Study shows managed care could affect access, quality of care for seniors needing long term care

A recent study released by the Claude Pepper Data Center underscores Florida long term care provider’s ability to effectively manage long term care costs and cautions lawmakers to ensure access to current and future quality services based on the needs of today’s long term care residents. The study reviews Florida’s long term care landscape, including its demographic makeup, regulatory environment and quality of care measures, and benchmarks it against Arizona and Wisconsin, two states with practical experience with Medicaid managed long term care.

“Florida’s nursing homes are a vital part of the long term care system; they provide good quality care for our state’s frail elders and as the state’s 14th largest employer, good jobs for Florida workers,” said Emmett Reed, Florida Health Care Association Executive Director. “We agree the Medicaid program is in need of reform; however, the growth in Medicaid has not been caused by an increase in nursing home enrollment, but rather an increase in Florida’s unemployment, which is causing more individuals to rely on Medicaid as a safety net to cover their health care needs.”


The study found that the average Medicaid nursing home caseload has decreased from 47,059 in 2001 to 42,661 in 2010. Reed emphasized that today’s nursing homes serve an important post acute care role, with 84 percent of admissions coming directly from the hospital and one-third of those patients returning home following a short-term stay. Over 75 percent of the long term care population, however, has Alzheimer’s or related dementias with no one to care for them in any other setting. Most of the remaining individuals require 24-hour skilled long term care, with an increasing number of those being younger persons with disabilities.

The study raises important considerations related to Medicaid managed long term care and current and future access based on adequate supply of services. Reed noted that Florida has among the lowest over-65 population to nursing home bed population ratio in the country, measuring in at 2 percent compared to 3.5 percent nationally. “Florida is a leader in ensuring individuals requiring long term care services receive the most appropriate care in the least restrictive setting based on their medical needs,” he said. A recent report presented by the Legislature’s Office of Program Policy and Government Analysis (OPPAGA) showed that just 1.3 percent of those who received nursing home care in 2009 (just over 700) had the potential to safely transition into community placement based on their needs assessment.

The effort to transition nursing home residents back to the community have required assisted living facilities (ALF) to offer a wider range of care; however, the study notes that the “typical” nursing home resident could not receive the appropriate medical care in an assisted living facility (ALF) where nursing services are limited and state and federal oversight of those services is less intense.

It also cites the lack of availability of ALFs as a major challenge for a statewide implementation of managed long term care, since approximately one-third of Florida’s licensed ALFs are located in Miami-Dade County, leaving large areas of the state unserved or underserved with available ALF beds. Additionally, many ALFs target the private market and are unwilling to accept Medicaid payments according to “A National Study for Assisted Living for the Frail Elderly,” Hawkes, Rose and Phillips 1999.

When it came to quality of care measures, Florida has a higher mandatory staffing minimum of Certified Nursing Assistants than in Arizona and Wisconsin, and Florida’s direct care outcomes, such as “new fractures, falls physical functioning and the quality of life indicator of activities” were better than those quality measures reported for Arizona and Wisconsin. The study also noted that there is no comparable data for assisted living facilities, and the Hawkes, et al survey found that only 40 percent of ALFs employed a full-time registered nurse.

“We will continue to work with lawmakers to explore ways to reform the Medicaid system in Florida,” said Emmett Reed, Executive Director of Florida Health Care Association. “Florida’s nursing homes care for the state’s most vulnerable population, and this study shows the need for lawmakers to carefully consider the complexity of this issue and the individuals we care for in our facilities.”