Methodology... 6 Nursing Homes... 6 Assisted Living Facilities... 7 Home Health Care... 8

Transcription

1 Cost of Care Survey NOTICE: Readers of this document, including any and all attachments, are hereby notified that any distribution or copying of this document without written consent is strictly prohibited.

2 Table of Contents Executive Summary... 3 Background... 4 Overview: Nursing Home Facilities... 4 Overview: Assisted Living Facilities... 4 Overview: Home Health Aides & Organizations... 4 Methodology... 6 Nursing Homes... 6 Assisted Living Facilities... 7 Home Health Care... 8 Results and Key Findings... 9 Nursing Home Data Private s s Assisted Living Facility Data Private s s Home Health Care Data Page 2 of 24

3 Executive Summary Univita completed the 2012 Cost of Care study by surveying the cost of care from Nursing Homes, Assisted Living Facilities and Home Health Care providers across specific regions through the United States. Univita surveyors made outbound calls to 101 major markets to obtain data for this study. Private pay rates have been obtained for private, single occupancy and semi-private, dual occupancy rooms in Medicare-certified nursing homes and assisted living facilities. Hourly rates for home health aides have been obtained for Medicare-certified home health care agencies offering private pay or self-pay options. Univita surveyors contact more than 1,000 Nursing Homes, Assisted Living Facilities and Home Health Care Agencies to complete over 3,500 surveys between August 2011 and November 2011 as well as February The regions surveyed correspond geographically with the Metropolitan Statistical Areas as defined by the U.S. Census Bureau. Page 3 of 24

4 Background Overview: Nursing Home Facilities The Nursing Home industry is comprised of establishments primarily engaged in providing inpatient nursing and rehabilitative services. The care is generally provided for an extended period of time to individuals requiring nursing care. These establishments have a permanent core staff of registered or licensed practical nurses that, along with other staff, provide nursing and ongoing personal care services. According to the North American Industry Classification System (NAICS), Skilled Nursing Care Facilities (SIC 8051) are establishments primarily engaged in providing inpatient nursing and rehabilitative services to patients who require ongoing healthcare, but not hospital services. This does not include continuing care retirement communities or psychiatric hospitals. Care must be ordered by and remain under the direction of a physician. The staff must include a licensed nurse on duty continuously with a minimum of one full-time registered nurse on duty during each day shift. Included are establishments certified to deliver skilled nursing care under the Medicare and Medicaid programs. Overview: Assisted Living Facilities Assisted Living Facilities provide supervision or assistance with activities of daily living (ADLs), coordination of services by outside health care providers and monitoring of resident activities to ensure their health, safety, and well-being. Assistance may include the administration of medication or personal care services provided by trained staff members. Assisted Living provides for those cases where independent living is no longer appropriate but the person does not need the 24-hour medical care provided by a nursing home. Overview: Home Health Aides & Organizations Home Health Aides provide routine, personal healthcare to elderly, convalescent, or disabled persons in home or residential care settings. Home Health Aides assist elderly or disabled persons with activities of daily living, including bathing, dressing, grooming, eating, transferring, toileting and other services to persons who would otherwise require a nursing home level of care. Duties performed at a place of residence may include housekeeping (making beds, doing laundry, washing dishes) and preparing meals. Home Health Aides may provide meals and supervised activities at non-residential care facilities. They also may advise families, the elderly and disabled on such things as nutrition, cleanliness and household utilities. Providing these services in person's home or in a daytime, non-residential facility allows people the option to remain at home, or reside in a community near family, friends, and things they enjoy while fostering independence and enhancing quality of care. Page 4 of 24

5 Home care organizations include home healthcare agencies, home care aide organizations, and hospice facilities. Some of these organizations are Medicare certified, which allows providers to bill Medicare for reimbursement. Agencies that are not Medicare certified cannot be reimbursed through Medicare. Types of Agencies who may provide Home Health Aide services include the following: Visiting Nurse Associations (VNA): Freestanding, voluntary, nonprofit organizations governed by a board of directors and usually financed by tax-deductible contributions as well as by earnings Combination Agencies: Combined with both government and voluntary agencies, combination agencies are sometimes included with counts for Visiting Nurse Associations Public Agencies: Government agencies operated by a state, county, city or other unit of local government having a major responsibility for preventing disease and for community health education Proprietary Agencies: Freestanding, for-profit home care agencies Private Not-For-Profit Agencies: Freestanding and privately developed, governed and owned nonprofit home care agencies Other Freestanding Agencies: Freestanding agencies that do not fit one of the categories for freestanding agencies listed above Hospital-Based Agencies: Operating units or departments within a hospital, agencies which have working arrangements with a hospital, or are owned by a hospital but operate as separate entities, are classified as freestanding agencies under one of the categories listed above Rehabilitation Agencies: Agencies based in rehabilitation facilities Skilled Nursing Facilities (SNF): Agencies based in skilled nursing facilities Page 5 of 24

6 Methodology Nursing Homes Definitions: Nursing Homes Nursing home facilities generally offer accommodations of either private rooms, or rooms shared between two or more residents. Private rooms may have a private bathroom or a bathroom shared between two adjoining rooms. Some facilities charge more for a private room with a private bathroom versus a private room with a shared bathroom. The daily room charge usually includes services beyond the daily bed charge (rent), such as three meals a day, laundry services, basic nurse supervision, and generic-brand, over the counter (OTC) or non-prescription pharmaceuticals. Nursing facilities are responsible for providing OTC pharmaceutical services when they are specified in the resident s plan of care. For the purpose of this study, the following facilities defined by the NAICS were deemed qualified for inclusion in the sample population: 2007 NAICS Corresponding Index Entries Nursing Care Facilities Nursing Homes Skilled Nursing Facilities Sampling Procedures: Nursing Homes The sample population was derived from a list of over 7,500 Medicare-certified Nursing Homes. Across all of the 101 defined regions, surveyors polled at least 10% of all certified Nursing Homes. A minimum of ten providers completed surveys for all regions, unless impractical. In many regions, the sample size was substantially larger. More than 1,000 total providers contributed data to this study. Data collected includes the daily rate for a private room (single occupant) and semi-private room in Medicare-certified nursing facilities. Data Collection: Nursing Homes Daily private pay room rate for private (single occupant) nursing home room Daily private pay room rate for semi-private nursing home room Results presented include average, maximum and minimum values within each region and in total Page 6 of 24

7 Assisted Living Facilities Definitions: Assisted Living Facilities People who live in newer assisted living facilities usually have their own private apartment. Trained staff members are usually on-site around the clock to provide needed services. Household chores are performed: sheets are changed, laundry is done, and food is cooked and served. Where provided, private apartments generally are self-contained; i.e., they have their own bedroom and bathroom, and may have a separate living area or small kitchen. Registered Nurses and License Practical Nurses are available by phone or 24 hours per day, to ensure proper teaching and/or education of staff available. Alternatively, individual living spaces may resemble a dormitory or hotel room consisting of a private or semi-private sleeping area and a shared bathroom. There are usually common areas for socializing, as well as a central kitchen and dining room for preparing and eating meals. For the purpose of this study, the following facilities defined by the NAICS were deemed qualified for inclusion in the sample population: 2007 NAICS Corresponding Index Entries Assisted-living facilities without on-site nursing care facilities Homes for the aged without nursing care Homes for the elderly without nursing care Sampling Procedure: Assisted Living Facilities The sample population was derived from a list of over 7,500 state-certified assisted living facilities. Across all of the 101 defined regions, surveyors polled at least 10% of all assisted living facilities. A minimum of ten providers completed surveys for all regions, unless impractical. In many regions, the sample size was substantially larger. More than 1,000 total providers contributed data to this study. Data collected includes the daily rate for a private room (single occupant) and semi-private room in state-certified assisted living facilities. Data Collection: Assisted Living Facilities private pay rate for one bedroom unit private pay rate for a semi-private room Results presented will include average, maximum and minimum values within each Region and in total Page 7 of 24

8 Home Health Care Definitions: Home Health Care Home Healthcare Aide refers to the Bureau of Labor Statistics Standard Occupational Code (SOC): Home Healthcare Aides provide routine, personal healthcare, such as bathing, dressing or grooming to elderly, convalescent, or disabled persons in the home of patients or in a residential care facility. For the purpose of this study, establishments primarily engaged in either providing skilled nursing or medical care in the home under supervision of a medical doctor qualified for inclusion in the sample population. The following are defined by NAICS to meet those qualifications: 2007 NAICS Corresponding Index Entries Home Care of Elderly, Medical Home Health Agencies Home Healthcare Agencies Home Nursing Services (except private practices) Nurse Associations, Visiting Nursing Agencies, primarily providing home nursing services Visiting Nurse Associations Sampling Procedure: Home Health Care The sample population is a list comprised of over 5,600 Medicare-certified home care agencies. Across 101 individual regions, surveyors polled a minimum of 10% of home care providers across state licensed Medicare-certified and state licensed non Medicare-certified provider types to determine the hourly private pay rates charged for the services of a Home Health Aide as defined by the U.S. Bureau of Labor. A minimum of ten providers completed surveys for all regions, unless impractical. In many regions, the sample size was substantially larger. Surveyors completed over 1,000 surveys to obtain Home Health Care data. All rates referred to throughout this document are weekday (Monday Friday) rates. Surveyors found that agencies often have a higher weekend hourly rate, with a differential premium of $2.00 to $10.00 per hour more than weekday (Monday-Friday) rates. Data Collection: Home Health Care Data collected includes hourly private pay rate for a Home Health Aide (certified provider). Results presented include average, maximum and minimum values within each region and in total. Page 8 of 24

9 Results and Key Findings The National average annual cost of a private room in a Medicare-certified nursing home for all regions surveyed in this study is $92,345 per year. This represents an increase of $12,410 from the 2009 average rate. The National average annual cost of a private room in a state-certified Assisted Living Facility for regions surveyed in this study is $39,396. The average daily rate for a single occupancy, private room in a Medicare-certified Nursing Home is $253. This is an increase of 15.5% from the 2009 average rate of $219. The average daily rate for a semi-private room in a Medicare-certified Nursing Home is $226. The average monthly rate for a single occupancy, private room in a state-certified Assisted Living Facility is $3,283. The average monthly rate for a semi-private room in a state-certified Assisted Living Facility is $2,448. The national average hourly rate for Home Health Aides provided by a certified Home Healthcare Agency is $20.59 per hour. This is a decrease of 2.0% from the 2009 average rate of $21. Page 9 of 24

10 Nursing Home Data Private s Private Daily Private Daily Private Daily Albany-Schenectady-Troy, NY $ $ $ Albuquerque, NM $ $ $ Anchorage, AK $ $ $ Atlanta-Sandy Springs-Marietta, GA $ $ $ Austin-Round Rock, TX $ $ $ Baltimore-Towson, MD $ $ $ Baton Rouge, LA $ $ $ Bethesda, MD $ $ $ Billings, MT $ $ $ Birmingham-Hoover, AL $ $ $ Boise City-Nampa, ID $ $ $ Boston-Cambridge-Quincy, MA-NH $ $ $ Bridgeport-Stamford-Norwalk, CT $ $ $ Buffalo-Cheektowaga-Tonawanda $ $ $ Burlington-South Burlington, VT $ $ $ Casper, WY $ $ $ Cedar Rapids, IA $ $ $ Charleston, WV $ $ $ Charleston-North Charleston, SC $ $ $ Charlotte-Gastonia-Concord, NC-SC $ $ $ Chicago-Naperville-Joliet, IL-IN-WI $ $ $ Cincinnati-Middletown, OH-KY-IN $ $ $ Cleveland-Akron-Elyria-Mentor, OH $ $ $ Columbus, OH $ $ $ Corpus Christi, TX $ $ $ Dallas-Fort Worth-Arlington, TX $ $ $ Denver-Aurora, CO $ $ $ Des Moines, IA $ $ $ Detroit-Warren-Livonia, MI $ $ $ El Paso, TX $ $ $ Fargo, ND-MN $ $ $ Fresno, CA $ $ $ Greenville, SC $ $ $ Page 10 of 24

11 Private Daily Private Daily Private Daily Harrisburg-Carlisle, PA $ $ $ Hartford-West Hartford-East Hartford, CT $ $ $ Honolulu, HI $ $ $ Houston-Baytown-Sugar Land, TX $ $ $ Huntsville, AL $ $ $ Indianapolis, IN $ $ $ Jackson, MS $ $ $ Jacksonville, FL $ $ $ Kansas City, MO-KS $ $ $ Kennewick-Richland-Pasco, WA $ $ $ Knoxville, TN $ $ $ Lafayette, LA $ $ $ Lansing-East Lansing $ $ $ Las Vegas-Paradise, NV $ $ $ Little Rock-North Little Rock, AR $ $50.00 $ Los Angeles-Long Beach-Santa Ana, CA $ $ $ Louisville, KY-IN $ $ $ Macon, GA $ $ $ Madison, WI $ $ $ Manchester-Nashua, NH $ $ $ Memphis, TN-MS-AR $ $ $ Miami-Fort Lauderdale-Miami Beach, FL $ $ $ Midland, TX $ $ $ Milwaukee-Waukesha-West Allis, WI $ $ $ Minneapolis-St. Paul-Bloomington, MN-WI $ $ $ Mobile, AL $ $ $ Montgomery, AL $ $ $ Nashville-Davidson--Murfreesboro, TN $ $ $ New Orleans-Metairie-Kenner, LA $ $ $ New York-Newark-Edison, NY-NJ-PA $ $ $ Oklahoma City, OK $ $ $ Omaha-Council Bluffs, NE-IA $ $ $ Orlando, FL $ $ $ Oxnard-Thousand Oaks-Ventura, CA $ $ $ Page 11 of 24

12 Private Daily Private Daily Private Daily Philadelphia-Camden-Wilmington, PA-NJ-DE-MD $ $ $ Phoenix-Mesa-Scottsdale, AZ $ $ $ Pittsburgh, PA $ $ $ Portland-South Portland, ME $ $ $ Portland-Vancouver-Beaverton, OR-WA $ $ $ Poughkeepsie-Newburgh-Middletown, NY $ $ $ Providence, RI $ $ $ Raleigh-Cary, NC $ $ $ Reno-Sparks, NV $ $ $ Richmond, VA $ $ $ Riverside-San Bernardino-Ontario, CA $ $ $ Roanoke, VA $ $ $ Rochester, NY $ $ $ Sacramento-Arden-Arcade-Roseville, CA $ $ $ Salt Lake City, UT $ $ $ San Antonio, TX $ $ $ San Diego-Carlsbad-San Marcos, CA $ $ $ San Francisco-Oakland-Fremont, CA $ $ $ San Jose-Sunnyvale-Santa Clara, CA $ $ $ Savannah, GA $ $ $ Scranton-Wilkes-Barre, PA $ $ $ Seattle-Tacoma-Bellevue, WA $ $ $ Shreveport-Bossier City, LA $ $51.00 $ Sioux Falls, SD $ $ $ Spokane, WA $ $ $ St. Louis, MO-IL $ $ $ Stockton, CA $ $ $ Tampa-St. Petersburg-Clearwater, FL $ $ $ Toledo, OH $ $ $ Tucson, AZ $ $ $ Tulsa, OK $ $ $ Virginia Beach-Norfolk-Newport News $ $ $ Washington-Arlington-Alexandria, DC-VA-MD-WV $ $ $ Wichita, KS $ $ $ NATIONAL AVERAGES $ $ $ Page 12 of 24

13 s Daily Room Daily Room Daily Room Albany-Schenectady-Troy, NY $ $ $ Albuquerque, NM $ $ $ Anchorage, AK $ $ $ Atlanta-Sandy Springs-Marietta, GA $ $ $ Austin-Round Rock, TX $ $ $ Baltimore-Towson, MD $ $ $ Baton Rouge, LA $ $ $ Bethesda, MD $ $ $ Billings, MT $ $ $ Birmingham-Hoover, AL $ $ $ Boise City-Nampa, ID $ $ $ Boston-Cambridge-Quincy, MA-NH $ $ $ Bridgeport-Stamford-Norwalk, CT $ $ $ Buffalo-Cheektowaga-Tonawanda $ $ $ Burlington-South Burlington, VT $ $ $ Casper, WY $ $ $ Cedar Rapids, IA $ $ $ Charleston, WV $ $ $ Charleston-North Charleston, SC $ $ $ Charlotte-Gastonia-Concord, NC-SC $ $ $ Chicago-Naperville-Joliet, IL-IN-WI $ $ $ Cincinnati-Middletown, OH-KY-IN $ $ $ Cleveland-Akron-Elyria-Mentor, OH $ $ $ Columbus, OH $ $ $ Corpus Christi, TX $ $ $ Dallas-Fort Worth-Arlington, TX $ $ $ Denver-Aurora, CO $ $ $ Des Moines, IA $ $ $ Detroit-Warren-Livonia, MI $ $ $ El Paso, TX $ $ $ Fargo, ND-MN $ $ $ Fresno, CA $ $ $ Greenville, SC $ $ $ Page 13 of 24

14 Daily Room Daily Room Daily Room Harrisburg-Carlisle, PA $ $ $ Hartford-West Hartford-East Hartford, CT $ $ $ Honolulu, HI $ $ $ Houston-Baytown-Sugar Land, TX $ $50.00 $ Huntsville, AL $ $ $ Indianapolis, IN $ $ $ Jackson, MS $ $ $ Jacksonville, FL $ $ $ Kansas City, MO-KS $ $ $ Kennewick-Richland-Pasco, WA $ $ $ Knoxville, TN $ $ $ Lafayette, LA $ $ $ Lansing-East Lansing $ $ $ Las Vegas-Paradise, NV $ $ $ Little Rock-North Little Rock, AR $ $ $ Los Angeles-Long Beach-Santa Ana, CA $ $ $ Louisville, KY-IN $ $ $ Macon, GA $ $ $ Madison, WI $ $ $ Manchester-Nashua, NH $ $ $ Memphis, TN-MS-AR $ $ $ Miami-Fort Lauderdale-Miami Beach, FL $ $ $ Midland, TX $ $97.00 $ Milwaukee-Waukesha-West Allis, WI $ $ $ Minneapolis-St. Paul-Bloomington, MN-WI $ $ $ Mobile, AL $ $ $ Montgomery, AL $ $ $ Nashville-Davidson--Murfreesboro, TN $ $ $ New Orleans-Metairie-Kenner, LA $ $ $ New York-Newark-Edison, NY-NJ-PA $ $ $ Oklahoma City, OK $ $ $ Omaha-Council Bluffs, NE-IA $ $ $ Orlando, FL $ $ $ Oxnard-Thousand Oaks-Ventura, CA $ $ $ Page 14 of 24

15 Daily Room Daily Room Daily Room Philadelphia-Camden-Wilmington, PA-NJ-DE-MD $ $ $ Phoenix-Mesa-Scottsdale, AZ $ $ $ Pittsburgh, PA $ $ $ Portland-South Portland, ME $ $ $ Portland-Vancouver-Beaverton, OR-WA $ $ $ Poughkeepsie-Newburgh-Middletown, NY $ $ $ Providence, RI $ $ $ Raleigh-Cary, NC $ $ $ Reno-Sparks, NV $ $ $ Richmond, VA $ $ $ Riverside-San Bernardino-Ontario, CA $ $ $ Roanoke, VA $ $ $ Rochester, NY $ $ $ Sacramento-Arden-Arcade-Roseville, CA $ $97.00 $ Salt Lake City, UT $ $ $ San Antonio, TX $ $ $ San Diego-Carlsbad-San Marcos, CA $ $ $ San Francisco-Oakland-Fremont, CA $ $ $ San Jose-Sunnyvale-Santa Clara, CA $ $ $ Savannah, GA $ $ $ Scranton-Wilkes-Barre, PA $ $ $ Seattle-Tacoma-Bellevue, WA $ $ $ Shreveport-Bossier City, LA $ $49.00 $ Sioux Falls, SD $ $ $ Spokane, WA $ $ $ St. Louis, MO-IL $ $ $ Stockton, CA $ $ $ Tampa-St. Petersburg-Clearwater, FL $ $ $ Toledo, OH $ $ $ Tucson, AZ $ $ $ Tulsa, OK $ $ $ Virginia Beach-Norfolk-Newport News $ $ $ Washington-Arlington-Alexandria, DC-VA-MD-WV $ $ $ Wichita, KS $ $ $ NATIONAL AVERAGES $ $ $ Page 15 of 24

16 Assisted Living Facility Data Private s Private Private Private Albany-Schenectady-Troy, NY $2, $1, $4, Albuquerque, NM $3, $1, $5, Anchorage, AK $4, $2, $6, Atlanta-Sandy Springs-Marietta, GA $2, $ $4, Austin-Round Rock, TX $3, $ $5, Baltimore-Towson, MD $5, $4, $7, Baton Rouge, LA $3, $3, $5, Bethesda, MD $4, $4, $4, Billings, MT $3, $2, $7, Birmingham-Hoover, AL $3, $2, $4, Boise City-Nampa, ID $3, $2, $4, Boston-Cambridge-Quincy, MA-NH $4, $3, $6, Bridgeport-Stamford-Norwalk, CT $4, $3, $5, Buffalo-Cheektowaga-Tonawanda $3, $2, $4, Burlington-South Burlington, VT $2, $1, $4, Casper, WY $3, $2, $4, Cedar Rapids, IA $3, $2, $4, Charleston, WV $2, $1, $3, Charleston-North Charleston, SC $2, $1, $3, Charlotte-Gastonia-Concord, NC-SC $4, $2, $5, Chicago-Naperville-Joliet, IL-IN-WI $4, $2, $7, Cincinnati-Middletown, OH-KY-IN $4, $2, $8, Cleveland-Akron-Elyria-Mentor, OH $2, $ $6, Columbus, OH $2, $ $4, Corpus Christi, TX $2, $1, $3, Dallas-Fort Worth-Arlington, TX $2, $ $5, Denver-Aurora, CO $3, $1, $6, Des Moines, IA $3, $ $7, Detroit-Warren-Livonia, MI $3, $2, $6, El Paso, TX $1, $ $2, Fargo, ND-MN $2, $1, $4, Fresno, CA $3, $2, $4, Greenville, SC $3, $2, $4, Page 16 of 24

17 Private Private Private Harrisburg-Carlisle, PA $3, $2, $5, Hartford-West Hartford-East Hartford, CT $4, $2, $6, Honolulu, HI $4, $1, $8, Houston-Baytown-Sugar Land, TX $1, $ $3, Huntsville, AL $3, $2, $6, Indianapolis, IN $2, $1, $4, Jackson, MS $2, $ $4, Jacksonville, FL $2, $1, $4, Kansas City, MO-KS $3, $1, $4, Kennewick-Richland-Pasco, WA $3, $2, $6, Knoxville, TN $3, $1, $6, Lafayette, LA $3, $1, $6, Lansing-East Lansing $2, $ $3, Las Vegas-Paradise, NV $2, $1, $4, Little Rock-North Little Rock, AR $3, $1, $5, Los Angeles-Long Beach-Santa Ana, CA $3, $1, $6, Louisville, KY-IN $2, $ $5, Macon, GA $2, $ $3, Madison, WI $3, $1, $5, Manchester-Nashua, NH $4, $2, $7, Memphis, TN-MS-AR $3, $2, $5, Miami-Fort Lauderdale-Miami Beach, FL $2, $1, $4, Midland, TX $3, $2, $6, Milwaukee-Waukesha-West Allis, WI $2, $ $4, Minneapolis-St. Paul-Bloomington, MN-WI $3, $1, $4, Mobile, AL $3, $1, $4, Montgomery, AL $3, $2, $6, Nashville-Davidson--Murfreesboro, TN $3, $1, $7, New Orleans-Metairie-Kenner, LA $3, $1, $5, New York-Newark-Edison, NY-NJ-PA $3, $1, $5, Oklahoma City, OK $2, $ $2, Omaha-Council Bluffs, NE-IA $2, $1, $3, Orlando, FL $2, $2, $4, Oxnard-Thousand Oaks-Ventura, CA $3, $2, $4, Page 17 of 24

18 Private Private Private Philadelphia-Camden-Wilmington, PA-NJ-DE-MD $4, $2, $6, Phoenix-Mesa-Scottsdale, AZ $3, $2, $5, Pittsburgh, PA $4, $4, $4, Portland-South Portland, ME $4, $3, $6, Portland-Vancouver-Beaverton, OR-WA $2, $1, $4, Poughkeepsie-Newburgh-Middletown, NY $3, $1, $6, Providence, RI $3, $2, $4, Raleigh-Cary, NC $3, $1, $4, Reno-Sparks, NV $2, $1, $5, Richmond, VA $2, $1, $4, Riverside-San Bernardino-Ontario, CA $2, $1, $3, Roanoke, VA $2, $1, $4, Rochester, NY $4, $3, $5, Sacramento-Arden-Arcade-Roseville, CA $3, $2, $6, Salt Lake City, UT $2, $1, $2, San Antonio, TX $3, $ $6, San Diego-Carlsbad-San Marcos, CA $3, $2, $7, San Francisco-Oakland-Fremont, CA $3, $ $6, San Jose-Sunnyvale-Santa Clara, CA $3, $1, $4, Savannah, GA $2, $1, $4, Scranton-Wilkes-Barre, PA $5, $2, $7, Seattle-Tacoma-Bellevue, WA $3, $1, $7, Shreveport-Bossier City, LA $2, $1, $3, Sioux Falls, SD $3, $2, $4, Spokane, WA $3, $2, $5, St. Louis, MO-IL $3, $1, $4, Stockton, CA $2, $1, $5, Tampa-St. Petersburg-Clearwater, FL $3, $2, $5, Toledo, OH $2, $ $5, Tucson, AZ $3, $2, $3, Tulsa, OK $3, $2, $5, Virginia Beach-Norfolk-Newport News $3, $2, $4, Washington-Arlington-Alexandria, DC-VA-MD-WV $3, $3, $3, Wichita, KS $3, $2, $6, NATIONAL AVERAGES $3, $1, $5, Page 18 of 24

19 s Albany-Schenectady-Troy, NY $1, $1, $1, Albuquerque, NM $2, $1, $3, Anchorage, AK $3, $3, $3, Atlanta-Sandy Springs-Marietta, GA $1, $ $2, Austin-Round Rock, TX $2, $ $3, Baltimore-Towson, MD $4, $3, $6, Baton Rouge, LA $3, $2, $4, Bethesda, MD $3, $3, $3, Billings, MT $3, $2, $6, Birmingham-Hoover, AL $2, $1, $3, Boise City-Nampa, ID $3, $1, $3, Boston-Cambridge-Quincy, MA-NH $2, $1, $4, Bridgeport-Stamford-Norwalk, CT $3, $2, $3, Buffalo-Cheektowaga-Tonawanda $3, $2, $4, Burlington-South Burlington, VT $2, $1, $2, Casper, WY $3, $3, $3, Cedar Rapids, IA $2, $2, $3, Charleston, WV $1, $1, $2, Charleston-North Charleston, SC $1, $1, $2, Charlotte-Gastonia-Concord, NC-SC $2, $2, $2, Chicago-Naperville-Joliet, IL-IN-WI $2, $2, $2, Cincinnati-Middletown, OH-KY-IN $3, $2, $6, Cleveland-Akron-Elyria-Mentor, OH $1, $ $2, Columbus, OH $1, $ $4, Corpus Christi, TX $2, $1, $3, Dallas-Fort Worth-Arlington, TX $2, $ $4, Denver-Aurora, CO $2, $2, $4, Des Moines, IA $3, $ $7, Detroit-Warren-Livonia, MI $2, $2, $2, El Paso, TX $1, $ $1, Fargo, ND-MN $1, $ $3, Fresno, CA $2, $1, $3, Greenville, SC $2, $1, $3, Page 19 of 24

20 Harrisburg-Carlisle, PA $1, $1, $2, Hartford-West Hartford-East Hartford, CT $3, $2, $5, Honolulu, HI $4, $3, $6, Houston-Baytown-Sugar Land, TX $1, $ $2, Huntsville, AL $3, $1, $5, Indianapolis, IN $2, $1, $3, Jackson, MS $1, $ $4, Jacksonville, FL $1, $ $2, Kansas City, MO-KS $1, $ $2, Kennewick-Richland-Pasco, WA $3, $3, $3, Knoxville, TN $1, $ $2, Lafayette, LA $2, $1, $4, Lansing-East Lansing $1, $ $2, Las Vegas-Paradise, NV $1, $ $2, Little Rock-North Little Rock, AR $2, $ $3, Los Angeles-Long Beach-Santa Ana, CA $2, $ $4, Louisville, KY-IN $2, $ $4, Macon, GA $1, $ $2, Madison, WI $3, $1, $6, Manchester-Nashua, NH $3, $2, $7, Memphis, TN-MS-AR $2, $1, $2, Miami-Fort Lauderdale-Miami Beach, FL $2, $ $3, Midland, TX $2, $1, $4, Milwaukee-Waukesha-West Allis, WI $2, $ $3, Minneapolis-St. Paul-Bloomington, MN-WI $3, $2, $5, Mobile, AL $1, $1, $1, Montgomery, AL $3, $2, $5, Nashville-Davidson--Murfreesboro, TN $2, $ $4, New Orleans-Metairie-Kenner, LA $3, $3, $3, New York-Newark-Edison, NY-NJ-PA $3, $2, $3, Oklahoma City, OK $1, $ $2, Omaha-Council Bluffs, NE-IA $1, $1, $1, Orlando, FL $2, $1, $4, Oxnard-Thousand Oaks-Ventura, CA $2, $1, $3, Page 20 of 24

21 Philadelphia-Camden-Wilmington, PA-NJ-DE-MD $4, $3, $4, Phoenix-Mesa-Scottsdale, AZ $2, $1, $3, Pittsburgh, PA $4, $3, $4, Portland-South Portland, ME $4, $4, $4, Portland-Vancouver-Beaverton, OR-WA $2, $1, $4, Poughkeepsie-Newburgh-Middletown, NY $2, $1, $4, Providence, RI $2, $2, $3, Raleigh-Cary, NC $2, $1, $3, Reno-Sparks, NV $1, $1, $2, Richmond, VA $1, $1, $4, Riverside-San Bernardino-Ontario, CA $1, $ $2, Roanoke, VA $1, $1, $3, Rochester, NY $2, $1, $4, Sacramento-Arden-Arcade-Roseville, CA $2, $2, $2, Salt Lake City, UT $1, $ $2, San Antonio, TX $2, $1, $5, San Diego-Carlsbad-San Marcos, CA $2, $1, $5, San Francisco-Oakland-Fremont, CA $2, $ $4, San Jose-Sunnyvale-Santa Clara, CA $2, $1, $4, Savannah, GA $2, $1, $2, Scranton-Wilkes-Barre, PA $5, $5, $6, Seattle-Tacoma-Bellevue, WA $3, $2, $6, Shreveport-Bossier City, LA $2, $2, $2, Sioux Falls, SD $2, $1, $3, Spokane, WA $2, $1, $4, St. Louis, MO-IL $1, $1, $2, Stockton, CA $1, $ $4, Tampa-St. Petersburg-Clearwater, FL $2, $ $3, Toledo, OH $2, $ $4, Tucson, AZ $2, $2, $3, Tulsa, OK $3, $1, $4, Virginia Beach-Norfolk-Newport News $1, $1, $2, Washington-Arlington-Alexandria, DC-VA-MD-WV $2, $2, $3, Wichita, KS $2, $1, $6, NATIONAL AVERAGES $2, $1, $3, Page 21 of 24

22 Home Health Care Data Home Health Care Hourly Home Health Care Hourly Home Health Care Hourly Albany-Schenectady-Troy, NY $24.14 $21.00 $32.00 Albuquerque, NM $20.30 $17.00 $23.00 Anchorage, AK $23.99 $22.00 $27.00 Atlanta-Sandy Springs-Marietta, GA $27.70 $13.00 $65.00 Austin-Round Rock, TX $17.80 $14.00 $20.00 Baltimore-Towson, MD $19.30 $17.00 $22.00 Baton Rouge, LA $14.60 $12.00 $17.00 Bethesda, MD $20.44 $18.00 $24.00 Billings, MT $23.57 $18.00 $30.00 Birmingham-Hoover, AL $19.13 $13.00 $45.00 Boise City-Nampa, ID $18.86 $18.00 $20.00 Boston-Cambridge-Quincy, MA-NH $24.10 $18.00 $30.00 Bridgeport-Stamford-Norwalk, CT $23.64 $16.00 $35.00 Buffalo-Cheektowaga-Tonawanda $22.25 $21.00 $23.00 Burlington-South Burlington, VT $23.09 $15.00 $29.00 Casper, WY $31.00 $10.00 $65.00 Cedar Rapids, IA $22.40 $18.00 $28.00 Charleston, WV $21.67 $14.00 $51.00 Charleston-North Charleston, SC $17.50 $15.00 $20.00 Charlotte-Gastonia-Concord, NC-SC $18.80 $14.00 $23.00 Chicago-Naperville-Joliet, IL-IN-WI $20.63 $10.00 $40.00 Cincinnati-Middletown, OH-KY-IN $20.30 $18.00 $22.00 Cleveland-Akron-Elyria-Mentor, OH $18.00 $12.00 $22.00 Columbus, OH $21.91 $16.00 $55.00 Corpus Christi, TX $17.08 $15.00 $20.00 Dallas-Fort Worth-Arlington, TX $21.11 $14.50 $60.00 Denver-Aurora, CO $22.74 $8.00 $50.00 Des Moines, IA $27.57 $22.00 $36.00 Detroit-Warren-Livonia, MI $19.63 $14.00 $24.00 El Paso, TX $23.86 $14.00 $70.00 Fargo, ND-MN $31.00 $17.00 $75.00 Fresno, CA $19.40 $15.00 $26.00 Greenville, SC $17.40 $10.00 $24.00 Page 22 of 24

23 Home Health Care Hourly Home Health Care Hourly Home Health Care Hourly Harrisburg-Carlisle, PA $20.13 $19.00 $23.00 Hartford-West Hartford-East Hartford, CT $29.40 $19.00 $40.00 Honolulu, HI $23.50 $21.00 $26.00 Houston-Baytown-Sugar Land, TX $26.16 $10.00 $75.00 Huntsville, AL $18.67 $15.00 $25.00 Indianapolis, IN $18.44 $9.00 $24.00 Jackson, MS $16.00 $13.00 $18.00 Jacksonville, FL $18.18 $11.00 $35.00 Kansas City, MO-KS $19.62 $14.00 $25.00 Kennewick-Richland-Pasco, WA $21.00 $20.00 $23.00 Knoxville, TN $17.08 $16.00 $18.00 Lafayette, LA $12.72 $9.00 $18.00 Lansing-East Lansing $19.15 $15.00 $25.00 Las Vegas-Paradise, NV $23.91 $11.00 $80.00 Little Rock-North Little Rock, AR $19.00 $13.00 $30.00 Los Angeles-Long Beach-Santa Ana, CA $21.15 $15.50 $55.00 Louisville, KY-IN $17.90 $17.00 $18.00 Macon, GA $16.44 $15.00 $20.00 Madison, WI $26.30 $19.00 $36.00 Manchester-Nashua, NH $30.40 $19.00 $45.00 Memphis, TN-MS-AR $15.82 $8.00 $26.00 Miami-Fort Lauderdale-Miami Beach, FL $17.70 $13.00 $30.00 Midland, TX $16.94 $15.00 $20.00 Milwaukee-Waukesha-West Allis, WI $25.67 $19.00 $55.00 Minneapolis-St. Paul-Bloomington, MN-WI $29.40 $22.00 $40.00 Mobile, AL $15.33 $8.00 $24.00 Montgomery, AL $13.60 $8.00 $16.00 Nashville-Davidson--Murfreesboro, TN $17.60 $15.00 $23.00 New Orleans-Metairie-Kenner, LA $13.22 $8.00 $16.00 New York-Newark-Edison, NY-NJ-PA $19.04 $8.00 $25.00 Oklahoma City, OK $18.09 $16.00 $19.00 Omaha-Council Bluffs, NE-IA $27.94 $20.95 $45.00 Orlando, FL $15.80 $10.00 $21.00 Oxnard-Thousand Oaks-Ventura, CA $22.70 $18.00 $30.00 Page 23 of 24

24 Home Health Care Hourly Home Health Care Hourly Home Health Care Hourly Philadelphia-Camden-Wilmington, PA-NJ-DE-MD $21.35 $17.00 $32.00 Phoenix-Mesa-Scottsdale, AZ $21.67 $16.00 $35.00 Pittsburgh, PA $18.20 $10.00 $25.00 Portland-South Portland, ME $21.38 $18.00 $23.00 Portland-Vancouver-Beaverton, OR-WA $21.36 $10.00 $45.00 Poughkeepsie-Newburgh-Middletown, NY $21.50 $13.00 $27.00 Providence, RI $23.70 $18.00 $28.00 Raleigh-Cary, NC $17.91 $15.00 $20.00 Reno-Sparks, NV $20.60 $20.00 $21.00 Richmond, VA $17.18 $15.00 $19.00 Riverside-San Bernardino-Ontario, CA $18.70 $16.00 $22.00 Roanoke, VA $16.64 $14.00 $19.00 Rochester, NY $21.60 $9.00 $27.00 Sacramento-Arden-Arcade-Roseville, CA $22.40 $20.00 $25.00 Salt Lake City, UT $20.00 $9.00 $35.00 San Antonio, TX $16.60 $11.00 $25.00 San Diego-Carlsbad-San Marcos, CA $21.18 $17.00 $25.00 San Francisco-Oakland-Fremont, CA $24.96 $20.00 $30.00 San Jose-Sunnyvale-Santa Clara, CA $22.70 $19.00 $25.00 Savannah, GA $17.91 $16.00 $20.00 Scranton-Wilkes-Barre, PA $17.80 $12.00 $21.00 Seattle-Tacoma-Bellevue, WA $21.55 $12.00 $26.00 Shreveport-Bossier City, LA $14.20 $13.00 $15.00 Sioux Falls, SD $33.00 $20.00 $49.00 Spokane, WA $19.80 $11.00 $25.00 St. Louis, MO-IL $19.25 $17.00 $22.00 Stockton, CA $21.33 $18.00 $25.00 Tampa-St. Petersburg-Clearwater, FL $15.80 $10.00 $22.00 Toledo, OH $18.62 $12.00 $23.00 Tucson, AZ $21.00 $18.00 $24.00 Tulsa, OK $18.40 $17.00 $20.00 Virginia Beach-Norfolk-Newport News $16.44 $14.00 $18.00 Washington-Arlington-Alexandria, DC-VA-MD-WV $19.67 $15.00 $28.00 Wichita, KS $17.78 $10.00 $20.00 NATIONAL AVERAGES $20.59 $14.86 $30.38 Page 24 of 24