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The Best and Worst States for Long-Term Care

Report: Even Among the Top Performing States There Is Room for Improvement

Quality of Life and Care

Ninety-one percent of adults with disabilities report that they are satisfied with their quality of life in South Dakota, Alaska, North Dakota, Hawaii, and Nebraska -- the top five states for this category. The lowest scoring states had an 81% satisfaction rate. In North Dakota, 57% of such adults held a job, the highest rate in the country. In the worst states, less than a fifth of disabled adults were employed.

Quality of care also varied greatly. One marker of nursing home care quality is the presence of pressure sores, which develop on the skin due to lying in bed without moving for extended periods. They can lead to dangerous, sometimes fatal infections. In 2008, 16% of long-stay nursing home patients in the five worst states had such pressure sores, compared to 7% in the top states. The national average was 12%.

Another measure of the quality of care is nursing home staff turnover. In the bottom states, nearly three-quarters of staff at such institutions changes each year. That's compared to 27% in the top states (Connecticut, Illinois, South Carolina, Rhode Island, and Hawaii).

Supporting Family Caregivers

The report's authors believe that support for caregivers, whether social, emotional, or legal, is an essential part of long-term care. They write that states that score highly in this category generally score highly in most other measures.

The authors urge states to offer more sick leave to caregivers than required by the federal Family and Medical Leave Act as well as adopting services that will help make their work less burdensome.

"We hope that this scorecard serves as a baseline or tool for improvement," Mary Jane Koren, MD, MPH, vice president of long-term care quality improvement at the Commonwealth Fund, told reporters.

The improvements the authors envision could be quite significant. For example, if all states performed as well as Minnesota, more than 120,000 hospitalizations would be avoided. That translates to $1.3 billion in health care savings. And if they all had public safety nets as effective as that of Maine, more than 667,000 people would be covered by Medicaid or other publicly funded programs.

The authors acknowledge that the report leaves many questions unanswered. For example, they were unable to address such issues as access to transportation and how well long-term services and support are coordinated with both primary and acute care. For many such questions, there was inadequate data.

"You can't improve what you can't measure," Koren told reporters.

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