Minnesota Tops New AARP Long-Term Care Scorecard; Other States Lag Behind

But the LTSS Scorecard, she says, is forcing every state to look at the difficult issue by compiling stats that the states cannot ignore. Then, by ranking the states publicly in so many data-driven categories, AARP is essentially setting off a competition whose ultimate goal is to encourage all to improve.

The overarching problem, of course, is that the U.S. has no national plan for long-term care, says Reinhard. So each state must step in and try to dig into the issue on its own. And, from time to time, signs of progress have sprouted as a result. For example, Reinhard says, since the LTSS Scorecard started, most states now focus their long-term care budgets on home-based and community-based care — where most prefer care and the dollar goes further — not nursing home care. That, she says, is real progress.  And, yes, COVID certainly played a role in directing this change.

AARP

But in a nation with 48 million family caregivers, the sheer weight of COVID has simply been too oppressive for the long-term caregiving system to quickly recover, Reinhard says. “COVID-19 tested our long-term care systems — and they failed,” she says.

For example, she says, as a result of COVID, adult day care centers nationwide remain in serious decline. Many of these centers, which give adults a safe and familiar place to be during the day, closed during the pandemic and never reopened. These centers not only benefit the clients, they also give family caregivers a break during the day. “When you close a business like this, it’s hard to reopen,” she says.

She compares this situation to the many restaurants that shuttered during COVID and never resumed service. Not only were they unable to stay financially afloat, but they were also unable to attract staff to return when the pandemic subsided. Adult day care centers — many of which are small businesses — suffered a similar fate, she says.

“We have to reinvest in operations like this that suffered because of COVID,” she says.

Even then, there are improvements to be made. The LTSS Scorecard offers these key recommendations for states to improve their support for long-term care:

• Bolster the workforce. Nursing homes and in-home care workforces need to improve recruitment and training and increase pay in order to attract and retain skilled workers.
• Expand innovative models. Effective nursing home models with smaller facilities and private rooms can improve the quality of care and the quality of life.
• Address inequities. Make investments that close the gaps in access to quality care facilities.
• Support family caregivers. Prioritize support for family caregivers with paid leave and tax credits to assist with financial needs.
• Invest in caregiver infrastructure. Increase support and training for home health aides and home visits and update key Medicaid regulations.
• Build coalitions. Support age-friendly health systems that allow individuals to live independently with things like affordable housing and accessible transportation.
• Support innovation.  Create comprehensive aging plans that can offer new approaches with things like smaller, more guest-friendly nursing homes.
• Mandate emergency plans. Develop sound emergency preparedness plans in every state to support nursing home residents in times of crisis.

Take initiative

So, what can concerned people do?

Make their voice heard, says Reinhard. Perhaps the single most impactful action is to let representatives at your state legislature know if you are unhappy with where your state ranks on the LTSS Scorecard.

Some years ago, when Reinhard was a new mother, she was upset about a toxic site that she read about that was relatively close to her home. She called her state senator to complain — never expecting to hear a response. The next thing she knew, however, he was on the phone speaking with her.

“I was stunned,” she said. “But when it’s your district, they want your vote.”

She came to realize that very few folks take the initiative to do this kind of outreach. “So those who do something can actually have a loud voice,” she says.

Wonder where your state ranks?

The LTSS Scorecard divides states into five tiers based on a series of 50 indicators in areas such as affordability, safety and family caregiver support.

Here are the 2023 AARP Scorecard state rankings:

• Tier 1: 1) Minnesota; 2) Washington state; 3) District of Columbia; 4) Massachusetts; 5) Colorado.
• Tier 2:  6) New York; 7) Oregon; 8) Hawaii; 9) Vermont; 10) New Jersey; 11) California; 12) Rhode Island; 13) Connecticut; 14) Maryland; 15) Wisconsin; 16) Maine.
• Tier 3: 17) Delaware; 18) Nebraska; 19) North Dakota; 20) New Mexico; 21) Pennsylvania; 22) Arizona; 23) Iowa; 24) New Hampshire; 25) Illinois; 26) Alaska; 27) Indiana; 28) Virginia; 29) Utah; 30) Kansas; 31) Michigan; 32) Ohio; 33) Montana; 34) Texas; 35) Idaho.
• Tier 4: 36) South Dakota; 37) Arkansas; 38) Missouri; 39) Georgia; 40) Wyoming; 41) North Carolina; 42) Kentucky; 43) Florida; 44) Nevada; 45) Louisiana; 46) Oklahoma.
• Tier 5: 47) Tennessee; 48) Mississippi; 49) South Carolina; 50) Alabama; 51) West Virginia.

For a deeper dive into how each individual state ranked, go to: Long-Term Services & Supports State Scorecard.