The quality of care for the frail elderly and adults with disabilities and the assistance available for their family caregivers varies widely among the states. Now, for the first time, researchers at AARP have tried to measure where you can get the highest quality care. And the differences among the states are even more dramatic than I thought.
A handful, including Minnesota, Washington, Oregon, and Maine, score at or near the top in each of four broad quality measures–affordability and access, choice of setting and providers, quality of life and care, and support for family caregivers. By contrast, a half-dozen states landed at or near the bottom of all four measures–including Mississippi, Alabama, West Virginia, Oklahoma, Indiana, and Florida.
Within those broad categories, AARP looked at dozens of specific indicators. For instance, its review of quality of life and care measures the percent of adults living in the community who believe they are getting needed help and are satisfied with their lives. It tracks nursing homes residents with pressure ulcers, those who are restrained, those with hospital admissions, and turnover rates at nursing facilities.
The report, funded by the Commonwealth Fund and the SCAN Foundation, left out one key indicator, quality of care transitions, simply because the researchers could find no data. This is a huge omission given the importance of integrating care across settings, and I hope (though don’t expect) it will spur governments and providers to start collecting this information.
There are lots of interesting tidbits, and I hope to come back to some of them in coming weeks. But here are a few highlights:
For the most part, states are like the little blond girl. When they are good, they are very good. When they are bad, they are very bad. Those states that rated highest do almost everything relatively well. Those at the bottom struggle to get anything right.
Some of those states ranked in the middle, however, are an interesting mix of very good and very bad. Pennsylvania, for instance, rates highly in choice of setting and providers. But it is terrible when it comes to caregiver supports and affordability and access of care
Not surprisingly, for the most part rich states do best and poor states do the worst. But there are exceptions. For instance, Wyoming, with one of the lowest poverty rates and highest per capita incomes, ranks only 20th in overall long-term services. By contrast, New Mexico, with one of the nation’s highest poverty rates and lowest per capita incomes, rates 26th.
And for those political junkies who want to know about Texas, the home state of Governor Rick Perry, the Lone Star State is squarely in the middle of the pack at 28th. It does best at affordability and access and worst at quality of life and quality of care.
The study makes three big contributions. First, it did a great job pulling together lots of research into one place. That makes it possible to compare states across lots of different measures, instead of looking at these issues in isolation. Second, it provides a good overall sense of how states do in caring for frail seniors and adults with disabilities. Finally, and maybe most important, it sets a baseline against which we can measure future changes.
This is going to be really important as states cut back social services in coming years. Will they be able to reduce spending but maintain quality? And if not, what measures will suffer the most? This will be worth watching closely over the next couple of years. I hope AARP will get the funds to update this important report.