DELAWARE NURSING HOME UTILIZATION STATISTICS JANUARY - DECEMBER 2006 Published January 2009 By Bureau of Health Planning & Resources Management 417 Federal Street Dover, Delaware 19901 302) 744-4555 Acknowledgments The Bureau of Health Planning and Resources Management wishes to express its appreciation for the excellent cooperation it has received from the Delaware Health Care Facilities Association and from all the private and public nursing homes that participated in this effort. Note This text version of this report provides narrative summaries of the information. In addition, we can provide all data, tables, and graphs in Microsoft Excel format, or the entire report in electronic format. To make such requests, please contact the Bureau of Health Planning and Resources Management at 302-744-4555. PREFACE This is the twenty-first edition of the Delaware Nursing Home Utilization Statistical Report. The source for all information for this document is monthly utilization statistical reports by Delaware nursing homes submitted to the Bureau of Health Resources Management. The data in this report does not include Intermediate Care Facilities for the Mentally Retarded (ICFMR). Note:See appendix A for recent changes in facility names and/or number of licensed beds. SUMMARY This report presents characteristics of Delaware's nursing homes and their patients. While focusing on information from 2006, the Summary presents various data from 1996 through 2006. Information generally relates to the following: (1) Facility characteristics (number of homes and beds by ownership); (2) Utilization data (patient days, occupancy, admissions and discharges); (3) Patient characteristics (age, sex, source of payment). Facility Characteristics The number of nursing homes in the state decreased from 46 in 2005 to 45 2006. The number of licensed beds increased from 4,707 in 2004 to 4,822 in 2005. Of the total beds, approximately 83.7% were privately owned in 1996, increasing to 86.3% in 2006. The percentage of beds in public facilities decreased correspondingly from 16.4% to 13.5%. The number of nursing home beds in Delaware decreased 4.8 % between 1996 and 2006. Figure 1: Total Number of Nursing Home Beds by County and Facility Type and the Percent of Change 1996-2006. Utilization by County, there was a 1.1% increase in New Castle, a 0.7% decrease in Kent and Sussex and a 1.6% increase in Sussex. The public facilities experienced an increase of 6.5%. The number of statewide patient days utilized by year has decreased 6.9% since 1996. There was a 3.6% reduction of utilized patient bed days in private facilities and a 29.5% decrease in utilization of beds in public facilities, during the same period. Figure 2: Number of Patient Days Utilized By Year, Facility Type, and County 1996-2006 Occupancy Between 2005 and 2006, the occupancy rate increased from 84.1% to 85.4% statewide (see table below). Private facilities in New Castle increased from 87.2% to 88.0%. Private facilities in Kent County decreased from 92.7% to 92.0%. Private facilities in Sussex County decreased from 88.8% to 88.7%. The occupancy rate in public facilities increased from 57.0% to 63.0%. The percent of nursing home bed occupancy decreased 0.2% percent statewide since 1996. There was a 2.7% reduction in private facility occupancy rates and a decrease of 8.2% occupancy rate in public facilities, during the same time period. Figure 3: Percent of Nursing Home Bed Occupancy 1996 through 2006, By Facility Type, and County and the Percent of Change Admissions There was an increase of 49.8% in admissions between 1996 and 2006 (from 5,685 to 8,515). Admissions to private facilities increased by 53.3% while admissions to public facilities decreased by 32.5%. Figure 4: Total Number of Admissions and Percent of Change by Year, Facility Type and County 1996-2006 The largest number of admissions to Delaware nursing homes in 2006 was for individuals aged 75-84 (37.9%) and for individuals age 85 and older (30.7%). According to the Delaware Population consortium, Populations Projections Series, dated October 31, 2008, in 2006 there were 41,452 Delawareans between ages 75 and 84 and 14,880 Delawareans age 85 and up. Keeping in mind that only 3.6 percent of all admissions to Delaware nursing homes and some Delawareans are admitted to nursing homes in other states, it is fair to estimate that the percent of Delawareans admitted to Delaware Nursing homes is accurately demonstrated in the following chart. Type of Prior Residency During 2006, 88.5% of the admissions to Delaware's private facilities were from hospitals and 6.7% were from the patients' or relatives' homes. In public facilities, 48.1% of admissions were from hospitals during 2006 and 30.8% from patients' or relatives' homes. Age of patient admission varies greatly by race. Blacks tend to enter nursing homes in Delaware at a much younger age than whites. Of the black admissions in 2006, 50.2% were less than 75 years of age, compared to 56.5% for whites. The percent of all Black admissions and the percent of all white admissions among specific age groups are as follows: • White admissions that were under 65 years of age equal 10.1%, while the percent of black admissions under age 65 equal 24.5%. The Delaware total of all races admitted under the age of 65 equal 12.8%. • White admissions that were aged between 65 and 74 years of age equal 16.3% while the percent of black admissions in the same age bracket equal 25.3%. The Delaware total of all races admitted between the ages of 65 and 74 is 18%. • White admissions that were aged between 75 and 84 years of age equal 40%, while the percent of black admissions in the same age bracket equal 29.8%. The Delaware total of all races admitted between the ages of 75 and 84 years of age is 38.1%. • White admissions that were aged 85 and older was 33.6% while the percent of black admissions in the same age bracket equal 33.6%. The Delaware total of all races admitted aged 85 and older equal 31.1% Percent of All admissions in Specific Age Groups • Of all admissions to Delaware nursing homes age 65 years of age and younger 8.2% were white, 4.6% were black and 0.3% were of other races; • Of admissions 65-74 years of age 13.3% were white, 4.6% were black and 0.3% were of other races; • Of admissions 75-74 years of age 32.5% were white, 5.6% were black and 0.5% were of other races; • Of admissions 85 years of age and older 27.3% were white, 3.8% were black and 0.2% were of other races. • Of all admissions to Delaware nursing homes 81.3% were white, 18.5% were black and 1.3% were of other races. Statewide 36.3% of all admissions were male and 63.7% were female. In public facilities 42.8% were male and 57.2%, while in private facilities 36.2% were male and 63.8% were female. Admissions by prior type of residency Statewide 7.1% of all admissions came from private homes, 87.8% from hospitals and 3.5% from other long term care facilities and 1.6 from other origins, including our of state. • Admissions to private facilities from individuals homes was 6.7%, hospital 88.5%, other long term care facilities 3.3% and 1.5 from other origins. • Admissions to public facilities from individuals homes was 30.8%, hospital 48.1%, long term care facilities 15.3% and 5.8% from other origins. Admissions by prior geographic locations Statewide 61.0% of all admissions were residents of New Castle County, 12.1% Kent County, 23.2% Sussex County, 1.4% Maryland, 0.4% New Jersey and 10.4% from Pennsylvania. The origin of the remaining 0.4% is unknown. • Admissions to public facilities were 74.4% from New Castle, 18.6% Kent, 531% Sussex, 0.6% Maryland with none from New Jersey or Pennsylvania with the remaining 1.3% unknown. • Admissions to Private facilities were 60.7% New Castle County, 12.0% Kent, 23.6% Sussex, 1.4% Maryland, 0.4% New Jersey, 10.4% from Pennsylvania with the remaining 0.4% unknown. Discharges The number of patients discharged increased from 5,676 in 1996 to 8,418 in 2006. The proportion of patients discharged from private facilities to a patients’ own or to a relatives’ home increased from 43.7% in 2005 to 45.8% in 2006. During the same period, patients discharged due to death decreased from 17.9% to 16.6%, while discharges to acute care hospitals increased from 28.5% in 2005 to 28.8% in 2006 In 2006 patients discharged to their own or a relative’s home from public facilities was 13.5%, while those discharges to their own or relatives home from private facilities was 46.2%. Discharges from public facilities as the result of death were 30.1%, while those from private facilities were 15.9%. Percent of Discharges by Race and Age • Of all white discharges 8.7% were under the age of 65, 14.4% were between the ages of 65 and 74, 36.3% were between the ages of 75 and 84 and 40.6% were 85 years of age or older. • Of all black discharges 21.1% were under the age of 65, 24.9% were between the ages of 65 and 74, 2934% were between the ages of 75-84 and 21.5% were of 85 years of age or older. • Of all other races discharged 20.6% were under the age of 65, 25.2% were between the ages of 65 and 74, 36.4% were between the ages of 75 and 84, and 17.8% were 85 years of age or older. Figure 5: Percent of Discharges by Race and Age Percent of All Discharges by Race and Age • Of all discharges 81.7% were white, 17.1% black, and 1.2% were of other races. • Of those discharged aged less than 65 years of age 7.1% were white, 4.1% black and 0.3% were of other races. • Of those discharged aged between 65 and 74, 11.8% were white, 4.3% black and 0.3% were of other races. • Of those discharged between 75 and 84 years of age 29.6% were white, 5.0% black and 0.2% of other races. • Of those discharged aged 85 and older 33.1% were white, 3.7% black and 0.2% were of other races. Figure 6: Percent of All Discharges by Race and Age Geographic Location Patients Were Discharged To • Of all discharges 61.0% were discharged to New Castle County, 12.1% to Kent County, and 23.2% to Sussex County with the remainder discharged to locations out of state. • Discharges from public facilities were identified as 74.4% to New Castle County, 18.6% to Kent County and 5.1% to Sussex County, with the remainder of discharges to locations out of state. • Discharges from private facilities were identified as 60.7% to New Castle County, 12.0% to Kent County, 23.2% to Sussex County, with the remainder of discharges to locations out of state. Figure 7: Total Yearly Number of Discharges 1996–2006 and Percent Change by Facility Type and County Sources of Payment The source of payment for nursing home care varies markedly between the private facilities and public facilities. In private facilities, while approximately 46.4% of the residents in 1996 had Medicaid as the source of payment, 53.0% of the residents in 2006 had Medicaid as the source of payment and they represented a growing portion of the Medicaid patient days (see graph on page 10). About 27.5% of patients in private facilities were self-pay. In public facilities, on the other hand, 75.4% of the residents had Medicaid as their source of payment in 2006 while only 18.9% were self-pay. Medicare is not a major payer of nursing home care. In 2006 Medicare was the source of payment for 15.1% of the patients in private facilities and 1.0% in public facilities. However, the percent of Medicare patients has changed considerably since 1996 when the percentages of patients with Medicare as a source of payment were 7.6% for private facilities and 2.3% for public facilities. Figure 8: Percent Delaware Patients by Payment Source and Facility Type for the years 1996 through 2006 Medicaid Expenditures Medicaid patient days in public facilities for the period of 2005 through 2006, increased by 3.9% while Medicaid patient days for private facilities were reduced 6.4% over the same period of time. Between the years of 1996 and 2006, Medicaid patient days in public facilities decreased 17.2% while Medicaid patient days in private facilities increased 9.8% Figure 9: Total Medicaid Patient Days for Delaware Nursing Homes Public vs. Private Facilities 1996-2006 Table 1.0 Total Patient Days by Facility and county with Percent of Change January- December, 2005-2006 Table 2.0 Number of Licensed Beds and Average Percent Occupancy by Facility and County January-December, 2005-2006 Table 3.0 Percent of Patients by Source of payment, Facility and county January-December, 2006 Table 4.0 Number of Admissions by Age, Sex, County and Facility January-December, 2006 (All Races) Table 4.1 Percent of Admissions by Age, county and Facility January-December, 2006 (All Races) Table 4.2 Percentage of Admissions by Sex, County and Facility January-December, 2006 (All Races) Table 4.3 Number of Admissions by Age, Sex, county and Facility January-December, 2006 (White) Table 4.4 Number of Admissions by Age, Sex, County and Facility January-December, 2006 (Black) Table 5.0 Number of Admissions by Source of Referral January-December, 2006 Table 5.1 Percent of Admissions by Source of Referral, County and Facility January- December, 2006 TABLE 6.0 Number of Admissions by County and State of Residence January-December, 2006 Table 6.1 Percent of Admissions by County and State of Residence January-December, 2006 Table 7.0 Number of Discharges by Age, Sex, Facility Type, County and Facility Name January-December, 2006 Table 7.1 Percent of Discharges by Age, Facility Type, County and Facility Name January- December, 2006 (All Races) Table 7.2 Percentage of Discharges by Sex, Facility Type, County and Facility Name January-December 2006 Table 7.3 Number of Discharges by Age, Sex, Facility Type, county and Facility Name January-December, 2006 (White) Table 7.4 Number of Black Discharges by Age, Sex, Facility Type, County and Facility Name January-December, 2006 (Black) Table 8.0 Number of Discharges by Disposition, Facility Type, County and Facility Name January-December, 2006 Table 8.1 Percentage of Discharges by Disposition, Facility Type, County and Facility Name January-December, 2006 Appendix A The table below shows new nursing homes (if any) and recent changes that have been made in names and/or number of licensed beds at certain facilities. These changes should be considered when making comparisons with data from previous years. Figure 10: New Delaware Nursing Homes and Recent Changes in Facility Name and/or Number of Licensed