Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers
Better data are needed to assess state LTSS system performance
At this time, limited data make it difficult to fully measure key concerns of the public and of policymakers, including the availability of housing with services, accessible transportation, funding of respite care for family caregivers, and community integration of people with disabilities. Improving consistent, state-level data collection is essential to evaluating state LTSS system performance more comprehensively. Most critically, an important characteristic of a high-performing LTSS system identified by the Scorecard team—how well states ensure effective transitions between hospitals, nursing homes, and home care settings and how well LTSS are coordinated with primary care, acute care, and social services—cannot be adequately measured with currently available data.
It is our hope that improved data collection will enable future Scorecards to expand upon the strong set of foundational indicators in this initial State LTSS Scorecard and provide a more complete and comprehensive analysis of LTSS system performance in the future.
The cost of LTSS is unaffordable for middle-income families
The cost of services, especially in nursing homes, is not "affordable" in any state. The national average cost of nursing home care is 241 percent of the average annual household income of older adults. Even in the five most affordable states, the cost averages 171 percent of income, and in the least affordable states it averages an astonishing 374 percent. When the cost of care exceeds median income to such a great degree, many people with LTSS needs will exhaust their life savings and eventually turn to the public safety net for assistance.
Though less extreme, the cost of home health care services also is unaffordable for the typical user, averaging 88 percent of household income for older adults nationally. People who receive home care services must add these costs to all their other living expenses. If they cannot afford the home care services they need, they may place added burdens on family caregivers who most likely already are providing services.