Massachusetts ranks 18th nationwide when it comes to meeting the long-term care needs of older residents, but AARP warns more must be done, at a greatly accelerated pace, to bolster support for family caregivers, balance funding, and improve transitions from nursing homes to community-based care.
This, according to a new, comprehensive state-by-state Scorecard from AARP with support of the nation’s leading organizations behind quality long-term care, The Commonwealth Fund and SCAN Foundation.
Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers — an update of the inaugural 2011 Scorecard — ranks each state overall and within 26 performance indicators along five key dimensions: 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, raising concerns about the quality of institutional care.
Long-term care (also called long-term services and supports) is a diverse set of services designed to help older people and those with disabilities; services can be provided in a person’s home, in a community setting such as an adult day center, or in a group residential facility like a nursing home.
“The vast majority of older Americans want to live independently, at home, as they age — most with the help of unpaid family caregivers,” said Mike Festa, state director of AARP Massachusetts, which serves more than 810,000 members age 50 and older in the Commonwealth. “Even facing tight budgets following the Great Recession, Massachusetts is making some progress to help our older residents achieve that goal. However, this Scorecard shows we have a lot more to do, and we have to pick up the pace.”
The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net. That’s why AARP is also fighting to expand services provided at home and in the community, by shifting funds away from more expensive nursing home care and into community-based settings.
While Massachusetts ranks eighth in the nation for the percentage of older and disabled residents receiving Medicaid and state-funded supports and services for care provided at home and in the community — the care setting that most Massachusetts residents prefer — the Scorecard spotlights areas that call for improvement, including choice of setting and provider; quality of life and quality of care; and effective transitions from nursing homes to the community. Specifically:
•40 percent of Medicaid long-term services and support users first receiving services in the community;
•73 percent of adults getting needed social and emotional support;
•6.5 percent of people with 90+ day nursing home stays successfully transitioning back to the community.
The Scorecard reveals that in just 12 years, the leading edge of the baby boom generation will enter its 80s, placing new demands on a still imperfect long-term care system. Further, this generation will have far fewer potential family caregivers to provide unpaid help. “The gradual pace of improvement must accelerate to be ready for the aging baby boomers,” said Festa.
Today, unpaid family caregivers provide the bulk of care for older Massachusetts residents, in part because the cost of long-term care remains unaffordable for most middle income families. In Massachusetts more than 1,260,000 caregivers help their aging parents, spouses and other loved ones stay at home by providing assistance with bathing and dressing, transportation, finances, complex medical tasks like wound care and injections, and more.
“When it comes to helping older Massachusetts residents live in the setting of their choice, this silent army of family caregivers assumes the lion’s share of responsibility,” explained Festa. “Many juggle full-time jobs with their caregiving duties; others provide 24/7 care for their loved ones. With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly nursing homes — most often paid for by Medicaid. AARP Massachusetts supports increasing the rate of pay of workers and family caregivers who keep elders and individuals with disabilities living independently at home.”
According to the state Scorecard, 40 percent of family caregivers face some degree of stress and worry. Massachusetts has taken action to improve legal and systems supports for this group, allowing nurses to delegate basic health maintenance tasks, like checking blood sugar or temperatures, to home aides. But, more must be done.
That’s why AARP Massachusetts, in the next legislative session, will fight for the Caregiver, Advise, Record, Enable (CARE) Act that will help family caregivers when their loved ones go into the hospital — and as they return home. Specifically, the CARE Act will require hospitals to:
•Record the name of the family caregiver when their loved one is admitted.
•Notify the family caregiver when their loved one is to be moved or discharged.
•Give instructions of the tasks the family caregiver will need to perform while caring for their loved one at home.
AARP Massachusetts is also fighting to expand the scope of practice for advance practice nurses, thereby allowing them to have more authority to help patients and their family caregivers by using all of their health care knowledge and training.
AARP Massachusetts also supports the delegation of basic health maintenance tasks to home aides so that nurses will have better opportunity to help patients and their family caregivers. Currently, Massachusetts ranks 40th in the nation, with just two of 16 health maintenance tasks that can be performed by a direct care aide through delegation by a registered nurse.
“This Scorecard gives us a snapshot of how well Massachusetts serves our older residents, those with disabilities, and family caregivers — and shows us where we must sharpen our focus to better assist hardworking Massachusetts residents,” said Festa. “Now is the time for policymakers to act.”
Of the 26 Scorecard indicators, 13 may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched this year, to help older Americans live independently at home, and the family caregivers that support them.
The full state Scorecard, along with an interactive map of state rankings and information, is available at www.longtermscorecard.org.