For Nebraska, the report flagged the cost of home care; adequacy of the in-home services workforce; balance in state spending between institutional and home- and community-based services; access to information about long-term services and supports; and the successful transition of residents from nursing homes back to the community as primary trouble spots.
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 Nebraskans want to live independently, at home, as they age – most with the help of unpaid family caregivers,” said Connie Benjamin, state director of AARP Nebraska, which serves nearly 200,000 members age 50 and older in Nebraska. “This Scorecard shows that we don’t have time to stand idle any longer. It identifies key areas that the Legislature’s Aging Nebraskans Task Force must tackle this year in guiding our state’s development of a long-term care system to meet the needs of an aging population.”
Today, unpaid family caregivers provide the bulk of care for older Nebraskans, in part because the cost of long-term care remains unaffordable for most middle income families. In Nebraska, an estimated 238,000 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 $2.2 billion annually.
“When it comes to helping older Nebraskans live in the setting of their choice, this silent army of family caregivers assumes the lion’s share of responsibility,” Benjamin said. “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.”
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 fighting to expand services provided at home and in the community, by shifting funds away from more expensive nursing home care.
Unfortunately, Nebraska ranks 35th 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 Nebraskans prefer. The Scorecard spotlights significant areas that call for improvement, specifically:
- Only 25 percent of Medicaid and state-funded long-term services and supports are being spent on home- and community-based services;
- Less than 32 percent of Nebraskans with Medicaid long-term services first receive those services in the community;
- Ranks 38 in the percent of people with 90+ day nursing home stays successfully transitioning back to the community;
- Ranks 39 for the number of home health and personal care aides per 1,000 population age 65+;
- Ranks 42 in median annual home care private pay cost as a percentage of median household income for age 65+; and
- Ranks 50 among all the states in providing the public access to information about long-term care services and supports.
“This Scorecard gives us a snapshot of how well Nebraska serves our older residents, those with disabilities, and family caregivers – and shows us that we must sharpen our focus to better assist hardworking Nebraskans,” Benjamin concluded “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 the family caregivers that support them.
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.
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.