States lag in keeping Medicaid enrollees out of nursing homes

Washington Watch

Every day, 10,000 people turn 65 and the eldest baby boomers will begin to turn 80 in 2026, so the demand for long term care services is about to explode in the near future. Already 1.4 million seniors live in nursing home facilities in the U.S. But states are only making lukewarm progress helping millions of seniors on Medicaid avoid costly nursing home care by arranging home or community services for them instead, a new AARP report finds.

Overall, AARP says states have made “incremental improvements” since its 2014 Scorecard, but calls the pace of change “slow and uneven.” That’s especially disturbing since many state budgets are healthier than they were three years ago.

While most states made modest improvements, “the pace of change is not keeping up with demographic demands,” according to the report, which compared state’s efforts to improve long-term care services over the past several years. Previous AARP reports on the same subject were issued in 2011 and 2014.

“People need to understand how this is playing out close to them, because changes often occur at the state and local level. There is no national long-term services and support federal policy, aside from Medicaid, which is administered by the states,” says Susan Reinhard, senior vice president and director, AARP Public Policy Institute, which produced the report.

AARP ranked state’s performance on long-term care benchmarks such as supply of home health aides, nursing home costs, long nursing home stays, the employment rate of people with disabilities and support for working caregivers.

The top-ranking states in the 2017 scorecard were Washington, Minnesota, Vermont, Oregon and Alaska. The states at the bottom were Indiana, Kentucky, Alabama, Mississippi and Tennessee. The most improved states since the 2014 Scorecard were Tennessee and New York.

Here’s a link to the entire chart so you can see how your state did:

The report did find some progress though. For instance, 48 states (nudged by the federal government), have reduced the use of antipsychotic medications given “off label” for nursing home residents whose conditions don’t support their use. The federal government started regulating the use of these medications for dementia patients in nursing homes three years ago.

That’s also the same time that nursing homes started getting graded on the percent of their dementia patients receiving antipsychotic medications in Medicare’s Nursing Home Compare online tool.

Another significant area of progress was that 42 states have moved toward person-and family-centered practices that support family caregivers. AARP policy folks suggest that the impetus for this program was the passage of the CARE Act, which stands for Caregiver, Advise, Record, Enable, which was developed and promoted by AARP.

The CARE Act requires hospitals to record the name of any family caregiver on the medical record of your loved one, inform the family caregiver when the patient is to be discharged and also provide the family caregiver with education and instruction of medical tasks he or she will need to perform the patient at home.

A downside of the Scoreboard report was a significant decline in the number of states where long-stay nursing home residents on Medicaid moved back to living in their communities. That number is now down to just 21 states. The top states are Utah, Oregon, Washington, Arizona and Idaho, where 12 percent of long-stay nursing home residents, on average, transitioned back to the community.

The report found wide discrepancies in how much state Medicaid spending went to long-term care directed to home- and community-based services for elderly and disabled adults in 2014, the latest year for data covering all states. Minnesota, the top-ranked state, spent about 69 percent, but Alabama, ranked last, spent less than 14 percent. Nationwide, the average ended up from 39 percent in 2011 to 41 percent in 2014. Only nine states and the District of Columbia spend more on home-and community-based services than on nursing home care, the report found. These services included home health care, caregiver training and adult day care.

AARP’s Reinhard noted many states have struggled to expand home-based and community-based options for Medicaid enrollees needing long-term care because that is an optional benefit, while nursing homes are mandated under federal law.

Also contributing to this column were Kaiser Health News (KHN), Twin Cities Public Television and AARP.

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