Some experts doubt need
 for more long-term care beds

By Cornelius Frolik, Staff Writer Updated 9:31 PM Monday, September 6, 2010

Ohio’s 65 and older population is expected to surpass 1.7 million people by 2015.

About one in five older Ohioans have a moderate or severe disability requiring long-term care, according to a May 2009 report by the Scripps Gerontology Center at Miami University.

As a result of the predicted growth, a 2010 certificate of need report by the Ohio Department of Health projects Montgomery, Miami, Warren, Preble and 28 other counties will need more long-term care beds by 2015 than they have available.

But some experts say just because the elderly population is increasing does not necessarily mean there will be a greater increase in need for long-term care beds, which are certified by Medicaid and Medicare and primarily found in nursing homes.

Occupancy rates in nursing homes have fallen in the state in the last decade, even though Ohio’s 85 and older population has increased by more than 75,000 people, said Bob Applebaum, director of the Ohio Long-Term Care Research Project at the Scripps Gerontology Center.

More seniors bypass nursing homes

More seniors are opting for assisted living, in-home care and other programs instead of moving into nursing homes, Applebaum said.

“The world of long-term care has changed so much,” he said. “The proportion of people using nursing homes is going down.”

There are about 93,000 active long-term beds in Ohio, and about 85 percent of which are occupied, said Christine Kenney, director of regulatory services with the Columbus law firm, Bricker & Eckler, and former director of the Ohio’s certificate of need program.

The state in 1993 placed a moratorium on new certified long-term care beds, because it determined there were more than enough to meet the demand. The state also wanted to restrain Ohio’s health care costs and avoid duplicating services. In 2007 alone, Ohio’s Medicaid program spent about $4.8 billion on long-term care, according to the Scripps report.

This year, the state health department started allowing nursing homes, hospitals and other facilities to sell certified long-term beds across county lines, said ODH spokeswoman Tessie Pollock.

The decision was aimed at relocating long-term beds from counties with projected surpluses, such as Cuyahoga and Clark, to counties in need, such as Montgomery, Miami, Warren and Preble counties.

“The bed need formula was developed to achieve a statewide long-term care bed occupancy rate of 90 percent for the 2015 projected population, aged 65 and over, based on current utilization,” Kenney said. “This calculates to 53.3 beds per 1,000 people aged 65 and over.”

In July, Greene County tried to sell 15 long-term beds that were certified for Greenewood Manor nursing home to another county. The nursing home has 100 beds.

But the bids for the beds came in at $10,000 each, well below the $25,000 or more they typically fetch, said county administrator Howard Poston.

He added the county hopes to sell the beds in the future, but the buyers will need to meet their price demands, because “we’ve seen some good prices in other places.”

Applebaum and other advocates for the elderly say the state is likely overestimating the number of long-term beds some counties will need because its projections are based on past use instead of current trends in the industry.

Home care becoming choice

Medicaid nursing home use in Ohio has declined by almost 10 percent among people 60 and older in the last decade, according to the Scripps report.

In 1993, 90 percent of older Ohioans supported by Medicaid were in nursing homes. By 2007, that proportion was down to 62 percent.

“Now 40 percent of folks are choosing home care,” said Doug McGarry, executive director of the Area Agency on Aging that covers Champaign, Clark, Darke, Greene, Logan, Miami, Montgomery, Preble and Shelby counties. “In the last 10 years, there has been significant growth in the assisted living industry, which is not a long-term care bed. It provides apartment-living type of atmosphere, with support services in place.”

But nursing homes are adapting to the changing needs for long-term care by increasingly providing care for shorter stays. Short-term admissions increased to 126,500 in 2007 from 30,000 in 1992, according to the Scripps report.

Following a stay in the hospital for acute care, many patients are discharged to nursing homes for short-term rehabilitative care, which is covered by Medicare, McGarry said.

“You are seeing more and more people going from the hospital to a rehab bed or a long-term care bed for anywhere from five to 60 days,” McGarry said.

Contact this reporter at (937) 225-0749 or cfrolik@DaytonDailyNews.com.