MECARE: Maine’s Pre-admission Screening Program

Background

· The Medical Eligibility Determination tool, MED, was introduced in 1994 in response to legislation aimed at reducing reliance on institutional care.

· Maine is recognized nationally as one of only three states to use both a uniform assessment instrument and a single, independent agency for performing assessments. The other states are Colorado and Arizona.

· MECARE is the name of the system that includes the electronic version of the MED. The MED allows Maine to collect and analyze information about who requests long-term care services and the kinds of assistance they require. The Department uses this information for quality improvement, consumer education, and to compare consumers across long-term care settings.

Who is Assessed?

Individuals seeking long-term care services in their home, or who plan to enter a nursing facility, receive an assessment.
Individuals, or families, may request an Advisory Assessment if they want information about available resources.
Last year 25,047 assessments were provided to 16,359 persons. Individuals may receive more than one assessment due to change in their condition.

How does MECARE work?

When someone calls to request an assessment the intake staff ask the caller for information the nurse will need to schedule the visit. For example, are there family members or a guardian who the person may want to be present? MECARE automatically shows if the person has had a prior assessment, or is receiving MaineCare (formerly Medicaid).

· A nurse meets with the person to determine medical eligibility for a variety of home care as well as nursing facility services.

Family members often participate in the assessment.

· Most questions include specific definitions and timeframes to provide consistent and objective evaluations of needs statewide.

· Eligibility is determined by reviewing the individual’s functional ability and need for support with activities of daily living.

· At the end of the assessment, the nurse gives the person a care plan that outlines available services.

What does MECARE cost?

· There is no charge to the individual for the assessment.

· Maine spent $331,577,063 on long-term care services last fiscal year. The cost for assessments was $3,706,956, or one percent of total spending.




4	16,359 persons received 25,047 assessments during the time period July 2000-June 2001.

4	69% of those assessed are women.

4	17% of those assessed are under 65 years of age.

What Is the Income of Persons Receiving Assessments?

Ø Among those age 65 and older, 40% have incomes below the Federal Poverty Level (FPL).

Ø For the younger age group, 66% are below the Federal Poverty Level.

Ø The Federal Poverty Level for an individual in 2001 was $716.00 per month.

	What Are the Primary Health Conditions of Persons Receiving Assessments?

	Top 10 Reported Health Conditions				Top 10 Reported Health Conditions
	for Individuals Age 65 and Older				for Individuals Under Age 65

		*# of*	%			*# of*	%
	*Health Condition*	*Individuals*	*Individuals*		*Health Condition*	*Individuals*	*Individuals*
1	Hypertension	7,221	53.6%	1	Depression	957	33.1%
2	Arthritis	5,866	43.6%	2	Allergies	927	32.1%
3	Alzheimer's & Other Dementia	5,437	40.4%	3	Hypertension	882	30.5%
4	Allergies	4,311	32.0%	4	Diabetes Mellitus	769	26.6%
5	Depression	4,216	31.3%	5	Arthritis	747	25.8%
6	Other Cardiovascular Disease	3,574	26.5%	6	Emphysema/COPD	478	16.5%
7	Diabetes Mellitus	3,544	26.3%	7	Anxiety Disorder	453	15.7%
8	Congestive Heart Failure	3,389	25.2%	8	Seizure Disorder	423	14.6%
9	Cardiac Dysrhythmia	3,066	22.8%	9	Other Cardiovascular Disease	420	14.5%
10	Arteriosclerotic Heart Disease	2,906	21.6%	10	Cerebrovascular accident	373	12.9%

	Top 10 Reported Health Conditions - Women				Top 10 Reported Health Conditions - Men

		*# of*	%			*# of*	%
	*Health Condition*	*Individuals*	*Individuals*		*Health Condition*	*Individuals*	*Individuals*
1	Hypertension	5,842	51.7%	1	Hypertension	2,261	44.8%
2	Arthritis	5,124	45.3%	2	Alzheimer's & Other Dementia	1,597	31.6%
3	Allergies	4,006	35.4%	3	Arthritis	1,489	29.5%
4	Alzheimer's & Other Dementia	3,987	35.3%	4	Depression	1,424	28.2%
5	Depression	3,749	33.2%	5	Diabetes mellitus	1,394	27.6%
6	Diabetes Mellitus	2,919	25.8%	6	Emphysema/COPD	1,269	25.1%
7	Other Cardiovascular Disease	2,726	24.1%	7	Other Cardiovascular Disease	1,268	25.1%
8	Osteoporosis	2,722	24.1%	8	Allergies	1,232	24.4%
9	Congestive Heart Failure	2,624	23.2%	9	Cerebrovascular accident	1,198	23.7%
10	Cardiac Dysrhythmia	2,223	19.7%	10	Cardiac Dysrhythmia	1,068	21.1%

							State Fiscal Year 2001

Ø The amount of help required to do daily tasks is a key factor driving the need for long-term care services.

Ø People who do not require assistance are represented by the white portion at the top of each column.
For example, 14% of persons assessed are independent in dressing.

Ø The dark sections of the bars indicate persons who are totally dependent on others in performing the activity. For example, 8% of those assessed are totally dependent on others for eating.

Ø The total is more than 100% because consumers may have more than one type of advance directive.

Ø Consumers are encouraged to have an advance directive so that they receive medical care consistent with their wishes.

Ø Medication and feeding restrictions, organ donation and autopsy request are chosen by less than 2% of those assessed.

§ Some individuals report having to make choices in essential purchases due to limited funds.

Ø 6,938 persons living in the community report receiving care from family or friends.

Ø Many also receive paid care in addition to care provided by family and friends.

Ø SPECIAL NOTE: The combined total adds up to more than 100% because some persons receive care from more than one person.

Level 1:
Must need at least limited assistance with 1 Activity of Daily Living (ADL).
Average Monthly Careplan Cost = $568.00

Level 2:
Must have a nursing need at least once a month and need limited assistance with 2 ADLs.
Average Monthly Careplan Cost = $693.00

Level 3:
Needs at least limited assistance with 2 ADLs and assistance with at least 3 Instrumental Activities of Daily Living (IADLs).

Average Monthly Careplan Cost = $1105.00

Level 4:
Meets nursing facility level of care.
Average Monthly Careplan Cost = $1754.00

Ø The total is more than 100% because consumers may live with more than one family member or friend. For example, the consumer may live with their spouse and children.

Ø Of the 9,987 persons found nursing facility eligible, 20% chose to receive care at home.

Ø 75% of persons are found eligible for nursing home level of care based on the need for extensive assistance with 3 "late loss" activities of daily living (ADLs).

Ø The category 'Other' includes those found eligible based on cognition and behavior problems.

Ø 884 persons qualified for nursing facility care based on cognitive impairments or behavioral problems.

Ø These 884 individuals represent 9% of those found eligible for nursing facility level of care.

Ø For example, 53% of persons choosing nursing facility care have a dementia diagnosis.

Ø Reported incidence of depression is comparable across care settings.

Location at Time of Assessment
Home	8,041	49%
Residential Care Facility	327	2%		Type of Assessment
Nursing Facility	7,554	46%		Initial	12,333	49%
Hospital	420	3%		Reassessment	12,714	51%
Other	17	0%		TOTAL	25,047
TOTAL	16,359	100%


Assessments Resulting in Denial or Reduction in Services
	Total # Assessments	Denials	Reductions
Community Assessments	10,920	17%	8%
Nursing Facility Assessments	10,524	7%	Not Applicable
Advisory Assessments	3,603	4%	Not Applicable
TOTAL	25,047

MeCare

Maine’s Long-term Care

Pre-admission Screening Program

Summary Data

July 2000 – June 2001

Bureau of Elder and Adult Services

MECARE: Maine’s Pre-admission Screening Program

Background