A recent report released by AARP’s Public Policy Institute, The Commonwealth Fund and The SCAN Foundation entitled Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers, ranks New York 41st in providing Long-Term Services and Support (LTSS). The study focuses on four main areas: affordability and access; choice of setting and provider; quality of life and quality of care; and support for family caregivers, further broken down into 25 individual indicators. The report indicates that if New York were to implement practices of states within the top 25% (including Minnesota, Washington, and Oregon at the top of the list) it is estimated that New York would experience the following changes:
– 2,106 additional low- or moderate-income adults age 21 and older with disabilities requiring assistance with activity of daily living would be covered by Medicaid.
-18,079 additional new users of Medicaid LTSS would first receive services in home and community based settings instead of nursing homes.
-11,113 nursing home residents with low care needs would instead be able to receive LTSS in the community.
-9,195 unnecessary hospitalizations of people in nursing homes would be avoided. (AARP*)
Such highlighted practices and policies put in place by states in the top 25% that were also shown to have positive impacts included:
–Improving access to services and choices in their delivery by directing state Medicaid programs to serve more people in need and offer alternatives to nursing homes that most consumers prefer.
–Establishing a single point of system entry to help people find needed information and more easily access services.
–Improve support for family caregivers by offering legal protections as well as other services to address caregiver needs.
All states show areas of deficiencies where changes and improvements are warranted. The scorecard shows that all states could improve in areas such as “home care, assisted living, nursing home care, support for family caregivers, and more efficiently spending the substantial funds they currently allocate to LTSS.” (AARP*)
In terms of overall costs nationally, nursing homes are especially unaffordable, averaging 241% of annual household income. States in the top 25% have average nursing home care costs at 171% of household income. States ranking in the lowest 25% average these costs at an astonishing 374%.
According to the Henry J. Kaiser Foundation’ s Statehealthfacts.org New York ranks number one in Medicaid spending totaling at over $49 billion, yet only only a fraction ( $1.7B) of the state’s Medicaid expenditures go towards Home and Community-Based Services, while the five highest performing states spend 60% of their dollars on Home and Community-Based Services (HCBS) compared to the national average of 37%, reaching as low as 13% in the lowest performing five states. In regards to this area “states have substantial control over establishing financial eligibility standards for Medicaid coverage. States also have great flexibility to determine the level of disability needed to qualify services,” having a huge impact on who is covered under Medicaid and to what extent their services will include. This is an area where strides can be made on the state level towards public policy that focuses on less costly and more efficient HCBS. Some of these services include the Nursing Home Transition Diversion (NHTD) waiver program that provides a range of services including Service Coordination, Day Programs (Medical and Social Model), Respite Services, Community Transition Services, Respiratory Therapy, Nutritional Counseling/ Educational Services as well as financial assistance towards Environmental Modifications and Assistive Technology. Another common HCBS includes the Consumer Directed Personal Assistance Program (CDPAP) which allows individuals to hire, fire, and train their own caregivers, cutting out the administrative middleman and restrictions traditionally tied to personal care assistance (i.e. driving, medication administration). These services are essential for individuals with disabilities so that they may function in the community whether it be for vocational or recreational purposes. Providing these services is vital in keeping with the 1999 Supreme Court Olmstead decision affirming the rights of individuals with disabilities the civil right to be provided access to services geared towards the most integrated, independent, setting possible that will foster the least restrictive environment to their needs.
The reports’ summary states, “geography should not determine whether people who need LTSS have a range of choices for affordable, high-quality services. All Americans should share unified vision that supports the ability of older people to have choices, to be able to aid in their own homes with dignity and the support they need to maximize their independence. The lives of people with disabilities should be integrated into the community, where they can maintain social connections, engage productively through employment or other meaningful activities, and contribute to the rich diversity of American life.” (AARP*)
The entire report is available at http://www.longtermscorecard.org/