349 51 16 42 Nursing facility residents, 2010 92,859 35 26 35 Nursing facility occupancy rate, 2010 70% 47 83% Direct care nursing hours per resident day, 2010 3.6 44 3.8 RN hours per day, 2010 0.42 48 0.64 Nursing facility staffing turnover, 2010 72% 1 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 48% 20 46% Nursing facility residents with low care needs, 2008 21% 11 17% Residents with Medicaid as primary payer, 2010 63% 21 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 22% 22 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 13% 24 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 25% 6 21% Long-term care facility beds per FTE ombudsman, 2010 2,964 19 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 90% 25 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 306 Trends Texas Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 107,655 1,270,155 with physical disabilities (excluding home health) 2008 91,103 1,577,471 % change -15% 47 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 92,585 1,460,185 2010 92,859 1,408,886 % change +0% 8 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $16,232 $285,710 2009 $24,121 $368,330 % change +49% 5 +29% Medicaid LTSS spending for older people and adults 2004 $3,143 $62,811 with physical disabilities (millions) 2009 $4,269 $80,181 % change +36% 10 +28% Medicaid nursing facility spending (millions) 2004 $1,763 $45,842 2009 $2,152 $51,403 % change +22% 12 +12% Medicaid HCBS spending for older people and adults 2004 $1,380 $16,969 with physical disabilities (millions) 2009 $2,117 $28,778 % change +53% 30 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 44% 6 27% people and adults with physical disabilities 2009 50% 7 36% change +6% 25 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $800 120% +108% +$690 $700 100% $600 Millions of Dollars +80% 80% $500 +$409 +$389 $400 60% $300 40% $200 +22% +$135 20% +15% $100 +$47 +9% $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 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. 307 AARP Public Policy Institute Utah Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 3,003 31 315,311 2032 4,136 29 376,660 +38% 2 +19% 2050 5,009 28 434,447 +67% 1 +38% Age 50-64 2012 428 14.3% 51 19.2% 2032 621 15.0% 43 16.4% +45% 1 +2% 2050 724 14.4% 49 16.6% +69% 1 +19% Age 65+ 2012 276 9.2% 50 13.6% 2032 552 13.3% 51 19.8% +100% 5 +74% 2050 855 17.1% 50 20.4% +210% 1 +107% Age 65-74 2012 153 5.1% 51 7.4% green line = 50-64 (WAS BLUE) 2032 289 7.0% 51 10.1% +89% 3 +64% red line = 65-74 (WAS PURPLE) 2050 434 8.7% 41 9.1% +184% 1 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 85 2.8% 50 blue line = 85+ (WAS RED) 4.2% 2032 190 4.6% 51 6.8% +122% 7 +94% 2050 260 5.2% 51 6.6% +205% 4 +116% Age 85+ 2012 38 1.3% 50 2.0% 2032 73 1.8% 51 2.9% +94% 10 +69% 2050 160 3.2% 50 4.8% +323% 5 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Utah as a Percentage of State Rank U.S. 2012 Population, by Age Group 7.5% 36 20.1% 600% Population (% of 2012 Population) Asian/Pacific Islander 500% State Rank U.S. 85+ 1.9% 15 3.6% 400% 75-84 Black 300% State Rank U.S. 65-74 0.5% 44 8.5% 200% Hispanic 50-64 State Rank U.S. 100% 2030 2040 2050 2060 4.2% 12 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Utah Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 58 2 48 People age 75+ living alone, 2010 29% 49 34% People age 60+ with grandchildren in household, 2010 6.9% 5 5.5% People age 60+ responsible for raising grandchildren, 2010 2.2% 5 1.6% Percent of age 65+ households with someone under 18, 2010 7.8% 13 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $40,784 6 $34,381 At/below poverty level age 65+, 2010 6.0% 50 9.0% At/below 250% of poverty level age 65+, 2010 36% 41 42% Women age 75+ at/below poverty level, 2010 9.3% 45 12.2% Women age 75+ at/below 250% of poverty level, 2010 49% 40 54% Bachelor level education or higher age 65+, 2010 26% 6 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 17 6.9% 37 8.8% Cognitive difficulty 20 8.2% 35 9.5% Any disability 85 34% 35 37% People age 18-64 with disabilities, 2010 Self-care difficulty 19 1.2% 47 1.8% Cognitive difficulty 56 3.4% 43 4.2% Any disability 124 7.6% 49 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 382,000 137 28 137 Economic value of family caregiving, 2009 . (state in millions of $) $4,200 $1,490 28 $1,460 Economic value per hour, 2009 $11.37 24 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 10.7 2 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 30,969 32 44 45 309 Public LTSS Expenditures Utah Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,643 38 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 71.68% 4 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 20% 39 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 43% 22 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Utah and the U.S., 2009 Utah United States 25% Percentages may not add 6% 81% to 100% due to rounding 64% Aged/Disabled Waivers 13% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $186 $68 51 $261 Nursing facilities $150 $55 51 $168 HCBS $36 $13 51 $94 Aged/disabled waiver services $24 $9 45 $29 Personal care services (PCS) ** $2 $1 32 $45 Home health services $11 $4 34 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $411 $151 50 $413 Institutional services $234 $86 48 $232 HCBS $178 $65 49 $181 Waiver services (all populations) $166 $61 44 $114 Other HCBS (including PCS and home health) $12 $4 46 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $25 $9.09 8 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 310 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. 5,498 2.1 48 5.3 Utah Nursing facilities (NF), 2008 HCBS (older people and adults with PD), 2008 5,592 2.1 48 8.2 Aged/disabled waiver services 1,492 0.6 46 2.2 Personal care services (PCS) ** 1,964 0.7 29 3.0 Home health services 2,136 0.8 40 3.0 Institutional services (NF and ICF-MR), 2008 6,326 2.4 48 5.6 HCBS (all populations), 2008 10,215 3.8 47 10.1 Waiver services (all populations) 6,115 2.3 46 4.1 Other HCBS (including PCS and home health) 4,100 1.5 40 6.0 Adults with disabilities self-directing services, 2011 2,875 1.08 23 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 27 37 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 50% 29 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 62% 24 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,933 26 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $5,091 44 $10,957 Aged/disabled waiver services $10,697 22 $10,710 Personal care services ** $832 32 $11,142 Home health services $5,322 9 $5,495 ICF-MR services, 2008 $70,476 45 $123,053 MR/DD waiver services, 2008 $31,161 37 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $163 28 $178 Medicare payment per day for nursing facility care, 2010 $414 25 $398 Medicare reimbursement per home health visit, 2010 $119 51 $154 Private pay rate per day in nursing facility, 2011 $157 43 $193 Private pay rate per month in assisted living, 2011 $2,648 48 $3,261 Private pay daily rate for adult day care, 2011 $40 49 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 311 LTSS Resources Utah Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 167 0.67 35 1.46 Assisted living and residential care units, 2010 5,926 24 35 31 Personal and home care aides, 2010 1,770 7 42 17 Median hourly wage, 2010 $9.03 33 $9.44 Home health aides, 2010 4,910 20 24 24 Median hourly wage, 2010 $10.17 25 $9.89 People receiving ACL congregate meals, 2009 * 15,747 65 20 42 People receiving ACL home delivered meals, 2009 * 8,421 35 15 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $12 $50 15 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 1 36 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 102 0.41 27 0.40 Nursing facility beds, 2010 8,335 33 39 42 Nursing facility residents, 2010 5,391 21 45 35 Nursing facility occupancy rate, 2010 65% 50 83% Direct care nursing hours per resident day, 2010 3.8 30 3.8 RN hours per day, 2010 0.88 6 0.64 Nursing facility staffing turnover, 2010 53% 8 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 38% 50 46% Nursing facility residents with low care needs, 2008 16% 27 17% Residents with Medicaid as primary payer, 2010 54% 47 63% Residents with Medicare as primary payer, 2010 19% 2 14% Residents with “other” as primary payer, 2010 27% 9 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 7% 3 4% High risk residents with pressure sores, 2008 9% 39 12% Long-stay residents with a hospital admission, 2008 10% 47 21% Long-term care facility beds per FTE ombudsman, 2010 1,421 37 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 42% 46 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 312 Trends Utah Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 1,407 1,270,155 with physical disabilities (excluding home health) 2008 3,456 1,577,471 % change +146% 3 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 5,496 1,460,185 2010 5,391 1,408,886 % change -2% 16 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $1,260 $285,710 2009 $1,643 $368,330 % change +30% 25 +29% Medicaid LTSS spending for older people and adults 2004 $123 $62,811 with physical disabilities (millions) 2009 $186 $80,181 % change +52% 6 +28% Medicaid nursing facility spending (millions) 2004 $106 $45,842 2009 $150 $51,403 % change +41% 2 +12% Medicaid HCBS spending for older people and adults 2004 $17 $16,969 with physical disabilities (millions) 2009 $36 $28,778 % change +116% 8 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 14% 36 27% people and adults with physical disabilities 2009 20% 39 36% change +6% 25 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $50 450% +421% $45 +$44 400% $40 350% Millions of Dollars $35 +$32 300% $30 250% $25 +$20 200% $20 +$14 150% $15 $10 100% $5 50% +26% +31% +41% $0 0% $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 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. 313 AARP Public Policy Institute Vermont Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 620 50 315,311 2032 722 51 376,660 +16% 36 +19% 2050 803 51 434,447 +29% 38 +38% Age 50-64 2012 144 23.2% 1 19.2% 2032 114 15.8% 36 16.4% -21% 50 +2% 2050 161 20.0% 2 16.6% +12% 39 +19% Age 65+ 2012 99 15.9% 4 13.6% 2032 172 23.8% 1 19.8% +74% 18 +74% 2050 175 21.8% 5 20.4% +77% 44 +107% Age 65-74 2012 55 8.9% 4 7.4% green line = 50-64 (WAS BLUE) 2032 85 11.8% 2 10.1% +53% 31 +64% red line = 65-74 (WAS PURPLE) 2050 73 9.1% 26 9.1% +32% 49 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 29 4.7% 7 blue line = 85+ (WAS RED) 4.2% 2032 62 8.6% 1 6.8% +111% 13 +94% 2050 55 6.9% 7 6.6% +89% 31 +116% Age 85+ 2012 14 2.3% 10 2.0% 2032 25 3.5% 3 2.9% +77% 19 +69% 2050 47 5.8% 2 4.8% +230% 20 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Vermont as a Percentage of State Rank U.S. 2012 Population, by Age Group 2.0% 50 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% State Rank U.S. 85+ 0.7% 35 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 0.3% 45 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 0.6% 46 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 314 Population & Characteristics Vermont Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 47 23 48 People age 75+ living alone, 2010 36% 11 34% People age 60+ with grandchildren in household, 2010 2.0% 49 5.5% People age 60+ responsible for raising grandchildren, 2010 0.6% 49 1.6% Percent of age 65+ households with someone under 18, 2010 3.3% 45 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $33,474 26 $34,381 At/below poverty level age 65+, 2010 6.8% 43 9.0% At/below 250% of poverty level age 65+, 2010 41% 30 42% Women age 75+ at/below poverty level, 2010 8.5% 49 12.2% Women age 75+ at/below 250% of poverty level, 2010 55% 28 54% Bachelor level education or higher age 65+, 2010 29% 3 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 6 6.9% 37 8.8% Cognitive difficulty 8 8.9% 26 9.5% Any disability 30 34% 35 37% People age 18-64 with disabilities, 2010 Self-care difficulty 7 1.8% 21 1.8% Cognitive difficulty 22 5.5% 11 4.2% Any disability 45 11.2% 17 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 83,000 134 32 137 Economic value of family caregiving, 2009 . (state in millions of $) $990 $1,590 13 $1,460 Economic value per hour, 2009 $12.37 10 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.1 40 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 16,510 51 17 45 315 Public LTSS Expenditures Vermont Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $1,146 46 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 58.73% 30 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 41% 14 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 65% 5 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Vermont and the U.S., 2009 Vermont United States 25% Percentages may not add 59% to 100% due to rounding 64% Aged/Disabled Waivers 11% 41% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $197 $316 10 $261 Nursing facilities $117 $187 18 $168 HCBS $81 $129 10 $94 Aged/disabled waiver services NA NA NA $29 Personal care services (PCS) ** $19 $31 17 $45 Home health services $7 $11 19 $16 Other HCBS *** $54 $87 1 $4 Medicaid LTSS expenditures for all populations, 2009 $336 $537 11 $413 Institutional services $118 $189 33 $232 HCBS $218 $349 6 $181 Waiver services (all populations) NA NA NA $114 Other HCBS (including PCS and home health) $218 $349 1 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $4 $6.96 10 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 316 Per 1,000 Medicaid HCBS Participants By Type of Service † Population Rank U.S. Vermont State Nursing facilities (NF), 2008 3,793 6.1 18 5.3 HCBS (older people and adults with PD), 2008 NA NA NA 8.2 Aged/disabled waiver services NA NA NA 2.2 Personal care services (PCS) ** 2,653 4.3 9 3.0 Home health services 3,723 6.0 5 3.0 Institutional services (NF and ICF-MR), 2008 3,802 6.1 22 5.6 HCBS (all populations), 2008 NA NA NA 10.1 Waiver services (all populations) NA NA NA 4.1 Other HCBS (including PCS and home health) 6,376 10.2 4 6.0 Adults with disabilities self-directing services, 2011 4,310 6.91 2 2.43 Medicaid Participant LTSS Balance † State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 NA NA 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * NA NA 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * NA NA 64% Medicaid Expenditures Per Person Served † State Rank U.S. Nursing facility services, 2008 $30,496 23 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) NA NA $10,957 Aged/disabled waiver services NA NA $10,710 Personal care services ** $7,676 18 $11,142 Home health services $1,639 36 $5,495 ICF-MR services, 2008 $143,510 16 $123,053 MR/DD waiver services, 2008 NA NA $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $189 18 $178 Medicare payment per day for nursing facility care, 2010 $442 8 $398 Medicare reimbursement per home health visit, 2010 $135 45 $154 Private pay rate per day in nursing facility, 2011 $249 11 $193 Private pay rate per month in assisted living, 2011 $3,600 14 $3,261 Private pay daily rate for adult day care, 2011 $120 1 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 † Because of Vermont’s unique Medicaid LTSS system, comparable data on participants and expenditures per person served are not available for many service types. 317 LTSS Resources Vermont Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 119 1.30 18 1.46 Assisted living and residential care units, 2010 2,749 30 19 31 Personal and home care aides, 2010 6,130 67 1 17 Median hourly wage, 2010 $10.40 12 $9.44 Home health aides, 2010 1,090 12 45 24 Median hourly wage, 2010 $12.13 5 $9.89 People receiving ACL congregate meals, 2009 * 10,325 115 7 42 People receiving ACL home delivered meals, 2009 * 4,390 49 6 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $7 $77 4 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 1 36 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 40 0.44 25 0.40 Nursing facility beds, 2010 3,276 36 34 42 Nursing facility residents, 2010 2,899 32 33 35 Nursing facility occupancy rate, 2010 88% 16 83% Direct care nursing hours per resident day, 2010 4.2 6 3.8 RN hours per day, 2010 0.81 15 0.64 Nursing facility staffing turnover, 2010 33% 38 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 52% 9 46% Nursing facility residents with low care needs, 2008 11% 41 17% Residents with Medicaid as primary payer, 2010 64% 17 63% Residents with Medicare as primary payer, 2010 16% 12 14% Residents with “other” as primary payer, 2010 19% 36 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 9% 39 12% Long-stay residents with a hospital admission, 2008 12% 42 21% Long-term care facility beds per FTE ombudsman, 2010 921 47 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 318 Trends Vermont Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 2,802 1,270,155 with physical disabilities (excluding home health) 2008 NA 1,577,471 % change NA NA +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 3,097 1,460,185 2010 2,899 1,408,886 % change -6% 37 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $801 $285,710 2009 $1,146 $368,330 % change +43% 9 +29% Medicaid LTSS spending for older people and adults 2004 $153 $62,811 with physical disabilities (millions) 2009 $197 $80,181 % change +29% 16 +28% Medicaid nursing facility spending (millions) 2004 $104 $45,842 2009 $117 $51,403 % change +12% 28 +12% Medicaid HCBS spending for older people and adults 2004 $49 $16,969 with physical disabilities (millions) 2009 $81 $28,778 % change +65% 24 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 32% 12 27% people and adults with physical disabilities 2009 41% 14 36% change +9% 15 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $14 60% $12 +$12 50% +48% Millions of Dollars $10 40% $8 30% $6 20% $4 +12% $2 10% $0 $0 $0 $0 0% 0% 0% $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 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. 319 AARP Public Policy Institute Virgin Islands Virgin % of Total % Change Population Year Islands Population U.S. from 2000 U.S. All ages 2000 108,612 2010 106,405 -2% +10% Age 50-64 2000 19,525 18.0% 14.9% 2010 22,459 21.1% 19.0% +15% +40% Age 65+ 2000 9,117 8.4% 12.4% 2010 14,384 13.5% 13.0% +58% +15% Age 65-74 2000 5,854 5.4% 6.5% 2010 9,570 9.0% 7.0% +63% +18% Age 75-84 2000 2,505 2.3% 4.4% 2010 3,660 3.4% 4.2% +46% +6% Age 85+ 2000 767 0.7% 1.5% 2010 1,154 1.1% 1.8% +50% +30% Older People of Color (%), 2000 Population of Virgin Islands, by Age, 2010 State U.S. 85.9% 16.3% 21.1% Asian/Pacific Islander State U.S. 9.0% NA 2.6% 65.4% 3.4% Black 1.1% State U.S. Percentages may not add to 100% due to rounding 75.4% 8.3% <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. 320 Population & Characteristics Virgin virgin islands Living Arrangements Islands U.S. Men per 100 women age 85+, 2010 49 48 People 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. People age 65+ with disabilities, 2000 Self-care difficulty 757 8.5% 9.5% Cognitive difficulty 1,022 11.4% 10.8% Any disability 3,424 38% 42% People age 16-64 with disabilities, 2000 Self-care difficulty 774 1.1% 1.8% Cognitive difficulty 1,644 2.4% 3.8% Any disability 12,135 17.7% 18.6% * Disability rates in 2000 are not comparable to rates in 2010 because of definitional differences 321 AARP Public Policy Institute Virginia Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 8,289 12 315,311 2032 10,746 10 376,660 +30% 8 +19% 2050 12,667 10 434,447 +53% 5 +38% Age 50-64 2012 1,582 19.1% 34 19.2% 2032 1,764 16.4% 22 16.4% +12% 6 +2% 2050 2,159 17.0% 26 16.6% +36% 4 +19% Age 65+ 2012 1,065 12.9% 38 13.6% 2032 2,004 18.6% 41 19.8% +88% 10 +74% 2050 2,543 20.1% 30 20.4% +139% 8 +107% Age 65-74 2012 603 7.3% 35 7.4% green line = 50-64 (WAS BLUE) 2032 1,048 9.8% 29 10.1% +74% 11 +64% red line = 65-74 (WAS PURPLE) 2050 1,153 9.1% 26 9.1% +91% 10 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 320 3.9% 38 blue line = 85+ (WAS RED) 4.2% 2032 671 6.2% 45 6.8% +110% 14 +94% 2050 813 6.4% 25 6.6% +154% 10 +116% Age 85+ 2012 142 1.7% 44 2.0% 2032 285 2.7% 38 2.9% +101% 6 +69% 2050 578 4.6% 34 4.8% +307% 7 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Virginia as a Percentage of State Rank U.S. 2012 Population, by Age Group 21.2% 16 20.1% 500% Population (% of 2012 Population) 450% Asian/Pacific Islander 85+ State Rank U.S. 400% 3.5% 9 3.6% 350% 300% Black 250% State Rank U.S. 75-84 200% 15.0% 9 8.5% 65-74 150% Hispanic 50-64 100% 2030 2040 State 2050 Rank 2060 U.S. 50% 1.9% 25 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Virginia Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 46 31 48 People age 75+ living alone, 2010 33% 35 34% People age 60+ with grandchildren in household, 2010 5.9% 13 5.5% People age 60+ responsible for raising grandchildren, 2010 1.9% 13 1.6% Percent of age 65+ households with someone under 18, 2010 7.7% 14 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $39,274 9 $34,381 At/below poverty level age 65+, 2010 7.4% 38 9.0% At/below 250% of poverty level age 65+, 2010 36% 41 42% Women age 75+ at/below poverty level, 2010 10.5% 35 12.2% Women age 75+ at/below 250% of poverty level, 2010 47% 44 54% Bachelor level education or higher age 65+, 2010 24% 13 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 77 8.0% 24 8.8% Cognitive difficulty 83 8.7% 28 9.5% Any disability 336 35% 31 37% People age 18-64 with disabilities, 2010 Self-care difficulty 77 1.5% 33 1.8% Cognitive difficulty 174 3.5% 40 4.2% Any disability 447 8.9% 36 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 1,180,000 150 10 137 Economic value of family caregiving, 2009 . (state in millions of $) $11,700 $1,480 29 $1,460 Economic value per hour, 2009 $10.37 38 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 6.0 10 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 243,465 65 10 45 323 Public LTSS Expenditures Virginia Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $5,806 23 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 35% 17 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 42% 24 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Virginia and the U.S., 2009 Virginia United States 25% Percentages may not add 65% to 100% due to rounding 64% Aged/Disabled Waivers 2% 11% PCS and other HCBS 34% Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,185 $149 48 $261 Nursing facilities $769 $97 44 $168 HCBS $416 $52 32 $94 Aged/disabled waiver services $398 $50 11 $29 Personal care services (PCS) ** $0 $0 35 $45 Home health services $7 $1 44 $16 Other HCBS *** $11 $1 15 $4 Medicaid LTSS expenditures for all populations, 2009 $2,092 $264 44 $413 Institutional services $1,209 $153 40 $232 HCBS $883 $111 41 $181 Waiver services (all populations) $865 $109 29 $114 Other HCBS (including PCS and home health) $18 $2 49 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $18 $2.27 28 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 324 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Virginia State Nursing facilities (NF), 2008 26,804 3.4 43 5.3 HCBS (older people and adults with PD), 2008 20,316 2.6 43 8.2 Aged/disabled waiver services 16,583 2.1 26 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 3,733 0.5 45 3.0 Institutional services (NF and ICF-MR), 2008 28,603 3.7 42 5.6 HCBS (all populations), 2008 28,493 3.6 48 10.1 Waiver services (all populations) 24,760 3.2 34 4.1 Other HCBS (including PCS and home health) 3,733 0.5 51 6.0 Adults with disabilities self-directing services, 2011 7,809 1.00 26 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 62 14 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 43% 38 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 50% 40 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,215 33 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $15,566 5 $10,957 Aged/disabled waiver services $15,566 7 $10,710 Personal care services ** NA NA $11,142 Home health services $1,565 38 $5,495 ICF-MR services, 2008 $143,378 17 $123,053 MR/DD waiver services, 2008 $54,967 11 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $153 31 $178 Medicare payment per day for nursing facility care, 2010 $358 38 $398 Medicare reimbursement per home health visit, 2010 $167 21 $154 Private pay rate per day in nursing facility, 2011 $191 26 $193 Private pay rate per month in assisted living, 2011 $3,705 12 $3,261 Private pay daily rate for adult day care, 2011 $55 37 $60 Private pay hourly rate for home health aide, 2011 $19 31 $19 325 LTSS Resources Virginia Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 618 0.63 36 1.46 Assisted living and residential care units, 2010 33,067 34 15 31 Personal and home care aides, 2010 16,000 16 24 17 Median hourly wage, 2010 $8.62 44 $9.44 Home health aides, 2010 16,410 17 31 24 Median hourly wage, 2010 $8.94 42 $9.89 People receiving ACL congregate meals, 2009 * 14,073 15 47 42 People receiving ACL home delivered meals, 2009 * 13,103 14 44 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $21 $22 44 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 2 32 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 289 0.29 39 0.40 Nursing facility beds, 2010 32,251 33 39 42 Nursing facility residents, 2010 28,572 29 38 35 Nursing facility occupancy rate, 2010 89% 13 83% Direct care nursing hours per resident day, 2010 3.8 30 3.8 RN hours per day, 2010 0.61 39 0.64 Nursing facility staffing turnover, 2010 38% 25 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 45% 31 46% Nursing facility residents with low care needs, 2008 9% 45 17% Residents with Medicaid as primary payer, 2010 61% 33 63% Residents with Medicare as primary payer, 2010 19% 2 14% Residents with “other” as primary payer, 2010 20% 34 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 13% 6 12% Long-stay residents with a hospital admission, 2008 22% 12 21% Long-term care facility beds per FTE ombudsman, 2010 2,413 24 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 46% 44 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 326 Trends Virginia Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 10,449 1,270,155 with physical disabilities (excluding home health) 2008 16,583 1,577,471 % change +59% 12 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 28,652 1,460,185 2010 28,572 1,408,886 % change +0% 8 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $3,955 $285,710 2009 $5,806 $368,330 % change +47% 7 +29% Medicaid LTSS spending for older people and adults 2004 $808 $62,811 with physical disabilities (millions) 2009 $1,185 $80,181 % change +47% 7 +28% Medicaid nursing facility spending (millions) 2004 $655 $45,842 2009 $769 $51,403 % change +17% 19 +12% Medicaid HCBS spending for older people and adults 2004 $153 $16,969 with physical disabilities (millions) 2009 $416 $28,778 % change +171% 3 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 19% 30 27% people and adults with physical disabilities 2009 35% 17 36% change +16% 5 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $300 450% +423% +$248 400% $250 +$223 350% Millions of Dollars $200 300% 250% $150 +$114 200% +165% $100 150% +$69 +91% 100% $50 +$14 50% +32% +17% $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 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. 327 AARP Public Policy Institute Washington Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 7,014 13 315,311 2032 8,924 14 376,660 +27% 11 +19% 2050 10,221 14 434,447 +46% 11 +38% Age 50-64 2012 1,388 19.8% 21 19.2% 2032 1,540 17.3% 2 16.4% +11% 7 +2% 2050 1,819 17.8% 15 16.6% +31% 7 +19% Age 65+ 2012 900 12.8% 40 13.6% 2032 1,731 19.4% 31 19.8% +92% 7 +74% 2050 2,223 21.8% 5 20.4% +147% 7 +107% Age 65-74 2012 511 7.3% 35 7.4% green line = 50-64 (WAS BLUE) 2032 878 9.8% 29 10.1% +72% 12 +64% red line = 65-74 (WAS PURPLE) 2050 1,035 10.1% 1 9.1% +103% 6 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 261 3.7% 44 blue line = 85+ (WAS RED) 4.2% 2032 609 6.8% 32 6.8% +133% 4 +94% 2050 687 6.7% 12 6.6% +164% 7 +116% Age 85+ 2012 128 1.8% 38 2.0% 2032 244 2.7% 38 2.9% +90% 15 +69% 2050 501 4.9% 18 4.8% +290% 10 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Washington as a Percentage of State Rank U.S. 2012 Population, by Age Group 11.7% 27 20.1% 450% Population (% of 2012 Population) Asian/Pacific Islander 400% 85+ State Rank U.S. 350% 5.4% 5 3.6% 300% 75-84 Black 250% State Rank U.S. 200% 65-74 1.8% 37 8.5% 150% 50-64 Hispanic 100% 2030 2040 State 2050 Rank 2060 U.S. 50% 2.6% 19 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Was hington Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 52 12 48 People age 75+ living alone, 2010 34% 28 34% People age 60+ with grandchildren in household, 2010 4.3% 28 5.5% People age 60+ responsible for raising grandchildren, 2010 1.1% 40 1.6% Percent of age 65+ households with someone under 18, 2010 5.5% 26 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $39,207 11 $34,381 At/below poverty level age 65+, 2010 6.9% 42 9.0% At/below 250% of poverty level age 65+, 2010 34% 46 42% Women age 75+ at/below poverty level, 2010 9.0% 48 12.2% Women age 75+ at/below 250% of poverty level, 2010 48% 43 54% Bachelor level education or higher age 65+, 2010 26% 6 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 70 8.7% 17 8.8% Cognitive difficulty 81 10.0% 16 9.5% Any disability 307 38% 14 37% People age 18-64 with disabilities, 2010 Self-care difficulty 68 1.6% 30 1.8% Cognitive difficulty 182 4.3% 24 4.2% Any disability 425 10.0% 29 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 854,000 128 40 137 Economic value of family caregiving, 2009 . (state in millions of $) $10,600 $1,590 13 $1,460 Economic value per hour, 2009 $12.94 4 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 4.8 17 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 155,059 50 18 45 329 Public LTSS Expenditures Washington Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $6,828 18 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.12% 40 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 62% 2 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 62% 7 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Washington and the U.S., 2009 Washington United States 25% Percentages may not add 38% to 100% due to rounding 30% 64% Aged/Disabled Waivers 11% PCS and other HCBS 32% Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,533 $230 28 $261 Nursing facilities $581 $87 45 $168 HCBS $952 $143 7 $94 Aged/disabled waiver services $496 $74 7 $29 Personal care services (PCS) ** $418 $63 8 $45 Home health services $29 $4 34 $16 Other HCBS *** $9 $1 15 $4 Medicaid LTSS expenditures for all populations, 2009 $2,333 $350 32 $413 Institutional services $884 $133 44 $232 HCBS $1,449 $217 14 $181 Waiver services (all populations) $992 $149 16 $114 Other HCBS (including PCS and home health) $456 $68 12 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $18 $2.63 26 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 330 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. Was hington State Nursing facilities (NF), 2008 21,209 3.2 45 5.3 HCBS (older people and adults with PD), 2008 62,105 9.5 13 8.2 Aged/disabled waiver services 31,748 4.8 7 2.2 Personal care services (PCS) ** 27,075 4.1 10 3.0 Home health services 3,282 0.5 45 3.0 Institutional services (NF and ICF-MR), 2008 21,271 3.2 45 5.6 HCBS (all populations), 2008 71,808 10.9 18 10.1 Waiver services (all populations) 41,451 6.3 11 4.1 Other HCBS (including PCS and home health) 30,357 4.6 21 6.0 Adults with disabilities self-directing services, 2011 22,585 3.44 7 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 150 4 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 75% 5 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 77% 4 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $24,899 39 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $11,692 15 $10,957 Aged/disabled waiver services $12,080 19 $10,710 Personal care services ** $11,236 11 $11,142 Home health services $1,305 39 $5,495 ICF-MR services, 2008 $73,741 43 $123,053 MR/DD waiver services, 2008 $43,715 22 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $168 25 $178 Medicare payment per day for nursing facility care, 2010 $459 4 $398 Medicare reimbursement per home health visit, 2010 $215 4 $154 Private pay rate per day in nursing facility, 2011 $224 16 $193 Private pay rate per month in assisted living, 2011 $4,000 9 $3,261 Private pay daily rate for adult day care, 2011 $60 27 $60 Private pay hourly rate for home health aide, 2011 $22 8 $19 331 LTSS Resources Washington Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 3,445 4.14 6 1.46 Assisted living and residential care units, 2010 44,687 54 5 31 Personal and home care aides, 2010 15,760 19 16 17 Median hourly wage, 2010 $10.85 6 $9.44 Home health aides, 2010 13,010 16 34 24 Median hourly wage, 2010 $10.88 12 $9.89 People receiving ACL congregate meals, 2009 * 51,328 64 21 42 People receiving ACL home delivered meals, 2009 * 12,792 16 38 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $15 $18 49 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 14 8 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 238 0.29 39 0.40 Nursing facility beds, 2010 22,244 27 44 42 Nursing facility residents, 2010 18,339 22 42 35 Nursing facility occupancy rate, 2010 82% 32 83% Direct care nursing hours per resident day, 2010 4.1 9 3.8 RN hours per day, 2010 0.90 4 0.64 Nursing facility staffing turnover, 2010 52% 10 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 45% 31 46% Nursing facility residents with low care needs, 2008 10% 43 17% Residents with Medicaid as primary payer, 2010 60% 37 63% Residents with Medicare as primary payer, 2010 17% 7 14% Residents with “other” as primary payer, 2010 22% 22 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 2% 35 4% High risk residents with pressure sores, 2008 11% 22 12% Long-stay residents with a hospital admission, 2008 14% 35 21% Long-term care facility beds per FTE ombudsman, 2010 2,597 21 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 78% 31 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 332 Trends Was hington Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 51,603 1,270,155 with physical disabilities (excluding home health) 2008 58,823 1,577,471 % change +14% 31 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 19,588 1,460,185 2010 18,339 1,408,886 % change -6% 37 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $5,396 $285,710 2009 $6,828 $368,330 % change +27% 31 +29% Medicaid LTSS spending for older people and adults 2004 $1,218 $62,811 with physical disabilities (millions) 2009 $1,533 $80,181 % change +26% 26 +28% Medicaid nursing facility spending (millions) 2004 $631 $45,842 2009 $581 $51,403 % change -8% 46 +12% Medicaid HCBS spending for older people and adults 2004 $587 $16,969 with physical disabilities (millions) 2009 $952 $28,778 % change +62% 27 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 48% 4 27% people and adults with physical disabilities 2009 62% 2 36% change +14% 6 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $250 80% +75% +$213 70% $200 +$189 +$176 +61% +63% 60% Millions of Dollars $150 50% $100 40% 30% +28% $50 +$34 20% $0 10% 0% -$50 -$50 -10% -8% -$100 -20% 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 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. 333 AARP Public Policy Institute West Virginia Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 1,861 37 315,311 2032 2,180 38 376,660 +17% 32 +19% 2050 2,386 39 434,447 +28% 39 +38% Age 50-64 2012 396 21.3% 4 19.2% 2032 369 16.9% 8 16.4% -7% 38 +2% 2050 440 18.5% 7 16.6% +11% 41 +19% Age 65+ 2012 307 16.5% 3 13.6% 2032 457 21.0% 12 19.8% +49% 51 +74% 2050 497 20.8% 17 20.4% +62% 49 +107% Age 65-74 2012 167 9.0% 3 7.4% green line = 50-64 (WAS BLUE) 2032 223 10.2% 20 10.1% +34% 51 +64% red line = 65-74 (WAS PURPLE) 2050 228 9.5% 11 9.1% +37% 47 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 97 5.2% 2 blue line = 85+ (WAS RED) 4.2% 2032 167 7.6% 6 6.8% +72% 48 +94% 2050 161 6.7% 12 6.6% +66% 49 +116% Age 85+ 2012 44 2.3% 10 2.0% 2032 68 3.1% 10 2.9% +55% 36 +69% 2050 109 4.6% 34 4.8% +150% 47 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in West Virginia as a Percentage of State Rank U.S. 2012 Population, by Age Group 3.7% 46 20.1% 300% Population (% of 2012 Population) Asian/Pacific Islander 250% State Rank U.S. 85+ 0.3% 47 3.6% 200% Black 150% 75-84 State Rank U.S. 65-74 2.1% 33 8.5% 100% 50-64 Hispanic 50% 2030 2040 State 2050 Rank 2060 U.S. 0.6% 46 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 65-74 50-64 334 75-84 Population & Characteristics West Virginia Living Arrangements State Rank U.S. Men per 100 women age 85+, 2010 47 23 48 People age 75+ living alone, 2010 38% 5 34% People age 60+ with grandchildren in household, 2010 4.3% 28 5.5% People age 60+ responsible for raising grandchildren, 2010 1.8% 17 1.6% Percent of age 65+ households with someone under 18, 2010 5.1% 32 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $26,796 51 $34,381 At/below poverty level age 65+, 2010 9.9% 13 9.0% At/below 250% of poverty level age 65+, 2010 54% 1 42% Women age 75+ at/below poverty level, 2010 12.5% 22 12.2% Women age 75+ at/below 250% of poverty level, 2010 64% 1 54% Bachelor level education or higher age 65+, 2010 12% 51 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 31 10.5% 7 8.8% Cognitive difficulty 34 11.6% 5 9.5% Any disability 126 43% 3 37% People age 18-64 with disabilities, 2010 Self-care difficulty 36 3.1% 1 1.8% Cognitive difficulty 81 7.1% 1 4.2% Any disability 197 17.2% 1 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 303,000 166 6 137 Economic value of family caregiving, 2009 . (state in millions of $) $2,800 $1,540 22 $1,460 Economic value per hour, 2009 $9.67 49 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.1 40 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 25,965 27 51 45 335 Public LTSS Expenditures West Virginia Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $2,446 36 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 74.04% 2 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 25% 29 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 40% 31 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in West Virginia and the U.S., 2009 West Virginia United States 25% Percentages may not add 12% 75% to 100% due to rounding 64% Aged/Disabled Waivers 11% 14% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $616 $334 8 $261 Nursing facilities $459 $249 8 $168 HCBS $157 $85 15 $94 Aged/disabled waiver services $84 $45 12 $29 Personal care services (PCS) ** $38 $21 21 $45 Home health services $35 $19 9 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $986 $534 12 $413 Institutional services $592 $320 9 $232 HCBS $395 $214 15 $181 Waiver services (all populations) $321 $174 14 $114 Other HCBS (including PCS and home health) $73 $40 22 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $13 $6.91 11 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 336 Per 1,000 Medicaid HCBS Participants By Type of Service Population Rank U.S. West Virginia State Nursing facilities (NF), 2008 11,474 6.2 16 5.3 HCBS (older people and adults with PD), 2008 13,765 7.5 22 8.2 Aged/disabled waiver services 5,592 3.0 21 2.2 Personal care services (PCS) ** 6,026 3.3 14 3.0 Home health services 2,147 1.2 34 3.0 Institutional services (NF and ICF-MR), 2008 12,046 6.5 17 5.6 HCBS (all populations), 2008 17,659 9.6 23 10.1 Waiver services (all populations) 9,486 5.2 18 4.1 Other HCBS (including PCS and home health) 8,173 4.4 22 6.0 Adults with disabilities self-directing services, 2011 690 0.37 38 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 49 24 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 55% 24 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 59% 27 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $37,860 9 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $9,054 26 $10,957 Aged/disabled waiver services $12,051 20 $10,710 Personal care services ** $6,273 23 $11,142 Home health services $1,570 37 $5,495 ICF-MR services, 2008 $105,026 29 $123,053 MR/DD waiver services, 2008 $57,480 9 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 NA NA $178 Medicare payment per day for nursing facility care, 2010 $339 49 $398 Medicare reimbursement per home health visit, 2010 $168 18 $154 Private pay rate per day in nursing facility, 2011 $233 13 $193 Private pay rate per month in assisted living, 2011 $3,275 26 $3,261 Private pay daily rate for adult day care, 2011 $55 37 $60 Private pay hourly rate for home health aide, 2011 $16 47 $19 337 LTSS Resources West Virginia Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 379 1.27 19 1.46 Assisted living and residential care units, 2010 3,565 12 48 31 Personal and home care aides, 2010 6,600 22 12 17 Median hourly wage, 2010 $8.14 51 $9.44 Home health aides, 2010 6,340 21 22 24 Median hourly wage, 2010 $8.45 50 $9.89 People receiving ACL congregate meals, 2009 * 24,736 84 11 42 People receiving ACL home delivered meals, 2009 * 10,006 34 16 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $15 $50 15 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 0 41 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 129 0.43 26 0.40 Nursing facility beds, 2010 10,828 36 34 42 Nursing facility residents, 2010 9,569 32 33 35 Nursing facility occupancy rate, 2010 88% 16 83% Direct care nursing hours per resident day, 2010 3.7 36 3.8 RN hours per day, 2010 0.59 42 0.64 Nursing facility staffing turnover, 2010 54% 7 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 53% 7 46% Nursing facility residents with low care needs, 2008 14% 31 17% Residents with Medicaid as primary payer, 2010 72% 5 63% Residents with Medicare as primary payer, 2010 15% 17 14% Residents with “other” as primary payer, 2010 14% 48 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 13% 6 12% Long-stay residents with a hospital admission, 2008 22% 12 21% Long-term care facility beds per FTE ombudsman, 2010 1,234 42 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 99% 21 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 338 Trends West Virginia Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 10,837 1,270,155 with physical disabilities (excluding home health) 2008 11,618 1,577,471 % change +7% 39 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 10,033 1,460,185 2010 9,569 1,408,886 % change -5% 30 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $1,961 $285,710 2009 $2,446 $368,330 % change +25% 34 +29% Medicaid LTSS spending for older people and adults 2004 $501 $62,811 with physical disabilities (millions) 2009 $616 $80,181 % change +23% 31 +28% Medicaid nursing facility spending (millions) 2004 $379 $45,842 2009 $459 $51,403 % change +21% 15 +12% Medicaid HCBS spending for older people and adults 2004 $122 $16,969 with physical disabilities (millions) 2009 $157 $28,778 % change +29% 42 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 24% 17 27% people and adults with physical disabilities 2009 25% 29 36% change +1% 44 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $90 60% +$79 +$80 +50% $80 +48% 50% $70 Millions of Dollars $60 40% $50 30% $40 +21% $30 +$27 20% +13% $20 +10% 10% $10 +$6 +$8 $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 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. 339 AARP Public Policy Institute Wisconsin Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 5,745 20 315,311 2032 6,392 21 376,660 +11% 44 +19% 2050 7,233 21 434,447 +26% 43 +38% Age 50-64 2012 1,186 20.6% 11 19.2% 2032 1,033 16.2% 27 16.4% -13% 45 +2% 2050 1,269 17.5% 20 16.6% +7% 43 +19% Age 65+ 2012 813 14.2% 23 13.6% 2032 1,402 21.9% 7 19.8% +72% 20 +74% 2050 1,521 21.0% 14 20.4% +87% 32 +107% Age 65-74 2012 431 7.5% 28 7.4% green line = 50-64 (WAS BLUE) 2032 722 11.3% 7 10.1% +67% 16 +64% red line = 65-74 (WAS PURPLE) 2050 656 9.1% 26 9.1% +52% 38 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 253 4.4% 18 blue line = 85+ (WAS RED) 4.2% 2032 485 7.6% 6 6.8% +92% 22 +94% 2050 481 6.7% 12 6.6% +90% 29 +116% Age 85+ 2012 129 2.2% 16 2.0% 2032 195 3.1% 10 2.9% +52% 38 +69% 2050 384 5.3% 8 4.8% +199% 28 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Wisconsin as a Percentage of State Rank U.S. 2012 Population, by Age Group 5.5% 41 20.1% 350% Population (% of 2012 Population) Asian/Pacific Islander 300% 85+ State Rank U.S. 0.7% 35 3.6% 250% 200% Black 75-84 State Rank U.S. 150% 2.7% 30 8.5% 65-74 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 1.3% 33 6.9% 0% 2010 2020 2030 2040 2050 2060 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 Living Arrangements State Rank U.S. Wisconsin Men per 100 women age 85+, 2010 46 31 48 People age 75+ living alone, 2010 39% 3 34% People age 60+ with grandchildren in household, 2010 2.4% 45 5.5% People age 60+ responsible for raising grandchildren, 2010 0.7% 46 1.6% Percent of age 65+ households with someone under 18, 2010 2.9% 47 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $32,315 33 $34,381 At/below poverty level age 65+, 2010 7.1% 40 9.0% At/below 250% of poverty level age 65+, 2010 44% 17 42% Women age 75+ at/below poverty level, 2010 11.1% 30 12.2% Women age 75+ at/below 250% of poverty level, 2010 60% 8 54% Bachelor level education or higher age 65+, 2010 19% 34 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 50 6.6% 44 8.8% Cognitive difficulty 50 6.7% 47 9.5% Any disability 246 33% 42 37% People age 18-64 with disabilities, 2010 Self-care difficulty 54 1.5% 33 1.8% Cognitive difficulty 132 3.7% 37 4.2% Any disability 306 8.7% 38 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 524,000 93 51 137 Economic value of family caregiving, 2009 . (state in millions of $) $5,800 $1,020 51 $1,460 Economic value per hour, 2009 $11.49 22 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 1.9 48 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 148,636 54 14 45 341 Public LTSS Expenditures Wisconsin Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $7,123 17 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 60.21% 29 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * † 44% 9 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * † 56% 10 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Wisconsin and the U.S., 2009 Wisconsin United States 25% Percentages may not add 56% to 100% due to rounding 16% 64% Aged/Disabled Waivers 11% PCS and other HCBS 29% Nursing Facilities Total Per Person LTSS & Home Health Expenditures † (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $1,767 $312 11 $261 Nursing facilities $986 $174 23 $168 HCBS $781 $138 9 $94 Aged/disabled waiver services $506 $89 5 $29 Personal care services (PCS) ** $198 $35 16 $45 Home health services $76 $13 15 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $2,654 $468 16 $413 Institutional services $1,177 $208 28 $232 HCBS $1,478 $261 10 $181 Waiver services (all populations) $1,203 $212 9 $114 Other HCBS (including PCS and home health) $274 $48 18 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 NA NA NA $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. † Because of inconsistencies in 2009 spending data for some services, an average of 2008 and 2009 data is used for Wisconsin’s Medicaid LTSS expenditures 342 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. Nursing facilities (NF), 2008 32,585 5.8 20 5.3 Wisconsin HCBS (older people and adults with PD), 2008 45,354 8.0 20 8.2 Aged/disabled waiver services 25,287 4.5 9 2.2 Personal care services (PCS) ** 14,032 2.5 19 3.0 Home health services 6,035 1.1 36 3.0 Institutional services (NF and ICF-MR), 2008 34,028 6.0 24 5.6 HCBS (all populations), 2008 67,941 12.0 14 10.1 Waiver services (all populations) 47,874 8.5 6 4.1 Other HCBS (including PCS and home health) 20,067 3.6 28 6.0 Adults with disabilities self-directing services, 2011 9,563 1.70 12 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 78 12 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 58% 19 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 67% 15 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $23,958 45 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $15,056 6 $10,957 Aged/disabled waiver services $17,661 4 $10,710 Personal care services ** $10,362 12 $11,142 Home health services $2,922 24 $5,495 ICF-MR services, 2008 $88,970 36 $123,053 MR/DD waiver services, 2008 $28,717 42 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $150 32 $178 Medicare payment per day for nursing facility care, 2010 $412 26 $398 Medicare reimbursement per home health visit, 2010 $163 27 $154 Private pay rate per day in nursing facility, 2011 $218 19 $193 Private pay rate per month in assisted living, 2011 $3,550 15 $3,261 Private pay daily rate for adult day care, 2011 $59 33 $60 Private pay hourly rate for home health aide, 2011 $21 11 $19 343 LTSS Resources Wisconsin Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 4,895 6.28 4 1.46 Assisted living and residential care units, 2010 44,537 57 4 31 Personal and home care aides, 2010 19,630 25 10 17 Median hourly wage, 2010 $9.62 27 $9.44 Home health aides, 2010 22,080 28 10 24 Median hourly wage, 2010 $10.35 22 $9.89 People receiving ACL congregate meals, 2009 * 53,176 69 18 42 People receiving ACL home delivered meals, 2009 * 20,284 26 23 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $39 $51 14 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 14 8 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 403 0.52 16 0.40 Nursing facility beds, 2010 36,422 47 19 42 Nursing facility residents, 2010 30,565 39 20 35 Nursing facility occupancy rate, 2010 84% 30 83% Direct care nursing hours per resident day, 2010 3.9 17 3.8 RN hours per day, 2010 0.82 13 0.64 Nursing facility staffing turnover, 2010 37% 28 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 48% 20 46% Nursing facility residents with low care needs, 2008 21% 11 17% Residents with Medicaid as primary payer, 2010 59% 39 63% Residents with Medicare as primary payer, 2010 14% 26 14% Residents with “other” as primary payer, 2010 27% 9 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 1% 48 4% High risk residents with pressure sores, 2008 10% 33 12% Long-stay residents with a hospital admission, 2008 14% 35 21% Long-term care facility beds per FTE ombudsman, 2010 2,968 18 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 32% 48 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 344 Trends Wisconsin Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 30,620 1,270,155 with physical disabilities (excluding home health) 2008 39,319 1,577,471 % change +28% 24 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 34,523 1,460,185 2010 30,565 1,408,886 % change -11% 48 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $4,540 $285,710 2009 $7,123 $368,330 % change +57% 2 +29% Medicaid LTSS spending for older people and adults 2004 $1,277 $62,811 with physical disabilities (millions) 2009 $1,767 $80,181 % change +38% 9 +28% Medicaid nursing facility spending (millions) 2004 $949 $45,842 2009 $986 $51,403 % change +4% 38 +12% Medicaid HCBS spending for older people and adults 2004 $329 $16,969 with physical disabilities (millions) 2009 $781 $28,778 % change +137% 7 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 26% 15 27% people and adults with physical disabilities 2009 44% 9 36% change +18% 4 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $400 300% +$358 $350 +242% 250% $300 +$267 Millions of Dollars $250 200% $200 150% $150 $100 +$94 100% +67% $50 +$37 +52% 50% $0 +4% 0% $-50 $-100 -$66 -50% -29% 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 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. 345 AARP Public Policy Institute Wyoming Population State Pop. % of Total % Change & Projections Year (1,000s) Population Rank U.S. from 2012 Rank U.S. All ages 2012 574 51 315,311 2032 786 49 376,660 +37% 3 +19% 2050 832 50 434,447 +45% 13 +38% Age 50-64 2012 116 20.1% 17 19.2% 2032 119 15.1% 42 16.4% +3% 16 +2% 2050 147 17.7% 16 16.6% +27% 12 +19% Age 65+ 2012 73 12.8% 40 13.6% 2032 135 17.2% 47 19.8% +84% 13 +74% 2050 166 19.9% 33 20.4% +126% 11 +107% Age 65-74 2012 41 7.2% 37 7.4% green line = 50-64 (WAS BLUE) 2032 67 8.6% 49 10.1% +63% 20 +64% red line = 65-74 (WAS PURPLE) 2050 80 9.6% 8 9.1% +94% 8 +69% Yellow line = 75-84 (WAS YELLOW) Age 75-84 2012 22 3.8% 41 blue line = 85+ (WAS RED) 4.2% 2032 50 6.3% 44 6.8% +125% 6 +94% 2050 49 5.8% 45 6.6% +120% 14 +116% Age 85+ 2012 10 1.8% 38 2.0% 2032 18 2.3% 47 2.9% +82% 17 +69% 2050 37 4.4% 41 4.8% +266% 14 +224% Projected Growth in the Older Population Older People of Color (%), 2010 in Wyoming as a Percentage of State Rank U.S. 2012 Population, by Age Group 6.3% 39 20.1% 400% Population (% of 2012 Population) Asian/Pacific Islander 350% 85+ State Rank U.S. 300% 0.6% 38 3.6% 250% Black 75-84 State Rank U.S. 200% 65-74 1.2% 40 8.5% 150% 100% Hispanic 50-64 2030 2040 State 2050 Rank 2060 U.S. 50% 3.2% 16 6.9% 0% 2010 2020 2030 2040 2050 2060 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. 346 Population & Characteristics Living Arrangements State Rank U.S. Wyoming Men per 100 women age 85+, 2010 55 7 48 People age 75+ living alone, 2010 35% 17 34% People age 60+ with grandchildren in household, 2010 2.8% 42 5.5% People age 60+ responsible for raising grandchildren, 2010 0.9% 43 1.6% Percent of age 65+ households with someone under 18, 2010 3.0% 46 7.0% Income & Poverty State Rank U.S. Median household income age 65+, 2010 $33,777 24 $34,381 At/below poverty level age 65+, 2010 6.8% 43 9.0% At/below 250% of poverty level age 65+, 2010 41% 30 42% Women age 75+ at/below poverty level, 2010 10.3% 37 12.2% Women age 75+ at/below 250% of poverty level, 2010 60% 8 54% Bachelor level education or higher age 65+, 2010 20% 28 21% Number Disability Rates (1,000s) Percent Rank U.S. People age 65+ with disabilities, 2010 Self-care difficulty 3 4.9% 50 8.8% Cognitive difficulty 6 8.6% 31 9.5% Any disability 25 37% 21 37% People age 18-64 with disabilities, 2010 Self-care difficulty 4 1.2% 47 1.8% Cognitive difficulty 15 4.2% 25 4.2% Any disability 36 10.2% 26 10.0% Per 1,000 Family Caregivers State Population Rank U.S. Family caregivers, 2009 72,000 133 34 137 Economic value of family caregiving, 2009 . (state in millions of $) $680 $1,260 48 $1,460 Economic value per hour, 2009 $9.87 46 $11.16 Ratio of the economic value of family caregiving. to Medicaid long-term care spending, 2009 3.2 37 3.8 Per 1,000 Long-Term Care Insurance State Age 40+ Rank U.S. Private long-term care insurance policies in effect, 2010 11,636 45 23 45 347 Public LTSS Expenditures Wyoming Medicaid Expenditures State Rank U.S. Total Medicaid expenditures (millions), 2009 $526 51 $368,330 Federal Medicaid Assistance Percentage (FMAP), 2009 50.00% 41 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 23% 34 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 51% 13 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in Wyoming and the U.S., 2009 Wyoming United States 25% Percentages may not add 7% 77% to 100% due to rounding 64% Aged/Disabled Waivers 16% 11% PCS and other HCBS Nursing Facilities Total Per Person LTSS & Home Health Expenditures (millions) in the State Rank U.S. Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $95 $170 43 $261 Nursing facilities $73 $130 36 $168 HCBS $22 $40 40 $94 Aged/disabled waiver services $15 $26 29 $29 Personal care services (PCS) ** NA NA NA $45 Home health services $8 $14 14 $16 Other HCBS *** NA NA NA $4 Medicaid LTSS expenditures for all populations, 2009 $245 $438 19 $413 Institutional services $121 $215 24 $232 HCBS $124 $222 13 $181 Waiver services (all populations) $117 $209 10 $114 Other HCBS (including PCS and home health) $8 $14 35 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $3 $5.45 15 $4.83 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. * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** 15 states did not report any PCS spending in 2009; the lowest possible rank is 36. In 2008, 19 states did not report any PCS participants; the lowest possible rank is 32. *** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. Only 26 states have spending categorized as this type; the lowest rank for this indicator is 22. 348 Per 1,000 Medicaid HCBS Participants By Type of Service State Population Rank U.S. Nursing facilities (NF), 2008 2,427 4.4 32 5.3 Wyoming HCBS (older people and adults with PD), 2008 2,464 4.5 37 8.2 Aged/disabled waiver services 1,909 3.5 14 2.2 Personal care services (PCS) ** NA NA NA 3.0 Home health services 555 1.0 37 3.0 Institutional services (NF and ICF-MR), 2008 2,522 4.6 34 5.6 HCBS (all populations), 2008 4,915 9.0 24 10.1 Waiver services (all populations) 4,360 8.0 7 4.1 Other HCBS (including PCS and home health) 555 1.0 48 6.0 Adults with disabilities self-directing services, 2011 506 0.93 28 2.43 Medicaid Participant LTSS Balance State Rank U.S. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 79 11 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 50% 29 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 66% 17 64% Medicaid Expenditures Per Person Served State Rank U.S. Nursing facility services, 2008 $28,427 28 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $5,970 38 $10,957 Aged/disabled waiver services $5,970 41 $10,710 Personal care services ** NA NA $11,142 Home health services $3,072 23 $5,495 ICF-MR services, 2008 $94,774 33 $123,053 MR/DD waiver services, 2008 $56,804 10 $42,896 LTSS Costs Public & Private Payment Rates State Rank U.S. Medicaid payment per day for nursing facility care, 2011 $164 27 $178 Medicare payment per day for nursing facility care, 2010 $421 20 $398 Medicare reimbursement per home health visit, 2010 $150 37 $154 Private pay rate per day in nursing facility, 2011 $192 25 $193 Private pay rate per month in assisted living, 2011 $3,407 22 $3,261 Private pay daily rate for adult day care, 2011 $54 39 $60 Private pay hourly rate for home health aide, 2011 $20 22 $19 349 LTSS Resources Wyoming Per 1,000 HCBS Resources State Age 65+ Rank U.S. Assisted living and residential care facilities, 2010 34 0.48 40 1.46 Assisted living and residential care units, 2010 1,440 21 37 31 Personal and home care aides, 2010 1,300 19 16 17 Median hourly wage, 2010 $10.56 8 $9.44 Home health aides, 2010 1,030 15 37 24 Median hourly wage, 2010 $11.16 9 $9.89 People receiving ACL congregate meals, 2009 * 19,753 289 1 42 People receiving ACL home delivered meals, 2009 * 5,171 76 1 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $9 $131 2 $36 Number of health maintenance tasks able to be . delegated to LTSS workers (out of 16 tasks), 2011 10 19 Per 1,000 Nursing Facility Resources & Utilization State Age 65+ Rank U.S. Total nursing facilities, 2010 39 0.56 14 0.40 Nursing facility beds, 2010 2,975 42 27 42 Nursing facility residents, 2010 2,435 35 26 35 Nursing facility occupancy rate, 2010 82% 32 83% Direct care nursing hours per resident day, 2010 3.7 36 3.8 RN hours per day, 2010 0.86 8 0.64 Nursing facility staffing turnover, 2010 50% 12 40% Nursing Facility Resident Characteristics State Rank U.S. Residents with dementia, 2010 47% 24 46% Nursing facility residents with low care needs, 2008 22% 8 17% Residents with Medicaid as primary payer, 2010 60% 37 63% Residents with Medicare as primary payer, 2010 13% 31 14% Residents with “other” as primary payer, 2010 27% 9 22% Quality & Oversight of Nursing Facilities State Rank U.S. Residents with physical restraints, 2008 3% 24 4% High risk residents with pressure sores, 2008 12% 12 12% Long-stay residents with a hospital admission, 2008 15% 34 21% Long-term care facility beds per FTE ombudsman, 2010 885 49 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 100% 1 76% 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. * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 350 Trends Wyoming Medicaid HCBS Utilization Year State Rank U.S. Medicaid HCBS participants, older people and adults 2003 1,355 1,270,155 with physical disabilities (excluding home health) 2008 1,909 1,577,471 % change +41% 18 +24% Nursing Facility Residents Year State Rank U.S. Nursing facility residents 2005 2,464 1,460,185 2010 2,435 1,408,886 % change -1% 13 -4% Long-Term Care Financing Year State Rank U.S. Total Medicaid spending (millions) 2004 $375 $285,710 2009 $526 $368,330 % change +40% 13 +29% Medicaid LTSS spending for older people and adults 2004 $74 $62,811 with physical disabilities (millions) 2009 $95 $80,181 % change +28% 21 +28% Medicaid nursing facility spending (millions) 2004 $61 $45,842 2009 $73 $51,403 % change +20% 16 +12% Medicaid HCBS spending for older people and adults 2004 $14 $16,969 with physical disabilities (millions) 2009 $22 $28,778 % change +64% 25 +70% Medicaid HCBS as a % of LTSS spending, for older 2004 18% 32 27% people and adults with physical disabilities 2009 23% 34 36% change +5% 29 +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $30 90% 80% +77% $25 +$24 70% Millions of Dollars $20 60% 50% +44% $15 +$12 40% +33% $10 30% +$6 +20% 20% $5 +$1 +$2 10% +4% $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 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. 351 AARP Public Policy Institute Data Documentation Data Documentation Care should be taken when making comparisons with indicators from other publications or earlier editions of Across the States, as data sources, definitions, and methodology may differ. Long-Term Services and Supports Maps Percent of Population Age 85+, 2012, 2032, and 2050. Source: AARP Public Policy Institute calculations from REMI (Regional Economic Models, Inc.) 2012 baseline demographic projections. People of Color, Percent of Age 65+. Source: U.S. Census Bureau, 2010 American Community Survey 1-Year Estimates, Table S0103, “Population 65 Years and Over in the United States,” generated by AARP Public Policy Institute using American FactFinder (http://factfinder2.census.gov), accessed November 2011. Calculation for Alaska from 2008–2010 American Community Survey 3-Year Estimates, as 1-year estimate was not available. Total population of color was calculated as the population other than “White alone, not Hispanic or Latino.” Medicaid HCBS Spending as a Percentage of LTSS Spending, for Older People and Adults with Physical Disabilities and All Populations. Source: AARP Public Policy Institute calculations based on data from Steve Eiken, Kate Sredl, Brian Burwell, and Lisa Gold, “Medicaid Expenditures for Long-Term Services and Supports: 2011 Update,” Truven Health Analytics (formerly Thomson Reuters), 2011, available at http://www.hcbs.org/moreInfo.php/doc/3661. For more detail, see “Public LTSS Expenditures” below. Medicaid HCBS Beneficiaries as a Percentage of LTSS Users, for Older People and Adults with Physical Disabilities and All Populations. Source: AARP Public Policy Institute calculations using data from 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 2011), available at http://www.kff.org/medicaid/7720.cfm; Centers for Medicare and Medicaid Services, Medicaid Statistical Information (MSIS) State Summary Datamart using annual 2008 data from the fiscal year 2008 Quarterly Cube, available at http://msis.cms.hhs.gov; and Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2010, Table 13.25, “Medicaid Persons Served (Beneficiaries), by Type of Service and Area of Residence: Fiscal Year 2008,” available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ MedicareMedicaidStatSupp/2010.html. Annual Cost of Care for Semi-Private Room in a Nursing Facility; Annual Cost of Home Care (30 Hours per Week); Annual Cost of Assisted Living. Source: Genworth Financial, “Genworth Financial 2011 Cost of Care Survey.” The annual cost of care for a semi-private room in a nursing facility is based on the daily semi-private room rate, multiplied by 365 days; the annual cost of home care is based on 30 hours of care per week, multiplied by 52 weeks; and the annual cost of assisted living is based on the monthly rate, multiplied by 12 months. Private Long-Term Care Insurance Policies in Effect per 1,000 Population Age 40+. Source: AARP Public Policy Institute calculations using data from U.S. Long-Term Care Insurance: 2010 Supplements (Windsor, CT: LIMRA, 2011) and U.S. Census Bureau State Intercensal Estimates (2000–2010), http://www. census.gov/popest/data/intercensal/state/state2010.html. Medicaid Presumptive Eligibility for HCBS. Source: Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica, Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, September 2011), available at http://www. longtermscorecard.org. AARP conducted a state survey to collect information about state provisions to 354 Data Documentation allow case managers or eligibility workers to presume Medicaid financial eligibility for individuals who are seeking home and community-based services and are at risk of entering a nursing home. Data are part of the composite indicator Tools and Programs to Facilitate Consumer Choice. States With or Planning to Implement Medicaid Managed LTSS. Source: Mike Cheek, Martha Roherty, Leslie Finnan, Eunhee (Grace) Cho, Jenna Walls, Kathleen Gifford, Wendy Fox-Grage, and Kathleen Ujvari, On the Verge: The Transformation of Long-Term Services and Supports (Washington, DC: National Association of States United for Aging and Disabilities, Health Management Associates, and AARP Public Policy Institute, 2012), available at http://www.aarp.org/health/health-care-reform/info-02-2012/On-the- Verge-The-Transformation-of-Long-Term-Services-and-Supports-AARP-ppi-ltc.html. States Exceeding Federal Requirements for Family and Medical Leave Acts for Adults. Source: Data from “State Family and Medical Leave Laws that Differ from the Federal FMLA,” assembled by National Conference of State Legislatures, 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 that employers with 50 or more employees must provide 12 weeks of unpaid leave during a 12-month period to— • care for a newborn, adopted, or foster child; •care for a family member (parent, child under 18, dependant adult child, or spouse) with a serious health condition; or • attend to the employee’s own serious health condition. See also http://www.ncsl.org/print/employ/fam-medleave.pdf. ADRC Coverage. Source: The Lewin Group, calculation based on state-reported data, ADRC Semi-Annual Reporting, June 2012. Medicaid Community Spouse Income and Asset Protection: Income Eligibility Allowance; Allowable Asset Standards. Source: Lina Walker and Jean Accius, Access to Long-Term Services and Supports: A 50-State Survey of Medicaid Financial Eligibility (Washington, DC: AARP Public Policy Institute, September 2010), available at http://www.aarp.org/health/health-care-reform/info-09-2010/i44-health.html. Percent of Long-Stay Nursing Facility Residents with Physical Restraints; Percent of High-Risk Nursing Facility Residents with Pressure Sores. Source: Agency for Health Research and Quality (AHRQ) National Healthcare Quality and Disparities Reports, 2010, available at http://www.ahrq.gov/qual/qrdr10/ index.html#Supportive. Percent of Long-Stay Nursing Facility Residents with a Hospital Admission. Source: Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica, Raising Expectations: A State Scorecard on Long- Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, September 2011), available at http://www.longtermscorecard.org. Percent of long-stay residents (residing in a nursing facility relatively continuously for 100 days prior to the second quarter of the calendar year) who were ever hospitalized within six months of baseline assessment. Data derived from analysis of Medicare enrollment data and MEDPAR file by V. Mor at Brown University, under a grant funded by the National Institute on Aging Program Project grant. Percent of Home Health Patients with a Hospital Admission. Source: AHRQ National Healthcare Quality and Disparities Reports, 2010, available at http://www.ahrq.gov/qual/qrdr10/index.html#Supportive. Nursing Facility Staffing Turnover Rate. Source: American Health Care Association, reported in “Report of Findings: 2010 Nursing Facility Staff Retention and Turnover Survey.” Data for the state of Alaska and 355 Data Documentation District of Columbia were insufficient to generate state-level analysis. Nursing home staffing turnover is the ratio of full- and part-time employee terminations that occurred during the year, regardless of cause, to the average number of active employees on the payroll during the same period. Percent of Nursing Facilities that are For-Profit. Source: Charlene Harrington, Helen Carrillo, Megan Dowdell, Paul P. Tang, and Brandee Woleslagle Blank, Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2005 Through 2010 (University of California, San Francisco, 2011), available at http://www. theconsumervoice.org/sites/default/files/OSCAR-2011-final.pdf. Dual Eligibles as a Percent of the Total Medicare Population. Source: The SCAN Foundation, “DataBrief: Dual Eligibles Across the States,” February 2012, available at http://www.thescanfoundation.org/sites/scan. lmp03.lucidus.net/files/1pg_DataBrief_No12.pdf. States with Integrated Medicare-Medicaid Programs Other than PACE. Source: Centers for Medicare & Medicaid Services, “Medicare-Medicaid Enrollee State Profile: The National Summary;” June 2012, available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/StateProfiles.html. State Profiles Population and Characteristics Total population, population by age groups, percentage of population by age groups (2012, 2032, and 2050), and percent change. Source: AARP Public Policy Institute calculations from REMI 2012 baseline demographic projections. Race & Ethnicity. Source: U.S. Census Bureau, 2010 American Community Survey 1-Year Estimates, Table S0103, “Population 65 Years and Over in the United States,” generated by AARP Public Policy Institute using American FactFinder (http://factfinder2.census.gov), accessed November 2011. Calculation for Alaska from 2008–2010 American Community Survey 3-Year Estimates, as 1-year estimate was not available. Total population of color was calculated as the population other than “White alone, not Hispanic or Latino.” Total population of color is not equal to the sum of the three reported groups because other racial groups and race and ethnicity (Hispanic/not Hispanic) are separate questions. Line graph, projected population growth by age group. Source: AARP Public Policy Institute calculations from REMI 2012 baseline demographic projections. Men per 100 women age 85+. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, Table QT-P1, “Age Group and Sex,” generated using American FactFinder (http://factfinder2.census.gov), accessed January 2012. People age 75+ living alone. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, Table B25116, “Tenure by Household Size by Age of Householder,” generated using American FactFinder (http://factfinder2.census.gov), accessed May 2012. People age 60+ with grandchildren in household, responsible for raising grandchildren. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, Table B10056, “Sex of Grandparents Living with Own Grandchildren Under 18 Years by Responsibility for Own Grandchildren and Age of Grandparent,” generated using American FactFinder (http://factfinder2. census.gov), accessed September 2011; and U.S. Census Bureau, 2010 American Community Survey 1-Year Estimates, Table B01001, “Sex by Age,” generated using American FactFinder, accessed November 2011. 356 Data Documentation Percent of age 65+ households with someone under age 18. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, public use microdata, accessed February 2012. Median household income age 65+. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, Table B19049, “Median Household Income in the Past 12 Months (In 2010 Inflation-Adjusted Dollars) by Age of Householder,” generated using American FactFinder (http://factfinder2.census.gov), accessed November 2011. All income variables are computed for the preceding 12 months (the survey is conducted throughout the year, so this reference period could be January 2009 to December 2009, December 2009 to November 2010, or any time in between) and are reported in 2010 inflation-adjusted dollars. 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 2010, Table GCT1703, “Percent of People Age 65 and Over Below Poverty Level in the Past 12 Months,” generated using American FactFinder (http://factfinder2.census.gov), accessed November 2011; and U.S. Census Bureau, American Community Survey 2010, Table B17001, “Poverty Status in the Past 12 Months by Sex by Age,” generated using American FactFinder, accessed January 2012. 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 2010 was $10,485. The 2010 poverty guideline for a single adult was $10,890. At/below 250 percent poverty level age 65+; Women age 75+ at/below 250 percent poverty level. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, public use microdata, accessed February 2012. Bachelor-level education or higher age 65+. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, Table B15001, “Sex by Age by Educational Attainment for the Population 18 Years and Over,” generated using American FactFinder (http://factfinder. census.gov), accessed November 2011. People age 18–64 and age 65+ with self-care difficulty. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, Table C18106, “Sex by Age by Self-Care Disability for the Civilian Noninstitutionalized Population 5 Years and Over,” generated using American FactFinder (http://factfinder2.census.gov), accessed March 2012. Questions ask, “Does this person have difficulty dressing or bathing?” “Does this person have serious difficulty walking or climbing stairs?” People age 18–64 and age 65+ with cognitive difficulty. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, Table C18104, “Sex by Age by Cognitive Difficulty for the Civilian Noninstitutionalized Population 5 Years and Over,” generated using American FactFinder (http://factfinder2.census.gov), accessed March 2012. Question asks, “Because of a physical, mental, or emotional condition, does this person have serious difficulty concentrating, remembering, or making decisions?” People age 18–64 and 65+ with any disability. Source: AARP Public Policy Institute calculations using data from U.S. Census Bureau, American Community Survey 2010, Table C18101, “Sex by Age by Cognitive Difficulty for the Civilian Noninstitutionalized Population 5 Years and Over,” generated using American FactFinder (http://factfinder2.census.gov), accessed March 2012. Includes persons with one or more of six types of disability—hearing, vision, cognitive, ambulatory, self-care, and independent living. Family caregivers; Economic value of family caregiving; Economic value per hour; Ratio of economic value to Medicaid LTSS spending. Source: Lynn Feinberg, Susan C. Reinhard, Ari Houser, and Rita 357 Data Documentation Choula, Valuing the Invaluable: 2011 Update, AARP Public Policy Institute Insight on the Issues #51, June 2011, available at http://www.aarp.org/relationships/caregiving/info-07-2011/valuing-the-invaluable.html. Private long-term care insurance policies in effect. Source: AARP Public Policy Institute calculations using data from LIMRA Individual and Group In-Force Lives, Long-Term Care Insurance Policies in Effect report, 2010 (Windsor, CT: LIMRA, January 2012) and U.S. Census Bureau State Intercensal Estimates (2000–2010), http://www.census.gov/popest/data/intercensal/state/state2010.html. Public LTSS Expenditures Federal Medical Assistance Percentage. Source: Department of Health and Human Services, Federal Register 73, no. 229 (November 26, 2008), pp. 72051–53, DOCID: fr26no08-75, available at http://www. gpo.gov/fdsys/pkg/FR-2008-11-26/pdf/E8-28233.pdf. The federal medical assistance percentage (FMAP) is the percentage of Medicaid spending that is normally paid by the federal government. The FMAP is calculated by the formula 100% – 45%*[(State per capita income)/(U.S. per capita income)], where per capita income is the three-year average of data from the National Income and Product Accounts, published by the Department of Commerce, and may not be lower than 50 percent. Total Medicaid expenditures; Pie chart; Expenditures by service. Source: AARP Public Policy Institute calculations based on data from Steve Eiken, Kate Sredl, Brian Burwell, and Lisa Gold, “Medicaid Expenditures for Long-Term Services and Supports: 2011 Update,” Truven Health Analytics (formerly Thomson Reuters), 2011, available at http://www.hcbs.org/moreInfo.php/doc/3661. Long-term services and supports for older people and adults with physical disabilities include all services reported as nursing facilities, and home and community-based services (HCBS) including personal care services, 1915(c) waiver programs for aged and/or disabled populations (referred to as HCBS waivers in the profiles and tables), Section 1115, 1915(j), and 1929 programs, and PACE. Home health services are also included in HCBS for LTSS balancing calculations. Institutional LTSS for all populations also include intermediate care facilities- mental retardation (ICF-MR) and inpatient mental health services. HCBS for all populations also include 1915(c) waivers (referred to as HCBS waivers in the profiles and tables) and Section 1915(a), 1915(i), and 1915(j) programs for all populations. Care should be taken when comparing balancing measures with previous editions of Across the States, as home health services were not included in such calculations in the 2009 edition and managed care services are included in the calculation for the first time in the 2012 edition. Because of inconsistencies in the numbers for some services, 2008 data are used for Hawaii, New Mexico, and Rhode Island, and an average of 2008 and 2009 is used for Georgia and Wisconsin. State-funded HCBS for older people and adults with physical disabilities. Source: Jenna Walls, Kathleen Gifford, Catherine Rudd, Rex O’Rourke, Martha Roherty, Lindsey Copeland, and Wendy Fox-Grage, Weathering the Storm: The Impact of the Great Recession on Long-Term Services and Supports (Washington, DC: AARP Public Policy Institute, January 2011), available at http://www.aarp.org/health/health-care- reform/info-10-2010/health-panel-10201.html. Medicaid LTSS users: Nursing facilities. Source: Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2010, Table 13.25, “Medicaid Payment per Person Served (Beneficiary), by Type of Service and Area of Residence: Fiscal Year 2008,” available at http://www.cms.gov/Research- Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareMedicaidStatSupp/2010.html. Medicaid LTSS users: HCBS for older people and adults with physical disabilities and HCBS for all populations. 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 358 Data Documentation California, San Francisco and Kaiser Family Foundation, December 2011), available at http://www.kff.org/ medicaid/7720.cfm. Medicaid LTSS users: Institutional services (nursing facilities and ICF-MR). Source: AARP Public Policy Institute calculations based on data from Centers for Medicare and Medicaid Services, Medicaid Statistical Information (MSIS) State Summary Datamart using annual 2008 data from the fiscal year 2008 Quarterly Cube, available at http://msis.cms.hhs.gov. Medicaid LTSS users: Adults with disabilities self-directing services. Source: Michael G. Murphy, Isaac Selkow, and Kevin J. Mahoney, “Financial Management Services in Participant Direction Programs” The SCAN Foundation, 2011, available at http://www.thescanfoundation.org/sites/scan.lmp03.lucidus.net/files/ TSF_CLASS_TA_No_10_Financial_Management_Services_FINAL.pdf. Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities; Medicaid HCBS beneficiaries as a percentage of LTSS users, for older people and adults with physical disabilities and all populations. Source: AARP Public Policy Institute calculations using data from 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 2011), available at http:// www.kff.org/medicaid/7720.cfm; Centers for Medicare and Medicaid Services, MSIS State Summary Datamart using annual 2008 data from the fiscal year 2008 Quarterly Cube, available at http://msis.cms.hhs. gov; and Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2010, Table 13.25, “Medicaid Persons Served (Beneficiaries), by Type of Service and Area of Residence: Fiscal Year 2008,” available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MedicareMedicaidStatSupp/2010.html. Medicaid nursing facility expenditures per person served. Source: Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2010, Table 13.27, “Medicaid Payment per Person Served (Beneficiary), by Type of Service and Area of Residence: Fiscal Year 2008,” available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ MedicareMedicaidStatSupp/2010.html. 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. Medicaid HCBS expenditures per person served; Expenditures per person served by service. Source: AARP Public Policy Institute calculations based on data from 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 2011), 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. ICF-MR services expenditures per person served. Source: AARP Public Policy Institute calculations based on data from Centers for Medicare and Medicaid Services, MSIS State Summary Datamart using annual 2008 data from the fiscal year 2008 Quarterly Cube, available at http://msis.cms.hhs.gov. MR/DD waiver services. 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 2011), available at http://www.kff.org/medicaid/7720.cfm. 359 Data Documentation LTSS Costs Medicaid payment rate for nursing facility care. Source: Eljay, LLC, “A Report on Shortfalls in Medicaid Funding for Nursing Home Care,” (American Health Care Association, December 2011), available at http:// www.ahcancal.org/research_data/funding/Pages/2011-Shortfalls-Report.aspx. Medicare payment rate for nursing facility care. Source: Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2011, “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 2010,” available at http://www.cms.gov/Research- Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareMedicaidStatSupp/2011.html. Medicare reimbursement per home health visit. Source: Centers for Medicare and Medicaid Services, Medicare & Medicaid Statistical Supplement 2011, “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 2010,” available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics- Trends-and-Reports/MedicareMedicaidStatSupp/2011.html. Private pay rate per day in nursing facility; Private pay rate per month in assisted living; Private pay daily rate for adult daycare; Private pay hourly rate for home health aide. Source: Genworth Financial, “Genworth Financial 2011 Cost of Care Survey.” The most current version of the Cost of Care Survey is available at http://www.genworth.com/content/non_navigable/corporate/about_genworth/industry_expertise/ cost_of_care.html; older versions are not easily available online. Rates for nursing facility assume a semi- private room. LTSS Resources Assisted living and residential care facilities; Assisted living and residential care units. Source: Ari Houser, Kathleen Ujvari, and Robert Mollica, Assisted Living and Residential Care in the States in 2010 (Washington, DC: AARP Public Policy Institute, with support from The SCAN Foundation and The Commonwealth Fund, April 2012). Refers to the 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 homes, 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 Alaska, District of Columbia, New York, and North Dakota; 2007 data are used for these states. Personal and home care aides and home health aides; Median hourly wage. Source: Bureau of Labor Statistics, Occupational Employment Statistics, May 2010 Estimates. Personal and home care aides are occupation code 39-9021; home health aides are occupation code 31-1011. People receiving ACL congregate meals; People receiving ACL home delivered meal; Total ACL congregate and home delivered meal expenditures. Source: AARP Public Policy Institute calculations using data from Administration on Aging, AGing Integration Database (AGID), State Program Reports, “SPR 2009, Expenditures, Total Expenditures: Home Delivered Meals” and “SPR 2009, Expenditures, Total Expenditures: Congregate Meals,” available athttp://www.agidnet.org/DataGlance/SPR, accessed January 2012. Number of health maintenance tasks able to be delegated to LTSS workers (out of 16 tasks). Source: Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica, Raising Expectations: A State Scorecard 360 Data Documentation on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, September 2011), available at http://www.longtermscorecard.org. Data collected from a 2011 National Council of State Boards of Nursing survey on nurse delegation in home settings. Total nursing facilities; Nursing facility beds; Nursing facility residents; Nursing facility occupancy rate. Source: Charlene Harrington and Helen Carrillo, University of California, San Francisco, analysis of data from Centers for Medicare and Medicaid Services, On-line Survey, Certification, and Reporting system (OSCAR). Direct care nursing hours per patient day; RN hours per resident day. Source: Charlene Harrington, Helen Carrillo, Megan Dowdell, Paul P. Tang, and Brandee Woleslagle Blank, Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2005 Through 2010 (University of California, San Francisco, 2011), available at http://www.theconsumervoice.org/sites/default/files/OSCAR-2011-final.pdf. Total nursing hours include RN, LPN/LVN, and CNA hours. Nursing facility staffing turnover. Source: American Health Care Association, reported in “Report of findings: 2010 Nursing Facility Staff Retention and Turnover Survey.” Data for Alaska and District of Columbia were insufficient to generate state-level analysis. Nursing home staffing turnover is the ratio of full- and part-time employee terminations that occurred during the year, regardless of cause, to the average number of active employees on the payroll during the same period. Residents with dementia; Residents by primary payer. Source: Charlene Harrington, Helen Carrillo, Megan Dowdell, Paul P. Tang, and BrandeeWoleslagle Blank, Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2005 Through 2010 (University of California, San Francisco, 2011), available at http:// www.theconsumervoice.org/sites/default/files/OSCAR-2011-final.pdf. Nursing home residents with low care needs. Source: Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica, Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, September 2011), available at http://www. longtermscorecard.org. Low care status is met if a resident does not require physical assistance in any of the four late-loss activities of daily living (bed mobility, transferring, using the toilet, and eating) and is not classified in either the “Special Rehab” or “Clinically Complex” Resource Utilization Group (RUG-III) groups. Data derived from analysis of MDS as reported in LTCFocUS.org, by V. Mor at Brown University, under a grant funded by the National Institute on Aging Program Project. Percent of long-stay nursing facility residents with physical restraints; Percent of high-risk nursing facility residents with pressure sores. Source: AHRQ National Healthcare Quality and Disparities Reports, 2010, available at http://www.ahrq.gov/qual/qrdr10/index.html#Supportive. Percent of long-stay nursing facility residents with a hospital admission. Source: Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica, Raising Expectations: A State Scorecard on Long- Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, September 2011), available at http://www.longtermscorecard.org. Percent of long-stay residents (residing in a nursing facility relatively continuously for 100 days prior to the second quarter of the calendar year) who were ever hospitalized within six months of baseline assessment. Data derived from analysis of Medicare enrollment data and MEDPAR file by V. Mor at Brown University, under a grant funded by the National Institute on Aging Program Project. 361 Data Documentation Long-term care facility beds per FTE ombudsman; Nursing facilities visited at least quarterly. Source: U.S. Administration on Aging, 2010 National Ombudsman Report Appendices, Table A-1, available at http://www.aoa.gov/aoaroot/AoA_Programs/Elder_Rights/Ombudsman/National_State_Data/2010/Index. 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 HCBS for older people and adults with physical disabilities. 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 2011), available at http://www.kff.org/medicaid/7720.cfm; and Martin Kitchener, 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 2006), available at http://www.kff.org/medicaid/7575.cfm. Total nursing facility residents. Source: Charlene Harrington and Helen Carrillo, University of California, San Francisco, analysis of data from Centers for Medicare and Medicaid Services, OSCAR. Total Medicaid spending and spending by type of service. Source: AARP Public Policy Institute calculations based on data from Steve Eiken, Kate Sredl, Brian Burwell, and Lisa Gold, “Medicaid Expenditures for Long-Term Services and Supports: 2011 Update,” Truven Health Analytics (formerly Thomson Reuters), 2011, available at http://www.hcbs.org/moreInfo.php/doc/3661; and Steve Eiken, Kate Sredl, Brian Burwell, and Lisa Gold, “Medicaid Long Term Care Expenditures FY 2009,” Truven Health Analytics (formerly Thomson Reuters), 2010, available at www.hcbs.org/moreInfo.php/doc/3325. MS data for 2005 do not include a large reported expenditure on PACE that was not reported in preceding or subsequent years. See also notes on these data under “Public LTSS Expenditures,” above. Bar chart graphics, change and percentage change in Medicaid LTSS by type of service. AARP Public Policy Institute calculations based on data from Steve Eiken, Kate Sredl, Brian Burwell, and Lisa Gold, “Medicaid Expenditures for Long-Term Services and Supports: 2011 Update,” Truven Health Analytics (formerly Thomson Reuters), 2011, available at http://www.hcbs.org/moreInfo.php/doc/3661; and Steve Eiken, Kate Sredl, Brian Burwell, and Lisa Gold “Medicaid Long Term Care Expenditures FY 2009,” Truven Health Analytics (formerly Thomson Reuters), 2010, available at www.hcbs.org/moreInfo.php/doc/3325. See also notes on these data under Public LTSS Expenditures, above. 362 AARP Public Policy Institute AARP State Offices AARP STATE OFFICES AARP Alabama AARP Connecticut AARP Idaho 201 Monroe Street, #1880 21 Oak Street, #104 3080 E. 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