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Long-term services and supports: Report ranks states

June 23, 2014
by Lois A. Bowers, Senior Editor
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Widespread disparities exist across the country in terms of long-term services and supports (LTSS) offered by states and the District of Columbia, finds a new report issued by the AARP, the Commonwealth Fund and the SCAN Foundation. The research examines nursing homes and other residential services, home care services, and supports for family caregivers, updating a 2011 effort.

“This scorecard shows that all states have work to do on improving their systems of care, including assessing people’s needs in a uniform way, helping people transition back home after a medical intervention and increasing the affordability of services regardless of who pays,” says Bruce Chernof, president and CEO of the SCAN Foundation. “As recognized by last year’s federal Commission on Long-Term Care, the responsibility for realizing these kinds of improvements means greater action by both state and federal leaders.”

The report, titled “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities and Family Caregivers,” evaluates 26 indicators in five dimensions that make up the LTSS system in each state/district. The dimensions include affordability and access, choice of setting and provider, quality of life and quality of care, support for family caregivers, and effective transitions. New indicators this year include length of stay in nursing homes and use of anti-psychotic drugs by nursing homes.

The highest-ranked states/districts, considered by report authors to offer the best LTSS:

  • Minnesota (#1),
  • Washington,
  • Oregon,
  • Colorado and
  • Alaska.

The lowest-ranked states/districts:

  • Indiana,
  • Tennessee,
  • Mississippi,
  • Alabama and
  • Kentucky (#51).

Top-ranked states use nursing homes less and minimize transitions between care settings, according to report authors. The leading states also have implemented laws and policies that are thought to strengthen Medicaid programs and support family caregivers, according to report authors. These laws include paid sick leave, nurse delegation of health maintenance tasks and devotion of more Medicaid dollars to home- and community-based services (HCBS).

The single strongest predictor of overall LTSS system performance is the reach of a state’s Medicaid LTSS safety net, report authors said. Twenty-four states have increased the percentage of Medicaid LTSS dollars that support HCBS in recent years, but widespread disparity exists across the states. For instance, the five top-ranked states dedicate 62.5 percent of Medicaid LTSS dollars to HCBS, whereas the lowest-ranking five devote 16.7 percent.



Colorado has been a leader in post acute care since the early 1990's for several reasons:

A large number of board certified geriatricians were hired by GeriMed of America to provide care for the elders in our community. These physicians then also hired more board certified geriatrians over the years resulting in Colorado having more geriatricians practicing medicine than any other state.

These geriatricians and administrators then also embraced Dr. Bill Thomas vision for better long-term care and were advocates for the Eden Alternative and the Greenhouses with many becoming members of the Pioneer Network and Colorado Culture Change Coalition. These same individuals have also held leadership positions nationally with these same organizations.

The geriatricians are also active in the health care community serving as Medical Directors in hospitals and long term care facilities. These same physicians are also involved in the American Medical Directors Association and attend the national meeting yearly; they have received CMD certification and are also involved in the Colorado chapter.

Thank you for the insights, Linda. I'm sure your peers will find them helpful.