State 'average' in long-term care services

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State 'average' in long-term care services

Life is no brief candle to me.  It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations — George Bernard Shaw, Irish Playwright (1856-1950)

Maryland ranks 24th out of the 50 states and Washington, D.C. for providing long-term care services and supports (LTSS) to its citizens.  This number comes from a recent report by AARP, the SCAN Foundation and the Commonwealth Fund rating each state’s performance with regard to LTSS.  Minnesota was ranked first and Mississippi last. Researchers insist that “even the top-performing states have some opportunities for improvement.

The Scorecard evaluates each state on four criteria:  (1) accessibility and affordability of services, (2) choice of setting and provider, (3) quality of life and care, and (4) support for family caregivers.  The Scorecard assessed each state’s performance as a whole and on 25 individual indicators, some of which were measured for the first time.

Maryland’s highest rating was in the category of affordability and access to services, where we ranked third overall. The study evaluated costs as a percentage of median household incomes of those over 65 according to 2010 statistics.  From other familiar statistics and census reports, we know that Maryland has among the highest median household income in the United States, including households over age 65.

In the category of “choice of setting and provider”, we ranked 28th.  Items within that category included Percent of Medicaid and state-funded LTSS spending going to Home and Community Based Services for older people and adults with physical disabilities.  In other words, is the state using government funds to support the idea of aging in place and allowing people needing care to remain at home? There are six other sub-categories under “choice of setting and provider” so the one just mentioned is only part of the picture.

In the category “quality of life and quality of care” our state ranked 33.  And, finally, in the category “Support for Family Caregivers” we ranked 34th – our lowest.

Public policy plays such an important role in LTSS systems by establishing who is eligible for assistance, what services are provided, how quality is monitored, and the ways in which family caregivers are supported.  The role of public policy is especially critical because the cost of services exceeds the ability to pay for most middle-income families.  Even in the most “affordable” states, the cost of nursing home care exceeds median income for the older population.

Public policy is so important that it could be very helpful if readers would contact their state Delegates and Senators, in addition to their federal representatives, to ask them to take action to ensure that alternatives to nursing homes are available, that there is an effective safety net that helps people who are not able to pay for care, and that family caregivers – who provide the largest share of help – receive the support they need and help to prevent burnout.

The Scorecard found wide variation across all dimensions of state LTSS system performance.  Part of this variation is attributable, according to the report, to the fact that the United States does not have a signle, unified approach to the provision of LTSS.  The primary program that funds LTSS is Medicaid.  Medicaid is a federal-state partnership that gives states substantial flexibility to determine who is eligible for LTSS, how LTSS are accessed, what services will be provided, what the payment rates will be, and where services will be delivered.

This flexibility does provide opportunities to learn from creative approaches to delivering services, yet results in disparities in the support available to frail older people and low-income people with disabilities.  Geography should not determine whether people who need LTSS have a range of choices for affordable, high-quality services.

Generally, Scorecard researchers contend that states with the highest level of performance have enacted public policies designed to:  improve access to services and choices in service delivery by directing state 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 to improve support for family caregivers by offering legal protections as well as other services to address caregiver needs.

The purpose of the Scorecard according to its authors is “to help states improve the performance of their LTSS systems so that older people and adults with disabilities in all states can exercise choice and control over their lives, thereby maximizing their independence and well-being.”  The report indicates that the researchers hope that the Scorecard will begin a dialogue among key stakeholders so that lagging states can learn from top performers and all states can target improvements where they are most needed.

The scorecard was designed to help states improve the performance of their LTSS systems.  It also underscores the need for states to develop better measures of performance over a broader range of services.

The report is available, as well as the scorecard by state, at

Thank you for reading.  Stay well.  See you next week


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