99025

Prepared by the North Dakota Legislative Council staff for the Budget Committee on Long-Term Care June 1997

MONITORING OF ALZHEIMER'S AND RELATED DEMENTIA POPULATION PROJECTS AND AN EXPANDED CASE MANAGEMENT SYSTEM - BACKGROUND MEMORANDUM

House Concurrent Resolution No. 3003 (1997) provides for the monitoring of the implementation of projects developed by the Department of Human Services relating to the conversion of existing nursing facility or basic care beds for use by the Alzheimer's and related dementia population. The resolution also calls for the monitoring of an expanded case management system for elderly persons and disabled persons. The resolution cites as reasons for the monitoring:

1. The Task Force on Long-Term Care Planning has declared that sufficient institutional capacity exists to meet the needs of the Alzheimer's and related dementia population, and the task force recommends that existing institutional service capacity be tailored to meet the needs of the Alzheimer's and related dementia population rather than construct additional facilities.
2. An expanded case management system would allow individuals in need of long-term care to access services through a single entry point which would provide "one-stop" accessibility for those individuals and their families.
3. Because case management for older adults and persons with disabilities in this state is currently provided to a limited number of individuals through a variety of private and public agencies, resulting in confusion for many individuals and their families who must work with a maze of different agencies located in several different locations in the community, it was considered in the people's best interest to develop an expanded case management system.

Attached as Appendix "A" is a copy of House Concurrent Resolution No. 3003.

Section 12 of House Bill No. 1012 provides for the Department of Human Services to establish projects designed to meet the service needs of the Alzheimer's and related dementia population. Section 21 of House Bill No. 1012 provides legislative intent relating to the establishment of an expanded case management system.

PRIOR STUDIES

1995-96 Interim Budget Committee on Home and Community Care

Section 1 of 1995 Senate Bill No. 2460 directed a study of the use of this state's resources and services in addressing the needs of the elderly residents, and Senate Concurrent Resolution No. 4030 directed a study of the continuum of care for North Dakotans with Alzheimer's and related dementias. The committee received the report of the Task Force on Long-Term Care Planning and the following information on Alzheimer's facilities and long-term care residents with an "organic mental" syndrome, including dementias:

Nursing Facility - Location	Alzheimer's Unit Bed Capacity
Baptist Home, Inc., Bismarck	15
St. Benedict's Health Center, Dickinson	15
Bethany Homes, Fargo	48
Trinity Nursing Home, Minot	22
Deaconess Health Center, Northwood	12
Bethel Lutheran Home, Williston	24
Home for the Aged, Wishek	10
Total nursing facility beds	146
Basic Care Facility - Location
Kensington Cottages, Bismarck	24

Long-Term Care Facility Reported Data
1992-93
Total long-term care resident occupancy (5/92 through 6/93)	6,730
Total residents with primary or secondary diagnosis of an "organic mental" syndrome, including dementias	2,316
Percentage of residents with dementias	34.4%
1994-95
Total long-term care resident occupancy (6/94 through 6/95)	6,857
Total residents with primary or secondary diagnosis of an "organic mental" syndrome, including dementias	2,797
Percentage of residents with dementias	40.8%

The committee recommended House Bill No. 1037, which failed. House Bill No. 1037 would have made permanent the moratorium on basic care and long-term care bed capacity and would have required the Department of Human Services to establish pilot projects to meet the service needs of the Alzheimer's and related dementia population. The pilot projects were to explore the financial and service viability of converting existing nursing facility or basic care capacity to a specific service environment that targets the Alzheimer's and related dementia population. The committee also recommended House Bill No. 1038, which failed. House Bill No. 1038 would have provided for the definition of case management and required the Department of Human Services to establish a project designed to provide an expanded case management system for individuals in need of long-term care services.

The provisions of both House Bill No. 1037 and House Bill No. 1038 were incorporated into House Bill No. 1012 as Sections 14, 15, and 21. Section 14 provides for a moratorium on the expansion of basic care bed capacity, Section 15 provides for a moratorium on the expansion of long-term care bed capacity, and Section 21 provides intent regarding an expanded case management system.

1997 LEGISLATION

The 1997 Legislative Assembly passed the following legislation relating to Alzheimer's and related dementia population projects and an expanded case management system:

• Section 12 of House Bill No. 1012 provides that the Department of Human Services shall establish projects designed to meet the service needs of the Alzheimer's and related dementia population. The section also states that the projects established under this section must explore the financial and service viability of converting existing nursing facility or basic care capacity to a specific service environment that targets the Alzheimer's and related dementia population.
• Section 14 of House Bill No. 1012 provides that the Department of Health may not issue a license for any additional basic care bed capacity above the state's gross licensed capacity of 1,471 beds, except when existing beds are converted for use by the Alzheimer's and related dementia projects.
• Section 15 of House Bill No. 1012 provides that the Department of Health may not issue a license for any additional long-term care bed capacity above the state's gross licensed capacity of 7,140 beds, except when existing beds are converted for use by the Alzheimer's and related dementia projects.
• Section 21 of House Bill No. 1012 provides that the intent of the Legislative Assembly is that the Department of Human Services establish pilot projects for expanded long-term care case management to assist functionally impaired adults in accessing necessary services to maintain the appropriate level of independence in the least restrictive setting and at the lowest possible cost. The section also states that these pilot projects are to be financed within available funding provided to the Department of Human Services.

TASK FORCE ON LONG-TERM CARE PLANNING REPORT

A task force on long-term care planning was formed by the State Health Officer and the executive director of the Department of Human Services. The mission of the Task Force on Long-Term Care Planning is to assist the executive and legislative branches of government in the design of a long-term care system responsive to the needs of North Dakota's elderly in a cost-effective manner and to assist in the development of incentives to change the long-term care system into a responsive cost-effective system.

The report of the task force cited that North Dakota's nursing facility capacity exceeds the national norm. The report stated the national norm is about 50 nursing facility beds per 1,000 population over age 65 and North Dakota's authorized capacity is 75.6 nursing facility beds per 1,000. The task force recommended that economic incentives be established to encourage reduction in the level of authorized nursing facility beds to 60 per 1,000 population over age 65. Due to this excess capacity, the task force recommended that existing institutional service capacity be refocused or retailored to meet the needs of the Alzheimer's and related dementia population.

The Task Force on Long-Term Care Planning report also addressed case management issues, stating that case management is a key component in assuring consumers are aware of all options and choices and have access to the least restrictive alternatives. The task force recommended the implementation of an expanded case management system statewide, pending the results of a pilot project. The task force also recommended the implementation of a uniform computerized assessment document with the ability to transfer client information to all agencies involved with the client.

A copy of the report of the Task Force on Long-Term Care Planning is available in the Legislative Council office.

DEPARTMENT OF HUMAN SERVICES PILOT PROJECTS

Alzheimer's and Related Dementia

The Department of Human Services has issued requests for proposals (RFPs) for both the expanded case management system and the Alzheimer's and related dementia pilot projects. The tentative schedule in the Alzheimer's and related dementia pilot project RFP includes June 30, 1997, as the final date for the receipt of proposals and July 15, 1997, as the final date for project selection. Attached as Appendix "B" is the schedule of events as included in the Alzheimer's and related dementia pilot project RFP. Cost estimates and funding sources are not known since the project selection has not taken place yet.

Expanded Case Management

The proposed timetable for the expanded case management RFP includes June 23, 1997, as the final date for receipt of all proposals and July 7, 1997, as the final date to formally notify applicants of selections. Attached as Appendix "C" is the proposed timetable as included in the expanded case management RFP.

MONITORING PLAN

The following is a plan that the committee may want to consider in its monitoring of the implementation of Alzheimer's and related dementia projects being developed by the Department of Human Services and the expanded case management system for elderly and disabled persons:

1. Receive reports from the Department of Human Services on the development of projects relating to the conversion of existing nursing facility or basic care capacity for use by the Alzheimer's and related dementia population and the expanded case management system for elderly and disabled persons.
2. Receive testimony from representatives of the following relating to projects being developed by the Department of Human Services related to the conversion of existing nursing facility or basic care capacity for use by the Alzheimer's and related dementia population and the expanded case management system for elderly and disabled persons:
   • Department of Health.
   • North Dakota Medical Association.
   • North Dakota Hospital Association.
   • North Dakota Long Term Care Association.
   • Other interested persons.

• Tour one or more of the Alzheimer's and related dementia pilot project facilities.
• Provide recommendations to the Legislative Council and the 1999 Legislative Assembly regarding the projects developed by the Department of Human Services related to the conversion of existing nursing facility or basic care capacity for use in serving Alzheimer's and related dementia population and the expanded case management system for elderly and disabled persons and consider any legislation necessary to implement the committee recommendations.

ATTACH:3

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