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Scorecard Rates States on Services for Older Adults, the Physically Disabled

Care doesn't have to be expensive, report finds

Long-term Care Best Services U.S. map

The quality of long-term services that states provide to older adults and individuals with physical disabilities varies widely, with no single state winning top marks across the board, according to a new report by AARP's Public Policy Institute (PPI).

See also: Caregiver's dilemma.

Called "Raising Expectations: A State Scorecard on Long-Term Services and Supports (LTSS) for Older Adults, People With Physical Disabilities and Family Caregivers," the report offers the first comprehensive look at how all 50 states and the District of Columbia stack up in helping people manage routine activities of daily life such as bathing, eating, preparing meals and shopping for necessities.

Its conclusion: States perform best when they adopt public policies that increase consumers' access to services and allow people to exercise more choice and control over where they receive those services and who provides them.

Quality doesn't have to be expensive

The good news, particularly in these belt-tightening times, is that providing a better level of service doesn't have to be costly. In fact, states can improve support at little or no cost in many ways. These range from making home- and community-based care more accessible — an option encouraged by the new Patient Protection and Affordable Care Act of 2010 and federal grants programs such as Money Follows the Person — to allowing home care workers to perform some of the services often relegated to a registered nurse. "States can take actions that save money and give people what they want," said Enid Kassner, director of Independent Living and Long-Term Services and Supports for PPI.

The scorecard evaluated states' performances in four key areas: affordability of and access to services and supports; opportunities for consumer choice of settings and providers; quality of life and quality of care for people with long-term care needs; and support for family caregivers. The extent to which states' performance vary was striking.

Next: Family caregivers are key. >>

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.

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