State performance in providing long-term services and supports for older adults, people with disabilities and family caregivers remains steady, according to the recent report “Advancing Action: A State Scorecard on Long-Term Services and Supports.” In addition, more than 20 states showed improvement in a handful of areas, including supporting working family caregivers, supporting person- and family-centered care and ensuring appropriate use of antipsychotic medications in nursing homes.
In its fourth edition, the scorecard, which is produced by AARP’s Public Policy Institute and supported by The Commonwealth Fund and The SCAN Foundation, provides comparable state data, measures progress and identifies areas for improvement.
Improving long-term services and supports (LTSS) has long been a priority for state legislatures. Not only do these services provide daily assistance to millions of older adults and people with disabilities, but they are also primarily paid for by Medicaid, which takes up a substantial portion of states’ budgets. The coronavirus pandemic underscored the importance of well-performing health care and LTSS systems that protect older adults and people with underlying health conditions, particularly as these groups are more susceptible to severe illness or death caused by COVID-19.
To create efficient LTSS systems, many states first assess their current arrangements. Policymakers may use various sources in their assessments, including state data, experts from their state agencies, state advocacy groups, and external tools such as the new state scorecard. The scorecard measures several indicators in five dimensions considered important to high-performing LTSS systems. These include:
- Affordability of and access to services.
- Choice of service setting and provider.
- Quality of life and quality of care.
- Support for family caregivers.
- Effective transitions between care settings and medical facilities.
While the pandemic clearly affects how LTSS are delivered, COVID-19-related data is not included in this edition of the scorecard due to timing. The measures are, however, linked to improving delivery systems that meet the needs of a population disproportionately affected by the virus. In fact, 40% of total COVID-19 deaths in the U.S. are associated with long-term care facilities, thus making LTSS delivery a timely discussion in the midst of this global crisis.
The scorecard highlights various innovative practices and strategies across the indicators for states to consider in refining their LTSS systems. For example, more than half the states (29) improved significantly on supporting person- and family-centered care (see chart below). This progress was linked to policies in such areas as conducting assessments of family caregivers for their own health needs and well-being, providing financial protection for spouses of Medicaid beneficiaries who receive home- and community-based services, and supporting caregivers as they help care recipients move from the hospital to home.
With largely incremental overall improvement at a time of increasing LTSS demand, the findings suggest that there may be multiple opportunities for states to enhance delivery of LTSS options for their residents.
Those wanting to learn more about best practices and innovations can look to the recipients of The SCAN Foundation’s Pacesetter Prize, which recognizes states “making significant progress in improving long-term services and supports … for older adults, people with disabilities and family caregivers,” according to its website.
More information on the scorecard and AARP’s “promising practices” can be found here.
Samantha Scotti is a senior policy specialist in NCSL’s Health Program.