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50+: Live Better, Longer

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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

Affordability and Accessibility continued...

The numbers reveal how well their different systems work. The top five states cover an average of 63% of their low- to moderate-income population that requires long-term care. The worst states cover only 20%. The nationwide average is 37%.

"States need to streamline eligibility rather than make it complicated to get into the system," Reinhard told reporters.

Most people, the authors write, prefer receiving care in their home or in a home-like setting in their community that affords them some measure of independence.

Choice, however, is in short supply in the worst states. In those states, only 26% of new Medicaid recipients benefit from home or community-based support (HCBS). By contrast, more than three-quarters of those receiving Medicaid in the five best states opt for HCBS.

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.

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