1. Presentation to Alaska Tribal Health Directors August 9, 2010 Alaska Native Tribal Health Consortium Statewide Need Long Term Care Facility

2.  100-bed long term facility in Anchorage  Total Cost $43,310,905 - $37.1 M needed ◦ Green House model  10 homes, 10 beds each  Community/administrative building  Culturally-appropriate nursing home units  Target population  Alaska Native elders and people with disabilities residing in the Anchorage bowl who need nursing home level of care  Alaska Native elders and people with disabilities who are temporarily unable to return home because of a skilled nursing need  Alaska Native elders and people with disabilities from regions who don’t have a nursing or assisted living home.

3.  Alaska Natives are 17.9% of the State Population ◦ 26% of Alaska Native population live in Anchorage bowl ◦ 11% of the Anchorage population is Alaska Native  Alaska has the fastest growing elderly population in the country ◦ A 60% increase in the over 65 Alaska Native population is expected between 2010 and 2020  Alaska Native migration from rural areas ◦ 53% move to Anchorage ◦ 23 % move to Fairbanks North Star Borough ◦ 9% move to Mat-Su ◦ 5% move to the Kenai Peninsula Borough ◦ 10% move to other areas of the State

4. Who Needs Residential LTC?  Nursing Home Resident, Alaska Native Female, 65 years old ◦ Medical issues: diabetes, hypertension, right side paralysis from stroke, overweight, incontinent, unable to transfer self from bed to chair ◦ Nursing Needs: regular testing of blood sugar and insulin monitoring, physical therapy to increase function, incontinence program, medication management, monitor weight, nutrition. ◦ Key factors in being able to return home: increased mobility, ability to use toilet independently or with limited assistance, family support.  Assisted Living Resident, Alaska Native Female, 89 years old ◦ Medical Issues : Advanced dementia, Alzheimer’s, otherwise physically healthy. ◦ Assisted Living Needs: All daily living activities, getting dressed, regular toileting program, 24 hour supervision (prone to wandering), monitor food intake. Needs staff trained in behavior management and dementia to deal with abusive verbal behaviors, refusal to bathe, etc.  Nursing Home Resident, Alaska Native Male, 38 years old ◦ Medical Issues: Quadriplegic (post snow machine accident). ◦ Nursing Home Needs: incontinence program, special chair/bed, special feeding devices (pureed food), physical therapy.

5. Who provides nursing home care today? FacilityLicensed BedsReimbursement rate per day Occupancy Rates/ Wait List Status Cordova* 10$787.20 89% Denali Center - Fairbanks 90$551.44 86% Heritage Place – Soldotna 60$390.31 86% Ketchikan 29$704.33 63% Prestige Care – (formerly Mary Conrad Center) 90$354.28 94% / Providence Extended Care - Anchorage 229$358.79 88% / Kodiak* 19$464.07 94% Valdez* 10$658.11 100% Petersburg* 15$533.74 94% Nome* 15$817.65 100% / Sitka Comm Hosp* 15$690.89 100% Homer* 25$657.35 108% Juneau 57$517.63 87% Seward 40$666.79 63% Wrangell* 14$487.88 93% Total 718$453.92 Weighted average nursing home rate per day

6. ServiceTribal Facility 100% FMAP (no state general fund cost) Non-Tribal Facility State pays % based on FMAP Number of Alaska Native Residents for SFY08 Total Medicaid Cost Nursing Home$3,945,812$19,089,348277 Assisted Living$8,450,286254 Total$3,945,812$27,539,634531

7.  ATHS Statewide Long Term Care Facility Plan ◦ Phase I projects  Maniilaq – 18 bed nursing home wing – funded  YKHC – 18 bed nursing or assisted living home - funded  ANTHC – 100 bed nursing home in Anchorage to address statewide needs of ATHS – planning funds received ◦ Phase II projects – (preliminary)  Prince of Wales Island – assisted living home  Tok subregion  Aleutian region

8.  Nursing home beds 314 ◦ Providence plans to reduce by 90 beds in 2012  Assisted Living beds - 990 ◦ State Pioneer Home – 165 (few Alaska Native residents) ◦ Providence Horizon House - 82 (few Alaska Native residents) ◦ Marlow Manor - 112 (few Alaska Native residents) ◦ Private assisted living homes – 796 * * Most Alaska Native residents are in small homes that accommodate up to 5 people * At one point in time there were 150 Alaska Native residents in 66 different small assisted living homes in Anchorage (ANTHC 2005 report)

9.  Secure Funding for Statewide LTC Facility ◦ $37.1 million next year’s state capital budget  Build a coalition of support ◦ Challenges  Governor typically focuses on state building needs  Bush legislators focus on district needs  Anchorage-based legislators brush aside Native requests ◦ Opportunities  2010 elections – educate those looking for votes  Increased awareness of needs of seniors/elders among public  Dramatic increase in Medicaid costs to the state  Tribes can save the state money over the long term by investing in tribal facilities in the short term.

10. Why is this important?  LTC is a tribal health system priority  LTC is a state priority  Alaska Native elders and persons with disabilities deserve LTC services that respect their cultural needs and traditional values  Alaska Native elders and people with disabilities are currently residing in settings that are far from home, offer unfamiliar environments and foods, don’t speak their language and may not speak English well, making communication and quality care very difficult.