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Iowa Ranks 13th: New Scorecard Highlights Overall High Marks for Iowa Long-Term Care Services and Supports, Identifies Areas for Improvement


Des Moines – Iowa ranks 13th in the nation when it comes to meeting the long-term care needs of older residents, but AARP warns more must be done to improve choice of long-term care setting and provider and effective transitions.  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.

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 Iowans want to live independently, at home, as they age. Most can only do so with the help of unpaid family caregivers,” says Kent Sovern, state director of AARP Iowa, which serves more than 375,000 members age 50 and older in Iowa. “Iowa has made some progress to help older residents achieve that goal in spite of tight budgets following the Great Recession. While our overall 13th rank reflects that, 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 Iowa, in part because the cost of long-term care remains unaffordable for most middle income families.   More than 540,000 Iowans 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, according to most recent estimates.  The value of this unpaid care totals about $4.1 billion in Iowa.

“When it comes to helping older Iowans live in the setting of their choice, this silent army of family caregivers assumes the lion’s share of responsibility,” explains Sovern.  “Many juggle full-time jobs with their caregiving duties; others provide 24/7 care for their loved ones.  With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly institutional care.  They have earned some basic support.”

According to the state Scorecard, thirty-eight percent of Iowa family caregivers face a degree of stress and worry for their health and livelihood as they provide care for their loved one.  Adding to that stress and burden is Iowa’s relatively low availability of paid caregivers who could assist unpaid family caregivers in provided care needs in the home.  Iowa ranks 48th in percentage of home health and personal care aides per 1000 Iowans 65+.

As an illustration of how different measures potentially impact each other, Iowa is in bottom half of states, ranked 36th,  in percentage of home health patients with a hospital admission.  These Iowa measures support why AARP Iowa is advocating for better help in Iowa for family caregivers when their loved ones go into the hospital – and as those loved ones return home.

While the Scorecard shows overall high marks for long term care quality the Scorecard also highlights concerns on over reliance of institutional care in Iowa.  The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net.  Iowa ranks 32nd in increasing the percentage of Medicaid long-term care dollars that support care provided at home and in the community – the care setting that most Iowans prefer – the Scorecard spotlights other areas that call for improvement, including choice of setting and provider and effective transitions.

Iowa ranks 51st in the percentage of Iowans with 90+ day nursing home states who successful transition back to the community, and indicator of Iowans getting “stuck” in nursing homes.  Even more troubling is one measure of whether the Iowans in nursing homes truly need to be in those nursing homes compared to their preferred home and community setting. Iowa ranks 41st in percentage of nursing home residents with low care needs, with 17.5% of residents having low care needs, as compared to the top performing state with only 1.1% of nursing home residents with low care needs.  These are indicators of why AARP continues to fight to expand services provided in Iowa homes and communities, advocating for increased funding of home and community services for greater access to care and options other than nursing homes.

If Iowa improved its performance to the level of the highest performing state on choice of care setting:
•    17,014 more low/moderate-income adults with ADL disabilities would be covered by Medicaid.
•    1,847 more new users of Medicaid LTSS would first receive services in the community.
•    4,085 nursing home residents with low care needs would instead receive LTSS in the community.
•    1,048 more people entering nursing homes would be able to return to the community within 100 days.
•    2,885 more people who have been in a nursing home for 90 days or more would be able to move back to the community.

Of the 26 Scorecard indicators, half may be improved through state policy changes.  To that end, AARP has launched a multi-state long-term care advocacy campaign to help older Americans live independently, at home, and the family caregivers that support them.  Currently, 42 states are advocating as part of the campaign, including Iowa.

“This Scorecard gives us a snapshot of how well Iowa serves our older residents, those with disabilities, and family caregivers – and shows us where we must sharpen our focus to better assist hardworking Iowans,” said Sovern.

Sovern noted that Iowa’s 13th overall is good, but in addition to the specific areas where Iowa needs dramatic improvement, Iowa is still behind neighboring states overall.  “Iowa still has work to do to match up to the higher standards set by neighboring state, Wisconsin at 8th overall, and Minnesota who is the top overall ranked state in the country.  Iowa state leaders need to step up and act,” concluded Sovern.

The full state Scorecard, along with an interactive map of state rankings and information, is available at

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*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.

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