1. Minnesota’s Seniors Public Policy Issues Toby Pearson, Vice President of Advocacy, Care Providers of Minnesota Heidi Holste, Director of Government Affairs, Care Providers of Minnesota Kari Thurlow, Vice President of Advocacy, Aging Services of Minnesota Crisis in Long Term Care

2. WHO WE ARE The Long-Term Care Imperative is a collaboration of Aging Services of Minnesota and Care Providers of Minnesota, two of the state’s largest long-term care associations. The Long-Term Care Imperative is committed to advancing a shared vision and future for older adult housing, health care and supportive services.

3. Supporting the Economy Economic Impact of Long Term Care Facilities for Minnesota Prepared by the Lewin Group for AHCA-NCAL LTC Supports $6.7 billion in Economic Activity

4. Powering the Workforce Economic Impact of Long Term Care Facilities for Minnesota Prepared by the Lewin Group for AHCA-NCAL. LTC Contribute to Approximately 112,600 Jobs

5. The Payment Gap Information and data on Shortfalls in Medicaid funding based on Report Prepared by ELJAY, LLC FOR THE AMERICAN HEALTH CARE ASSOCIATION Projected 2012 Nursing Facility Shortfall Between Medicaid Reimbursement and Allowable Medicaid Costs (Per Patient Day) Minnesota vs. North Dakota The annual cost of eliminating the shortfall to the State would be $78.5 million.

6. Nursing Facility Rebasing Unallottments, Suspensions, and Repeal (State Savings) Source: Long Term Care Imperative 2013

7. % of Nursing Facilities at Risk of Closure (Operating Margins of -5% or Worse) Legend =<15% =15%-25% =25%-35% =>25% East Central 29.4% Metro 8.2% Northeast 45.0% Northwest 21.1% Southeast 32.7% Southwest 23.7% West Central 20.8% Approximately 85 Nursing Facilities in MN are facing a financial crisis, placing more than 12,000 jobs at risk. LTC Imperative 2011 Nursing Facility Financial Survey Prepared by CliftonLarsonAllen LLP

8. The Wage Gap Sources: 2011 LTC Imperative Salary Survey and 2011 MN Health Care Cost Information Service Hospital Salary Data Gap=$2.07 per hour or $4,306 per year Gap=$5.79 per hour or $12,043 per year Gap=$17.39 per hour or $36,171 per year Gap=$15.77 per hour or $32,802 per year Gap=$1.81 per hour or $3,765 per year Gap=$6.13 per hour or $12,750 per year Senior Living Workers Underpaid in the Marketplace

9. The Worker Gap Source: Long Term Care Imperative 2013 Legislative Survey Estimated Number of Selected Vacant FTE Positions in Minnesota’s Nursing Homes

10. The Worker Gap Source: Long Term Care Imperative 2013 Legislative Survey Vacant FTE Positions as a Percent of Budgeted Positions in Minnesota’s Nursing Homes

11. Losing Workers Source: DHS Nursing Home Cost Reports (2011) Employee Retention Percentage Declined in Care Centers

12. Staff Turnover Source: American Health Care Association, LTC Trend Tracker

13. Nursing Home Costs Without the Elderly Waiver Program Decrease due to increased Federal Match Source: DHS Spending Forecast November 2010 Elderly Waiver Program Saved State Up To $275 Million in 2010

14. Rate Changes Assisted Living (Elderly Waiver Customized Living) Nursing Facility Source: LTC Imperative 2012 Nursing Facility and Elderly Waiver/Customized Living No base increase in last four years In 2011, 70 low rate homes received increases of up to 2.45% In 2012, 7 homes were designated “critical access” and received rate increases

15. 2013 Legislative Proposal Employees 3% rate increases for nursing facilities and EW is targeted to cover increases in compensation and other operating costs, including wages, benefits, recruitment and new staff costs. – 1% of these increases is to address workforce needs such as staff training and retention. Quality 2% rate increases for both nursing facilities and EW providers to develop new quality improvement efforts. – Nursing facility increase to focus on Advancing Excellence – EW is targets toward implementing a new quality improvement program. Nursing Facility and Elderly Waiver Rate Increases