The Best and Worst States for Long-Term Care

Sept. 8, 2011 -- Geography determines the type of long-term care available to Americans, a new report suggests.

The "scorecard" report finds that states vary widely in the services they provide to the elderly, to disabled adults, and to the family caregivers who support them.

"Our intention is that this 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 authors write.

The scorecard is a collaboration between the AARP's Public Policy Institute, the Commonwealth Fund, and the Scan Foundation. It ranks states' performance according to four categories:

1. Affordability and access
2. Patient choice of both provider and setting
3. Quality of life and care
4. Support for family caregivers

The Best and the Worst

Overall, the five states that scored the highest were:

1. Minnesota
2. Washington
3. Oregon
4. Hawaii
5. Wisconsin

The lowest scores went to:

1. Mississippi
2. Alabama
3. West Virginia
4. Oklahoma
5. Indiana

A list of all the states can be found at www.longtermscorecard.org.

The authors of the report point out that even the states with the highest scores need to improve the services they provide. They also note that each of the lowest ranked states performed well in at least some of the categories measured.

"There was wide variation across the states as well as within states," Bruce Chernof, MD, FACS, president and CEO of The SCAN Foundation, told reporters during a telebriefing.

Affordability and Accessibility

Long-term care is unaffordable for middle income families, according to the report. Even in states where nursing home care is most affordable, such care averages 171% of an older person's household income. The national average is 241%.

For home care, the numbers are less staggering. But at an average of 88% of income nationwide, they still put a great stress on household means.

"We looked at affordability, and it's just not affordable," Susan Reinhard, senior vice president for public policy at AARP, told reporters.

Accessibility is also an issue. As the report points out, states have a great amount of flexibility when it comes to determining Medicaid eligibility.

The numbers reveal how well their different systems work. The top five states cover an average of 63% of their low- to moderate-income population that requires long-term care. The worst states cover only 20%. The nationwide average is 37%.

"States need to streamline eligibility rather than make it complicated to get into the system," Reinhard told reporters.

Most people, the authors write, prefer receiving care in their home or in a home-like setting in their community that affords them some measure of independence.

Choice, however, is in short supply in the worst states. In those states, only 26% of new Medicaid recipients benefit from home or community-based support (HCBS). By contrast, more than three-quarters of those receiving Medicaid in the five best states opt for HCBS.