Scoring and Rewarding States’ Efforts to Improve Long-Term Care

By Alison Hood

How are states performing in their efforts to create and sustain effective long-term services and supports (LTSS) that serve older adults, adults with disabilities and their family caregivers?

To demonstrate states’ progress, the AARP Public Policy Institute, with support from The SCAN Foundation and the Commonwealth Fund, presented “Picking up the Pace of Change Through Innovation: Long-Term Services and Supports Scorecard,” a 90-minute session at the 2018 Aging in America Conference.

The session reviewed AARP’s 2017 Long-Term Services and Supports Scorecard data (and how to use it), analyzed how states are doing in their LTSS endeavors and showcased two exemplary states, Minnesota and Vermont, two of the four winners of The SCAN Foundation’s Pacesetter Prize.

Presenters included Jean Accius, vice president, Long-Term Services and Supports Group, Ari Houser, senior methods advisor and Susan Reinhard, senior vice president and director, all of the AARP Public Policy Institute; Monica Caserta Hutt, commissioner, Vermont Department of Disabilities, Aging and Independent Living; Megan Juring, program officer, The SCAN Foundation; and Jacqueline Peichel, Live Well at Home manager, Aging and Adults Services, Minnesota Department of Human Services.

Accius defined the Scorecard and how it ranks performance, explaining the five hallmarks of a high-performing LTSS system (affordability and access; choice of setting and provider; quality of life and care; family caregiver supports; and effective transitions). In an overview of the Scorecard’s “high-level findings,” he said states “need to pick up the pace to serve aging people and people with disabilities,” noting that for this third-in-a-series Scorecard, Washington State ranked first for meeting the needs of a growing number of people aging and living with disabilities. States showing marked improvement were Tennessee and New York.

Diving into the Data

Houser delved into the Scorecard’s data measurement processes, saying, “where you live matters,” because the states vary greatly in how they provide LTSS.

“Measurement matters—if you can measure it, you can improve it,” he said. Data should be of high quality; and because data changes constantly, he said, quality measures must be consistent and measured across states.

Houser noted positive gains, but said they need to be accelerated. What can drive faster change? Along with measurement, federal and state initiatives, stakeholder engagement and Medicaid are key drivers.

Few states, Houser said, achieve meaningful change, but some states progress on at least one quality indicator. For example, with LTSS affordability and access, there is not much change or improvement; with choice of setting, there is some improvement; with quality of life and care and support for caregivers, there is much improvement. For transitions, data collection is down.

He further noted that the pace of change is insufficient, citing the need for more home health aides, and “to get to benchmarks, by 2026, we need the Scorecard in order to develop promising practices and toolkits.”

Prize Winners Set the Pace

The SCAN Foundation’s Pacesetter Prize, established in 2017, uses data from the Scorecard to recognize states and programs that are effecting real change in LTSS, notably in the four main domains measured by the Scorecard tool, according to Juring. The 2017 Pacesetter Prize winners were from Minnesota, New York, Vermont and Wisconsin.

Caserta Hutt spoke about Vermont’s Choices for Care program, created in 2005. “We wanted to shift the balance to move people away from long-term-care settings to home,” she said, but added that they are continuing to “strive” for improvement. Of the prize, Caserta Hutt said, “it’s important to know where you are internally, as well as how you stack up against [other] states.” She noted that while stories of improved quality of life are powerful, “data tell a tale that can’t be refuted.”

Vermont, which excels in the Scorecard domain of LTSS access and affordability, is working in three key areas: policy, funding and practice. “Each area is distinct, Caserta Hutt said, but they must “merge together; they have to connect and work together. Without that there is no change.”

Focusing on providing residents with choices of setting, care and services; options for consumer- and surrogate-directed care; and flexible spending programs, Vermont improved access to Medicaid and increased the percentage of low-income adults with disabilities covered through the program via the ACA. It developed a continuum of services based on high, medium high and moderate needs, operating all the while with expectation that “choice, inclusion and independence are paramount in [Vermonters] lives.”

Vermont has risen through the Scorecard ranks in overall LTSS performance, moving from No. 20 in 2011 to No. 3 in 2017.

From Minnesota, which won the Pacesetter Prize for its work supporting family caregivers, Peichel outlined the initiative MN2030: Maintaining our Family Caregiving Workforce, which “supports the 585,000 family caregivers in Minnesota.”

Minnesota’s efforts to strengthen its LTSS system include supports for caregivers (e.g., assessments, dementia-capable coaching, respite care support and consultations through the state’s Senior LinkAge Line), but also an awareness campaign about the caregiver role. Another new program of note, said Peichel,  “is the Cultural Consultation, which works with different, diverse populations, such as Somalis.”

Minnesota’s consistent and proactive efforts to create a more robust LTSS system translate to the state’s improvement in three of four Scorecard measures and its No. 6 rank in the country for supporting family caregivers.