State Scorecard on Long-Term Services.

State Scorecard on Long-Term Services. Information Bulletin # 342 (10/2011).

A recent report entitled “Raising Expectations” – “A State Scorecard on Long-Term Services and Supports [LTSS] for Older Adults, People with Physical Disabilities, and Family Caregivers” – was prepared jointly by AARP, the Scan Foundation and the Commonwealth Fund. This report analyzes and scores each State’s LTSS performance regarding, (1) affordability and access, (2) choice of setting and provider, (3) quality of life and care, and (4) support for family caregivers. Twenty-five criteria are used.

You can download how your state scores by going to http://www.longtermscorecard.org/

The entire report is very important for advocates to use. However, in this era of constant talk about cutting costs, there are a few items that are particularly relevant. The Scorecard estimates per State the “impact of improvement” if your State “improved to the level of the best-performing state.”

The following three items potentially offer your State some BIG DOLLAR savings!!!! The three fit together quite nicely, IF your State really wanted to save Medicaid expenditures and comply with the ADA.

1. The Scorecard lists the number of people on Medicaid who would “first” receive their Long-Term Services and Supports (LTSS) in the home and community based settings INSTEAD OF FIRST RECEIVING MEDICAID in a nursing homes. We know from the Minimum Data Set (MDS) data that more than 10% of people enter nursing homes directly WITHOUT receiving any Medicaid LTSS in their homes and communities BEFORE they are institutionalized. Another 61% go directly from an acute care hospital into a nursing home.

The Scorecard tells you exactly how many people would “first receive” LTSS in the community – IF YOUR STATE really cared about saving Medicaid funds. We all know it is much, much cheaper to provide services in the community than in an institution. We also know that once a person is institutionalized, a lot of support systems fade away. Therefore, “close the front door” by providing services before there is any institutionalization.

2. The Scorecard lists the number of nursing home residents with “low care needs” who would “instead be able to receive LTSS in the community.” Surprise! There are people in nursing homes who have very few Activities of Daily Living impairments. The best states had only 5 percent of nursing home residents with “low care needs” while the worst states had 22% of their residents with low care needs.

Many advocates know that most of the people in institutions can have all their needs met in the community. The Scorecard takes an incremental and pragmatic approach.

Why are people with “low care needs” institutionalized? Why isn’t your State going into the nursing homes and offering these people an assortment of LTSS so they could move back into the community? Why aren’t advocates for older Americans and for people with disabilities doing this?

Again, the Scorecard gives you the number of people in nursing homes with “low care needs” in your State compared to the best State. Your State will save considerable Medicaid funds by offering institutionalized people with “low care needs” community-based services.

3. The Scorecard lists the number of people in nursing homes for whom “unnecessary hospitalizations” would/could/should be avoided. The Scorecard found that the worst states had three times greater the rate of hospitalizations of nursing home residents than the best States - 29% compared to the 10%. Ask your Governor if s/he likes spending Medicaid funds on “unnecessary hospitalizations.”

Guess what was highlighted as one main reason for “unnecessary hospitalizations” people get in nursing homes because the staff does not provide the minimal assistance folks need? Pressure sores, “a condition that is preventable with good-quality care.” The Scorecard states that “this finding is important” because “pressure sores are preventable … and can result in serious, life threatening infections….” The Scorecard also points out that they are costly – Medicaid hospitalization is expensive, especially when it is unnecessary.

We know we are beating the same tune as in other Information Bulletins, but why would your State not want to prevent hospitalizations and save money.

Advocates for older and younger Americans with disabilities in nursing homes have been “nice too long.” We have been so polite and well-behaved by not focusing on the intentional discrimination occurring when a State could avoid unnecessary institutionalized AND save money but does not and when a nursing could have avoided bed sores but did not, especially when the State has surveyed the nursing homes and found them deficient in this area.

Is it asking too much for CMS taking some initiative? The Scorecard found that if all the States achieved the level of the leading states, there would be “significant gains in health, better care experiences and potentially lower costs.”

There would be 201,531 fewer persons with disabilities in costly and unnecessary nursing home admissions -- if all states could do as well as the state with the lowest rate of unnecessary nursing home admissions! That’s a lot of disabled people..

There would be 120,602 fewer avoidable hospitalizations—at a savings of $1.3 billion nationally—if all states could achieve the rate of avoidable hospitalizations of the state that performs best on this indicator.