Module 8:
Trends in Older Adult
Services
Aging Services of Minnesota
Older Adult Services Orientation Manual
© Aging Services of Minnesota 2014
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Acknowledgements
This resource was made possible by funding from the
Ronald Patterson Governance Fund
of the Aging Services of Minnesota Foundation
Developed by Health Dimensions Group, Minneapolis, MN
TERMS OF USE
Aging Services of Minnesota (Aging Services) is the sole and exclusive owner of and retains all rights to this Orientation Manual (“Manual”) and
all associated registrations. Aging Services makes this Manual available free of charge only to its members on the Members Only section of
the Aging Services website, which is password protected.
Member representatives are authorized to use any or all of this Manual only in the performance of duties and responsibilities on behalf of the
member organization. The contents of the Manual may be customized to meet the needs of the member organization, and copies of any portion
of the Manual may be distributed within the member organization.
In every other respect, members and member representatives may not: (i) alter the Manual; (ii) add to the Manual; (iii) update the content of the
Manual; (iv) distribute reproductions of the Manual to any person or organization not a member of Aging Services; (v) borrow portions of the
Manual for use in other works; (vi) make derivative works; or (vii) be identified as an author of the Manual.
© Aging Services of Minnesota 2014
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Older Adult Services
© Aging Services of Minnesota 2014
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Trends
Internal and external forces shaping the future of older
adult services:
Person-Centered Care Movement
Technology to Support Aging in Place
Shift in Funding to HCBS
Affordable Care Act: Health Care Reform
Alliances Between Hospitals and PAC
© Aging Services of Minnesota 2014
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Trend #1: The Person-Centered Care Movement
Culture
Values
Goals
Family
Situation
C
Needs
hoice
Preferences
P
M
urpose
eaning
Culture change = national movement for the transformation of older
adult services, based on person-centered values
© Aging Services of Minnesota 2014
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Trend #1: The Person-Centered Care Movement
The Green House® Project
Small house neighborhood model for more intimate living
environment
Promotes privacy, dignity, independence, and mobility for
improved quality of life
More than 260 Green House Homes in 32 states
© Aging Services of Minnesota 2014
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Trend #1: The Person-Centered Care Movement
Palliative Care Model
Comfort care for those with
chronic or terminal illness
Relief from pain and suffering
Palliative
Care
© Aging Services of Minnesota 2014
Physical, emotional, social, and
spiritual dimensions of health
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Trend #1: The Person-Centered Care Movement
myPotential© Rehabilitation Program
A person-centered rehab model developed by The
Village at Rockville, a nursing home provider in
Rockville, MD
Person-centered features of the program include the
myStay© personal care plan, concierge services, private
rooms, and a therapy care team
© Aging Services of Minnesota 2014
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Trend #2: Technology to Support Aging in Place
Both an Opportunity and a Threat
Consumers indicate a strong desire to remain independent and
in the home as long as possible.
The use of technology to support independence in home and
community-based settings is a growing enterprise.
Technology presents aging services providers with the
opportunity to innovate, expand service lines, and broaden
market share.
Technology may also pose a threat to aging services providers
that do not innovate. Competitor technology offerings may
serve as an innovative alternative to traditional services
offerings.
© Aging Services of Minnesota 2014
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Trend #2: Technology to Support Aging in Place
Healthsense launches eNeighbor®
Many senior living providers
are using technology to extend
services outside their walls
Healthsense eNeighbor® uses
sensors in the home to learn
the behavior of residents and
automatically issue alerts when
unexpected changes occur
Sensor monitoring systems
like eNeighbor have the
potential to help prolong the
time that individuals with
Alzheimer's or other types of
dementia are able to live at
home or with family
members.
eNeighbor ® Monitoring System
© Aging Services of Minnesota 2014
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Trend #2: Technology to Support Aging in Place
LG and Thrive Senior Living
Partnership between LG, an electronics and telecom
company, and Thrive Senior Living, an owner and
operator of senior housing communities
Provide Smart Senior Living Solutions – a suite of
technologies that integrate an assisted living resident’s
health information into one platform
Smart walkers and
wheelchairs currently under
development by LG
© Aging Services of Minnesota 2014
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Trend #2: Technology to Support Aging in Place
Aetna and Addus Home Care Smart Phones
Health plan provider Aetna and
home care provider Addus partner
to conducting a pilot study–impact
of providing smart phones to home
care aides
© Aging Services of Minnesota 2014
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Trend #3: Funding Shift to HCBS
There is a continued shift of Medicaid Long-Term Care
(LTC) funding from institutional to home- and communitybased. Medicaid is the primary source of LTC funding.
Kaiser Family Foundation indicates Medicaid is in a historic
time of transformation.
Factors shaping Medicaid today:
Affordable
Care Act
Delivery and
Payment System
Reform
BILLION
Medicaid
Economic
Conditions
© Aging Services of Minnesota 2014
$123
Amount of funding Medicaid
program provided for LTC in the
United States during 2012
Cost Containment
& Program
Improvements
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Trend #3: Funding Shift to HCBS
Medicaid LTC Spending in United States
United States Medicaid LTC Expenditures
Care Center
2012
55.0%
HCBS
45.0%
15% increase in
HCBS spending
2000
70.0%
30.0%
*Care center includes institutional care settings
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Trend #3: Funding Shift to HCBS
Medicaid LTC Spending in Minnesota
Minnesota Medicaid LTC Expenditures
Care Center
2012
HCBS
67.7%
32.3%
20% increase in
HCBS spending
2000
87.7%
12.3%
*Care center includes institutional care settings
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Trend #3: Funding Shift to HCBS
Impact on Occupancy
The impact of this trend is evident by continued declines
in care center occupancy across the country
Care Center Occupancy
95%
Providers can
expect Medicaid
funding for
care centers to
continue to
decrease and a
continued emphasis
on HCBS
90%
85%
80%
2004
2005
© Aging Services of Minnesota 2014
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US
2007
2008
2009 2010
Minnesota
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2011
2012
Trend #4: Affordable Care Act: Health Care Reform
The Triple Aim
Improve
Patient
Experience
TRIPLE
AIM
Improve
Population
Health
© Aging Services of Minnesota 2014
Lower
Costs
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Trend #4: Affordable Care Act: Health Care Reform
Value-Based Payment
Value-based payment is an emerging payment model,
driven by health care reform, in which the payment to
health care providers is determined by the quality of
outcomes
Value-based payment has a measurable impact on the
triple aim
Lower
cost
Improved
quality
© Aging Services of Minnesota 2014
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Trend #4: Affordable Care Act: Health Care Reform
Value-Based Payment in Post Acute Care
President Obama’s FY 2015 budget includes value-based
purchasing for skilled nursing facilities and home health
agencies beginning 2018
It proposes at least 2% of payments to be tied to the quality
and efficiency of care
Quality metrics will include:
• Avoidable re-hospitalizations
• Percentage of Medicare
discharged home
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Trend #4: Affordable Care Act: Health Care Reform
Bearing Financial Risk through Bundled Payment
Bundled payment is a health care reform driven payment
model in which providers are responsible for a patient’s
healthcare costs over an episode of care
Post Acute Care Episode
Bundling (BPCI Model 3)
Specialty
Care
Physicians
Outpatient
Hospital
and
Ambulatory
Care
Inpatient
Hospital
Acute Care
Inpatient
Rehab and
Long-Term
Acute
Hospital
Skilled
Nursing
Facility
Acute Care Episode with PAC Bundling (BPCI Model 2)
© Aging Services of Minnesota 2014
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Home
Health
and
Hospice
Trend #4: Affordable Care Act: Health Care Reform
Reduce PAC Spending via Bundled Payment
Billions
At least 50% of Total PAC Provider Payments
will be Bundled by 2021
Reduce PAC
Spending by
2.85%
$35
$30
$25
$20
$15
$10
$5
$0
2013
2015
2017
2019
2021
BPCI begins for all PAC
providers
BPCI pilot began
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Trend #4: Affordable Care Act: Health Care Reform
Narrowing Preferred Provider Networks
Acute Care Preferred Provider Network
Hospital/Network
Providers
Providers driving
PAC referrals
PAC Preferred
Providers
“Value” Providers
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PAC Non-Preferred
Providers
Low-Quality,
High-Cost Providers
Trend #5: Alliances Between Hospitals and PAC
Partnership Developments
Alliances are developing between hospitals and
post-acute providers
“Policymakers and health care providers increasingly
recognize that coordination between acute care hospitals and
post-acute providers is essential to achieve quality health
outcomes and ultimately better manage episodes of care.”
Rich Umbdenstock
President & CEO, American Hospital Association
“Long-term care facilities were
among the best partners for
hospitals to lower their
preventable readmission rates,
a new survey shows.”
“Partnering with long-term care and
skilled nursing facilities was a chief
strategy among 64% of senior hospital
leaders working to limit preventable
hospital readmissions.”
Senior Housing News
Survey from HealthLeaders Media Intelligence Unit
© Aging Services of Minnesota 2014
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Trend #5: Alliances Between Hospitals and PAC
Examples
Amedisys Home Health and
Monongahela Valley Hospital
Allina Health and
Minnesota Care Centers
Partner to reduce hospital
readmissions
Enter a joint venture to
increase clinical integration
Kindred HealthCare and
Cleveland Clinic
Participate in bundled (value-based)
payment demonstration
© Aging Services of Minnesota 2014
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Trend #5: Alliances Between Hospitals and PAC
Amedisys Home Health and Monongahela Valley Hospital
Amedisys Home Health has partnered with hospitals through its
Care Transitions program, designed to reduce unnecessary hospital
readmissions through patient and caregiver health coaching and
care coordination, which starts in the hospital and continues
throughout completion of the patient's home health plan of care.
Partnering with home healthcare
73%
60%
of senior hospital leaders have
adopted this strategy to lower
preventable readmissions
of hospitals have already
selected home health care
partners
Source: “Readmission Reduction Strategies for Hospitals & Health Systems” and two surveys conducted by the Health Leaders Intelligence Unit
© Aging Services of Minnesota 2014
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Trend #5: Alliances Between Hospitals and PAC
Allina Health and Minnesota Care Centers
In February 2013, Allina announced it would enter into joint ventures
with 5 care centers in the Minneapolis-St. Paul area to create
transitional care units of the future
Focus is specifically on short-stay, post-hospital care
Transitional care units range from 40 to 60 beds and involve
construction of new facilities as well as adaptation of existing
hospital spaces
The intention of these care center alliances is to create a clinically
advanced care setting
Participating care centers will benefit from increased clinical
integration, skill development, and preferred provider status
© Aging Services of Minnesota 2014
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Trend #5: Alliances Between Hospitals and PAC
Kindred HealthCare and Cleveland Clinic
“Kindred seeks to shake up the post-acute care continuum”
- Modern Health Care
Kindred HealthCare and Cleveland Clinic have been awarded
participation in the Bundled Payment for Care Improvement initiative
(BPCI)
Participation in this initiative is just one of several means in which
Kindred is “shaking up the post acute care continuum”
• It already has partnered with Cleveland Clinic to serve the system’s
post-acute care patients in Cleveland
Kindred is the nation’s largest provider of post-acute care
Current:
Future:
12 established
integrated-care markets
© Aging Services of Minnesota 2014
expanding to 25 markets
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Notes
© Aging Services of Minnesota 2014
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