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Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers

View a webcast of the AARP Solutions Forum: Improving Long-Term Services and Supports: How Are States Doing?

The event featured an overview of the major findings of the landmark report, and a panel of LTSS experts.

This report by AARP’s Public Policy Institute, The Commonwealth Fund and The SCAN Foundation shows some states significantly out-perform others in the delivery of long-term services and supports (LTSS) to older adults and people with disabilities. 

The report is available at, where it may be downloaded as a pdf or viewed dynamically. State-specific data is also available on demand at

While states are making measureable progress in improving long term services and supports (LTSS) – which includes home care services, family caregiver supports, and residential services such as nursing homes – widespread disparities still exist across the country, with even top performing states requiring improvement. Further, the pace of change remains slow, threatening states’ ability to meet the needs of the aging population. 

The LTSS Scorecard evaluates performance in five key dimensions:  (1) affordability and access, (2) choice of setting and provider, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions. New indicators this year include length of stay in nursing homes and use of anti-psychotic drugs by nursing homes, raising serious concerns about the quality of institutionalized care.  

Even facing tight budgets following the Great Recession, all states made progress in at least one of the Scorecard’s 26 indicators.  In particular, more than half of the states (29) improved their laws and supports for family caregivers – including expanding family and medical leave requirements and laws requiring sick days, and allowing nurses to delegate health maintenance tasks to home care workers – and, 28 improved the functioning of Aging and Disability Resource Centers, which help residents navigate available services and supports. At the same time, the cost of LTSS remains unaffordable for middle income families.

The single strongest predictor of overall LTSS system performance is the reach of a state’s Medicaid LTSS safety net. Nearly half the states (24) increased the percentage of Medicaid LTSS dollars that support home and community-based services – the care setting that most Americans prefer.   However, widespread disparity exists across the states on this important indicator. While the five top-ranked states dedicate 62.5 percent of Medicaid LTSS dollars to HCBS, the lowest-ranking five only devote 16.7 percent.

The report is available as a single document and information on each state may be viewed below or dynamically at