Louisiana ranks 37th when it comes to meeting the long-term care needs of older residents, and AARP warns more must be done, at an accelerated pace, to improve across-the-board – but especially when it comes to quality of care and quality of life, 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 Louisianans want to live independently, at home, as they age – most with the help of unpaid family caregivers,” says Nancy McPherson, state director of AARP Louisiana, which serves more than 475,000 members age 50 and older in Louisiana. “Even facing tight budgets following the Great Recession, most states made clear progress to help older residents achieve that goal. It’s time for Louisiana to step up to the plate, and this Scorecard shows where we need to improve.”
That’s why AARP and other organizations are fighting to expand services provided at home and in the community, by shifting funds away from low quality and more expensive nursing home care. The Scorecard highlights serious concerns about institutional care in Louisiana: the high percentage of nursing home residents with pressure sores and those receiving antipsychotic medication, and the high percentage of nursing home residents with low care needs who may be institutionalized because of a lack of caregiving services in their own communities.
Unfortunately, Louisiana ranks 28th in the percentage of Medicaid long-term care dollars that support care provided to older people and adults with physical disabilities at home and in the community – the care setting that most Louisianans prefer. The Scorecard spotlights areas that call for improvement, including choice of setting and provider. Specifically:
• 30.2% of Medicaid and state-funded long-term care supports and services spending for older people and adults with physical disabilities goes toward home and community based services;
• Only 45% of new Medicaid aged or disabled long-term support and services users first receive services in the community;
“This Scorecard gives us a snapshot of how well Louisiana serves our older residents, those with disabilities, and family caregivers – and shows us that we must sharpen our focus to better assist hardworking Louisianans,” concludes McPherson. “Now is the time for policymakers to act.”
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 to help the family caregivers that support them. Currently, 42 states are advocating as part of this campaign, including Louisiana.
Today, unpaid family caregivers provide the bulk of care for older Louisianans, in part because the cost of long-term care remains unaffordable for most middle-income families. In Louisiana, more than 627,000 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 $5.7 billion.
“When it comes to helping older Louisianans live in the setting of their choice, this silent army of family caregivers assumes the lion’s share of responsibility,” explains McPherson. “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 nursing homes – most often paid for by Medicaid. They have earned some basic support.”
According to the state Scorecard, many family caregivers face a degree of stress and worry. Louisiana’s Lifespan Respite Coalition, of which AARP is a member, is taking action to improve legal and systems supports for this group. Under the guidance of this coalition, the state is developing strategies to provide training and support for caregivers. The Lifespan Respite Coalition is a statewide coalition of organizations, coordinated by the Louisiana Department of Health and Hospitals, and chaired by Kelly Hutson-Viator, Executive Director of the ALS Association Louisiana-Mississippi Chapter.
Respite care helps to support family caregivers who are on call 24 hours a day, seven days a week, by giving them a hard-earned, well-deserved break, allowing them to recharge and continue the essential role they serve in safely caring for their loved ones. Family caregivers often put aside their own needs—skipping doctor’s appointments, developing poor eating habits, and not getting enough sleep.
While more needs to be done to help seniors live independently in their homes, it is critical to have advocates in every public and private setting who champion person-centered care for Louisiana elders. LEADER is a nonprofit organization of advocates in Louisiana who are part of a national movement to change the way services are delivered to an aging population. Their work is important to changing the indicators around quality in our state. So is the work of the Coalition for Choice in Advancing Long Term Care Options in Louisiana.
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.