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A Different Approach to Providing Care to Utah's Nursing Home Patients in a High-Cost, Dynamic Environment


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Keywords: home- and community-based services;                           needed. Without carefully planned, cost-effective options, the
deinstitutionalization; waiver; long-term care                          accelerated growth in the senior population may soon result in an
                                                                        inability to sustain coverage of other Medicaid populations, fund
                                                                        expansions for uninsured populations, or maintain levels of sup-
                                                                        port in other areas of state responsibility. It is not clear that the
                                                                        current, ever-tightening federal regulatory approach to the Medic-
                                                                        aid program facilitates the needed development of new, innovative

A Different Approach                                                    program models.

to Providing Care to
Utah’s Nursing Home                                                            With the expected rapid
Patients in a High-Cost,                                                     acceleration in the growth of
                                                                           the age 65+ population and the
Dynamic Environment                                                         consequent increasing utiliza-
                                                                           tion of high-cost, long-term care
Michael Deily, BA
                                                                             services, additional planned
                                                                            and tested options are needed.

         he State of Utah foresees a boom in the growth of its senior
         population over the next 40 years. This increase will poten-
         tially create more conflict between the financing of human
service programs for seniors and other state priorities (e.g., public       This article will address the intersection of the demographics of
education, transportation, and corrections). A major concern in         Utah’s population with the historical approaches to Medicaid long-
this area is the State’s Medicaid program. Medicaid is the major        term care coverage. It will describe an alternative model developed
payer of long-term care services for the senior population, and         in Utah for providing care to nursing home patients that responds
at the same time Medicaid is responsible for the financing of the        to the cost pressures in long-term care and individual preferences
health care needs for an increasing number of the lower income          in service delivery. It will also describe how Utah has recently been
persons.                                                                forced to undergo major modifications as a result of regulatory
    Compared to Medicare, which pays for 19% of long-term care          compliance issues.
costs, Medicaid supports nearly half of the total national long-term
care expenditures. These dollars constitute about one-third of Med-
icaid spending. Despite initiatives diverting individuals to commu-
                                                                                          UTAH DEMOGRAPHICS
nity-based settings, nationally 63% of fiscal year 2005 Medicaid’s
long-term care spending went to nursing homes (Georgetown Uni-          The aging of the baby boomers in Utah is changing the state’s pop-
versity, 2007). This continuing reliance on nursing home care for       ulation. In 2004, the Utah’s growth rate of its senior population
the delivery of long-term care services may be difficult to sustain      started to exceed that of the overall population, and is expected
for several reasons; (a) the increase in the age 65+ populations, (b)   to continue to do so through 2050 (Ellis & Dodge, 2005). The
the expense of nursing home care, and (c) consumer’s apparent           projections for the increase in Utah’s age 65 and older population
preferences regarding where to receive long-term care. These all        are sobering. They indicate a growth of 4,167 people in 2006,
point toward a need to decrease the reliance on nursing homes as        increasing to an estimated 13,186 in 2020 (Utah Commission on
the dominant service provider of such services.                         Aging, 2006). As a proportion of Utah’s total population, the age
    Given these issues, states have been working to develop ways to     65+ population will increase from 8.5% in 2000 to a projected
provide more flexibility in their long-term care delivery systems.       17.8% in 2050 (Ellis & Dodge, 2005). Additionally, the state is
With the expected rapid acceleration in the growth of the age 65+       experiencing a rapid increase in the number of residents turning
population and the consequent increasing utilization of high-cost,      age 75 and 85. The 85+ population is considered to be the most
long-term care services, additional planned and tested options are      fragile of the senior population. There will be 55% that require

Care Management Journals • Volume 10, Number 3 • 2009                                                                                    121
DOI: 10.1891/1521-0987.10.3.121

some form of long-term care (Melnyk, 2005). Utah’s age 85+ pop-
ulation is predicted to grow from 28,340 in 2006 to 59,470 in
2030, increasing 110%, compared to a national projected growth
of 80% (Utah Commission on Aging, 2006).
                                                                             Nationally, Medicaid expendi-
    While the senior population will increase rapidly in Utah, the            tures have grown to a point
under age 18 population will remain relatively constant. It will
hover just over 31% of Utah’s pop
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