The scoring and ranking methodology in the 2020 Long-Term Services and Supports (LTSS) State Scorecard is based on the same methodology used in previous LTSS State Scorecards. As in the 2017 Scorecard, the Quality of Life and Quality of Care dimension is given half the weight of the other dimensions in determining the overall rank and the Support for Family Caregivers dimension is calculated as a single composite rather than an average of indicator ranks. These changes are discussed in more detail below.
Dimensions and Indicators: The Scorecard measures LTSS system performance using 26 indicators (or policy categories) across 5 dimensions:
- Affordability and Access (6 indicators)
- Choice of Setting and Provider (7 indicators)
- Quality of Life and Quality of Care (4 indicators)
- Support for Family Caregivers (12 policy areas, grouped into 4 broad categories)
- Effective Transitions (5 indicators)
The framework for assessing LTSS system performance was developed in consultation with the Scorecard National Advisory Panel (NAP). NAP members are listed in the acknowledgments section of the 2020 LTSS Scorecard report, which can be found on the LTSS Scorecard website www.longtermscorecard.org. The NAP was instrumental in providing and evaluating the merits of the data indicators that populate each of the five dimensions. The NAP also helped refine some indicators from the past Scorecard.
The indicator selection criteria included the following conditions: indicators had to be clear, important, meaningful, and have comparable data available at the state level. Several composite indicators were constructed from a range of data in a related area, enabling us to rank states in areas of performance that would otherwise be difficult to assess. The methodology for each composite indicator is described in the detailed indicator descriptions. Indicators are based on data that are expected to be updated regularly, so that change can be observed over time.
The 26 indicators were selected because they represent the best available measures at the state level. No single indicator fully captures state performance but taken together they provide a useful measure of how state LTSS systems compare across a range of important dimensions.
Ranking Methodology: The Scorecard ranks the states from highest to lowest performance on each indicator in the Affordability and Access, Choice of Setting and Provider, Quality of Life and Quality of Care, and Effective Transitions dimensions. Within each of these four dimensions, individual indicator ranks are averaged, and those averages are then re-ranked for dimension-level ranks. The Support for Family Caregivers dimension is a single composite across all 12 policy areas, and dimension rank is based on the total composite score.
The dimension ranks are then averaged (with the Quality dimension given one-half the weight) and re-ranked to compute the overall ranking of LTSS system performance. In the case of missing data or ties in rank, minor adjustments were made to values used in calculating the average.
- For ties: the average rank is given for the computation of the dimension or overall average (e.g., two states tied at third; both get a score of 3.5 for the calculation of the dimension average).
- Missing data: a constant value is added to all ranks so that the average rank for the indicator is 26 (e.g., if two states are missing data for an indicator, the remaining states rank 2 to 50 for the calculation of the dimension average).
One of the main goals of this report is to assess how state LTSS systems improved or declined between the 2017 Scorecard and the 2020 Scorecard. However, state ranks at the dimension and overall levels should not be compared directly between the current Scorecard and prior Scorecards. There are significant changes in the methodology and indicator sets, so changes in rank may not reflect actual changes in relative performance.