Ohio Department of Aging
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Publisher: Scripps Gerontology Center, Miami University
Published Date: April 2007
Executive Summary
As a state with one of the largest aging populations in the country, Ohio faces substantial challenges in its efforts to provide long-term care services for its citizenry. In 2005, 172,000 of Ohio’s 2 million older people had a severe disability, and this number will more than double by 2035. The Medicaid program represents almost a quarter of the entire state budget, and long-term care accounts for 42% of that total. In 2005, Ohio spent $2.8 billion on nursing home care and $950 million on Medicaid in-home services. Expenditures on the PASSPORT program were $310 million. Ohio has been criticized for spending a high proportion of Medicaid funds on institutional long-term care compared to in-home services, receiving a ranking of 47th in 2005.
Nursing homes continued their trend of providing short-term care to a majority of those admitted. In 2005, Ohio recorded 190,000 admissions for the 91,000 beds in service. More than two-thirds of all nursing home admissions are no longer residents after 6 months. Nursing home occupancy rates increased from 84.7% in 2003 to 86.4% in 2005. The number of Medicaid residents age 60 and older declined slightly during this same time period. Nursing home residents are severely disabled, more so than ten years ago. The proportion of residents under age 60 has almost tripled in the past ten years. The occupancy rate in 2005 for the 543 residential care facilities was 77%.
Ohio’s PASSPORT program has grown from 4,200 individuals in 1992 to 26,000 in 2006. PASSPORT participants have high levels of disability and these rates have remained constant over the past decade. The expansion of PASSPORT means that the way older Ohioans use longterm care has changed in the past 12 years. In 1993, 9% of Medicaid long-term care recipients 60 and over received PASSPORT; in 2005 that proportion was 35%. The total rate of older people using Medicaid for long-term care services (33 per 1,000) was unchanged. This happened because as the home care use rate increased, the nursing home use rate under Medicaid for the over 60 population decreased.
Long-term care remains costly. In 2005 the Medicaid per diem was $164, the Medicaid share of Program of All Inclusive Care for the Elderly (PACE) was $93 per day, and the PASSPORT daily rate was $48. Although there are differences in both covered services and the rates of disability across these programs, these costs indicate the importance of making sure that Ohioans receive care in the appropriate setting.
The current costs and projected demographic increases suggest that the state faces serious challenges both today and tomorrow in meeting the long-term care needs of older Ohioans. Current concerns will be multiplied in the future as we more than double the size of the older population with severe disability between now and 2035. It is critical for Ohio to begin the strategic planning process today in order to prepare for the challenges ahead.
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Ohio Department of Aging