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State-by-state scorecard argues need for improved LTC services nationwide

September 8, 2011
by root
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A report released jointly today by AARP's Public Policy Institute, The Commonwealth Fund and The SCAN Foundation shows most states are struggling to provide “high-performing” systems of affordable long-term care.

The report’s authors argue that all states need to vastly improve provisions in home care, assisted living, nursing home care and supports for family caregivers as well as find more efficient ways to spend funding for long-term care and related support services.

The report, “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers,” examines four dimensions of state long-term care system performance: affordability and access; choice of setting and provider; quality of life and quality of care; and support for family caregivers. It assesses each state's performance as a whole and on 25 individual indicators, some of which were measured for the first time. (See interactive map for state rankings)

According to the scorecard, states with the highest level of performance have enacted public policies that direct state Medicaid programs to serve more people and offer alternatives to nursing homes.

“This scorecard is a critical first step toward creating a much more person- and family-centered system of care that delivers services honoring each individual's dignity and choices,” said Bruce Chernof, president and CEO of The SCAN Foundation. “To fully realize the vision of a high-performing long-term services and supports system, we must measure performance, track improvements and create opportunities for states to learn from each other.”

The report shows wide variations between states in performance on: spending that goes toward home- and community-based services (HCBS); the percentage of Medicaid recipients receiving HCBS before nursing home placement; and the hospitalization rates of nursing home residents—10 percent in the top five states, 29 percent in bottom five states, with a median of 19 percent.

According to the report, if all states reach the levels maintained by the top-performing states, the United States would see:

667,171 more individuals with disabilities covered by Medicaid

201,531 fewer unnecessary nursing home admissions

120,602 fewer avoidable hospitalizations—at a savings of $1.3 billion nationally
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