Demand for Home Care Outstripping Supply
June 15, 2017 03:33 PM
The needs of seniors and disabled citizens for home care workers is growing much faster than the number of direct care workers, raising the specter of Americans being forced out of their homes to receive the care they deserve, according to a new report.
The new State Scorecard report from the SCAN Foundation, Commonwealth Fund and AARP ranked each state (and Washington, D.C.) based on their performance on long-term service and supports (LTSS) in five areas:
Affordability and access,
Quality of life and quality of care,
Choice of setting and provider,
Support for family caregivers,
Transition between nursing homes, hospitals and homes.
Ominously, most states achieved no “meaningful change” in making home care more affordable or available and the cost of LTSS over the long term continues to be unaffordable for many middle class families. Most adults do not have long-term care insurance in the private sector.
The state of Washington ranked first in the United States for LTSS, with Minnesota, Vermont, Oregon and Alaska rounding out the top five. The worst state in the union for LTSS, according to the report, was Indiana, with Kentucky, Alabama, Mississippi, and Tennessee filling the other five spots at the very bottom of the list.
A major point of concern is that most of Medicaid LTSS funding for seniors and the disabled went to nursing homes, which is hardly the most efficient way to care for the elderly and contrary to the wishes of about 90 percent of Americans, who say they prefer to age in their own homes and communities.
Some states devote more Medicaid funding to home-and-community-based services (HCBS), such as Minnesota, which spent 69 percent of its Medicaid dollars on HCBS in 2014. Alabama, however, devoted a mere 14 percent of its Medicaid funding to HCBS in the same year.
The share of Medicaid spending being devoted to HCBS in 2014 was 41 percent, an increase from 39 percent in 2011. Disappointingly, only 10 states spent more on HCBS than they did on nursing homes. Progress is being made in this area, but it is slow progress.
The lack of funding for HCBS is exacerbating the staffing problem we see in home care and hospice. For example, the five states with the fewest home and personal care aides will need 34 years to equal the number of aides in the five states with the most workers.
Only 24 states “significantly increased” the number of home and personal care aides, meaning most places in the country will need to ramp up their hiring and training of home health workers to have any hope of keeping pace with the growing demand.
Overall, 29 states showed impressive improvement in delivering LTSS in the home to new HCBS patients. The up-and-comers in this area include Montana, Pennsylvania, Maryland, Iowa, Delaware, Louisiana and Vermont – all showing significant improvement in delivering LTSS to new patients. However, there continues to be a massive gap in achievement, with 80 percent of new Medicaid beneficiaries receiving HCBS in the top five states, but only 30 percent receiving such care in the bottom five states. Clearly, much remains to be done to spread LTSS and HCBS around the country.
“Overall, states have made incremental improvements,” the report concluded, “but must pick up the pace of change to meet the needs of a growing number of people aging and living with disabilities.”