AARP’s Long Term Care Scorecard Places Wyoming 40th For Services For Aging and Disabled

Wyoming ranked just outside the bottom 10 on a recent AARP report ranking states for their services and support to older adults. The Wyoming-specific scorecard with an explanation can be seen here.

“The scorecard shows we have plenty of room for investment in more service lines inside the category of home and community-based services,” says AARP Wyoming State Director Sam Shumway. “Our geography and sparse population centers make delivering HCBS difficult in Wyoming, but we know offering more options for home health saves state dollars while treating residents in their home communities.”

Wyoming scored low for a lack of public investment in specific supplies of home and community-based services measured by the scorecard. Wyoming ranked 42nd in the nation for adult day services supply. The Scorecard estimates that the state has only about 13 adult day services slots per 1,000 people over the age of 65, compared to the national average of 54. Wyoming also ranked 35th in assisted living and residential care units per 1,000 population ages 75 and over.

Wyoming also ranked low in LTSS worker wage competitiveness - specifically what is the average wage shortfall that those who work in direct patient services for older adults and the disabled receive when compared to other entry-level jobs. According to the scorecard, Wyoming’s direct care workers make $3.38 per hour less than other entry-level jobs. A lack of available Programs for the All-Inclusive Care for the Elderly (PACE) also hurt Wyoming’s overall score. In previous years, there was a PACE program in Cheyenne, which closed in 2020.

Wyoming showed well when it came to nursing home costs, ranking fourth in the nation with a median nursing home cost of 170% of the state’s median income. Nursing homes in Wyoming also had the nation’s eighth-best percentage of long stay nursing home residents hospitalized within a six-month period. However, high nursing home staff turnover (the nation’s ninth worst) and low nursing home staffing levels (11th worst in the nation) impacted the rankings.

One other component that hurt Wyoming’s rankings is being addressed. Wyoming was scored low due to the lack of an Aging and Disability Resource Center (ADRC) when the data was pulled. Wyoming has since started an ADRC, which allows citizens to call one number to find services available to older adults and those with disabilities in their area. Wyoming’s ADRC is run through the state’s 2-1-1 program, and those interested in finding home health, home-delivered meals, and other services in their area are encouraged to call 2-1-1.

The Wyoming Department of Health has also recently presented on expanding reimbursement for adult day services and an 1115 waiver to provide more in the way of home services. Wyoming’s legislators will have the opportunity to fund those projects during the 2024 Legislative Session, which begins in February.

State Rankings:

• Tier One: 1: Minnesota; 2: Washington state; 3: District of Columbia; 4: Massachusetts; 5: Colorado.
• Tier Two: 6: New York; 7: Oregon; 8: Hawaii; 9: Vermont; 10: New Jersey; 11: California; 12: Rhode Island; 13: Connecticut; 14: Maryland; 15: Wisconsin; 16: Maine.
• Tier Three: 17: Delaware; 18: Nebraska; 19: North Dakota; 20: New Mexico; 21: Pennsylvania; 22: Arizona; 23: Iowa; 24: New Hampshire; 25: Illinois; 26: Alaska; 27: Indiana; 28: Virginia; 29: Utah; 30: Kansas; 31: Michigan; 32: Ohio; 33: Montana; 34: Texas; 35: Idaho.
• Tier Four: 36: South Dakota; 37: Arkansas; 38: Missouri; 39: Georgia; 40: Wyoming; 41: North Carolina; 42: Kentucky; 43: Florida: 44: Nevada; 45: Louisiana; 46: Oklahoma.
• Tier Five: 47: Tennessee; 48: Mississippi; 49: South Carolina; 50: Alabama; 51: West Virginia. 

Recommendations
Key recommendations from the report and AARP to strengthen support for long-term care and aging at home:

• Prioritizing support for the 48 million family caregivers, 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 Services 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 making investments that 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, like Green House® Nursing Homes and presumptive eligibility, that can then be scaled.
• Ensuring every state in the nation has a sound emergency preparedness plan to support nursing home residents, in particular, in times of crisis – including natural disaster.

About the Scorecard
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 a charitable project made possible by a grant from the AARP Foundation, with support from The SCAN Foundation, The Commonwealth Fund, and The John A. Hartford Foundation, and has been updated every three years since 2011.


National Trends
AARP’s latest 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 gaps persist in every state, especially related to support for family caregivers, the long-term care workforce, equity in nursing homes, and emergency preparedness.

Minnesota (first) and Washington state (second) outperformed all other states in the country, particularly due to strong support for family caregivers, and providing many options in terms of health care providers and long-term care settings. The lowest scoring states were in the Southeast, with Alabama and West Virginia ranking 50th and 51st, respectively.

Key findings from the report include:
Family Caregiving 

• Only six states — Georgia, Missouri, Montana, New Jersey, North Dakota, and South Carolina — provide a tax credit for family caregivers’ out-of-pocket expenses. Oklahoma enacted a caregiver tax credit bill in June after data for the Scorecard was collected. Family caregivers on average spend $7,242 per year on out-of-pocket costs. Wyoming does not have this tax credit as it does not have a state income tax.
• Most states do not have statewide laws protecting caregivers from discrimination in the workplace that ensure they are not unfairly treated due to caregiving duties outside of work. Seven states have statewide laws — Alaska, Connecticut, Maine, Minnesota, New Jersey, New York, and Wisconsin. 
• Twelve states have enacted paid family leave laws, and 18 have paid sick day laws, which can be used for caregiving.
• Dozens of states had declines in care choices that help support families managing caregiving. For instance, 21 states experienced declines of 10% or more in adult day services since 2016, and 16 states had declines of 10% or more in access to home health aides since 2019.

Home and Community-Based Services

• There has been a surge in older adults 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.
•  Eleven states had state policies that improve presumptive eligibility for Medicaid HCBS at the time of data collection, making it possible for people to go home to receive care after being in the hospital rather than having to be admitted to a nursing home while their eligibility for Medicaid payments is being determined.
• Many states have large numbers of people with low care needs living in nursing homes, indicating a lack of HCBS access and services. More than 20% of residents in Montana, Kansas, South Dakota, Oklahoma, and Missouri have residents with low needs, compared to 9% nationally. Wyoming did not have enough participants in this 

Nursing Homes and Institutional Care 

• A major workforce crisis exists in nursing home care. Across all states, wages for direct care workers are lower than wages for comparable occupations; wage shortfalls range from $1.56 to $5.03 per hour, with New York, California, Texas, Louisiana, and Washington, D.C. offering the least competitive wages. 
• Nationally, more than half of nursing staff in nursing homes leave their job within a year (53.9% turnover rate). Montana, Vermont, and New Mexico have the highest averages in staffing turnover. 
• Staffing disparities are a significant challenge. Residents of nursing homes with high admissions of Black residents receive almost 200 fewer hours of care per year than residents of nursing homes with high admissions of white residents.
• Nationally, only 22% of nursing home residents live in a facility with a 5-star rating. Gaps in workforce and equity result in persistent problems in care. For instance, about 10% of nursing home residents nationwide experienced a pressure sore. Pressure sores can be life-threatening, leading to bone or joint infections, cancer, and sepsis.
• Only nine states have enhanced hazard mitigation plans for natural disasters and other emergencies to address the needs of vulnerable older adults and people with disabilities, including for nursing home residents. 
• There is some progress toward innovative and effective alternatives to traditional nursing home models. For instance, 10 states made strides in nursing home innovations, such as by supporting Green House® Nursing Home availability and policies, which includes small facilities, private rooms, and other best practices.