Important info from AARP

Arkansas ranks 40th when it comes to meeting the long-term care needs of older residents, and AARP warns that much more must be done, at an accelerated pace, to improve across-the-board –especially when it comes to effective transitions between one form of care and another.

These findings are 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 The 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 and the District of Columbia 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, as noted above, effective transition. 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.

Arkansas ranks in the bottom quartile of states and D.C. Among the five dimensions, Arkansas ranked weakest (49th out of 51) on Effective Transitions. The performance indicators in that dimension include a ranking of 42nd in the Percentage of Nursing Home Residents with Low-Care Needs, indicating that many people currently in nursing homes could receive quality care at a much lower cost and remain in their homes and communities.

In a 2011 AARP survey of Arkansans 50 and older, an overwhelming 94 percent of respondents said it was important to have services that allow people to remain home as long as possible. Of those who said this was important, 47 percent said it was "extremely important" and 34 percent said "very important." AARP Arkansas serves more than 300,000 members age 50 and older in the Natural State.

Herb Sanderson, AARP Arkansas Associate State Director for Advocacy, said a key reason for the state's low ranking is how the state spends taxpayer dollars on long-term care. "The state of Arkansas is not spending its long-term care dollars as wisely as it could be," Sanderson said. "It makes financial sense and common sense to enable people to stay in their own homes and communities whenever possible and as long as possible."

If Arkansas improved its performance to the level of the highest performing state, 2,945 Arkansas nursing home residents with low-care needs could instead receive long-term care services and supports in their community, the Scorecard found. Sanderson said this translates into potential savings to the state of at least $77 million a year, and that is a conservative estimate based on nursing home care costing twice as much as home & community based services in Arkansas.

Arkansas has made progress in recent years, including applying for federal help through the Balancing Incentive Program to start the shift toward home and community-based care, and providing home and community-based attendant services through the Community First Choice option as part of the state Medicaid program, which gives states the opportunity to transform their care systems. Sanderson noted that system changes take time and time is running out; in just 12 years, the leading edge of the Baby Boomer Generation will enter its 80s, placing new demands on the state.

Arkansas' population of residents 65 and older is projected to grow by 40 percent through 2030. If the state doesn't take serious steps to change how it pays for long-term care, the costs could well be unsustainable, Sanderson said. The good news is that the Scorecard offers positive examples from other states showing how Arkansas can do better.

"The Scorecard shows other states that have achieved success," Sanderson said. "It really provides a roadmap for Arkansas to follow—we can look at other states, learn from them, and find solutions enacted all over the United States. Arkansas has made progress, but we need system change—a variety of things that need to happen, and need to happen soon."

Another key priority for AARP is supporting family caregivers. 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.

Today, unpaid family caregivers provide the bulk of care for older Arkansans in part because the cost of long-term care remains unaffordable for most middle income families. In Arkansas, more than 478,000 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 $4.5 billion.

According to the state Scorecard, 37.4 percent of family caregivers in Arkansas face a degree of stress and worry; Arkansas ranks 16th nationally in the dimension of Support for Family Caregivers and 14th in the Family caregivers without much worry or stress, with enough time, well-rested performance indicator. But more must be done and in Arkansas, the state could help caregivers by increasing the level of respite care services to give family caregivers additional, much-deserved relief, Sanderson said.

"Family caregivers really perform a herculean task and they should be commended and supported," Sanderson said.

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 has fought and continues to fight to expand services provided at home and in the community, by shifting funds away from more expensive nursing home care.