Long-Term Care - Illinois General Assembly

There is also an automated pre-admission screening process. A nurse uses a laptop computer,
goes into the person's home, does the assessments and makes the eligibility determination right
then and there. That information is filed that day electronically with the department.
Again in 2002, 2003, and 2004, the state faced budget crises. Ten years into this process, we
had to determine what has worked. The state has shifted spending away from the institutional
side to the home and community-based care side. It has also doubled the number of people
who are using home and community-based services. One way to do this is to just ratchet down
the whole system, but in a state with a growing elderly population, that wasn't a strategy that
would work. More people had to be provided services less expensively.
Medicaid nursing home census is down by 17%. Discharges from the nursing home to home
have tripled, and length of stay is down by half. One of the reasons is that, in addition to preadmission
screening, the same assessor who looked at the person before he or she went into
the nursing home also visits that person once they have been admitted, to determine whether
there is a continuing need for that type of care. I don't know if that is done in Illinois? That was
a very critical factor in the Maine’s success, because it has kind of changed the culture and
perception of nursing homes. They are no longer a place where you necessarily go to die. It's
a place where you go to get better, so that you can go home and have another crack at staying
at home a little bit longer.
Maine spends about 1% of the total long-term care budget on pre-admission screening and
maintaining that system, and that's a pretty good investment.
With respect to pre-admission screening, a nurse assesses the person's strengths and needs,
and then the system shows the program for which the person would be eligible based on that
person’s functional assessment. In Maine, if you're not eligible for nursing home, and you're
expecting Medicaid to pay, you don't get admitted. Private pay people have the same
assessment, and they may opt for a nursing home placement, even if we tell them that when
their money runs out they might not meet the Medicaid criteria. In those cases, the nursing
home is at risk, if they accept that person knowing that they probably won't be Medicaid eligible.
Over the last ten years, Maine has taken about 20% of nursing home beds off-line. This is not
quite as high as Minnesota. This was accomplished by imposing stricter reimbursement
penalties on facilities that had low occupancy. The lower the occupancy, the less of a
percentage of fixed, or capital costs that would be paid. That created a very strong incentive for
facilities to take beds off-line.
Maine used a financial disincentive. What we said to nursing homes was that, if occupancy
dropped below a certain percentage, 90%, we reduced the percentage of the facility's debt
service mortgage costs that we would pay. That created an incentive for facilities to convert
those beds to other uses. Many converted those beds to residential or assisted living. We
started with 10,000 beds, and today we have 7,500, keeping in mind that we're a state that's
about a tenth of your population. The state population is 1.2 million, and we have about
220,000 elderly.
I have someone on staff who we call "let's make a deal." She works very closely with individual
nursing home providers to help them assess what they might do with that excess capacity and
to just get them through the process. You have to have the supports in place to bring people,
along, and I think that's helped a lot. We've tried to be as creative and flexible as possible
around this cost neutrality, so that if you have excess capacity, you can sell the revenue stream
to another provider, and that's proved to be quite popular.
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