Delaware ranks twenty-eighth overall when it comes to meeting the long-term care needs of older residents and people with disabilities, but AARP warns more must be done, at an accelerated pace, to meet changing demographic demands. Specific areas of concern in Delaware include “Support for Family Caregivers,” in particular the area of nurse delegation and nurse practitioner scope of practice. 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.
Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers –the third in a series of reports—ranks each state overall and on 25 specific indicators in 5 key dimensions: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and, effective transitions between nursing homes, hospitals and homes.
“The vast majority of older Delawareans want to live independently, at home, as they age—most with the help of unpaid family caregivers,” says Lucretia Young, state director of AARP Delaware, which serves more than 183,000 members age 50 and older in Delaware. “Even facing tight budgets, Delaware is making clear progress to help our older residents achieve that goal. However, this Scorecard shows we have more to do, and we need to pick up the pace.”
Today, unpaid family caregivers provide the bulk of care for older Delawareans in part because the cost of long-term care remains unaffordable for most middle income families. In Delaware, more than 123,000 residents 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. The value of this unpaid care totals about $1.58 billion.
Delaware is making progress in its efforts to support family caregivers, as evidenced by the passage of the CARE Act in 2016, yet much more can and needs to be done. An important step in the right direction toward better support for family caregivers is to give nurses more authority to heal. Delaware ranks 41st out of all states on this indicator. Nurse practitioners should be able to practice to the fullest extent of their education and training. This would help Delaware family caregivers more easily access quality care. The scorecard ranked Delaware as having “reduced practice authority.”
Another area that would improve support for family caregivers is nurse delegation. Currently in Delaware, home health aides are limited on tasks they are permitted to perform. For example, they are not allowed to manage medications. Nurse delegation would allow registered nurses to delegate some tasks to health care workers under their supervision. This would remove a burden from the family caregiver who often can’t be home to perform a variety of tasks such as medication management.
Both nurse delegation and nurse practitioner scope of practice ranked forty-first among all states, signaling a need for improvement.
“We should explore all options to keep our loved ones and seniors in the home, including a possible expanded scope of practice,” said Lt. Governor Bethany Hall-Long. “Having championed the CARE Act, I know how critical it is to be able to provide quality care in a home setting.”
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 working to expand services provided at home and in the community, by shifting funds away from low-quality nursing homes and more expensive nursing home care. Inappropriate use of antipsychotic medication in nursing homes has decreased, as has the number of patients with pressure sores.
Delaware ranks thirty-fifth in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care provided at home and in the community—the care setting that most Delawareans prefer—the Scorecard spotlights areas that call for improvement, specifically the percent of adults with disabilities at or below poverty receiving Medicaid.
“This Scorecard gives us a snapshot of how well Delaware’s system serves our older residents, those with disabilities, and family caregivers—and shows us where we must sharpen our focus to better assist hardworking Delawareans, concludes Young. “Now is the time for policymakers to act.”
Of the 25 Scorecard indicators, many may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched in 2014, to help older Americans live independently, at home, and the family caregivers that support them.
The Scorecard reveals that in less than 10 years, Boomers will begin to turn 80, placing new expectations and demands on a still imperfect long-term care system. Further, this generation will have far fewer potential family caregivers to provide unpaid help.
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 full state Scorecard, along with an interactive map of state rankings and information, is available at www.longtermscorecard.org.