Almost half of people who turn 65 this year will need long-term care at some point, according to the U.S. Department of Health and Human Services.

Yet, as a report released this week by AARP makes clear, most states are doing a poor job at helping people who need those services.

The report defines long-term services and support (LTSS) as daily-living assistance given to older adults and people with disabilities who cannot perform routine activities (such as preparing meals, bathing, dressing and managing medications) on their own due to physical, cognitive or chronic health conditions. The assistance also includes support to family caregivers.

The AARP report found that although many states have made some “incremental” progress in providing those services since 2014, when the organization issued its last report on this topic, “the pace of change has been slow and uneven.”

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The new report, therefore, “sounds the alarm,” said Susan Reinhard, director of the AARP Public Policy Institute, in a released statement.

“The proposed cuts to Medicaid — the largest public payer of long-term assistance — would result in millions of older adults and people with disabilities losing lifesaving supports,” she added.

The report is titled “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,” and was compiled in conjunction with the Commonwealth Fund and the Scan Foundation.

Minnesota given high ranking

For people aging in Minnesota, there’s some relatively good news in the report. The “Scorecard” ranked our state second for long-term care, behind Washington.

The ranking is, however, a drop for Minnesota. We were listed 1st — ahead of Washington — in the previous two “Scorecard” reports. But, as the authors of the current report point out, “ranks are not directly comparable between years, [and] the results across all three editions… indicate that Washington and Minnesota are consistently leading the pack.”

The scorecard is based on how each state performs in five broad categories: affordability and access, choice of setting and provider, quality of life and quality of care, support for family caregivers, and effective transitions.

Minnesota scored best (#1) in the “choice of setting and provider” category, which the report defines as “a person-centered approach [that] allows for consumer choice and control of services.” It includes such things as state spending on home- and community-based services for older adults and those with disabilities, access to home care workers for those same populations, and options for residential care when living at home is no longer possible.

Minnesota also had high scores for three of the other categories: quality of life and quality of care (3), affordability and access (5), and support for family caregivers (6).

Its lowest ranking (19) was in the “effective transitions” category, which the report defines as the “integration of health, LTSS, and social services [in a way that] minimizes disruptions such as unnecessary hospitalizations, institutionalizations, and transitions between settings.”

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Highs and lows

In addition to Washington and Minnesota, the five top-ranking states in the AARP report were Vermont, Oregon and Alaska (in that order).

The five bottom-ranking states were (again, in order) Indiana, Kentucky, Alabama, Mississippi and Tennessee.

States made the most significant progress, overall, in reducing the inappropriate use of antipsychotic medications among older people living in nursing homes and in increasing supportive services for family caregivers.

Where states showed the most significant decline was in their employment rates for people with disabilities and with the rates at which they effectively transitioned patients from long-stay nursing homes back into the community.

Minnesota ranked well on that employment measurement, however. We were second among the states for the rate at which we employ disabled adults aged 18 to 64 relative to the rate of employment for adults without disabilities. But we ranked poorly on the transitioning measurement. We were 38th among the states for the percent of people we successfully transition back to the community after they have spent 90 or more days in a nursing home.

“This new Scorecard shows that it’s time for all states to accelerate care improvements for older adults and people with disabilities,” said Dr. Bruce Chernof, president and CEO of the Scan Foundation, in the released statement. “States that consistently rank at the top have strategically planned for their aging population across the main sectors of health, housing, transportation and family caregiving.”

FMI: You can download the full report here [PDF].