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AARP AARP States Iowa Caregiving

New AARP Scorecard Shows Iowans Have Too Few Options for Long-Term Care

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AARP’s new Long-Term Services and Supports (LTSS) Scorecard finds that more than three years after the COVID-19 pandemic began, care provided in the United States for older adults and people with disabilities is painfully inadequate. The report finds that major gaps persist in Iowa, especially related to the options available to Iowans who need long-term care.

Key findings from Iowa’s Scorecard emphasize the problematic lack of options:

  • Too Little State Funding Directed Toward Home-Based Care: State funding is weighted too heavily toward institutional care and not enough is being spent on home-based care. The report shows Iowa ranks 38th in Medicaid spending on home-based care (27.6%) meaning a significant majority of state Medicaid dollars are being allocated to institutions, rather than improving an already lacking home and community-based services network.

  • Home-Based Care is Too Expensive: Home-based care, where it is available, is too expensive. Iowa ranks near the bottom, 46th, in terms of affordability of home-based care.
  • Inadequate Adult Day Services: Iowa ranks in the bottom half of states providing adequate Adult Day Services, a care option that offers greater flexibility for individuals who don’t need institutional care full-time but could still benefit from additional support. These adult day services help allow family caregivers to remain in the workforce while still caring for a loved one.
  • No Access to Green House Homes: There is no access to Green House® homes, an alternative to traditional nursing homes, best known for being smaller structures with just 10 to 12 residents that have the look and feel of a “real home” with private rooms. Long-term care solutions like this approach care from a person-centered perspective and aim to give residents an experience as similar to their own home as possible.

Additionally, Iowa has significantly more nursing home residents with “low care needs” than most states across the country. This means there are too many Iowans with low care needs (e.g., do not require physical assistance with bed mobility, eating, using the toilet, and transferring) in nursing homes who could be better served in their own home but are unable to do so due to lack of Home and Community-Based Services (HCBS).

Older Iowans deserve the best possible care in a setting that makes the most sense for their individual needs. AARP’s Scorecard shows that home and community-based care options are severely lacking and too expensive for most Iowans. We need to re-think our approach to long-term care in Iowa and give Iowans what they want, which is access to quality, affordable care in the comfort of their own home.
Brad Anderson, AARP Iowa State Director

State leaders at the Department of Health and Human Services understand the current long-term care system is unsustainable and are working to find solutions, including an examination of ways Medicaid dollars could more effectively boost access to home and community-based services.

To view the full Scorecard and state-by-state information visit

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