State Scorecard on Long Term Care Needs Help

Costs Out of Reach. Not Enough Being Done to Move to Home Based Care

State Scorecard
State Scorecard on LTSS - Costs Rising. More emphasis on Home Care Needed.. AARP, SCAN, The Commonwealth Fund

Raising Expectations: A State Scorecard on Long-Term Services and Supports (LTSS) for Older Adults, People with Disabilities, and Family Caregivers was issued by the AARP Public Policy Institute with support from The SCAN Foundation and The Commonwealth Fund.

This Scorecard measures state-level performance of LTSS systems that assist older people, adults with disabilities, and their family caregivers.

This second edition measured performance across five key dimensions: (1) affordability and access, (2) choice of setting and provider, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions.

  • The cost of LTSS continues to outpace affordability for middle-income families, and private long-term care insurance is not filling the gap.

    The cost of LTSS was not affordable for middle-income families in all states, even for those in the top states. Nationally, this situation did not improve. On average, nursing home costs consume 246 percent of the median annual household income of older adults. Home care generally is more affordable.
  • Tremendous variation exists in states’ Medicaid LTSS safety nets.
  • Once people access Medicaid, shifting service delivery toward home- and community-based (HCBS) services is critical. The top five states allocated an average of 62.5 percent of LTSS dollars for older people and adults with physical disabilities for HCBS, nearly four times the proportion in the bottom five states.
  • Few HCBS consumers have the choice to direct their own services. California leads the nation in the proportion of people with disabilities that self-direct their services.
  • States play a key role in minimizing the inappropriate use of antipsychotic medications in nursing homes. As states have dramatically reduced the use of physical restraints in nursing homes, some appear to have substituted the inappropriate use of sedating antipsychotic medications.
  • More states or jurisdictions are enacting laws that support family caregivers. Among the components measured in this indicator are the extent to which the state exceeds federal requirements under the Family and Medical Leave Act, the state’s paid family leave and mandatory paid sick day provisions, and its policies to prevent discrimination toward working caregivers.
  • States with more effective transitions have lower use of nursing homes and generally score better on both choice and quality. States in which a relatively high proportion of nursing home residents have low care needs may not be taking appropriate steps to transition these individuals to HCBS settings.
  • Excessive transitions between nursing homes and hospitals are disruptive to patients and their families and costly to the system. In the top five states, 10.3 percent of nursing home residents were hospitalized, almost a third the level in the bottom five states, which averaged 27.9 percent.
  • People who enter nursing homes and remain for 100 or more days are far less likely to return to the community than are those who have shorter stays. In the top five states, 12.9 percent of nursing home residents remained for 100 or more days, less than half the average (27.9 percent) in the bottom five states.
  • A measure of high performance is the states’ continuing efforts to help nursing home residents who would prefer to reside in the community make this transition. On average, the top five states transitioned 13.1 percent of long-stay nursing home residents to HCBS settings, compared to only 5.3 percent in the bottom five states.
  • People cannot have the option of remaining at home if there aren’t enough workers to provide services. If all states rose to Minnesota’s level of performance, 1.5 million more personal care, home care, and home health aides would be available to provide LTSS in communities nationwide.
  • If all states rose to Alaska’s level of performance approximately 200,000 more people per year would first receive services in the community instead of in a nursing home.
  • If all states achieved the level found in Utah, more than 100,000 individuals per year would be able to leave a nursing home for a more homelike setting.

How does your state stack up and what are you doing to address these issues in your organization?

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