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Press Release


Jun 19, 2014

New Scorecard Shows Gradual Improvement in State Long-Term Care Performance, Warns Progress Must Pick Up to Keep Pace with Aging Population

Update to Groundbreaking Report from AARP, The Commonwealth Fund and The SCAN Foundation Finds Wide State Differences in Progress

CONTACT: Nancy Thompson 202-434-2560 or [email protected]

WASHINGTON, DC – 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.

Released today, Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities and Family Caregivers, evaluates 26 indicators in five key dimensions that make up the LTSS system in each state. This state-by-state report updates the inaugural 2011 LTSS Scorecard.

The highest ranked states—Minnesota, Washington, Oregon, Colorado—can offer lessons for possible solutions, but they too have opportunities for improvement. Leading states have implemented laws and policies that build stronger Medicaid programs and support family caregivers. These laws include paid sick leave, nurse delegation of health maintenance tasks, and devoting more Medicaid dollars to home and community based services. Top states also have lower use of nursing homes and minimize disruptive transitions between care settings, providing lessons for lower-ranked states.

“Americans want to live independently in their homes and communities as they age,” says AARP Senior Vice President for Public Policy Susan Reinhard. “States are starting to step up to meet this challenge, but more must be done in short time to meet the changing needs of a growing older population. By addressing the findings in the Scorecard, states have the power to affect positive change both immediately and in the long run so older residents and their family caregivers can access the quality long term services and supports they require.”

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 underscores the importance of public policies, including those that support providing care for people in their own homes and communities,” said Melinda K. Abrams, Vice President for Health Care Delivery System Reform at The Commonwealth Fund. “Without strengthening such services, we put millions of frail elderly and disabled at risk for frequent emergency room visits, hospital stays or poor quality of care.”

Further, states with more effective transitions—both those that help people move out of institutions and back to the community as well as those between care settings—performed better overall in the Scorecard.

The Scorecard’s authors warn of the demographic imperative to hasten progress. “In just 12 years, the leading edge of the Baby Boom Generation will enter its 80s, placing new demands on the LTSS system. This generation, and those that follow, will have far fewer potential family caregivers to provide unpaid help,” the report reveals.

“This scorecard shows that all states have work to do on improving their systems of care, including assessing people’s needs in a uniform way, helping people transition back home after a medical intervention, and increasing the affordability of services regardless of who pays,” said Bruce Chernof, president and CEO of The SCAN Foundation. “As recognized by last year’s federal Commission on Long-Term Care, the responsibility for realizing these kinds of improvements means greater action by both state and federal leaders.”

The full LTSS State Scorecard, along with an interactive map of state rankings and information, is available at

Publication Details


Jun 19, 2014