New Scorecard Gives Pennsylvania Low Marks for Serving Older, Disabled Residents

AARP Pennsylvania today warned that a new study ranking Pennsylvania 42 ^nd nationally in meeting the long-term care needs of older residents calls for across the board improvements, with particular emphasis on enhancing caregiving affordability and access. The ranking comes from 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 Pennsylvanians want to live independently, at home, as they age – most with the help of unpaid family caregivers,” said Bill Johnston-Walsh, state director of AARP Pennsylvania, which serves more than 1.8 million members age 50 and older statewide. “Even facing tight budgets following the Great Recession, most states made clear progress to help older residents achieve that goal. It’s time for Pennsylvania to step up to the plate, and this Scorecard shows what we have to do. We don’t have time to stand idle any longer.”

Today, unpaid family caregivers provide the bulk of care for older Pennsylvanians, in part because the cost of long-term care remains unaffordable for most middle income families.  In Pennsylvania, more than 1.8 million family caregivers 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 $20 billion annually.

“When it comes to helping older Pennsylvanians live in the setting of their choice, this silent army of family caregivers assumes the lion’s share of responsibility,” said Johnston-Walsh. “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 (61%) face a degree of stress and worry. Pennsylvania needs to pass Senate Bill 1063 that will broaden the scope of practice for nurses and allow them to delegate basic health maintenance tasks, like checking blood sugar or temperatures, to home aides. The legislation will allow nurses to have more authority to help patients and their family caregivers by using all of their health care knowledge and training.

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 undesirable and more expensive nursing home care, beginning with the 2014-15 state budget. AARP Pennsylvania and other state senior advocacy organizations are asking lawmakers to include the Governor’s proposed $21 million increase for state Lottery-funded nursing home alternatives in the final state budget to further reduce waiting lists and help seniors remain at home.  

Unfortunately, Pennsylvania ranks 37 in the percentage of Medicaid long-term care dollars that support care provided at home and in the community – the care setting that most Pennsylvanians prefer. The Scorecard spotlights areas that call for improvement, including affordability and access, quality of life and quality of care and effective transitions. Specifically:

•  24.9% of Medicaid and state funded LTSS spending going to HCBS for older people and adults with physical disabilities.
• Median annual nursing home private pay cost as a percentage of median household income age 65+ was 311%, ranking 46 nationally.
• PA ranked 35 in legal and system supports for family caregivers.

"This Scorecard gives us a snapshot of how well Pennsylvania serves our older residents, those with disabilities, and family caregivers – and shows us that we must sharpen our focus to better assist hardworking Pennsylvanians,” said Johnston-Walsh. “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. Currently, 42 states are advocating as part of the campaign, including Pennsylvania.

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.