AARP’s new Long-Term Services and Supports (LTSS) Scorecard finds that care provided in the United States for older adults and people with disabilities is inadequate. The report finds major gaps in every state, such as the cost of home care, the long-term care workforce and support for family caregivers.
South Dakota has made some progress to improve care options for older adults, including advocacy for family caregivers, supporting additional funding for adult day services, expanding the nursing scope of practice and enhancing nurse delegation, referencing tasks nurses may delegate to a direct care aide. However, the report shows there is still much more to be done to keep up with the rapidly changing needs of an aging population.
“From our own statewide survey related to long-term care and caregiving, we know there is a need to strengthen long-term care for countless loved ones across the country, including in South Dakota,” said Erik Gaikowski, AARP South Dakota State Director. “AARP’s Scorecard shows that there are many roads to meet the needs of all South Dakotans who deserve the very best care, including the 80,000 family caregivers in our state. It’s time to accelerate our efforts, for the sake of saving more lives.”
Additional key findings from the report include:
- Only six states provide a tax credit for family caregivers’ out-of-pocket expenses. Family caregivers on average spend $7,242 per year on out-of-pocket costs.
- Only seven states, have statewide laws protecting caregivers from discrimination in the workplace that ensure they are not unfairly treated due to caregiving duties outside of work.
- Twelve states have enacted paid family leave laws and 18 states have paid sick day laws, which can be used for caregiving.
- Dozens of states experienced declines in the number of care choices, such as adult day services or home health aides, that help support families managing caregiving.
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.
- Many states have large numbers of people with low care needs living in nursing homes, indicating a lack of HCBS access and services, and there are differences across race/ethnicities. Nationally, less than 9% of nursing home residents have low-care needs, but in five states 15% or more have low-care needs, including South Dakota with a rate of 22.1%.
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, with shortfalls ranging from $1.56 to $5.03 per hour. South Dakota does, however, rank among the most competitive states.
- Nationally, more than half of nursing staff in nursing homes leave their job within a year (53.9% turnover rate). South Dakota’s rate of 53.8% is right at that average.
- 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 as they can lead to bone or joint infections, cancer, and sepsis.
- Only nine states, including South Dakota, have enhanced hazard mitigation plans for natural disasters and other emergencies to systematically address the needs of vulnerable older adults and people with disabilities, including for nursing home residents.
“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,” says Gaikowski. “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.”
Key recommendations from the report and AARP to strengthen support for long-term care and aging at home:
- Prioritizing saving time, money, and increasing support for the nation’s 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.
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.