Data Offers Insight Into Costs, Stay Length and Demographics of Care for Older Oregonians
Oregon’s Department of Human Services is gearing up for a public data dump this Friday detailing the results of several new studies on assisted living and nursing facilities.
The event, which will be held at Portland State University, will feature scientists from PSU, DHS and Oregon State University. Speakers will present a host of information based on new studies on assisted living, residential care, endorsed memory care, adult foster homes and nursing facilities in the state.
“Anyone is welcome to attend,” said Ashley Carson Cottingham, director for DHS’ program on Aging & People with Disabilities. “It will be particularly relevant for consumers, policy-makers, educators, providers, tribal leaders, and advocates for older adults and people with disabilities.”
The Department of Human Services has sponsored studies on the broader topics since 2014, funded through the state Legislature, and the agency publishes the results online each year. This year the agency decided to go a step further, though, and have scientists present their data to the public so people can ask questions, Carson Cottingham said.
“Right now, this is a one-time event, but it could turn into an annual or every-other-year briefing,” Carson Cottingham said. “In the past, we’ve released the reports and published them on our website, but haven’t had an event to talk about the findings. We thought it was important to use the findings in the report to have a broader discussion about Oregon’s long-term services and supports (LTSS) system.”
Among the findings?
On the financial side, the average monthly cost of assisted living is about $3,667 and residential care facilities are about $3,770 - overall more than $44,400 a year. The average nursing facility cost for a bed in a semi-private room is $8,425. Oregon also has the highest rate in the U.S. of assisted living communities that accept Medicaid.
Nursing facilities are where the most intense medical services are needed, including round-the-clock care. A step down from that are assisted living facilities, which Oregon has been actively working to support. In assisted living facilities and retirement homes, people generally have their own small apartments but are provided meals, housekeeping and laundry, with nursing and medical services on staff.
“Oregon DHS’ Aging and People with Disabilities has conducted lots of listening tours across the state in cities and in the rural and frontier areas,” Carson Cottingham said. “Consistently, we’ve heard that older adults and people with disabilities in Oregon want better options for transportation, supports for caregivers (paid and unpaid/family caregivers), and more/affordable housing. People want to be able to live in their own home and their community for as long as possible and we need the tools to enable them to live where they choose regardless of age or disability.”
One rapidly growing area of service is memory care - which is a state-licensed version of assisted living with extra care for people suffering dementia or Alzheimer's disease, said Paula Carder, an associate professor at the Institute on Aging at the Oregon Health and Science University-PSU School of Public Health.
“Oregon was one of the first states in the country to license memory care,” Carder said. “And what we observed is that’s where most of the growth is in number of units.”
Carder has several papers that will be discussed at the event.
Since 2008, memory care services have increased 70 percent in Oregon, she said.
Patients in memory care need a formal diagnoses to be admitted. The demand is likely growing because people are living longer, she added.
“The longer you live, the more susceptible you become to those illnesses,” Carder said. “People are living longer and acquiring dementia. It’s very difficult for people to stay in their homes for a long time with that. They need support staff and a safe place to be.”
Memory care is also more expensive than some other services, costing residents about $5,400 a month.
With Medicaid, the reimbursements are a bit different, Carder added. Medicaid reimburses $1,100 a month for assisted living care, $3,686 for memory care and just under $8,000 a month for full nursing services.
If they didn’t have the option of memory care, those patients would likely be in more expensive nursing homes, Carder said.
“It saves the state money,” she said.
She also found that 78 percent of the state’s assisted living facilities have a full-time registered nurse on staff - something they’re not required to do.
“That was kind of a surprise,” Carder said. “I don’t know what that is. It could be related to the needs of residents. They’re not required to do that, but they do.”
In her new study of the state’s nursing facilities, Carolyn Mendez-Luck, an assistant professor at Oregon State University’s College of Public Health and Human Services, found a declining number of beds and less use of nursing care in Oregon compared with other states - likely due to state efforts to help residents stay in other options like assisted living or in-home care for a longer time.
Her study found 137 nursing facilities in Oregon providing long term services and support, with 11,542 licensed beds, a 5 percent decline from 2015. In fiscal 2016, there were 33 facilities in Multnomah County, and none at all in six counties, averaging out to about four per county.
In 2016 34,627 people were in an Oregon nursing facility for at least one day, a 3 percent increase over 2015.
“In the past three years we’ve noticed that Oregon has a relatively low length of stay - very low,” Mendez-Luck said. “We’ve seen a consistent trend in decreased number of days. That result is a reflection of the state’s effort to keep people in their homes.”
The portion of Oregonians who live in nursing homes is actually far lower than any other state, said Mendez-Luck’s co-author and husband, Jeff Luck, who is also an OSU professor.
“Overall our perspective is that Oregon is doing well in terms of planning for and meeting the needs of elderly residents who need assistance,” Luck said. “The state’s done some good initiatives to reduce facilities where there are too many of them, so there’s less administrative costs, as well.”
Mendez-Luck and Luck completed The State of Nursing Facilities in Oregon 2016 report this June, based on data from fiscal 2016, which covers July 2015 to June 2016.
The report also found that residents of Oregon nursing facilities were more likely to be under age 85 and to be white, non-hispanic. More were male than female. And Medicare was the primary payer for 59 percent of those using the services.
So far, there hasn’t been a big impact from the Baby Boomer generation on nursing homes, but it’s likely coming in the next five to ten years, Mendez-Luck said.
“Oregon’s older adult population is higher than many other states, but the oldest boomers are still in their 70s,” she said. “In facilities here the residents tend to be older than that - they’re in their 80s. I don’t think we’ve seen the hit yet from the Baby Boomers.”
That’s something the state will need to prepare for, although currently occupancy rates in Oregon’s nursing homes still show room to grow. More people tend to use assisted living facilities than nursing facilities, she said.
“I think there will be an increase in all long-term services,” Mendez-Luck said of the coming Boomer influx. “I think there will be increased demand for community-based care. Nursing homes aren’t going to go away in Oregon, though. There’s going to be increased demand as people get older.”
Members of the Silent Generation, born before 1945, have also been living longer - which is adding to the state’s assisted living needs, Luck said.
“The group that needs the most assistance are people over age 85,” he said. “It’s a fast-growing part of the population. And as that continues, they’ll need more assistance.”
That’s one reason DHS wants to continue the studies, and perhaps also continue the roundtable discussions annually, Carson Cottingham said.
“It’s so important that we focus on ensuring we have the right system of long-term services and supports as the boomer generation begins to need and access these critical programs,” Carson Cottingham said. “Oregon has long been a leader in innovating new ways to serve older adults and people with disabilities. We need to keep innovating and ensure that our state and federal dollars are utilized effectively while upholding our core values around safety, independence and consumer choice.”
Carder said she hopes people will come with lots of questions.
“I would like to hear what kinds of questions and concerns people have and get some dialogue going about where we want to take this in the future,” she said.
What: Round table discussion on the results of recently-completed studies on assisted living, residential care, endorsed memory care, adult foster homes and nursing facilities. The event will feature researchers from Oregon State University, Portland State University and the Department of Human Services.
Where: Portland State University, Smith Memorial Student Union, Room 294, 1825 SW Broadway, Portland, OR, 97201.
When: September 15, 2:30 p.m.
Cost: Free and open to the public
To browse the reports visit http://www.oregon.gov/DHS/SENIORS-DISABILITIES/Pages/publications.aspx.
The event will also be streamed live from DHS’ Facebook page https://www.facebook.com/OregonDHS.APD/
and Twitter @OregonDHSAPD.