If You Need Long-Term Care, It Matters Where You Live

If you or a loved one needs long-term care, where you live matters…a lot. A new report by AARP shows wide variation in the quality of supports and services among states—whether delivered at home or in a nursing facility. While it found important improvements across states, it also identified significant shortcomings, even in the highest-rated states.

The best states to get care: Washington, Minnesota, Vermont, Oregon, and Alaska. Washington and Minnesota have been consistent leaders in the AARP reports, which began in 2011. The worst states: Tennessee, Mississippi,   Alabama, Kentucky, and Indiana.  However, Tennessee, along with New York, showed the greatest improvement since AARP’s last report in 2014.

The report is called “Picking Up the Pace of Change, 2017: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers. ” It measured supports across five dimensions: affordability and access;  consumer choice when picking a care setting;  quality; support for family caregivers; and effective integration of health, long-term supports and services, and social services that eases transitions among care settings.

There is a ton of good information in the report, and some useful online tools that allow you to play with the data. Here are just a few of the highlights–and lowlights.

Affordability of long-term supports and services. It is unaffordable for median-income families everywhere. But it is far more unaffordable in some states than others. AARP looked at the cost of both home care and nursing home care as a share of median household income for those 65 and older in each state.

On average, a year in a nursing home costs an average family more than twice their annual income (233 percent).  But in Utah, it costs nearly five times as much. In Oklahoma, it costs “only” 164 percent of median income.

Home care is less costly but there also are big differences among states.  On average, a family will pay about 80 cents of every dollar they make on home care.  But in the District of Columbia, they’ll spend about 50 cents while in Utah, they’ll spend all of their income on home care. One reason that DC ranks so high: People’s incomes are significantly higher than in other jurisdictions.

The likelihood of getting care in a nursing home vs. at home:  AARP looked at where people with low care needs lived, and found striking variation. In the top 5 states, one in 20 nursing home residents had low care needs. In the bottom 5 states, it was one-in-five.  In Maine, the rate was 4 percent. In Missouri, it was nearly 24 percent.

Medicaid funding for nursing home vs. community care. The study found huge differences in how much   states paid for Medicaid nursing home care compared to home and community-based care. On average, states spent about one-third of their Medicaid long-term care budgets on community-based care. But Minnesota, the top-ranked state, spent two-thirds while Alabama, the lowest-ranked, spent just 14 percent.

The report showed backsliding in a couple of important areas, including the percentage of long-stay nursing home residents who are able to return to the community.  Even among the Top 5 states–Utah, Oregon, Washington, Arizona, and Idaho—only 12 percent made it out of the nursing home.  In the lowest performing states, only 5 percent did so. Most troublingly, in nearly half the states the rate of transitions fell since 2014.

The report, funded by the Scan Foundation and the Commonwealth Fund, is a valuable tool for both   consumers and researchers. Its basic story–that there is wide variation among states in the quality and availability of long-term supports and services–is especially important today. Policymakers are debating changes in federal Medicaid law and other cuts in federal programs for those needing care. And those changes will only widen the differences among states.

If you or a loved one are going to need care in old age or due to a disability, it will matter more than ever where you live.

(Full disclosure: I served as an unpaid member of the AARP advisory panel on the report)

 

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