While states are making measureable progress
in improving long-term services and supports
(LTSS) – which includes home care services,
family caregiver supports, and residential
services such as nursing homes – widespread
disparities still exist across the country, with
even top performing states requiring improvement,
according to the AARP.
Further, the pace of change remains slow,
threatening states’ ability to meet the needs of
the aging population, the study said.
Raising Expectations: A State Scorecard on
Long-Term Services and Supports for Older
Adults, People with Physical Disabilities and
Family Caregivers, evaluates 26 indicators in
five key dimensions that make up the LTSS
system in each state. The state-by-state report
updates the inaugural 2011 LTSS Scorecard,
according to AARP.
The highest ranked states – Minnesota,
Washington, Oregon, Colorado – can offer lessons
for possible solutions, but they too have
opportunities for improvement, the study said.
Leading states have implemented laws and
policies that build stronger Medicaid programs
and support family caregivers.
These laws include paid sick leave, nurse
delegation of health maintenance tasks, and
devoting more Medicaid dollars to home and
community based services. Top states also
have lower use of nursing homes and minimize
disruptive transitions between care settings,
providing lessons for lower-ranked states.
“Americans want to live independently in
their homes and communities as they age,” said
AARP Senior Vice President for Public Policy
Susan Reinhard. “States are starting to step up
to meet this challenge, but more must be done
in a short time to meet the changing needs of
a growing older population.
“By addressing the findings in the Scorecard,
states have the power to affect positive change
both immediately and in the long run so older
residents and their family caregivers can access
the quality long-term services and supports
they require.”
The LTSS Scorecard evaluates performance
in five key dimensions: affordability and access,
choice of setting and provider, quality of life
and quality of care, support for family caregivers,
and effective transitions.
Officials said new indicators this year
include length of stay in nursing homes and
use of anti-psychotic drugs by nursing homes,
raising serious concerns about the quality of
institutionalized care.
Even facing tight budgets following the
Great Recession, all states made progress in
at least one of the Scorecard’s 26 indicators.
According to the study, more than half of the
states (29) improved their laws and supports
for family caregivers – including expanding
family and medical leave requirements and
laws requiring sick days, and allowing nurses
to delegate health maintenance tasks to home
care workers – and, 28 states improved the
functioning of Aging and Disability Resource
Centers, which help residents navigate available
services and supports. At the same time,
the cost of LTSS remains unaffordable for
middle income families.
The single strongest predictor of overall
LTSS system performance is the reach of a
state’s Medicaid LTSS safety net. Nearly half
the states (24) increased the percentage of Medicaid LTSS dollars that support home and
community-based services – the care setting
that most Americans prefer. However, widespread
disparity exists across the states on this
important indicator. While the five top-ranked
states dedicate 62.5 percent of Medicaid LTSS
dollars to HCBS, the lowest-ranking five only
devote 16.7 percent.
“The report underscores the importance of
public policies, including those that support
providing care for people in their own homes
and communities,” said Melinda K. Abrams,
vice president for health care delivery system
reform at The Commonwealth Fund. “Without
strengthening such services, we put millions of
frail elderly and disabled at risk for frequent
emergency room visits, hospital stays or poor
quality of care.”
Further, states with more effective transitions
– both those that help people move out of
institutions and back to the community as well
as those between care settings – performed
better overall in the Scorecard.
The Scorecard’s authors warn of the demographic
imperative to hasten progress. “In just
12 years, the leading edge of the Baby Boom
Generation will enter its 80s, placing new
demands on the LTSS system. This generation,
and those that follow, will have far fewer
potential family caregivers to provide unpaid
help,” the report said.
“This scorecard shows that all states have
work to do on improving their systems of care,
including assessing people’s needs in a uniform
way, helping people transition back home
after a medical intervention, and increasing
the affordability of services regardless of who
pays,” said Bruce Chernof, president and CEO
of the SCAN Foundation. “As recognized by last
year’s federal Commission on Long-Term Care,
the responsibility for realizing these kinds of
improvements means greater action by both
state and federal leaders.”
The full LTSS State Scorecard, along with an
interactive map of state rankings and information,
is available at www.longtermscorecard.org.