Long-Term Care Introduction

States that Stand Out

SUCCESS STORIES

Arizona
A statewide managed care system helps patients avoid improper long-term care choices. “Nursing home eligibles” can move between different levels of care. There are no waiting lists for home care; only 1.1 percent of the 65-plus population lives in nursing facilities, among the nation’s lowest rates.

Arkansas
A pioneer in consumer-directed programs, Arkansas gives people in need of care — or their representatives — control over spending and hiring to meet their needs. Arkansas also does well promoting home and community-based alternatives. Since Elder Choices was put in place in 1992, nursing home residency has decreased by 60 percent.

Maine
Assisted-living programs and screening protocols for nursing home care have, since 1995, restrained spending growth on long-term care to 17 percent of Medicaid budgets, compared with 53 percent nationally. Since 1995, there’s been an 18 percent decline in the number of Medicaid residents in nursing homes and a 24 percent decline in the number of nursing home beds in the state.

Oregon
The state boasts the nation’s lowest percentage of elderly people in nursing facilities. Its long-term care program provides incentives to the nursing home industry to develop home-care programs and diverts savings in institutional care to community and home care. Recent budget cutbacks, however, will limit patient access to the system.

Pennsylvania
To address the shortages of personal aides and other staff that bedevil long-term care, Pennsylvania has been a pioneer in finding out what direct-care workers themselves think are the issues in promoting better recruitment and retention. The legislature provides funding so local agencies can put creative ideas into practice.

Vermont
The state has a very good track record for getting diverse groups involved with long-term care to work together. Patients are diverted from nursing homes, and the money saved goes into a trust fund, which is then used to develop more community and home-care programs.

TROUBLE SPOTS

Kentucky
Projected Medicaid deficits led to cutbacks in long-term care services last year that were among the most extreme in the country. About 1,400 people formerly eligible for long-term care are now denied these benefits, though officials say they may appeal the decision. There’s a 3,000-person waiting list for the state-funded elderly home care system.

Louisiana and Mississippi
Both states have unbalanced long-term care systems with very high percentages of funding going to institutional care. In Louisiana, the courts are now forcing the state to expand home and personal-care services.

Ohio
State statutes guarantee nursing home rate increases. This makes it hard to apportion money to home and community-based alternatives. Although Medicaid administrators are trying to alter the equation, spending is substantially below most states.

Tennessee
Managed care organizations, at the heart of the TennCare system, bear no responsibility once someone is deemed nursing-home eligible. The result is that patients have been denied home health care and steered to nursing homes. The state ranks low in spending on home and community services as a percentage of long-term care expenditures.

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