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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
WebMD Health News
Reviewed by Laura J. Martin, MD

Sept. 8, 2011 -- Geography determines the type of long-term care available to Americans, a new report suggests.

The "scorecard" report finds that states vary widely in the services they provide to the elderly, to disabled adults, and to the family caregivers who support them.

"Our intention is that this scorecard will begin a dialogue among key stakeholders so that lagging states can learn from top performers and all states can target improvements where they are most needed," the authors write.

The scorecard is a collaboration between the AARP's Public Policy Institute, the Commonwealth Fund, and the Scan Foundation. It ranks states' performance according to four categories:

  1. Affordability and access
  2. Patient choice of both provider and setting
  3. Quality of life and care
  4. Support for family caregivers

The Best and the Worst

Overall, the five states that scored the highest were:

  1. Minnesota
  2. Washington
  3. Oregon
  4. Hawaii
  5. Wisconsin

The lowest scores went to:

  1. Mississippi
  2. Alabama
  3. West Virginia
  4. Oklahoma
  5. Indiana

A list of all the states can be found at

The authors of the report point out that even the states with the highest scores need to improve the services they provide. They also note that each of the lowest ranked states performed well in at least some of the categories measured.

"There was wide variation across the states as well as within states," Bruce Chernof, MD, FACS, president and CEO of The SCAN Foundation, told reporters during a telebriefing.

Affordability and Accessibility

Long-term care is unaffordable for middle income families, according to the report. Even in states where nursing home care is most affordable, such care averages 171% of an older person's household income. The national average is 241%.

For home care, the numbers are less staggering. But at an average of 88% of income nationwide, they still put a great stress on household means.

"We looked at affordability, and it's just not affordable," Susan Reinhard, senior vice president for public policy at AARP, told reporters.

Accessibility is also an issue. As the report points out, states have a great amount of flexibility when it comes to determining Medicaid eligibility.

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