AARP scorecard on long term care to older adults: `time to accelerate services'

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With America’s baby boomers beginning to turn age 80 in 2026, days ago the Washington, D.C.-based AARP released Scorecards detailing how each state spends its dollars on long-term services and supports (LTSS) to assist older adults and adults with disabilities. The report findings revealed a need for state legislatures to quicken the pace of improving LTSS for their older residents. LTSS include assistance with activities of daily living provided to older adults and people with disabilities who cannot perform these activities on their own because of physical, cognitive, or chronic health conditions. The types of assistance include such things as help with bathing, dressing, managing medications, preparing meals, and transportation, as well as support for family caregivers. 

The latest comprehensive state-by-state Scorecard report was funded by AARP Foundation with support of the nation’s leading organizations behind quality long-term care, The Commonwealth Fund and SCAN Foundation. This is the third edition of the Scorecard, initially released in 2011 and again in 2014.

Pick up the pace

AARP’s 2017 report, “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 (“Scorecard”), released on June 14, finds that although Rhode Island and most states have taken small steps to make some progress, this pace of change overall remains too slow and has not kept up with demographic demands.  

“This Scorecard sounds the alarm, but it also provides a range of tools states can use to spark new solutions and create systems that are aligned with the new realities of aging and living with a disability,” said 

Susan Reinhard, RN, PhD, Senior Vice President and Director, AARP Public Policy Institute. “The proposed cuts to Medicaid – the largest public payer of long-term assistance – would result in millions of older adults and people with disabilities losing lifesaving supports.”

“This new Scorecard shows that it’s time for all states to accelerate care improvements for older adults and people with disabilities,” said Bruce Chernof, MD, FACP, President and CEO of The SCAN Foundation. “States that consistently rank at the top have strategically planned for their aging population across the main sectors of health, housing, transportation and family caregiving.”

Like previous two LTSS scorecards, states are ranked on their performance in five categories: Affordability and access, Choice of setting and provider; Quality of life and quality of care; Support for family caregivers; and Effective transitions between nursing homes, hospitals and homes. Within the five categories, states are scored on their performance in 25 specific indicators, including such things as Medicaid spending, nursing home cost, home health aide supply, antipsychotic medication use in nursing home residents, long nursing home stays, employment rate of people with disabilities, and support of working caregivers.

But this year, AARP has made changes in LTSS Scores in the way information is presented on its interactive website (www.longtermscorecard.org), making it easier for a user to customize data to suit their specific needs. Visitors to the Scorecard site will be able to access videos, called Impact Stories, that show how improving on the Scorecard can impact the lives of real people.

Users can also download Promising Practices as well as Emerging Innovations (updated throughout the year) that state officials can use as they work to improve their long-term care delivery systems.

RI improves delivery

In the 2017 AARP report, Rhode Island ranks 32nd overall when it comes to meeting the long-term care needs of older residents and people with disabilities, but showed improvement in all but one Scorecard category. AARP warns more must be done, at an accelerated pace, to meet changing demographic demands. Rhode Island ranks 22nd nationally Support for Family Caregivers and 24th in Quality of Life & Quality of Care. The state ranks 35th in Effective Transitions – the only category in decline.

“The vast majority of older Rhode Islanders want to live independently, at home, as they age – most with the help of unpaid family caregivers,” says Kathleen Connell, State Director of AARP Rhode Island, which serves more than 138,00 members age 50 and older in the state. “Even facing tight budgets, Rhode Island is making progress to help our older residents achieve that goal. However, this Scorecard shows we have more to do, and we need to pick up the pace.” 

According to Connell, today, unpaid family caregivers provide the bulk of care for older Rhode Islanders in part because the cost of long-term care remains unaffordable for most middle-income families. In Rhode Island, more than 134,000 residents help their aging parents, spouses and other loved ones stay at home by helping with bathing and dressing, transportation, finances, complex medical tasks like wound care and injections, and more. The value of this unpaid care totals about $1.78 billion.

“When it comes to helping older Rhode, Islanders live in the setting of their choice, family caregivers take on big responsibilities,” explains Connell. “Many juggle full-time jobs with their caregiving duties; others provide 24/7 care for their loved ones. With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly nursing homes – most often paid for Medicaid. They have earned some basic support.”

“That’s why AARP Rhode Island has fought for Caregiver, Advise, Record, Enable (CARE) Act; caregiver temporary leave insurance; and caregiver tax credits, adds Connell.

Rhode Island has made progress to improve long-term services and supports for older adults and people with disabilities, as highlighted in this Scorecard. But, proposals in Washington, D.C. to drastically cut federal Medicaid funding would threaten these advancements, likely resulting in our most vulnerable citizens losing the lifesaving supports that they count on,” says Connell.

“The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net,” says Connell, noting that’s why AARP fights to expand services provided at home and in the community, by shifting funds away from and more expensive nursing home care. “While the percent of long-stay nursing home residents hospitalized within a six-month period has decreased, the Scorecard highlights additional serious issues related to institutional care in Rhode Island, such as residents with pressure sores and residents with low care needs],” she notes.

While Rhode Island has improved its rank from 50th to 44th in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care provided at home and in the community – the care setting that most Rhode Islanders prefer – the Scorecard spotlights areas that call for improvement, including choice of setting and provider; and effective transitions.

Specifically, the percent of Medicaid and state-funded LTSS going to HCBS; Medicaid LTSS users first receiving services in the community; people with 90 day nursing home stays successfully transitioning back to the community; and nursing home stays lasting 100 days or more.

“This Scorecard gives us a snapshot of how well Rhode Island serves our older residents, those with disabilities, and family caregivers – and shows us where we must sharpen our focus to better assist hardworking Rhode Islanders,” concludes Connell. “We will continue to work with the governor, legislative leaders and policymakers to take the actions needed now to protect our expanding needs.”

Connell says that of the 25 Scorecard indicators, many may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched in 2014, to help older Americans live independently, at home, and the family caregivers that support them. 

Director Charles Fogarty, of Rhode Island’s Division of Elderly Affairs, sees the importance of AARP’s Rhode Island’s Scorecard, to evaluate progress in meeting the needs of older Rhode Islanders. “This report reinforces what we already know: while Rhode Island is showing improvements in some areas, there is still much to be done to provide the level of care and services our seniors deserve. Our improved ranking from 50th to 44th in the percentage of Medicaid long-term care dollars spent on home and community care options is a step in the right direction,” says Fogarty.

“We must continue to build upon the success of Reinventing Medicaid and move towards rebalancing of the long-term care system while preserving access and quality of care for older Rhode Islanders,” adds Fogarty.

Top ranked

Washington State and Minnesota are top-ranked states again (followed by Vermont, Oregon and Alaska), but all states lag in helping care for the nation’s growing populations of older persons with people aging and living with disabilities.

AARP’s LTSS Score card noted that the bottom ranking states were Indiana, (No. 51), Kentucky (No. 50, Alabama, (No. 49), Mississippi, (No. 48), and Tennessee (no. 47).

According to researchers, overall, states made incremental LTSS improvements since the previous report in 2014, but the pace of change has been slow and uneven. However, two states – Tennessee and New York – showed the most improvement across measures since the last Scorecard.

States made the most significant progress in reducing inappropriate ‘off label’ use of antipsychotic medications among nursing home residents and increasing support of family caregivers.

In general, states showed the most significant declines 

in employment rates for people with disabilities and rates of transitioning long-stay nursing home residents back into the community. Notably, the majority of states showed no real change on “Affordability and Access,” meaning that the cost of LTSS over time continues to be much higher than what the majority of families can afford.

Herb Weiss, LRI’12 is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

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