Long-Term Care Critiques, State-by-State

The report cards are out and for many states, remediation will be needed.

The report, “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers,” shows that most states need to improve in areas of home care, assisted living, nursing home care and family caregiver support.  The report was released jointly by AARP’s Public Policy Institute, The Commonwealth Fund and The SCAN Foundation and examined 25 individual factors relating to four areas or interest in the long-term care industry: Long-term care evaluations by state

  1. Affordability and access
  2. Choice of setting and provider
  3. Quality of life and quality of care
  4. Support for family caregivers

The states were ranked as a whole, based upon their performances.  According to the report, the states ranking the highest have made strides in public policy surrounding the aging with direction being given to state Medicaid programs.  They also show to have more options available as an alternative to nursing home placement.

The South East as a region fared the worst in the study with most of the states ranking in the bottom quarter.  The top states were spread throughout the country, with Minnesota garnering the number one spot.

Minnesota offers quality long-term care

Minnesota ranked number one in several of the 25 categories, including number of assisted living facilities per 1000 people (80), the number of home health aides per 1000 people(108), the percentage of high-risk nursing home patients with pressures sore (6.6%) and the percentage of long-term nursing home patients requiring hospitalization (8.3%). The lowest ranking state, Mississippi, in comparison only had 14 assisted living facilities per 1000 people and 13 home health aides per 1000 people.  It also had nearly double the percent of nursing home patients with pressure sore (12%) and four times the number of long-term nursing home patients requiring hospitalization (32%).

Proof is in the numbers

So why is this report important? It provides possibilities.  It is possible for facilities and states to limit the number of rehospitalizations and center-acquired pressure ulcers.  It is possible to provide affordable housing and opportunities for long-term care.

The authors of the report suggest that if all of the low-performing states were to reach the levels that the highest states have maintained, the nation could see vast improvements in care for the elderly.  They estimated that 667,171 more individuals with disabilities would covered by Medicaid, 120,602 fewer avoidable hospitalizations and 201,531 fewer unnecessary nursing home admissions.

The intial costs of such programs may costly, but the decreased number of hospitalizations alone could save the country more than $1.6 billion.  More importantly, the care of our nation’s senior citizens would improve dramatically.  Where does your state rank? From what you know about long-term care do you think it’s a fair assessment?

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3 Responses to “Long-Term Care Critiques, State-by-State”

  1. Dear Ms. Stringfellow,

    The goals of the SCAN Foundation (et al) Report are laudable: after all, who would want to see elderly inpatients suffering from *more* pressure sores? Who would recommend against more Home Health Aides per recipient? No one.

    The disconnect occurs when the solutions point us down the same road which gave rise to the symptoms in the first place: an over-reliance on Medicaid.

    One need look no further than the ironically named section, “The Proof is in the Numbers”. I may mis-understand what’s being suggested, but covering 660,000 more individuals on Medicaid (and for back-of-the-napkin’s sake, I’ll use WA State HHC Medicaid Reimbursement Rates since I have them handy), would cost an additional $9.2B/yr. And for this we “save” $1.6B in hospitalization costs? Am I missing something?

    Even so, saving scraps here or there is like re-arranging deck chairs on the Titanic. That’s why I find Reports like this so disingenuous to the public-at-large. The States, collectively, have a $121B Debt going into FY 2012, and unlike the Federal Gov’t, must balance their budgets. Behind Education, Medicaid is typically the 2nd largest item and faces terrible pressures going forward.

    At the Federal Level, Medicaid is responsible for $103B of our nation’s LTC bill, and according to a GAO Report at the beginning of the year, our 3 Entitlement Programs will soon put the Country out of business. As soon as 2020, 89 cents of every Federal dollar could go to Social Security, Medicare, Medicaid, and Interest: http://www.gao.gov/new.items/d11451sp.pdf

    So whenever I read recommendations which presume a great expansion of Medicaid and its services, I have to take those with a grain of salt. They sound good in theory, the ideals are worthy… but the money simply is not there.

    (These sorts of dire warnings like the GAO Report above, have been generated for 20 or 30 years… but there’s been no political will in Washington to enact the necessary changes, regardless of political persuasion. Just like the “Doc Fix” whose can has been kicked down the road every time it’s come up for a vote, no one wants to take responsibility.)

    Thank you for listening to an alternative opinion.

    Best regards,
    Stephen D. Forman
    Senior Vice-President, LTCA INC
    Follow @ltcassociates

  2. Angela Stringfellow says:

    Hi Stephen,

    Thanks for sharing your thoughts. You’re right in that there’s simply no easy solution to the crisis we’ve found ourselves in. What will happen to our public programs, such as Medicare, Medicaid and Social Security, no one can adequately predict. The one thing that is certain in all of this is that these are costly programs.

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