Ohio Department of Aging Press Release

FOR IMMEDIATE RELEASE
March 18, 2009

State Releases Results of Medicaid Assisted Living Evaluation
Researchers Identified Successes, Areas of Improvement

COLUMBUS - The Ohio Department of Aging today announced the results of the second phase of evaluation for the state's Assisted Living Waiver Program. The evaluation, conducted by researchers at the Scripps Gerontology Center at Miami University, the Benjamin Rose Institute and the Jesse Richardson Foundation, includes a comparison of participating and non-participating providers, a profile of waiver participants, participant satisfaction data, program costs and overall design issues.

National Medicaid long-term care costs have nearly doubled in the past decade. The Assisted Living Waiver Program was launched in 2006 to expand the range of long-term care options for people with disabilities, while realizing Medicaid cost savings. Medicaid expenditures for Assisted Living Waiver Program participants averaged $30,600 per year; the average cost for a nursing home resident was $67,000 during the same period.

"It is abundantly clear that we must refocus our provision of services from the more expensive institutional care to more cost-effective and desirable options," said Barbara E. Riley, director of the department. "This evaluation shows that we are on track for effectively providing an additional choice for long-term care consumers, but we still have much work to do and very good reasons for doing it."

The report is available on the department's Web site, www.aging.ohio.gov. Among the key findings:

• While the program enrolled fewer people than expected in the first year, enrollment increased considerably in the second, and trends indicate the state will be close to meeting its maximum slots by the end of the biennium.
• At the beginning of February, 2009, the program had 169 certified providers. Researchers determined that 367 facilities statewide meet the criteria to be a participating provider, resulting in a 46 percent participation rate among providers.
• There are currently more than 1,000 participants, though more than 500 potential participants are waiting to enroll for the program. The primary barrier to enrollment for most consumers is the lack of an available local facility.
• Assisted Living Waiver Program consumers tend to be less functionally impaired than nursing home residents, but have more cognitive impairments than participants in the state's PASSPORT home care program.
• Since the program began, about 20 percent of participants have left the program. About half of these moved to a nursing home, while one in five died.
• Consumers in the Assisted Living Waiver Program reported satisfaction scores for their providers comparable to non-waiver assisted living residents.

Researchers also made some recommendations that would improve access to the program and increase efficiencies for Medicaid spending in the state:

• Some regions of the state have been more effective at recruiting participating facilities. The state should facilitate the sharing of successful approaches across regions.
• State partners, such as ODA, the Ohio Department of Job and Family Services and the Unified Long-term Care Budget Committee should continue pursuing strategies to expand residential assisted living and other supportive housing options.
• ODA and the area agencies on aging should look carefully at individuals who leave the program to enter nursing homes to better understand if some of these placements could be avoided.
• The state should revise its reimbursement system for the waiver to better reflect the relatively low levels of physical impairment and high levels of cognitive impairment of its participants.
• The state should carefully examine approaches to integrating the acute and long-term care needs of the population under age 65, as these individuals are not covered by Medicare, but have high care needs.
• The state should maintain solid communication between state officials, area agencies on aging and industry providers - including expanding participation to other types of housing providers - as it continues to expand this area of service delivery.

About ODA

The Ohio Department of Aging provides leadership for the delivery of services and supports that improve and promote quality of life and personal choice for older Ohioans, adults with disabilities, their families and their caregivers. Working with 12 area agencies on aging and other community partners, the department offers home- and community-based Medicaid waiver programs such as PASSPORT, the long-term care ombudsman program, the Golden Buckeye Card and more. Visit www.aging.ohio.gov.