In the top five states, for example, nearly two-thirds of low- and moderate-income people with long-term care needs received support from Medicaid. By contrast, in the five lowest-performing states only 20 percent were covered. Similarly, the five highest-performing states spent 60 percent of their Medicaid dollars on home-based care, compared with just 13 percent in the bottom five states. The report urges states to help new long-term care users receive home-based care, because once they enter nursing homes, it can be hard to return to the community.
In every state, however, the scorecard reported, the cost of long-term care — even home-based health care — is beyond the financial reach of most middle-income families. As a result, the report notes, many people who need long-term care "will exhaust their life savings and eventually turn to the public safety net for assistance."
Family caregivers are key
The alternative is to depend increasingly on family members. "Family caregivers are the backbone of long-term care, and there are things states can do to ease their burden," said Susan C. Reinhard, a senior vice president of AARP and director of PPI. "For example, if states permit home health visitors to give insulin or oxygen, the caregiver doesn't have to run home from work to do it."
In fact, how a state treats family caregivers is a critical measure of the quality of its long-term services, according to the scorecard. The report recommends that states mandate paid sick leave to help working family caregivers, and try to prevent burnout by adopting programs that provide respite care and other support.
The goal of the scorecard, which was also sponsored by the Commonwealth Fund and the SCAN Foundation, is to assess state performance as well as encourage states to improve their systems of care and invest more efficiently, so that people can live in the environment that suits them best.
The top-ranked states were Minnesota, Washington, Oregon, Hawaii, Wisconsin, Iowa, Colorado and Maine. Of the states in the bottom quartile (Mississippi, Alabama, West Virginia, Oklahoma, Indiana, Kentucky, Tennessee, Florida, Louisiana, Georgia, New York and Nevada), many have among the lowest median incomes and highest rates of both poverty and disability in the nation.
Sandra Salmans is a writer based in New York.