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Report Scores States on Long-Term Care Support

By Jane Norman, CQ HealthBeat Associate Editor

September 8, 2011 -- A new state-by-state scorecard on long-term care recently released shows eight states at the top when it comes to doing best at providing services and support for the elderly and people with disabilities.

Minnesota, Washington, Oregon, Hawaii, Wisconsin, Iowa, Colorado, and Maine are performing best in a variety of ways, though they still have room to improve, says the scorecard developed by AARP, The Commonwealth Fund, and The SCAN Foundation.

There's wide variation among states because there's no uniform way to approach long-term care in the United States, the report says. Most of the policy issues in play in long-term care involve Medicaid, a federal–state program that pays for nursing home care and other services for low-income people and allows states to determine how they will provide that care.

States have direct control over the extent to which low-income people and those with disabilities on Medicaid are supported in staying in their homes and avoid going into costly nursing home care, says the report.

Ways to improve the quality of Medicaid while reducing costs are also likely to figure in discussions about deficit reduction in a congressional supercommittee this fall.

The report's researchers say it is the first that takes a multidimensional approach in measuring performance in long-term care at the state level. It's designed to "begin a dialogue among key stakeholders so that lagging states can learn from top performers and all states can target improvements where they are most needed," says the report.

At the bottom of the list are Mississippi, Alabama, West Virginia, Oklahoma, Indiana, and Kentucky.

The scorecard looked at four aspects of long-term care:

  • Affordability and access—items such as the median annual nursing home private pay cost as a percentage of median household income for people over 65.
  • Choice of setting and provider. For example, the number of home health and personal care aides per 1,000 population.
  • Quality of life and quality of care, such as the percentage of high-risk nursing home residents with pressure sores.
  • Support for family caregivers, such as the number of health maintenance tasks that can be delegated to health aides.

States that fared the best on the scorecard improved access to services by transforming their Medicaid programs to cover more of the population in need and offer alternatives to nursing homes, the report said.

They also made it easier for people to obtain information about long-term care by developing a single point of contact system. And they helped stressed-out family caregivers by giving them legal protections and services to prevent burnout.

Poverty and high rates of disability make it tough for states to move forward, the report acknowledges. Many low-scoring states are in the South and have low median incomes.

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