New AARP Scorecard for long-term care services & supports for older Americans: where does Wisconsin rank?

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 service/support gaps persist in every state, including Wisconsin, which experienced declines in categories related to home care costs and enrollment in PACE (Program of All-Inclusive Care for the Elderly).

Ranking 15^th overall nationally, Wisconsin outperformed most states and has made progress caring for older adults in four areas: supporting Aging and Disability Resource Centers, increasing the number of assisted living and residential care units, increasing home health and personal care aides, and reducing hospital admissions for home health patients.

However, the report shows there are still significant challenges facing the long-term care system in Wisconsin as we strive to keep up with the rapidly changing needs of an aging population.

“AARP’s Scorecard shows that there are many roads to meet the needs of all Wisconsinites who deserve high quality care that treats people with dignity and increases independence, including the more than 680,000 family caregivers in our state."

OTHER KEY FINDINGS FROM THE REPORT

There has been a surge in older adults nationwide receiving long-term care at home, rather than in nursing homes and other institutions. For the first time, more than half (53%) of Medicaid LTSS spending for older people and adults with physical disabilities went to Home and Community-Based Services (HCBS).

This is up from 37% in 2009. HCBS includes support for home health care aides, respite services, assistive technology and home modifications and other services. The average annual per person cost of home care in 2021 was $42,000.

A major workforce crisis also exists in nursing home care. Across all states, wages for direct care workers are lower than wages for comparable occupations, with shortfalls ranging from $1.56 to $5.03 per hour. In Wisconsin, wages are $1.56 lower than other entry level jobs. 

Nationally, more than half of nursing staff in nursing homes leave their job within a year (53.9% turnover rate). In Wisconsin, the turnover rate is better than the average, at 39.3%. Montana, Vermont, and New Mexico are experiencing the highest averages in staffing turnover.

Staffing disparities also remain a significant challenge. Residents of nursing homes with high admissions of Black residents receive almost 200 fewer hours of care per year compared to residents of nursing homes with high admissions of white residents. Gaps in workforce and equity result in persistent problems. For instance, about 10% of nursing home residents nationwide experienced a pressure sore. Pressure sores can be life-threatening as they can lead to bone or joint infections, cancer, and sepsis.

“AARP’s LTSS Scorecard shows some progress and innovation, but there’s still a long way to go before we have systems that allow people to age well and independently for as long as possible and support the nation’s 48 million family caregivers. It’s also clear some emerging issues deserve more attention – from whether nursing homes are prepared to confront natural disasters, to whether they have plans in place to maintain and grow their workforces,” Reinhard said.

KEY RECOMMENDATIONS FROM THE REPORT
Key recommendations from the report and AARP to strengthen support for long-term care and aging at home include:

· Prioritizing saving time, money, and increasing support for the 48 million family caregivers, who are the backbone of the long-term care system, providing over $600 billion in unpaid care, such as with paid leave, tax credits, and other mechanisms to address health and financial needs.

· Investing in all aspects of Home and Community-Based Care infrastructure, such as increasing support and training for home health aides and home visits, supporting the ability to access and use medical devices and equipment, and updating key Medicaid regulations and payment models.

· Bolstering the nursing home and in-home care workforce, with improved recruitment and training, increasing pay, and expanding the ability of trained nurses, aides, community health workers and other paraprofessionals to take on some aspects of care. States can choose to enact and enforce staffing and related care standards.

· Expanding the use of innovative, effective models for nursing homes can improve both quality of care and quality of life, such as with smaller facilities and private rooms.

· Addressing inequities by investing to close the staggering gaps in access to quality care and facilities and staffing shortages.

· Building multisector plans for aging, coalitions and age-friendly health systems, and consider the wider needs to allow individuals to live independently in their homes and communities, such as having affordable and accessible housing and transportation, improved community design, and comprehensive emergency preparedness plans.

· Advancing innovation in cities, counties, and states by supporting comprehensive state- and community-wide aging plans and piloting new approaches and programs that can then be scaled.

The Scorecard includes a series of 50 indicators focused on 1) affordability and access; 2) choice of setting and provider; 3) safety and quality; 4) support for family caregivers; and 5) community integration, using data from a variety of publicly available sources, such as the Centers for Medicaid and Medicare Services, American Community Survey, and Bureau of Labor Statistics.

The LTSS Scorecard is funded by AARP Foundation with the support of The SCAN Foundation, The Commonwealth Fund, and The John A. Hartford Foundation and has been updated every three years since 2011.

To view the full Scorecard and state-by-state information visit www.ltsschoices.aarp.org.