Where Does Nebraska Rank on Care for Older Adults?

Nebraska ranks 15 ^th among the states when it comes to meeting the long-term care needs of older residents and people with disabilities, but AARP warns more must be done, at an accelerated pace, to meet changing demographic demands.  Specific areas of concern in Nebraska include support for working caregivers, a shortage of home care workers; spending on home- and community-based services; and a lack of transportation options.  The findings are reported in a 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.

Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers –the third in a series of reports—ranks each state overall and on 25 specific indicators in 5 key dimensions: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and, effective transitions between nursing homes, hospitals and homes.

“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 the state. “Nebraska is making some progress to help our older residents achieve that goal. However, this Scorecard shows we have more to do, and we need to pick up the pace.”

The Scorecard spotlights significant areas that call for improvement under the support for family caregivers and choice of setting and provider dimensions.  Specifically:

• The percent of Medicaid and state-funded long-term services and support going to home- and community-based services;
• Support for working caregivers, such as paid leave policies;
• The number of home health and personal care aides serving adults with disabilities; and
• Transportation options for older adults and persons with disabilities.

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, about 200,000 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 $2.5 billion annually.

“When it comes to helping older Nebraskans live in the setting of their choice, family caregivers take on big responsibilities,” 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 Nebraska’s Medicaid program. They have earned some basic support.”

The state Scorecard shows Nebraska is at the bottom of the rankings regarding support for family caregivers. Family caregivers who hold down full-time jobs need workplace flexibility, but many Nebraska workers have no family leave or paid or unpaid sick leave through their employers.

“Nebraska has not taken any steps to help working caregivers balance the demands on their time from work and providing care to a family member with a disability,” she said.

LB 305, sponsored by State Sen. Sue Crawford, would establish the Paid Family and Medical Leave Act to replace a portion of wages for these workers who need to take time off for caregiving. Crawford also is the sponsor of LB 372 to protect workers against discrimination in the workplace based on their caregiving responsibilities. Benjamin noted that passage of the two bills would move Nebraska into the top quartile for the Scorecard’s ranking on support for family caregivers.

Nebraska ranks 34th in the supply of home health and personal care aides and 28 ^th for transportation policies. “Addressing the shortage in the long-term care workforce needs to be a priority for state policy makers,” she said. “And Nebraska communities continue to struggle with transportation needs, particularly in rural areas.”

The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net. AARP is fighting to expand services provided at home and in the community, by shifting funds away from more expensive nursing home care.

Nebraska ranks 33rd in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care provided at home and in the community—the care setting that most Nebraskans prefer. Despite progress made in this area since 1990, the Scorecard indicates that Nebraska has recently lost ground on the issue.

“Public policy should refocus on assuring that people who need long-term care are able to get the services they need where they live,” Benjamin said. “If Nebraska improved its performance to the level of the average of the top five-performing states, $168.2 million more would go to home-and community-based services instead of nursing homes.”

Using the same measure, the Scorecard estimates that Nebraska would have 6,046 more home health and personal care aides available to provide care in the community and 15,093 more people of all ages would receive Medicaid long-term services and supports to help them with daily activities.

Nebraska is in the top 10 states on five of the 25 Scorecard indicators in the affordability and access, choice of setting and provider, and quality of life and quality of care domains. Nebraska has made substantial reductions and ranks 4th in the percent of high-risk nursing home residents with pressure sores. Additionally, the state ranks 5 ^th in the number of assisted living and residential care units per 1,000 Nebraskans age 75-plus and 9 ^th in private pay costs of nursing home care for residents 65 and older.

“This Scorecard gives us a snapshot of how well Nebraska serves our older residents, those with disabilities, and family caregivers—and shows us where we must sharpen our focus to better assist hardworking Nebraskans,” Benjamin concluded. “Now is the time for policymakers to act.”

Of the 25 Scorecard indicators, many may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched in 2014, to help older Americans live independently, at home, and the family caregivers that support them.

The Scorecard reveals that in less than 10 years, Boomers will begin to turn 80, placing new expectations and 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.

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About AARP: AARP is the nation’s largest nonprofit, nonpartisan organization dedicated to empowering Americans 50 and older to choose how they live as they age. With nearly 38 million members and offices in every state, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, AARP works to strengthen communities and advocate for what matters most to families with a focus on health security, financial stability and personal fulfillment. AARP also works for individuals in the marketplace by sparking new solutions and allowing carefully chosen, high-quality products and services to carry the AARP name. As a trusted source for news and information, AARP produces the world’s largest circulation publications, AARP The Magazine and AARP Bulletin. To learn more, visit www.aarp.org or follow @AARP and @AARPadvocates on social media.