Some states significantly out-perform others in the delivery of long-term services and supports (LTSS) to older adults and people with disabilities, according to a report recently released by AARP's Public Policy Institute, The Commonwealth Fund, and The SCAN Foundation.
However, even the top 3 states—Minnesota, Washington, and Oregon—have a long way to go to create a high-performing system of LTSS, the authors add.
Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People With Physical Disabilities, and Family Caregivers examines 4 key dimensions of state LTSS 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.
The scorecard shows that generally states with the highest level of performance have enacted public policies designed to improve access to services and choices in their delivery by directing Medicaid programs to serve more people in need and offer alternatives to nursing homes that most consumers prefer, establish a single point of system entry to help people find needed information and more easily access services, and enhance support for family caregivers by offering legal protections as well as other services to address caregiver needs.
Wide variation in performance in specific dimensions shows that all states can do better in areas where performance lags, say the author. For example, the report found that the percent of LTSS spent on home- and community-based services is 60% in the top 5 states, but only 13% in the bottom 5. The average is 37%. Additionally, the top 5 states cover 63% of Medicaid LTSS, while the bottom 5 cover 20%. The national average is 36%.