New AARP Scorecard: Washington Ranks #2 in the Country for Long-Term Care Services and Supports for Older Americans, Including Family Caregivers

AARP’s new 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 inadequate. The report finds that, while Washington is a national leader, major gaps persist, even here, especially related to our need for more qualified workers to help deliver home care, a too-high turnover rate for nursing home staff, and a lack of adult day services to offer respite to family caregivers. 

Ranking #2 in the country, Washington outperformed most states and has made progress in improving care options for older adults, including the amount of Medicaid spending that goes toward home- and community-based services and a robust network of organizations at the state and community levels that help consumers and family caregivers learn about, consider and navigate LTSS options. However, the report shows there is still more to be done to keep up with the rapidly changing needs of an aging population. 

As the population continues aging, millions of Americans will face greater health needs over the next several decades. The country is falling short of addressing those needs, especially in how we care for people of color and those with lower incomes. 

“The pandemic reinforced the need to strengthen long-term care for countless loved ones across the country, including in Washington,” said Cathy MacCaul, AARP Washington Advocacy Director. “While Washington has made a decades-long commitment to bring services into the home, where older adults prefer to be, there are many roads to travel before we meet the needs of all Washingtonians who deserve the very best care, including the 820,000 family caregivers in our state. It’s time to accelerate our efforts for the sake of saving more lives.”

“Washington’s Department of Social and Health Services is committed to providing innovative services and programs, which provide quality care and allows people to remain at home or in community-based settings of their choice,” says Bea Rector, Assistant Secretary for DSHS’ Aging and Long-Term Support Administration. “We are pleased to be recognized as a leader in long-term care, and it shows the hard work and dedication of DSHS staff, providers, caregivers, policymakers, and advocates across the state.” 

Additional key findings from the report include:

Family Caregiving 

• Dozens of states experienced declines in the number of care choices that help support families managing caregiving. For instance, 21 states experienced declines of 10% or more in adult day services since 2016, including Washington, which ranked number 48. We also had a significant decline 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). Washington state leads by more than 20 percentage points, coming in at 76%. 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, including Washington, had state policies that improved 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.

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. In Washington, wages are $2.48 lower than other entry-level jobs.
  
  • Nationally, more than half of nursing staff in nursing homes leave their job within a year (53.9% turnover rate). In Washington, the rate is above the average, at 54.9%
    
  • 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 compared to residents of nursing homes with high admissions of white residents.

• Washington is one of only nine states that have enhanced hazard mitigation plans for natural disasters and other emergencies to address the needs of vulnerable older adults and people with disabilities, including nursing home residents.

“COVID-19 tested our long-term care systems, and they failed. Now is the time to take the lessons we’ve learned to fix them, for the sake of saving lives,” said Susan Reinhard, Senior Vice President, AARP Public Policy Institute. “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. 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.”

Recommendations

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 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.
  
  • Washington has made great strides in helping our family caregivers, including the implementation of WA Cares, which will help pay family caregivers for their efforts to keep our older adults out of facilities in their homes where they prefer to be.

• Investing in all aspects of Home and Community-Based Care infrastructure, such as increasing support and training for home health aides and home visits.

• 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.

•  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.
  
  • Great progress was made during the 2023 legislative session to expand housing choices, like accessory dwelling units. Transit-oriented development will be a priority issue for AARP Washington in the 2024 legislative session.

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. 

"Every person, regardless of where they live, their race, or their socioeconomic background, deserves long-term care that is accessible, safe, and prioritizes what matters most to them,” said Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation. “The Scorecard shows that there are significant regional and racial disparities in the care a person receives. State policymakers can and should take steps now to close the gap in access to quality care.” 

"The LTSS Scorecard indicates progress in some state programs, but opportunities exist for both public and private sectors to enhance LTSS,” said Sarita A. Mohanty, MD, President and Chief Executive Officer of The SCAN Foundation. “Most older adults prefer home and community-based care that meets their needs, but it remains financially out of reach for many working-class families, particularly those who are part of the 'forgotten middle'. TSF is committed to identifying, highlighting, and elevating innovative policies and programs to ensure all older adults can age well in home and community."

“Equity is an essential component of high-quality health care, and is especially important in LTSS,” said Melinda Abrams, Executive Vice President, Programs, The Commonwealth Fund. “I am thrilled AARP was able to add race and ethnicity data for several indicators. This year and going forward, this new data will shed light on the experiences people of color in LTSS and draw attention to individuals with the greatest need.”

To view the full Scorecard and state-by-state information visit ltsschoices.aarp.org.

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.

About AARPAARP is the nation's largest nonprofit, nonpartisan organization dedicated to empowering people 50 and older to choose how they live as they age. With a nationwide presence, AARP strengthens communities and advocates for what matters most to the more than 100 million Americans 50-plus and their families: health security, financial stability and personal fulfillment. AARP also produces the nation's largest circulation publications: AARP The Magazine and AARP Bulletin. To learn more, visit www.aarp.org/about-aarp/, www.aarp.org/español or follow @AARP, @AARPenEspañol and @AARPadvocates on social media. 

About AARP Foundation

AARP Foundation works to end senior poverty by helping vulnerable people over 50 build economic opportunity. Our approach emphasizes equitable outcomes for populations that have faced systemic discrimination. As AARP's charitable affiliate, we serve AARP members and nonmembers alike. Through vigorous legal advocacy and evidence-based solutions, and by building supportive community connections, we foster resilience, advance equity, and restore hope. To learn more, visit aarpfoundation.org or follow @AARPFoundation on social media. 

About The SCAN Foundation

The SCAN Foundation envisions a society where all of us can age well with purpose. We pursue this vision by igniting bold and equitable changes in how older adults age in both home and community. For more information, visit www.TheSCANFoundation.org.

About The Commonwealth Fund

The Commonwealth Fund, among the first private foundations started by a woman philanthropist—Anna M. Harkness—was established in 1918 with the broad charge to enhance the common good. The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, and people of color. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. For more information, visit: https://www.commonwealthfund.org.

About The John A. Hartford Foundation

The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the Foundation has three areas of emphasis: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care. For more information, visit: https://www.johnahartford.org.