Nursing homes Part 1 – Adapting to changing needs, new expectations

by Howard Lestrud
ecm political editor

(Editor’s Note: ECM Publishers is providing readers with a multi-part series on elderly care and nursing home facilities. The following is the first story in the series, which provides an overview how the state is involved with nursing home care and elderly care. Loren Colman, assistant commissioner for continuing care at the Minnesota Department of Human Services, discusses how elderly care has changed in recent years.)

Everyone wishes to be independent, whether they are 2 or 102 years old.
The way we age has changed considerably over the years. Many of us live to an older age and many of us are able to maintain independent, busy lifestyles to an advanced age.
The greater share of Americans are choosing to age in place, opting to live in their own homes as long as possible.
Nursing homes were once regarded as the last stop for an elderly person. That is no longer true, with nursing homes and other elderly care facilities offering not only skilled nursing care but rehabilitation care that often returns them to their homes in an independent atmosphere.
According to the United States Department of Health and Human Services, the older population, those 65 and older, numbered 39.6 million in 2009. These seniors represented 12.9 percent of the U.S. population, about one in every eight Americans. That figure is expected to represent 19 percent of the population by 2030.
It is projected nationally that by 2030, there will be about 72.1 million older persons, more than twice the number in 2000. By 2020, it is expected there will be more seniors turning 65 or older than students in our Minnesota school systems.
This all means there will be more demand for elderly care options in the coming years. Assisted living facilities and independent living apartments are choices that many of our elderly are choosing today.
Elderly care touches all of us, whether we are the one termed elderly or whether we are caring for elderly family members.
Let’s take a look at nursing home care in Minnesota. It is difficult to know where to begin, in describing nursing home care, said Loren Colman, assistant commissioner for continuing care for the Minnesota Department of Human Services. He has held that post since 2003 and has directed efforts of many programs that serve the people of Minnesota. These include aging and adult services, disability services, deaf and hard of hearing services and nursing facilities.
Colman has provided focus and leadership for Transform 2010, designed to prepare Minnesota for the age wave of retiring baby boomers. He considers himself a boomer.
Colman has provided additional focus on consumer-directed initiatives that will allow Minnesotans to have more decision-making options on where, who and what services they need. Other interests have been employment and housing options for people with disabilities. He has more than 25 years of operations experience in directing and managing long-term care facilities.
Minnesota DHS administers funds to nursing homes through the Medical Assistance program and is also responsible for developing and interpreting policy concerning nursing home services, quality of care and rates. Policies are ultimately decided by the Minnesota Legislature. Lawmakers look to the DHS for recommendations.
Minnesota has 375 licensed and Medicaid-certified nursing facilities with 30,468 beds in active use as of Aug. 1, 2012. Of all Minnesota nursing facilities, 28 percent are for-profit, 61 percent are nonprofit and 11 percent are owned by a government entity. Occupancy rate of active beds for the year ending Sept. 30, 2011, was 90.2 percent. Median length of stay in a nursing facility is 27 days.
Changing of consumer preferences and implementation of incentives and restrictions by the state has led to a 37 percent reduction of the state’s nursing home industry in the past 25 years. Since there is more of an emphasis for home and community-based services, approximately 11,300 nursing facility beds have been closed since Oct. 1, 1999.
Minnesota DHS reports $2.32 billion was spent on nursing home care in fiscal year 2011. That’s not just state funds but rather a combination of state dollars, federal dollars and private-paying dollars, Colman said. It represents about a third from state appropriations and medical assistance, a third from federal assistance and a third from private pay, Medicare and insurance.
Colman is the first to point out that the use of nursing home facilities is changing. Many of our communities will attest to the fact that nursing homes have become a part of a spectrum of care, he said. At one time, nursing home care was the only opportunity for long-term care.
Now, elderly care comes in a variety of forms – nursing homes, assisted living, in-home care and independent senior housing. Nursing homes have become more specialized, more focused on a particular service, Colman said.
Transitional care, post-acute care and rehabilitation care are now offered following hospital stays. Many facilities have become specialists in memory care or dementia care, Colman said. This leads to staff being trained differently to provide a high quality of service.
Many facilities have been downsizing over the years, Colman said, to adjust to demands in communities. The nursing care has also become flexible, allowing residents to enjoy single or private rooms and have more of a neighborhood like environment, Colman explained. “They have been reinventing whom they serve and how they serve them,” he said.
A number of nursing home facilities have closed in the state during recent years due to a variety of factors, usually, but not exclusively, due to outdated buildings and the facility requiring a substantial investment in upkeep. For some this has forced closure or consolidation into one new facility, Colman said.
Many investments have been made in technology, with the acquisition of safety equipment, adoption of new electronic health records and addition of new call systems that allow employees to be more flexible and responsive to consumer needs. Colman said more investments have been made in upgrading the environment by providing more private space, which makes it easier to accommodate quality care.
Investments have also been made, Colman said, in clinical technology that allows nurses and therapists to do a better job in rehabilitating people. New therapy areas, therapy pools and swimming pools for hydrotherapy have been added, he said. Wellness centers have also been introduced to the nursing home environment, Colman said.
Nursing homes have become full-service providers to seniors in the community, offering wellness and swimming programs.
Every older person, since the beginning of time, has always wanted to be independent, Colman said. This has become more of a focus strategy at DHS, he said, by consumer advocates who help individuals maximize independence.
Seniors want to stay in their homes, Colman said, and wish to stay engaged by volunteering and being part of the family.
“They want to live their lives,” he said. “This is a positive trend.”
There does come a time, however, when seniors need support. That support may come from living in a nursing center for a short period of time or for an extended time.
Elderly care is also provided in a campus-like setting on the same property. It can feature nursing home beds, assisted living apartments and independent living apartments. It is then not necessary to change caregivers. Many care centers become full-service senior care providers, Colman said.
“We also have a different attitude emerging about seniors with the consumer being in charge. It use to be where the nursing home decided when a resident got up for breakfast, when the resident would watch TV and when to do anything during the day. Now, the consumer is in charge and decides when to have breakfast and even decides a menu.”
Minnesota has nursing home facilities as small as 15 beds and as large as 500 beds, Minneapolis having the largest at the Veterans Home. The average nursing home facility has 80 beds, Colman reported. The largest concentration of nursing homes is in the Twin Cities seven-county metropolitan area. Hennepin and Ramsey counties have about a third of the beds in the state, Colman said.
Looking to the future in nursing home care, Colman said he envisions these changes:
• More downsizing of nursing homes.
• More closures.
• Continued growth in senior housing; it’s a bit saturated now, Colman said.
• Different models of service will emerge. Seniors and boomers won’t be as interested in senior-specific housing as we see it today, Colman predicted. People will want to see more integrated settings. Seniors will desire to live with accessible services, such as banking, groceries and entertainment, within a reasonable distance to where they live.
• Transportation is important to seniors. There are features in new cars that will extend the ability of individuals to drive.
• Technology is yet to explode in how seniors receive support in the home, for example, there is emerging technology that monitors whether individuals are taking pills, getting the right food in their diet, going to the bathroom and getting up in the middle of the night. Some of this technology is now available in the seniors’ own homes and will help ensure that seniors remain independent and have the quality care they deserve, Colman said.
The ability to communicate is very important to seniors as well as to boomers and younger people, Colman said. People now can communicate visually, and this allows seniors to be supported long-distance by their children, he added.
How does the Minnesota DHS rate Minnesota nursing home care centers? Colman said he believes Minnesota has demonstrated a higher quality of care than what one may see in a number of other parts of the country.
“Minnesota is very open to change, in improving and in providing several programs where we provide support to facilities to improve their outcomes,” Colman said.
DHS works with nursing care facilities on report cards, which allow for ways to improve various elements of care.
“We interview residents of nursing homes as part of our quality initiative,” Colman said.
“Are they perfect?” he asked. “There are always areas to improve.”
The Minnesota Legislature during the past session also did its part in providing some rate increases to nursing home facilities. A 5 percent increase was granted to nursing facilities across the board. A portion of that rate increase has to be dedicated to employee compensation and benefits. It is effective Sept. 1.

Howard Lestrud can be reached at howard.lestrud@ecm-inc.com.

NEXT IN THE SERIES: Part 2 – Legislative perspective on elderly care will be provided by Rep. Jim Abeler, past chairman of the Health and Human Services Finance Committee and by Rep. Patti Fritz, a licensed practical nurse who has served on the Health and Human Services Finance Committee. Other perspectives on senior care will be provided by Aging Services of Minnesota and by other lobbying groups.

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