Delaware ranks 29th when it comes to meeting the long-term care needs of older residents, but AARP cautions more must be done, at an accelerated pace, to improve an individual’s choice of setting where they receive long term care. Delaware ranked toward the bottom in this area. Delaware also ranks in the bottom for Medicaid spending for community care. Despite increased Medicaid support for in-home care, Delaware still ranks 48th among all states. These findings are from 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.
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.
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 serious concerns about the quality of institutional care.
“The vast majority of older Delawareans want to live independently, at home, as they age – most with the help of unpaid family caregivers,” says Jeanne Nutter, state president of AARP Delaware, which serves more than 175,000 members age 50 and older in the First State. “Even facing tight budgets following the Great Recession, Delaware is making clear progress to help our older residents achieve that goal. However, this Scorecard shows we have more to do – and we don’t have time to stand idle.”
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 202,000 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 $1.5 billion.
“When it comes to helping older Delawareans live in the setting of their choice, this silent army of family caregivers assumes the lion’s share of responsibility,” explains Nutter. “As a caregiver for many friends and family members, I know what it’s like to juggle full-time work with caregiving duties that require time, energy and money. People want to be at home when they receive care, and that creates challenges when the supports aren’t 100 percent available.”
According to the state Scorecard, about one-third of all family caregivers in Delaware still face a degree of stress and worry in their family caregiving duties. Individuals in Delaware report an overwhelming desire to live in their home and community as they age. More work needs to be done to give all Delawareans needed supports to remain active and productive wherever there homes may be.
That’s why AARP Delaware lobbied for the passage of HCR 57, which forms a caregiver task force. The task force, co-chaired by AARP, will review resources for caregivers and find new pathways for caregiver information in Delaware.
“Delaware has a rapidly growing senior population, and caregivers are a huge part of the support network needed to provide services to them,” said Rep. Valerie Longhurst, the lead sponsor of the resolution. “Our senior population is only going to increase, so we need to determine what we as a state can do to help families with their aging relatives and make sure they have the care they need.”
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 advocated to expand services provided at home and in the community, by shifting funds away from more expensive nursing home care.
“This Scorecard gives us a snapshot of how well Delaware 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 Nutter. “Now is the time for policymakers to assess the situation.”
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.
One area for policy change that AARP Delaware has been working on is Nursing Scope of Practice. By broadening their scope of practice, nurses will have more authority to help patients and their family caregivers by utilizing all their professional training. By delegating basic health maintenance tasks to home aides, nurses will have better opportunity to help patients and their family caregivers.
Finally, the Scorecard reveals, “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."