(00:00:00) From Minnesota Public Radio. I'm Greta Cunningham Minnesota education officials today will announce who is on a panel to help rewrite. The state's academic standards 2100 people applied for the 60 positions on the Minnesota academic standards committee Governor Tim pawlenty and the State education commissioner want the committee of parents teachers and education experts to come up with new standards in reading and math by the end of March citizens from Minnesota's Iron Range will appear before a senate committee today to persuade lawmakers not to cut funding for several projects. They are pushing the idea of a copper nickel Cobalt mine proposed by a large Canadian mining firm. The minear Babbitt would create a thousand permanent jobs a Southeastern Minnesota man charged with placing pipe bombs in rural mail boxes has won the right to undergo psychological tests that could help with his Insanity defense Minnesota public radio's Erin Kelly reports (00:00:50) 21 year old Luke Elder is already undergone multiple psychological tests given by (00:00:54) prosecution and (00:00:55) defense experts the former University of Wisconsin. Stout student is accused of placing Than a dozen pipe bombs and mailboxes in five states last spring six people were hurt helders lawyer requested additional psychological testing and says, she's concerned about helders ability to understand the charges against him (00:01:12) Federal prosecutors did not object to the motion (00:01:14) a US District Court Judge also gave attorneys (00:01:16) more time to file pretrial (00:01:18) motions. The judge is expected to delay helders trial which is scheduled to begin next month Amira Galilee, Minnesota Public Radio (00:01:26) Rochester the forecast for Minnesota calls for partly cloudy skies in the North. Mostly cloudy in the South. It will not be as cold today with highs ranging from 18 in the north to 27 in the South checking conditions around the region of mixture of sunshine and clouds Duluth reports Sunshine into above it's cloudy in Rochester and twenty degrees and in the Twin Cities sunny skies with a temperature of 20 degrees. That's a news update. I'm Greta Cunningham. This is midday. I'm Mike Mulcahy and for Gary eichten hundreds of people including nursing home residents their relatives and nursing home employees held a rally at the state capitol this morning to urge lawmakers not to cut State funding for long-term care. That's a big order given the cost of nursing homes about a billion dollars a year in the short term. Of course, Minnesota is facing a big budget deficit and in the long term the baby boom is getting older one estimate says the number of minnesotans over 85 will increase by nearly 60 percent within the next 20 years or so how the state cares for the elderly and disabled in nursing homes is a huge issue for those people their families those who work in nursing homes and the cities and towns where the nursing homes are located and who will pay and how to pay is a major issue the governor and lawmakers are trying to resolve our guests today are Republican representative Fran Bradley of Rochester. He chairs the Health and Human Services. It's Committee in the house and Gail Quinn vould president and CEO of the Minnesota Health and housing Alliance. That's a non-profit Statewide trade Association that represents nursing homes Senior Housing and Community Based Services. As always we'd like you to join the conversation. If you're listening in the Twin Cities, give us a call at six five. One two, two seven six thousand 6512276 thousand if you're outside the metro area call us toll-free 1-800 to for to 2828 1-800 to for to 2828 representative Bradley. Thanks for being here. Let me start with you. What are you telling the folks who came to the Capitol today? Is there any way to balance the budget with without providing less money for long-term care? (00:03:36) Well, I'm first of all trying to express a sense of hope. This is a time in these difficult Financial Times when reforms regulatory reforms paperwork reforms those kinds of things are More on the Forefront. We lose a lot of Staff in nursing homes because there's just so fed up with some of the regulations that don't really add quality. So one of the themes major theme is let's take advantage of this time to really do meaningfully right regulatory reform. The other is that we've had very successful very very successful sort of long-term care broad-based and we need to think of this more than just nursing homes. This is about giving people options and choices. We've had great success in these last couple of years since the long-term care tasks for so although it's difficult time and I don't kill anybody we trying to be honest. We know these are difficult times and we need to make the right choices as we handle his budget challenge. We have to (00:04:33) hmm and certainly want to talk about some of the things you raised also want to bring Gail Quinn volt into the conversation Gail. Are you expecting less money? And and if there is less money coming for the next biennium, what does that mean for nursing homes and for assisted living facilities? (00:04:50) Well, we're certainly I'm full of the situation. The state is in we realized that this is historic in terms of the deficit that lies ahead and we've done the math and we know that Health Care programs account for about 18 percent of the state's spending and as legislators, look at the tough choices that they're going to have to make we are braced for the fact that they will have to look at Older Adult Services as well. But we're very hopeful that they will be able to protect the reform efforts. They investment they've made in caregiving over the last two years and really the honor that they've done to the people who built this great state and that's who were caring for in nursing (00:05:31) homes today. Hmm, and I I know that when we talk about long-term care, we are talking about a number of things but I guess the the first option that comes to mind is a nursing home and and let me ask you some basic questions. I don't know if you have these answers right at the tip of your finger tips, but just on average, how much does it cost to keep someone in a nursing? Home. (00:05:53) Well, the average rate in Minnesota is a hundred and twenty nine dollars a day and I but I would stress the word average right because each facilities rate structure varies even in the same Community to facilities can have different rate structures and they're actually 34 different prices that an older person might pay as they're admitted to a nursing home based on their care needs but a hundred and twenty nine dollars a day is a good round figure. (00:06:18) Okay, let's call that the average then and then is there an average for how long a person would stay in a nursing home? (00:06:25) Well, there is an average and there's a really good news story there as well in the last decade Minnesota's have mints minnesotans have been using nursing homes less and staying in them for shorter and shorter periods of time. The average is still a little over a year, but the median length of stay is down to about 50 days and what that means is about 50% of the people who are discharged from Nursing Home in any given year of stayed there 50 days or less so very short period of time and those individuals are there very often for rehabilitation after a hospital stay and the good news is they're going home again or to assisted living or to a setting where they get Home Based Services think it's fair to say that when you look at the distribution of time, there's sort of two major ranges one is would miss one ball. Just mention that is we're having a lot more use of nursing homes for short-term rehabilitative stay and that's of course what brings the average down on the other hand. You do have a number of people who are much more longer term. If you go into a nursing home these days you'll find that whatever image we may have had a 15 years ago of bingo playing smiling well-off people is not where it is anymore the people in nursing home business the almost acute end of the spectrum of care those that that don't need that kind of level of care are hopefully being cared for in their home assisted living foster care. And this is exactly what we want is a spectrum of options. (00:07:50) Hmm. And so for the people who are there often the the old people I mean, it's pretty intense care that they need. (00:07:57) Oh indeed it is I think if people haven't and I've been in nursing homes all of the state and I sort of Marvel at the the cute needs medical needs physical needs that people most often have their and of course also pay homage to the people who care for (00:08:13) them. Absolutely. Well, let me then switch over to sort of the funding side and that is how many people pay for their own care how many rely on the government to pay the bill and How much of the money is federal how much is State, you know all those sort of complicated questions? (00:08:30) Yeah, let me just sort of give you a kind of a thumbnail on average about two thirds of the people or the dollars spent in nursing homes are taxpayer funded through our medical assistance program. Our medical assistance program. Minnesota's level of matched by federal money is about 50/50. So of that two-thirds of the people the state money is about half and the federal money is about the other half. (00:08:55) Okay, and now you mentioned, you know, the other options of keeping people in their homes as long as possible and things like that. It seems like does that really save money I guess is my question because it seems like if you need, you know fairly intense Care at home, you would have to pay somebody a significant amount of money to do that too. (00:09:17) Oh, absolutely. I mean we're saying the spectrum of care the Spectrum has to be adjusted to the level of needs in general by the When we talked about what's covered by taxpayers, we should not forget that most of elderly people with normal kinds of needs are cared for by their families by Nancy. Exactly. Right? I mean, it's really important to recognize and to respect that and hopefully to hang on to it because frankly the challenge that we have financially would be greatly exacerbated if we lost that so there's we're sort of focused on the state's participation, but most of it really is being taken care of by by families in their their own homes, and and you're right if if someone is in their home and their health needs a change over time there comes a time when the line crosses and both from a quality of care and from a cost. It's time to move to the next level ultimately to the hospital level. I'm sorry to the nursing home level and as I mentioned even in some cases for truly acute and to hospital, so we do have to make sure both from a financial and formal quality of care that we mindful of people being in the right place. (00:10:25) That's Republican representative friend Bradley. He's from Rochester. He chairs the Health and Human Services finance committee in the house. We're also talking with Gail Quenneville today. She is president and CEO of the Minnesota Health and housing Alliance, which is a non-profit Statewide trade Association that represents nursing home senior housing facilities and Community Based Services talking about long-term care in Minnesota. There was a rally at the Capitol this morning folks urging legislators to be careful when they go about balancing the budget to be very careful in this area. We'd like you to join the conversation. If you're listening in the Twin Cities the number to call six five one two, two seven six thousand 6512276 thousand if you're outside the Twin Cities, it's a toll free call 1-800 to four to Twenty Eight twenty eight one eight hundred two, four two 2828. Let's talk about one more aspect to get the basic questions out of the way. And that is the folks who work at these facilities. And Gail, maybe you can help me out here. How hard is it to find people to staff long-term care facilities. And you know, what kind of money are they being paid and tell me about some of the issues there. (00:11:38) Hmm. Well, let me start out by saying that we are blessed with a very dedicated group of people in Minnesota who do the 24/7 care particularly in the nursing home setting shifts around the clock and we're really fortunate that people take those jobs because in fact in many cases they do pay less than other jobs in the community and are often more emotionally and physically demanding the probably an average wage rate. And again this would differ around the state but I'd say about ten dollars an hour and a lot of our nursing assistants in particular are very often single moms with kids and they're working at near a minimum wage in many cases and caring for a family to at the Time that they're doing wonderful work caring for older people. We do better in terms of attracting employees in times when the economy is bad and that has to do in part with the wages and benefits that we can offer but we are also challenged to keep the good people who do come to us our turnover rates for let's say nursing assistants in the metropolitan area is about 60 percent in a year. So what that means is about 60% of the people who come to those jobs leave them in less than a year. And that's where we're really focused. Today is making sure that not only we can attract people but we can keep them as a life's career in caring for older adults. (00:13:07) Let's talk a little bit about the funding options. It seems if two-thirds of the dollars going into this area are paid by the taxpayers if there are fewer taxpayer dollars. It seems like the options are to either, you know, give people less help paying for the for this fewer people. Getting government help or the money has to come out of the budgets of the of the facilities that provide the care which means even less pay for the employees and or maybe cuts and services are those the options represent a Bradley that the legislature is looking at. (00:13:40) Well, hopefully there's one missing and that's productivity to the extent that regulatory reform can allow people to be more productive, of course that leverages and that means that that's sort of the efficiency side of it. There is another one. I think you sort of hinted at it the fact that it's 2/3 in some cases at least is a consequence of some fairly clever estate planners and lawyers who help people move and hide and do different tricks with their assets. I frankly I don't think that's very much fun. Even for the family and we are seeing the emergence of a long-term care insurance market for families that do that. I think the good news for them whether they're paying themselves or their children are paying Is it's a big relief? I mean, it's almost a moral relief for them because they feel better about planning for this it I don't think most of our elderly really like the idea of sort of going into senior welfare really kind of what amounts to if they have the means. So I think on that end it's very important that we help people recognize that potential obligation. We plan for it. In other ways. We ensure our homes. We ensure lots of things but this for some reason has been sort of Forgotten area. That is finally starting to grow. (00:14:53) Okay. It's a number of issues you raised there and we'll get to them. Let's see what our callers have to say first though. Mark is on the line from Anoka County Mark. You're on. Midday High, I guess what I'd like to focus on is I remember reading an article from The New York Times has been within the last 12 months and it talked about more than 90 percent of the nation's nursing homes have too few workers to take proper care of the patients. And this was a federal study and I just think to myself listen we've got people in these facilities. This is One of the most sacred parts of their life and I think nurses should be able to take care of them. There should be incentives for these for these nurses, but my question is the representative Bradley because there's these administration's out in these nursing homes that I don't think have the accountability of having Staffing ratios. I know I lost a great-aunt here recently in a nursing home. And every time I went in these nurses were running around it's like they don't have enough time to take care of each each patient each resident because there's not enough of them and there's a lot of Mount nutrition and dehydration and I remember the current Administration in this article saying that with the cost involved, it had no plans of setting minimum Staffing ratios, and I'm just wondering if representative Bradley feels that there should be some accountability here on the state level with with Staffing ratios, and I can take my Off the air. Okay. (00:16:27) Well, I think it's a fair question. However, I'm really more focused on outcomes and quality in the end how well are people being taken care of and we do have I would say that the nursing home industry is probably more regulated than nuclear power. We have surveyors. We have Ombudsman offices. We have all kinds of things. We have family consoles and most nursing homes. So there's a tremendous amount of oversight. I have talked to states that have tried to adopt the so-called minimum Staffing ratios, and it sounds on a Surface like a good idea most of the states that did it frankly abandon it because what they found out was that this is sort of a cookie cutter approach and what it became is it became an excuse whatever level you set it at that's if I have that that I must be okay, and that's not the case. I mean, it's much more complicated than that. So what sounds like a good idea on the surface, I'm afraid can backfire if we're really focused on the care of people. I mean and there's tremendous. Samad of oversight and frankly, I don't think our outcome Quality Systems are as modern as they should be then then the Staffing ratio would take care of itself because it would be deliver quality (00:17:37) and Gail Quenneville. Let me ask you a question that we just touched on very briefly before but I've heard a lot of people complain just about the sheer amount of paperwork there is to fill out in nursing homes. Is that a real issue is that is that a problem when it comes to Staffing? (00:17:54) Oh that's a very real issue in representative Bradley gave the example of Nursing Home Care being more regulated than nuclear power it Federal Regulations alone. There are 500 of them and there are state regulations on top of that and some of them certainly have to do with the outcomes that representative Bradley is referring to but others of them. We feel involved taking the the nursing assistant or the nurse away from the direct contact with the resident and into Lions with charting or paperwork we've given representative Bradley in his doing more with less initiative examples of a number of regulations that we believe could in fact be modified or eliminated in Minnesota without impacting the quality outcomes for older people and it would send a positive message to caregivers in these settings that we understand that their real goal is to do the best job they can for older people and I don't think there's a caregiver in a Minnesota nursing home today who doesn't have that as their goal. I remember vividly one of my first introductions to this when I visited a nursing home and one of the nurses told me here's a these clipboards that we have, you know, we all sort of know these clipboards that are inpatients and she said five years ago. It used to take us two years to fill up an inch worth of this paper. Now it takes in many in some cases 14 days. I mean it just it just Believable amount of paperwork now some of that paperwork is sort of the consequence of surveyors who are more interested in whether or not you filled out things and whether you documented then whether a person's cared for and I can't necessarily blame the surveyor. They're doing the job according to what the book says. This is the old sort of clipboard approach the micro management approach. I think at one time Ventura said something about telling people which side of the toast butter. It may not be quite that bad. But it's almost that bad. (00:19:53) Okay, let's take another caller. Jim is on the line from Rochester Jim. Go ahead. Hello. Hi. Okay. I'm worked in nursing homes for over 20 years and I'm I made question in terms of from a staff Viewpoint is where is the money going now? You use the the example of an average of a hundred and twenty nine dollars a day a little earlier and I did some quick figuring and if you have a wing with 30 people on it, and it's got 3/8 so 10 8 or 10 people to an aide at $10 an hour and one nurse at $15 an hour that comes out to $95 that you've spent on that floor for one shift for wages for the entire staff are the tire group of people 30 people that are paying a hundred and twenty-nine a day and I would like to see some kind of digging into the books or the accountability. You know, where is the waste going to it is it isn't going to wages and and the minimum Staffing level you have problems there already because they're not getting people to come into this line of work except for two people two kinds of people essentially the kind of people that are dedicated and view it more as a mission then they then they see it as a line of work. You just go to for eight hours a day. I mean, these are truly dedicated people that do everything they can to make life better, even though they are short-staffed and then you've got the other group of people that are going in there and they're spending their eight hours and they're wandering from room to room and they're doing little or nothing and the people that really care are so busy. They can't even check on them and make sure they're doing their work. Okay, Jim. Let's see if we can get response to your question. And I guess it's is the money that is being spent being well-spent represent a Bradley. (00:21:59) Well, actually I was I was going to turn to Glenn Gould because I think there were specific questions about I mean just make sort of an observation. I've actually poured over books especially because frankly I found nursing homes about three or four years ago a many who are about to go out of business who are running the red. It is a complicated business and when you look at the amount of overhead the 24/7 coverage the skills that you need to make the whole cross base it it's it's a complicated business, but I don't think there's much fat. I think if you were to audit books in virtually every nursing home, you wouldn't find that anybody is getting rich even at the highest level and you know, I would welcome the opportunity to respond to that both from my professional employment. But also as someone whose mother is in a nursing home here in Minnesota, but to Echo first representative Bradley's words that we're pretty transparent in terms of how we spend these precious dollars in our facilities and I think sometimes we emphasize nurse As the part of nursing home care, but in fact, there's quite a team of other additional professionals at work from social workers to activity staff to rehab staff to housekeepers to Engineers to dietary staff and they comprise a caregiving team. They may not be quite as visible as that nursing assistant or that charge nurse, but they're all they're contributing to a quality outcome and from a personal standpoint my own mother recently fell and broke her hip. She's been in a Minnesota nursing home. Now almost well actually little over three years and as a result of having only one leg and the brake being and that one good leg. It takes three people to transfer her and I think just about the care that she alone needs when I know that nursing assistants generally care one nursing assistants for eight people. It takes three of them to help her get up in the morning to use the bathroom to go to bed at night to lay down for a nap. So I I think it's sometimes shocking to hear the number a hundred and twenty nine dollars a day. But I think if you look closely you'll see that that's money indeed very well (00:24:07) spent and is the bottom line for people like Jim the caller that just given the budget situation this year don't expect to see much more than ten dollars an (00:24:18) hour. Well, we would love to see a cost of living adjustment that we could provide to our caregivers, but we're mindful of the situation. The state is in and what we're hoping is that we can protect the investment that is already there. (00:24:37) Okay. We are talking with Gail Quinn vould she is president and CEO of the Minnesota Health and housing Alliance were also talking with Rochester representative Fran Bradley who chairs the Health and Human Services finance committee in the Minnesota house talking about nursing homes, and we're going to just take a short break first of all to test the emergency alert system. This is a test of the emergency alert system. Programming is supported by Simon delivers.com your new Neighborhood Grocery. You can visit them online at www.ciminobenham.com. And now let's check in with Greta Cunningham and get an update of the latest news Greta. Thanks Mike. Good morning. NATO has canceled an emergency meeting today on the stalemate over defending member turkey from a possible Iraqi attack Germany earlier suggested any progress would have to wait until after un inspectors report to the security Council tomorrow. The White House is describing. The latest finding on Iraq's weapons program as quote serious and troubling there's word missile experts believe in Iraqi missile can travel beyond the limits imposed by the UN Iraq is disputing the finding US Secretary of State Colin Powell told a house panel the US has to be prepared for a fairly long term commitment in Iraq Powell says, there's no estimate of how much a war with Iraq would cost police officers have evacuated part of London's Gatwick Airport as part of a security. Earth a spokeswoman for the company that runs the airport says all outgoing flights from the terminal have been suspended. She says inbound flights have been diverted to gather Gatwick south terminal the news follows word that British police arrested two men near London's Heathrow Airport on terror suspicions British officials have beefed up airport security this week due to what they say is an increased Terror threat from the Al Qaeda Network in Regional news. Minnesota u.s. Senator Mark Dayton's trip to the Middle East has been canceled. Again Dayton was to have been part of a Congressional Delegation that would visit Turkey Pakistan Afghanistan Qatar Kuwait and Jordan from this Saturday through February 22nd. The trip was originally scheduled for January but was postponed when the Senate remained in session to debate a major funding bill Dayton says the trip may still take place, but he and several others won't be a part of it the forecast for Minnesota calls for partly cloudy skies in the North. Mostly cloudy in the South today temperatures won't be as cold high temperatures today ranging from 18 in the north to near 20. Seven in the South right now in Sioux Falls sunshine and 30° skies are cloudy and Moorhead 12 degrees. It's cloudy in Rochester and 20 sunny in Duluth and to above and in the Twin Cities Sunshine a temperature of 20 degrees Mike. That's a look at the latest news. Thanks Greta. You're listening to midday on Minnesota Public Radio. I'm Mike Mulcahy in today for Gary. Eichten. We're talking about nursing homes. This our a long-term care in the state of Minnesota. Our guests are Republican representative Fran Bradley of Rochester chairs, the Health and Human Services finance committee in the Minnesota house and Gail Quenneville president and CEO of the Minnesota Health and housing Alliance. Lots of people on the line. So let's get right back to the caller's norm from Inver Grove Norm. Go ahead. Yes, I wondering what other First World countries do about this problem, you know and view the fact though that that they spend about 10 percent of their GDP s in General on Healthcare regular health Here that would stand we spend about 14% So for us that means we're wasting about 400 billion dollars a year nationally on needless paperwork and here's here's that term again paperwork and administrative waste and so on money which could be used to provide long-term care. For instance just to give you a specific example of that about three weeks ago on this very radio station. There was a former head of HCMC Hennepin County Medical Center in Minneapolis. Who said that when he had some Canadian students come through. Yes them showed them the billing department at HCMC and he asked them how many people would they require at a at a Canadian Hospital of similar size and they said about four or five people well at HCMC They had 200 people. So, you know, there's you don't want to look at just LTC you want to look at other areas of the health care Spectrum to see where dollars are just going out the door money, which could be used for long-term care. Okay. Let's get some response from our guests. Anybody with (00:29:39) well, let me let me just try a little I don't really know for sure about all the other nations. I do know of a few because we've had students from about eight different countries in our home as a exchange students and it's sort of interesting phenomena. And I also we have a very large Somali community in the city of Rochester in many of those cases the idea of sort of Institutions or Community settings for care are just almost foreign to them almost can't identify with it and I'm assuming it because I just don't know for sure. But I know at least in some of the cultures what that means is the families basically say, it's our job. I mean they just they do the caregiving aside from the the acute medical care, but there's a lot more of that but I'd to be honest, I'm not so sure in the European countries what it's like but that's at least partial observation. The only other countries long-term care system with which I'm very familiar is Scandinavia of Norway in particular and they relied very heavily. Heavily as representative Bradley is saying on home-based care as opposed to institutional care now they care for a smaller population and I don't know what the economics of that are for them. But I do know that that's their emphasis. I would say that one thing about our Older Adult Services System and about our health care System generally is that we tend to the word we use is we tend to fund out of silos. So we look at nursing home care apart from how we might fund acute-care apart from how we might fund home-based care apart from how we might fund other services and we've long thought that if we could break down some of those barriers across the programs that perhaps there's some cost savings and looking at Chronic care for older people and I think we've made some we've stretched in that direction with some State programs, but I think that is one area we could look at (00:31:35) let me ask you another question we touched on this briefly before But there's this issue of assets transferring assets. How does that work in the state? I've heard a lot of talk that Minnesota allows people to do things with with money so that it's sheltered when it comes time to pay the bills and they go on the federal on the government program because they they give it they've they've hidden their own assets somehow. Is that true? And is that are you going to try to tighten that up some more representative (00:32:07) Bradley? Well, we sure are and I know sometimes this is anecdotes. So you had to be a little bit careful about reacting to anecdotes. But we do here the current rules that we're allowed to use because of some federal limitations is a three-year look-back. So theoretically if people have done transactions to move their assets to something that wouldn't be included as they entered the possibility of medical assistance. We would have the prerogative to do a 3-year look-back. We would like to make that a five-year look back. However, I think in addition to that and I'm told this is another kind of an anecdote but I was told of a case where somebody bought a very very expensive diamond ring. And even when we do have assets there are certain assets that are not included for example, a spousal home is not included now, ultimately some of those things can be liquidated later on but that there are certain assets also particular that are protected. I think what you're going to see us doing this session is taking another hard look it is it is difficult. I'm told as a matter of fact when I when I hit the the Rye pages and my later 50s here, I was receiving these brightly colored invitations to these seminars and what it said right at the top of it was let us show you how to protect yourself from the ugly government taking away your assets and it was exactly along the same line. So there is a whole industry out there doing it. We're doing our best I frankly What I'd rather I wish we could do better is more positive to make it more attractive for people to plan this and we are trying to do that by providing a little bit of a tax credit for long-term care insurance. We're trying to look at ways that maybe we could for those who have been responsible that we could make it a positive incentive. I mean that's an angle that we haven't done very well at the underlying dynamic in in estate planning is I think found in the fact that they're there is not a readily acceptable or there are many readily acceptable vehicles to ensure against long-term care risk. And so you do see people to vesting of assets is part of estate planning. There are a few states in the nation who have looked at using long-term care insurance in a sort of public-private partnership where you allow individuals who have purchased long-term care insurance to maintain a higher level of assets than they otherwise would be able to have and qualify for medical assistance as an incentive to get the population buying long-term care insurance. We are also very interested in the possibility of expanding the state's current long-term care insurance program for state employees to include for example, local units of government. And again, this is an attempt to get long-term care insurance is a more viable vehicle for those people who see themselves as having long term care risk. Now, let me be room for improvement just as a kind of quick comment. The one that this has been some years ago and I looked at it but at that point in time North Dakota had about twenty six percent of their population over 65 who were carrying long-term care insurance and Minnesota was down in the two to three percent. So and we're probably know better than that now but we have a long way to go. (00:35:19) Now. Let me just look at sort of the other side of this issue. And that is I've seen at least one proposal that would have family members borrow money to pay for the older relatives nursing home care, you know sign on to a lone sort of open-ended that seems like it could get pretty expensive in a hurry. And you're asking families to make some some really tough choices. There is that any kind of an option you would look at (00:35:46) all. This is probably on the edge of the envelope. I think it's a fair question at least arrays. And by the way, I know more than one senior who is whose long-term care insurance premiums are being paid for by their children. Hmm because what the children are doing is they're saying this is the way to protect the estate of our parents. So in that regard you could say there is some precedent for the siblings to take some responsibility. I think it's worth considering it's probably enough on the edge of the envelope that I don't know if the public is quite ready for the idea what you're really in a sense saying is that you begin to have the notion of deeming you're really saying you're sort of deeming the income of the children as you consider whether or not people should be receiving medical assistance. It's fair to consider but probably pretty tough public. (00:36:36) Let me give out the phone numbers again. If you're listening in the Twin Cities and you want to join our conversations 6512276 thousand 6512276 thousand. If you're outside the metro area call us toll-free 1-800 to for to to 8281800242. 2828 and back to the phone's Carolyn is on the line from South st. Paul. Hi, I am a representative of people who work in nursing homes in Minnesota the Saint Paul mostly and Southern Minnesota, and I found there's two things that I wanted to point. I wanted to make one of the biggest problems for workers is the availability of reasonable health insurance as everybody knows the cost of an escalating and most employers on an average will pay 80% of the single coverage coverage just for the worker and they pick up the 20 percent which has been escalating over the years higher than the wages have been going up. If they want to purchase Family Insurance if they want to cover a child if they want to cover a spouse they pay out of their own pocket anywhere from 800 to 1200 dollars, which tells you not many of them can afford that coverage and take us there is a big turnover because of hiring and retaining quality employees when they can go someplace else and and and that's a benefit that they can get the other thing. I've noticed from back in the 80s. When I first started servicing nursing home, there were very few offices that held management people or the professional people there would be an administrator there would be a director of nursing there would be bookkeeper there be supervisors of the the department and that could be four or five people now when you go to a nursing home because of the regulatory issues They have anywhere near a whole floor of management or professionals people working there. It used to be that the people who actually took care of the resident the one who fed them who gave the medicines who tiresome who change them in goddamn dress. We're about 80% of the people working in the in the facility and now you've seen that shrink and keep shrinking that the professional level has group mean they have people who they hire and and it's wonderful if we can continue. It has mastered a master's degree that teach music in the activity Department. Whereas it used to be people who worked in the home nursing assistants who represent out and particular professional ago that department they would do the Bingo they would do the different events that they have. So we saw a large increase in that. Relation, which is the most expensive group of people that are servicing the nursing home. Okay, so you'd would rather have a good health insurance program for the for the workers. Then more people in offices filling out paperwork at the correct. Okay. Thanks for the call Gail Quinn volt. What about that is she right is it has the management increased in part because of some of these regulatory issues. (00:39:58) Well, let me come back to that. I want to take the first part of her question first because I don't want to lose her point about health care insurance. Okay, because we do identify that as one of the key issues in retaining our employees as I mentioned earlier many of them single moms who don't have a spouse on whom they can rely for health care insurance. We've had increases in our healthcare insurance costs as a provider community in the 25% per year range and although That's Not Unusual if there were Other people sitting around the table, they could tell you they've experienced similar kinds of increases in their businesses. What's unusual for us in the nursing home setting is that our our Revenue? Our rates are a hundred percent controlled by the government. So we can't raise our rates to cover those costs. We can't raise tuition. We can't do a tax levy we don't have anywhere to go except to trim costs. And if we are facing Cuts in this deficit situation, the state finds themselves in unfortunately, you do everything you can to protect the care areas and things like benefits are unfortunately where we very often have to go to trim and it is a it's a downward spiral because those are the very things that keep your good employees with you. So I would very much agree with the caller on that point to her sense of the offices of of administration increasing I would say that the largest class of him. Lawyers in a nursing home still are Far and Away the nursing providers. And and in that class. The biggest class would be nursing assistants. I think that it is true that regulation has driven some different Staffing patterns over the last two to three decades. For example, it's not unusual for a facility to employ someone full-time who just does billing for Medicare not even looking at what's done for other payment programs, but just for that single program and I think when representative Bradley speaks to regulatory reform opportunities, that's the kind of opportunity. We're hoping to cease in this context (00:42:08) and representative Bradley. Why does the government control every what everybody pays and and why couldn't the nursing home charge people who are paying themselves a little more and people who, you know, get the Medicare a little less or what problems. Would that cause (00:42:26) Well, I actually support that Minnesota is one of two states only in the nation that have a law called Equalization and what that says is that the nursing homes are not allowed to charge more for their medical assistance patients than they do for their private pay patients. I think it is time to repeal that it mean the problem of course is if you do repeal that just how much cost shifting were there be I mean, I don't think we want to have a huge amount but but I think it would open up some better options. So I'm in favor actually of getting rid of (00:42:59) that. Okay, let's hear from another caller. Carla is on the line from Ely Carla. Go ahead, please. My mom was diagnosed with Alzheimer's and she went into the nursing home about three years ago. And my question has to do with hospice care versus nursing home. I know that she's terminally ill but I also know that I can't get her into Hospice Care unless she has six months left of her life and I would like to be able to take her home and I can't do that. I work for small nonprofit. I can't afford her bills and I'm just wondering what is the cost difference on that as far as like through the state or or Med medical assistance programs or and I'll take my comments off the air. Thank you. Okay. (00:43:45) Let me try. I to be honest. I don't know what the cost differences are. Really. I think there's a we sort of struggle with as I remember some language struggle. We had on this business of requiring six month for that matter. How does anybody know when you're really actually six months from dying but I don't know what the cost differences are intuitively. One would think that if what you are is you've read that a state where you're just providing a person a dignified substitutions kind of a thing and you're not doing intense acute care that it would cost less but we have classifications and cares and in nursing homes to I mean, so I would think that if it's less cost you could be in a different class of service to I think what the caller may be referring to is a hospice benefit under Medicare essentially referred to the six month eligibility requirement. And that's a federal rate a federal program and a Federal Regulation and she is correct that generally you need a physician to indicate that the person to receive the services has a life expectation of six months or less. And of course that nothing is certain but I do understand that of late Medicare has been a bit more flexible than they were in the past about that six-month prognosis and it is a very good program what it Is it provides some one-on-one time that perhaps you wouldn't have outside of that hospice program and it also brings into the setting individuals who are very trained in working not just with individuals who are at the end of their life, but with the families of those individuals as well and it it's a very good program. (00:45:31) Okay. Well, let's go back to the telephone lines. I'm Alyssa is calling from Golden Valley. Yes. I wanted to go back to the issue of Estate Planning and medical assistance look back. I work. I'm a social worker in a nursing home. And currently we see more admits that are crisis driven and families and residents and spouses never anticipated or expected that their loved one would have a major Health crisis that would indicate that they need long-term care and not Meet the criteria for other forms of care, and it throws families into a huge tizzy. Not only the cost of long-term care now, but also going into, you know, looking back and trying to hide or transfer funds. It's really difficult once they're in the nursing home and Medicare will only pay provided that the resident needs criteria up to 100 days and most people don't even get that. It's a very difficult thing and also for Carla for hospice. She may want to check with the nursing home staff because different hospices under Medicare have some different guidelines now, and it's not usually the six months to live there have to be sets of other standards to that may make someone qualify for the hospice benefit under Medicare and I can take comments off the air. Thank you. Okay. Thank you. I guess this Melissa has raised a pretty fundamental issue here. How do you get people to think about this in advance? If the state is going to move more toward long-term care insurance representative Bradley. How do you get people to actually realize that you know, that's something they should be looking into. (00:47:24) Well. I wish I had I mean, I think I indicated before that we have tried as a matter of fact, we put two hundred thousand dollars in the last biennium into the promotion just just information promotion of long-term care insurance. So we are trying to make this more obvious to people, you know, this is tragic when it hits somebody like that. But of course, there are all kinds of other catastrophes that can happen to a family and it just re-emphasize again the need for families to be thinking longer term. I mean lots of times people get into this one. There's a death and there hasn't been a will. I mean we can keep reminding ourselves and I think to some extent those of us in public service have the Possibility hopefully our media also shares in it, but the whole business of planning our lives around the possibilities of cat catastrophes so that we are prepared is very important, but I don't know how we get a hundred percent of people in some cases. Maybe we're just going to have these kinds of things. I know my parents who are getting old sort of came to me and said we have to do something and I said dad mom, you know, what what you've earned what you have is yours and if you end up having something that happens and you go into a nursing home and it takes all the assets. So what are your assets? I don't own them and I hope most children feel that way. I think there's a huge role for public education here as representative. Bradley was talking about most of us don't like to think about getting older and we particularly don't like to think about the possibility that we could be older and fragile and in need of care, but one of the great myths about Medicare which the caller pointed out is that Many people believe that that's a long-term care program and it is not it is at best a program that at its best is a program that provides some benefit after you have been hospitalized for an acute incident but it's not a long-term care program. (00:49:19) All right, let's take another caller Jeff on the line from Egan Jeff. Go ahead. Hi, you know the kind of triggered me there when you said talking about hiding assets. My father-in-law is a 65 years old now and he is a taking every measure he can there's like these living trust living wills or different programs out there to help hide his assets and he's been determined to hide his assets here for the last like year how he's coming on somebody's working pretty hard at it. But the argument I would have is Is it he feels that he's worked all his life and saved and not squandered money. So when he goes to retire, he has some assets left hand down to his children were the next person may have never worked their whole life or squander their money and they wind up broke and they have to pay for their he has to pay for his long-term care and then Medicare picks up there. So as a young 40 help me, how do you encourage me to save for my long-term care when I know if I don't they're just going to be paid for anyhow. Well, that sounds like the key question. (00:50:21) Well, it's the combination we talked about before in one part. Of course, we'll make it as difficult as possible. Because in the end what we're talking about is we're not talking about an insurance policy paying for it. We're talking about the taxpayers paying for the choices to hide the assets, but the other which I think is a much more a much better approach to it would be to provide positive incentives. So that that in a case of this caller is father that just like that. He probably carries life insurance. I bet I'll bet he does. I'll bitty Insurance his home the things that sort of as it's sort of an interesting social cultural phenomenon that for some reason we've treated long-term care differently than we do most other life liabilities. And as we've said I think before a lot of this has to do with sort of public awareness education experience those kinds of things, but I just hope that we're sort of turning that around and that the culture will change, you know part of the answer there to lies in stepping back at the age of 40 and and Think about how you want to live when you're an older person and the degree to which you have choices in living options and service options May in fact depend upon the degree to which you're saving for those options today. You may not be very happy with the alternative that can be paid through public programs. And I think we all owe it to ourselves to think about how we'd like our parents to live what choices we want them to be able to have and ourselves as we grow older (00:51:48) and I suppose the other the other side of it is you if you look at it the way the caller did you're also kind of taking it out of the hides of the poor folks who are working in the nursing homes with the inadequate health insurance and low wages and tough working conditions. (00:52:03) Well in this environment that's you know, that's certainly true if if we had budget cuts. Let's say that the the nursing home expenditures were cut by five percent that would be in a typical facility six employees who would have to be laid off. And I think the message that has come through so far as we don't have six people to spare in terms of the care that we provide. Oh and I think your point if I'm understanding would be just that two-thirds figure that I said before who are medical assistance if that was reduced to 50% and we held the same amount of investment or maybe even slightly less. We'd have more leverage. I mean, it's that that would the arithmetic of that works wonderfully. (00:52:42) Okay. Let's take another caller here Sue on the line from st. Paul Sue. Go ahead. I'm sorry. Hello. Yeah. Yeah. I was I've got two parents that are ones in a nursing home in ones in assisted living and they've been paying their own way. And I think one thing that hasn't been talked about today is, you know, talking about long-term health insurance or care long-term care, but the cost of actually purchasing long-term care is an people if you know with people being older the causes is pretty exorbitant and a lot of people can't afford it. Okay, I'm going to have to cut you off suit because we're running really short on time. But the cost of long-term Health Care insurance premiums pretty steep for a lot of (00:53:28) people will depends on when you buy it. The key is not to wait until you're 70 or 80 to look at long-term care insurance. The key is to look at it when you are in fact 30 or 40 and part of why we're interested in looking at an expansion of the state-run long-term care insurance program is the more people you get into long-term care insurance the more you can spread the risks across a broader population and those premiums come down. Yeah, and I think the caller might have been referring to the shock at most people have when they go into Long-Term Care Nursing Home facilities and $129 you said and how quickly of course that can drain any assets and it's all the more reason to be thinking in terms of how should you protect it insurance or otherwise, but but I know for many people even who had decent savings if you're spending $50,000 a year doesn't take long to drain those (00:54:21) right represented Bradley. We're down to less than a minute here. We're going to see major Cuts in this area this session. (00:54:29) No, I don't believe we're going to see major Cuts. I mean, this is such an important area. We just can't harm the people in nursing homes or receiving now that doesn't mean that we're not going to have some challenges and that we're not going to be squeezing efficiency. Absolutely. No area I think is going to go completely untouched but we're not going to see major Cuts. (00:54:46) All right. I want to thank you for being here today. That's a Republican representative friend Bradley of Rochester the chair of the Health and Human Services finance committee in the Minnesota house. We were also joined by Gail Quinn volt president and CEO of the Minnesota Health and housing Alliance a non-profit Statewide trade Association that represents nursing homes senior housing facilities and Community Based Services. Thanks as well to everyone who called with questions and comments a very interesting hour to talk about some big issues in people's lives. Programming is supported by Augsburg weekend college for over 20 years a school dedicated to helping thousands of working adults achieve their personal and professional dreams information online at Augsburg dot EDU. (00:55:34) When world events touch your life, you can count on Minnesota Public Radio to bring you (00:55:38) insightful and accurate (00:55:39) information. I'm Steve inskeep National Public Radio correspondent. Don't take this valuable community resource for granted Minnesota Public Radio depends on listeners to keep this Independent News service going. Essentially you own it. Just click and join at Minnesota Public Radio dot org, or call one eight hundred two to seven 28:11. (00:56:02) And you're listening to 91.1 knnow Minneapolis. St. Paul. It's sunny and 21 degrees right now in the Twin Cities for the rest of the day expect partly sunny skies with highs in the lower 20s tonight partly cloudy alone near 10 above zero tomorrow. It'll be cloudy with a 40% chance of some snow the highs tomorrow should be in the mid-20s and again right now. We're probably about as warm as we're going to get today sunny 21 degrees above zero. And midday will continue after the news were going to go to the Westminster Presbyterian Church for a Westminster Town Hall Forum today featuring William George. He's the former CEO of the Medtronic Corporation. He'll be talking about business ethics.