When the first boomers begin turning 80 in 2026, the nation may not be ready for them. A new state scorecard on long-term care services from AARP Foundation, the SCAN Foundation and the Commonwealth Fund paints a distressing picture of uneven, slow progress in providing the care older adults and people with disabilities want and need.
“Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers,” the third in a series, found that the pace of improvement in long-term care is scattered and incremental, and the cost of care remains prohibitive for most of the middle class.
The scorecard found that more states have improved in these areas than having declined in the past three years, but it will take generations for states on the bottom to climb to the middle. At this rate, the demographic demand for services will outstrip most states’ capacity to provide them.
Progress will be further hindered by proposed massive cuts to Medicaid, the largest public payer of long-term assistance, according to Susan Reinhard, RN, Ph.D., and senior vice president and director of AARP Public Policy Institute. Such cuts, part of the House-passed American Health Care Act, “would result in millions of older adults and people with disabilities losing life-saving supports,” she said.
Older adults and people with disabilities account for more than 60 percent of Medicaid spending. Families who have already exhausted their resources and rely on Medicaid for critical home- and community-based services or nursing home care, for example, might not be able to afford care.
That care is critical. It includes assisting with the activities of daily living for older adults and people with disabilities, whose physical, cognitive or chronic health conditions prevent them from performing the tasks on their own. They range from bathing, dressing and managing medications to preparing meals and providing transportation.
Many states have been increasing the proportion of Medicaid spending for home- and community-based services, which enables more people to stay in their homes and neighborhoods. Such services are less expensive than institutional care, averaging one-third the cost per person on Medicaid.