The quality and accessibility of long-term supports and services depends in large part on where you live, according to a new report by AARP, The Commonwealth Fund, and the SCAN Foundation.
Eight states—Minnesota, Washington, Oregon, Colorado, Alaska, Hawaii, Vermont, and Wisconsin—provide the best care by nearly all of AARP’s measures. Kentucky, Alabama, Mississippi, Tennessee, West Virginia, and Indiana provide the worst, pretty much across each of the five main indicators in the survey.
The study looks at nearly two dozen measures—from access to Medicaid’s home-based care programs to private long-term care insurance coverage to the quality and cost of nursing homes and home care. It divides those measures into five main categories—affordability and access of care, choice of setting and provider, quality of life and quality of care, support for family caregivers, and effective transitions in and out of nursing homes.
Two main trends jumped out at me: The first was the consistency within the best and worst states. Those eight top-ranked states did well across the board. And the bottom six were consistently below average across all of AARP’s indicators.
The other was the tremendous variation among states. The best states were far better than the worst. The gap was, in fact, enormous.
Here are two examples: Among the top-ranked states, an average of about 7 percent of long-stay nursing home residents are hospitalized within a six month period. But among the lowest-ranked states, the percentage soared to nearly 19 percent—almost one in five. Similarly, the highest-ranked states spent an average of about two-thirds of their Medicaid long-term care dollars on home and community based care, twice what the lowest rank states spent.
Variation is important because it says that states can do better if they want to. If there is a secret sauce for keeping nursing home residents out of hospitals, some states have found it. The others could if they’d just look a little harder. Or committed the resources to fixing the problem.
If you compare the new AARP study with another state survey just published by the United Health Foundation, the story is remarkably similar: States such as Minnesota, Hawaii, Colorado, and Oregon score in the top 10 in both studies. States such as Kentucky, Mississippi, West Virginia, and Alabama land in the bottom 10.
The studies were not identical. AARP targeted only long-term supports and services among the states, both for seniors and other adults with disabilities. United Health looked more broadly at quality of life issues, but only for seniors.
Of course, these studies measure only certain objective service-based indicators. They did not include more subjective factors that can be critical for frail elders and other adults with disabilities. For instance, Minnesota may have a top-rated system for long-term supports and services, but it also has its winters.
And neither AARP nor United attempted to measure what may be the single most important factor in determining someone’s quality of life in frail old age: Do they have a caring, competent family caregiver?
AARP and United Health are not advising people to buy snow boots and move to Minnesota. They are suggesting that many states can do better when it comes to supporting high-quality services for frail elders and adults with disabilities.
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