How State Long-Term Care Services and Supports Measure Up

A look at the Long-Term Care Services and Supports Scorecard, 2014.

In the next few years, our nation faces an upsurge of older adults living longer with debilitating chronic conditions. Their need for specialized long-term care will soar and place new demands on health care and support systems. And adding more demand on care systems is the decline of family caregivers who give unpaid help.

Currently, Americans lack a national solution for adequate home and community-based long-term care services and supports. They depend on the state governments to help fulfill the need but few provide the quality care needed.

In the study, Long-Term Care Services and Supports Scorecard, driven by AARP and funded by the Commonwealth Fund and the SCAN Foundation, it found the support and services in local communities hold the key for healthcare. The study also found that not all states are equal in quality of care; some do better than others.

Long-term care services and supports report

Digging deep into its findings, one discovers which states perform the best and why, and which ones fall on their face. This data should be motivation for consumers to become informed and take action with state legislatures for change in long-term care policies. To help you better understand the Long-Term Support and Services Scorecard (LTSS) and how it measured local state healthcare services for residents, here’s a summary of the findings: The 5 Dimensions of Quality Healthcare

• Affordability and access
• Choice of setting and provider
• Quality of life and quality of care
• Support for family caregivers
• Effective transitions

Within these five dimensions, it also measured 26 indicators specific to support and services in each state. Here are a few of them (view all by clicking on link below):

• Percent of adults age 21+ with ADL disability at or below 250% of poverty receiving Medicaid or other government assistance health insurance.
• Percent of Medicaid and state-funded LTSS spending going to HCBS (home and community-based services) for older people and adults with physical disabilities.
• Family caregivers without much worry or stress, with enough time, and who are well-rested.

To find all 26 LTSS indicators go to the Executive Summary or go to the Scorecard Chartpack.

Result: If costs are high, people will deplete life savings and turn to a public safety net. Because many states have inadequate residential alternatives; they’re forced to rely on costly nursing homes. This puts extra pressure on resources.

Examples:

– When transitioning from the hospital, the best performing states allow registered nurses to delegate tasks to direct care workers, lessening the burden on family caregivers. In the worst performing states, registered nurses cannot delegate any tasks.

– In the worst performing states, close to 25% of Medicaid LTSS users receive care in their homes and communities. While in the best states, more than 75% do.

– The top states transitioned close to 15% of people who spent more than 3 months in a nursing home back to their community. The bottom states transitioned only 5%.

The Scorecard emphasizes several key findings related to public policy:

• Few home and community-based consumers have the choice to direct their own services. Hiring the people who will help with daily living needs and move from one place to another helps one gain personal control.
• Given the critical role that caregivers play in support for people with LTSS needs, support for family caregivers is an area of great public policy interest.
• Excessive transitions between nursing homes and hospitals are disruptive to patients and costly to the system.

How States Rank

Minnesota ranked the highest across all five dimensions.

New York ranked 25.

Kentucky ranked 51.

Find out how your state ranks for long-term services and supports.

LTSS continues to outpace affordability for middle-income families.

Nursing home costs: Even in the five most affordable states (Minnesota, Washington, Oregon, Colorado, Alaska) the cost averages 171% of income, and in the least affordable states, it averages 382% of income.

Home care generally is more affordable and allows consumers to stretch their dollars further.

Help make changes in LTSS – Connect with your local and state governing bodies. It’s imperative that we fight for more home and community-based services to decrease costs, especially for those who cannot afford to pay for support services in a nursing home.