Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers
Published: September 08, 2011 Authors: Susan C. Reinhard, Enid Kassner, Ari Houser, and Robert Mollica

NEW PUBLICATIONS: Read a new set of related case studies that highlight the differences between high- and low-performing states. The case studies cover the top-ranked state (Minnesota), a middle-ranked state (Idaho), and a low-ranked state (Georgia).

Overview

This State Long-Term Services and Supports (LTSS) Scorecard is the first of its kind: a multidimensional approach to measure state-level performance of LTSS systems that provide assistance to older people and adults with disabilities. Performance varies tremendously across the states with LTSS systems in leading states having markedly different characteristics than those in lagging states. Yet even the top-performing states have some opportunities for improvement.

The Scorecard examines state performance across four key dimensions of LTSS system performance: (1) affordability and access; (2) choice of setting and provider; (3) quality of life and quality of care; and (4) support for family caregivers. It is designed to help states improve the performance of their LTSS systems. It also underscores the need for states to develop better measures of performance over a broader range of services and collect data to more comprehensively assess the adequacy of their LTSS systems.

Executive Summary

This State Long-Term Services and Supports Scorecard is the first of its kind: a multidimensional approach to measure state-level performance of long-term services and supports (LTSS) systems that provide assistance to older people and adults with disabilities. Analysis of the "starter set" of indicators included in this report finds that performance varies tremendously across the states with LTSS systems in leading states having markedly different characteristics than those in lagging states. Yet even the top-performing states have some opportunities for improvement. In general, the states at the very highest levels of performance have enacted public policies designed to:

  • improve access to needed services and choice in their delivery by transforming their Medicaid programs to cover more of the population in need and offer the alternatives to nursing homes that most people prefer;
  • facilitate access to information and services by developing effective "single point of entry" systems so that people who need services can find help easily; and
  • address the needs of family caregivers by offering legal protections as well as the support and services that can help prevent burnout.

Exhibit 1 Public policy plays an important role in LTSS systems by establishing who is eligible for assistance, what services are provided, how quality is monitored, and the ways in which family caregivers are supported. Its role is especially critical because the cost of services exceeds the ability to pay for most middle-income families. Even in the most "affordable" states, the cost of nursing home care exceeds median income for the older population. Thus, states need to take action to ensure that alternatives to nursing homes are available, an effective safety net helps people who are not able to pay for care, and family caregivers, who provide the largest share of help, receive the support they need. States also have a leading role to play in ensuring that the LTSS delivered in all settings are of high quality. But public policy is not the only factor affecting state LTSS performance: actions of providers and other private sector forces affect state performance either independently, or in conjunction with the public sector.

 

Podcast

Scorecard Offers Vision of Improved Long Term Services

The first of 70 million baby boomers turn 65 this year, and long-term services and supports (LTSS), which include home care, assisted living, and nursing home care, are on the rise. To help states identify gaps, AARP’s Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation, developed the first state LTSS scorecard.

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The 2011 Long-Term Services and Supports Scorecard: Learning from Top-Performing States