02/05/2020

Brod, Wallace Present Demographic, Workforce Challenges for House Committee

Presentations on Ohio's demographics and the long-term care sector spurred members of a House panel to consider the role of Medicaid and other issues as the state's population ages.  Members of the House Aging & Long-Term Care Committee focused last Thursday on workforce issues and the sustainability of the Medicaid long-term services and support benefit.

Bob Applebaum, with the Scripps Gerontology Center at Miami University, provided the committee with an overview of Ohio's changing population.

Between now and 2040, Ohio is going to continue to age, he said. The 60-plus population is expected to roughly double from 2000 to 2040, and the 85-plus population is expected to double between 2020 and 2040. Population growth, meanwhile, is expected to be relatively flat.

About 40% of retirees rely primarily on Social Security, with the average monthly benefit of about $1,500, he said. Long-term care accounts for about a third of the state's Medicaid budget, and the aging population could drive up those costs over the coming years, he said.

Most Ohioans are not prepared for long-term disability, meaning more of a burden will fall on the state, he said. He suggested individuals be encouraged to prepare for long-term disability, including saving money and obtaining long-term disability insurance.

He encouraged policymakers to focus on keeping older Ohioans from ending up needing Medicaid to begin with.  "One of the policy problems that I believe we see at the state is we invest almost all of our money on the Medicaid program…but only 10% of older Ohioans are on Medicaid," he said. "Most older Ohioans are not on Medicaid. They end up on Medicaid when their nursing home care bankrupts them or when their home care needs become so great that they have to spend so much money that they end up on Medicaid."

He encouraged the state to lower Medicaid use through prevention, individual planning and other efforts.

Rep. Allison Russo (D-Upper Arlington) said Medicaid expenditure growth is largely driven by increases in long-term care.  "As you pointed out, that is completely unsustainable given the demographic shift in our population," she said.  She asked what investments can be made to help people before they get to age 65.

One problem is that county programs often encourage people to get on Medicaid, driving up costs for the state, he said.  "What we could possibly explore is creating some incentives for counties," he said. Those could encourage programs that keep people off of Medicaid, he added.

Rep. Mark Fraizer (R-Newark) asked if the complexity of private long-term care insurance is preventing people from signing up for it.  The number of carriers has dropped significantly in the last few years, Mr. Applebaum said. Much of the problem is people can't imagine that they would eventually be disabled.  "This is a place where we need to do a lot more to create better products and haven't done that yet," he said.

Rep. Janine Boyd (D-Cleveland Hts.) asked about addressing turnover rates and training in the long-term care workforce.  Mr. Applebaum said some of the facilities with lowest turnover in the state are run by nuns, and those nuns were able to provide a better work environment by supporting workers.

Kathryn Brod, president and CEO of LeadingAge Ohio, and Susan Wallace, the group's director of government affairs, said most of the Medicaid spending on older adults comes from a small percentage of frail and chronically ill patients. 

The state has also moved toward increased home and community-based services for adults using long-term services and supports in Medicaid, Ms. Wallace said. Providers are seeing rising acuity of patients because people are not entering long-term care facilities until it is absolutely necessary.  "We're trying to keep people in the least-restrictive setting and trying to be good stewards of health care dollars," she said.

Occupancy is down and some LeadingAge Ohio members are converting facilities to assisted living or making other changes, she said. Those using the assisted living waiver are restricting how they're making those beds available because of the low reimbursement rates.

"We know that assisted living can be available to anyone, but in terms of finding a provider that's willing to offer that care, we're seeing delays," she said.

Some LeadingAge Ohio members are also affordable housing providers and that space is one where there are opportunities, she said.  More than half of middle-income seniors won't have financial resources to pay for housing and care, Ms. Brod said. She said policymakers can encourage people to prepare with long-term disability insurance or by encouraging small businesses to have retirement planning options.

Home health aides and personal care aides are among the fastest growing job fields today, but they often pay much lower than other fast-growing industries, Ms. Wallace said.  Because the workforce is so lowly paid, employees often face benefit cliffs when they move up the pay scale, being forced to cut back hours in order to maintain child care benefits or other supports, she said.

LeadingAge Ohio encouraged lawmakers to incentivize retirement and long-term care planning, support family caregivers and to strengthen community-based care through helping out the workforce, Ms. Wallace stated. The state can also build up housing-based models of long-term care.

Rep. Beth Liston (D-Dublin) asked how the state can provide home health care for middle-acuity people so they don't have to spend down to get Medicaid coverage.  "How do we keep people in their homes where it's cheaper?" she asked.

Ms. Brod said enhanced community living can create more opportunities. That service, which is currently under the PASSPORT program, could use some tweaks.

"That's an area where we would like to see some growth because it allows a single worker to walk into a building and serve a large number of people for a limited period of time," she said.

Rep. Howse asked what percentage of women work as home health aides and personal care aides. Mr. Applebaum said the workforce is more than 90% women. He said turnover rates are about 80% in long-term care facilities.

Home health aides and personal care aides also have high injury rates, Ms. Wallace said.

Rep. Howse said the low pay contributes to unequal working conditions between women and men.  "We really have to think about this and do some different policy work," she said. (Gongwer News Service)

To review the presentation offered by Dr. Applebaum, click here. 

To review the presentation offered by Kathryn Brod and Susan Wallace, click here. 

To hear the testimony, click here.  Dr. Applebaum’s testimony begins around the 1 hour mark, and LeadingAge Ohio testimony begins around 1:40.