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Bay State Ranks Low on Long Term Services

Massachusetts scores in the bottom half, at number 30, of all states when it comes to the overall affordability and quality of long-term services and supports (LTSS).

As described in a new report by AARP Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, these services include:

  • home care
  • adult day health services
  • residential services such as assisted living and nursing homes
  • respite care as well as other support for family caregivers

Ahead of the curve?

“This scorecard screams: More attention must be paid to long-term care services and support systems in Massachusetts,” says Deborah Banda, state director of AARP Massachusetts. “As a commonwealth, we pride ourselves as being ahead of the curve when it comes to health care reform, yet this critical piece seems to have been left in the dust.”

The report, entitled “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers”, looks at four key dimensions of LTSS performance:

  • affordability and access
  • choice of setting and provider
  • quality of life and quality of care
  • support for family caregivers

Room for improvementWhile there is definite room for improvement in all areas, Massachusetts ranks too close to the bottom when it comes to the cost of care and an overreliance on institutional care,” explains Banda. “We have a unique opportunity to address these issues now, as state leaders work to craft health care payment and systems delivery reform. Long-term services and support are part of health care delivery, across the continuum, and as such, should be included in payment reform discussions.”

By the numbers

Although Massachusetts ranked 17th overall for affordability and access, the state scored extremely low (46) in two key indicators within that dimension: “median annual nursing home private pay” and “median annual home care private pay” costs as a percentage of median household income.

As for choice of setting and provider, the state ranked 14th, but that score was dragged down by a low grade (40) for the percent of new Medicaid LTSS users first receiving services in community.

The state’s worst rankings among the four overall dimensions came in quality of life and quality of care (34) and support for family caregivers (39). In both, improvement is needed across the board, from adults with disabilities getting needed support in the community (27) and being satisfied with life (38) to the use of physical restraints in long-stay nursing homes (35) and intervention for pressure sores in home health plans for at risk patients (40).

Some good news

Two bright spots for the commonwealth: Massachusetts ranks third in the country on two key individual indicators, the percentage of low income disabled adults receiving health insurance assistance, and the functionality of Aging and Disabled Resource Centers.

Tools for independence

“Bottom line: This scorecard reflects fragmentation in the long-term services and supports system,” says Banda. “While Massachusetts scored well on having tools and programs to help facilitate consumer choice, the state scored poorly on the percent of new LTSS users who first received services in the community. Since we know people prefer to remain in their own homes and communities as they age, that’s a disconnect.”

Another AARP survey, “Voices of 50+ Massachusetts”, released earlier this year, finds having quality long-term care options when needed is a top concern for 85 percent of Massachusetts residents age 50 and older.

Demographic imperative According to the scorecard, if Massachusetts improved its performance to the level of the highest-performing state:

  • 10,203 more new users of Medicaid LTSS would first receive services in home and community based settings instead of nursing homes.
  • 3,945 nursing home residents with low care needs would instead be able to receive LTSS in the community.
  • 2,616 unnecessary hospitalizations of people in nursing homes would be avoided.
  • 2,129 more low-or moderate-income (<250% poverty) adults age 21 and older with activity of daily living disabilities would be covered by Medicaid.

“We’ve got a demographic imperative to get this right,” Banda concludes. “With the first of the 76 million Baby Boomers turning 65 this year, there’s no time to waste when it comes to building a better system of long-term services and supports in this state – and in this country.”

Read the full report online.

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