Long-Term Care Services Are Improving Too Slowly

When it comes to access to long-term supports and services (LTSS) for older or disabled Americans, where you live matters.

Washington edged out Minnesota this year as the best state for supporting older adults and family caregivers, according to the 2017 Long-Term Services and Supports State Scorecard. The state ranks highest for affordability and access, and choice of provider. Even so, Washington – like every state on the list – has room to improve.

LTSS helps people who need assistance with activities of daily living like bathing and dressing, because of physical, cognitive, or chronic health conditions. States must address the five performance measures more quickly to keep up with shifting demographics, according to the new report.

The oldest baby boomers will begin turning 80 in less than a decade, the report noted, and the pace of improving LTSS for older people and adults with disabilities is moving far too slowly. To reach these benchmarks by 2026, when the demand for LTSS peaks, the rate of improvement must triple (or in some cases, quadruple), the report concluded.

The AARP Foundation, Commonwealth Fund and SCAN Foundation funded creation of the scorecard.

“People age 65 today have 50-50 chance of needing long-term services and supports, Susan Reinhard, R.N., Ph.D., AARP’s senior vice president of public policy and the report’s lead author, said in a June 13 media conference call. “If not you, it might be your spouse or sibling. So this affects everybody.”

This is the third edition of the scorecard, which evaluates all 50 states and the District of Columbia on their performance in five areas: affordability and access, choice of setting and provider, quality of life and care; support for family caregivers and enabling effective transitions between nursing homes, hospitals and homes.

While many states showed improvement in some areas, others, such as Kentucky, Indiana, and Mississippi, still fall far short of goals in all five categories.  Many states made good progress in reducing inappropriate “off-label” use of antipsychotic medications among nursing home residents and in increasing support for family caregivers. Most states showed no real change on “affordability and access,” meaning that the cost of LTSS over time continues to be much higher than the majority of families can afford.

The report states that nearly two-thirds of Medicaid spending focuses on older adults and people with disabilities. A majority of the money pays for nursing home care and home- and community-based services. “It’s especially timely now, because these services are at great risk in light of the potential repeal of the Affordable Care Act,” she said.  As people with disabilities live longer and baby boomers grow older, the LTSS need will increase significantly, both in the number of affected people and as a percentage of the U.S. population.

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com and other outlets. She is a senior fellow at the Center for Health, Media & Policy at Hunter College in New York City, and co-produces HealthStyles for WBAI-FM/Pacifica Radio.
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