Long-term care systems are in a critical need of reform across the country, according to AARP’s latest report on the state of the sector.
The AARP report found that major gaps persisted in every state, especially related to support for family caregivers, the long-term care workforce, equity in nursing homes, and emergency preparedness.
A few key recommendations highlighted in the AARP report include prioritizing family caregivers, investing in community-based infrastructures and bolstering the workforce.
“Our ability to get this right largely depends on our ability to care for our loved ones, as a society that we are facing both health and mobility challenges down the road,” Susan Reinhard, senior vice president at AARP, said during a press briefing to discuss the report, noting that the number of people aged 65 and above are expected to surpass the number of children by 2030. “That requires providing both humane and holistic long-term care support and services.”
AARP’s Long-Term Services and Supports (LTSS) Scorecard for 2023 found that more than three years after the Covid-19 pandemic began, care provided in the United States for older adults and people with disabilities has been painfully inadequate.
According to the scorecard, Minnesota and Washington state outperformed all other states in the country, particularly due to strong support for family caregivers, and in providing many options in terms of health care providers and long-term care settings. The lowest scoring states were in the Southeast, with Alabama and West Virginia ranking last.
‘We do believe there is a silver lining’
Reinhard emphasized that the Covid-19 pandemic tested long-term care systems nationally, revealing shortcomings in many states.
“We do believe there’s a silver lining, and that in today’s scorecard you’ll have examples of states that are outperforming others, and they can provide a roadmap for progress across the country,” she said.
She also acknowledged the challenges posed by an aging population, including health and mobility issues, and emphasized the importance of providing humane and holistic long-term care support and services.
While some states have taken steps to innovate and implement new policies, such as paid leave for family caregivers and payroll tax credits, Reinhard noted that these policy efforts often fall short of meeting the needs of aging populations.
In recommending the changes, Reinhard acknowledged that reforming and modernizing long-term care systems won’t happen overnight, but the data in AARP’s scorecard report can guide state governors, legislators, and the federal government in making informed decisions.
With 48 million family caregivers providing over $600 billion in unpaid care, Reinhard called for measures like paid leave, tax credits, and other mechanisms to support their health and financial needs.
Reinhard also called for improving support and training for home health aides, increasing access to medical devices, and updating Medicaid regulations and payment models.
And as for addressing workforce shortages, Reinhard advocated for recruitment and training improvements, increased pay, and expanding the roles of healthcare professionals to provide better care.
Moreover, an emerging issue to pay attention to seems to be long-term care facilities having sufficient plans for national disasters and state hazard mitigations, Reinhard said.
Most Americans ‘want to age at home’
Rita Choula, the senior director of caregiving with AARP, said that even as most Americans aspire to age in place at home, the financial and emotional costs to family caregivers goes unacknowledged.
States have a long way to go in providing the necessary relief to family caregivers, she said.
“Only six states, Georgia, Missouri, Montana, New Jersey, North Dakota and South Carolina, provide a tax credit for family caregivers out of pocket expenses,” Choula said. “And just 12 states have enacted paid family leave laws while 18 states have paid sick day laws which can be used for caregiving needs. We must do better as a society.”
Home and Community-Based Services (HCBS) were another key area of focus of the AARP report, with Choula noting that more than half of Medicaid spending for older people and adults with disabilities goes to HCBS. This spending significantly supports home health aides, hospice care, and essential medical equipment needed for individuals living at home.
Nursing homes were also highlighted as needing more attention, with only 22% receiving top ratings nationally. Choula emphasized the need to close disparity gaps, particularly in communities of color, where inadequate long-term services and supports persist.
Industry stakeholders weigh in
One operator based in Vermont commented during the press briefing that there is a big gap for people who do not qualify for Medicaid.
“They make too much for Medicaid but they do not make enough to pay the private pay costs for many assisted living facilities if they can’t live alone anymore,” she said. “We’ve had a lot of long-term care facilities in the state of Vermont close because of staffing shortfalls and Medicaid reimbursement rates.”
Reinhard said those who have the highest income have more resources to pay for this care out-of-pocket and those with the lowest income and assets qualify for Medicaid, although they only really are entitled to nursing home care by federal law – and it’s up to the states to allow home and community-based care.
“Vermont has been a leader in the past in that area,” she said. “So it is a challenge. Now we also have an indicator around long-term care insurance which has a very low uptake across the country.”
Another industry stakeholder asked if there was any correlation between the high and low performing states and their Medicaid reimbursements.
Reinhard said that there was indeed a high correlation between states that pay a lot of attention to family caregivers and higher Medicaid reimbursements.
“And people with disabilities, as well as Medicaid payment policies ranked the highest,” Reinhard said. “It’s the strongest correlation in the performance in general because it’s showing that you’re paying attention to the people that are providing the care and where the care is being given. So Medicaid policy is extremely important and performance.”
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