A Short Look at Long-Term Services.

• Author: Scotti, Samantha
• Position: STATESTATS - "State Scorecard" of the AARP Public Policy Institute, the Commonwealth Fund, and the SCAN Foundation

As the population ages and new technologies allow more independence for those with disabilities, states are re-evaluating their long-term services and supports systems. And, because Medicaid remains the largest single payer of these services, state policymakers have a keen interest in improving them in ways that also control costs. Medicaid accounted for 19.7 percent of spending from state general funds in FY 2015.

AARP's Public Policy Institute, The Commonwealth Fund and The SCAN Foundation created a "State Scorecard" to quicken the pace of enhancements to long-term services and supports. By providing comparable state data, the scorecard tracks each state's performance and progress and identifies areas for improvement. In its third year, the scorecard measures several indicators in five categories considered essential to high-performing long-term services and support systems:

1. Affordability of and access to services

2. Choice of service setting and provider

3. Quality of life and quality of care

4. Support for family caregivers

5. Effective transitions between care settings and medical facilities

What Are These Services?

Long-term services and supports help older adults and people with disabilities or chronic diseases accomplish everyday tasks, like bathing, dressing, driving to the doctor, going grocery shopping, preparing meals, taking their medicines and managing a home-activities many of us take for granted. These services can last for several weeks, months or years and are offered through nursing homes, home health aides, personal care providers, transportation drivers, adult day care programs, as well as family members.

Areas of Improvement

The scorecard shows 23 areas in which at least one state has improved since 2015. The most active areas have been in reducing the use of antipsychotic drugs in nursing homes (48 states) and offering more person- and family-centered care (42 states).

Who Pays for Long-Term Services and Supports? The country spent $310 billion on a wide array of long-term services in 2013. Medicaid 51% Out-of-Pocket 19% Private Insurance 8% Other Public 21% Note: Table made from pie chart. Indicator Improvement Performance Decline Affordability and Access Nursing Home Cost 5 4 Home Care Cost 5 0 Long-Term Care Insurance 0 3 Low-Income People with 15 4 Disabilities with Medicaid People with Disabilities with 4 5 Medicaid LTSS Choice of Setting and Provider Medicaid LTSS Balance: Spending 17 7 Medicaid LTSS Balance...