Virginia ranks #28 in the country for Long-Term Care Services, supports for older Americans: AARP Scorecard

AARP’s new Long-Term Services and Supports (LTSS) Scorecard finds that more than three years after the COVID-19 pandemic began, care provided in the United States for older adults and people with disabilities is painfully inadequate. The report finds that major gaps persist in every state, including Virginia, especially related to support for family caregivers, worker wages, nursing home staffing, transportation and housing.

Ranking #28 in the country, Virginia has made some progress in improving care options for older adults, including providing Medicaid for low-income people with disabilities and in the supply of available assisted living facilities, the report finds. However, the report shows there is still much more to be done to keep up with the rapidly changing needs of an aging population.

"Too many Virginians rely on a long-term care system that struggles — and often fails — to keep them and their loved ones healthy and safe," said AARP Virginia State Director Jim Dau. "The AARP Scorecard shows that lawmakers and industry providers have plenty of opportunities to improve care and better meet the needs of all Virginians."

KEY FINDINGS

Family caregiving

Dozens of states experienced declines in the number of care choices that help support families managing caregiving. For instance, 21 states, including Virginia, experienced declines of 10% or more in adult day services since 2016, and 16 states, had declines of 10% or more in access to home health aides since 2019.

Only six states provide a tax credit for family caregivers’ out-of-pocket expenses. Family caregivers on average spend $7,242 per year on out-of-pocket costs.

Only seven states have statewide laws protecting caregivers from discrimination in the workplace that ensure they are not unfairly treated due to caregiving duties outside of work.

Twelve states have enacted paid family leave laws and 18 states have paid sick day laws, which can be used for caregiving.

Home and Community-Based Services

There has been a surge in older adults receiving long-term care at home, rather than in nursing homes and other institutions. For the first time, more than half (53%) of Medicaid LTSS spending for older people and adults with physical disabilities went to Home and Community-Based Services (HCBS). This is up from 37% in 2009. HCBS includes support for home health care aides, respite services, assistive technology and home modifications and other services.

• The average annual per person cost of home care in 2021 was $42,000.

Eleven states had state policies that improve presumptive eligibility for Medicaid HCBS at the time of data collection, making it possible for people to go home to receive care after being in the hospital rather than having to be admitted to a nursing home while their eligibility for Medicaid payments is being determined, the report said.

Many states have large numbers of people with low care needs living in nursing homes, indicating a lack of HCBS access and services.

Nursing homes and Institutional Care

A major workforce crisis exists in nursing home care. Across all states, wages for direct care workers are lower than wages for comparable occupations, with shortfalls ranging from $1.56 to $5.03 per hour.

• In Virginia wages are $3.96 lower than other entry level jobs.

Nationally, only 22% of nursing home residents live in a facility with a 5-star rating; only about 12.5% of Virginia residents live in a 5-star facility. Gaps in workforce and equity result in persistent problems in care.

• For instance, about 10% of nursing home residents nationwide experienced a pressure sore. About 12.5% of Virginia nursing home residents get pressure sores. Pressure sores can be life-threatening as they can lead to bone or joint infections, cancer, and sepsis.

Only nine states have enhanced hazard mitigation plans for natural disasters and other emergencies to address the needs of vulnerable older adults and people with disabilities, including for nursing home residents.

“COVID-19 tested our long-term care systems, and they failed. Now is the time to take the lessons we’ve learned to fix them, for the sake of saving lives,” said Susan Reinhard, senior vice president, AARP Public Policy Institute. “AARP’s LTSS Scorecard shows some progress and innovation, but there’s still a long way to go before we have systems that allow people to age well and independently for as long as possible and support the nation’s 48 million family caregivers.”

Recommendations

Key recommendations from the report and AARP to strengthen support for long-term care and aging at home:

Prioritizing saving time, money, and increasing support for the 48 million family caregivers, who are the backbone of the long-term care system, providing over $600 billion in unpaid care, such as with paid leave, tax credits, and other mechanisms to address health and financial needs.

Investing in all aspects of Home and Community-Based Care infrastructure, such as increasing support and training for home health aides and home visits, supporting the ability to access and use medical devices and equipment, and updating key Medicaid regulations and payment models.

Bolstering the nursing home and in-home care workforce, with improved recruitment and training, increasing pay, and expanding the ability of trained nurses, aides, community health workers and other paraprofessionals to take on some aspects of care. States can choose to enact and enforce staffing and related care standards.

Expanding the use of innovative, effective models for nursing homes can improve both quality of care and quality of life, such as with smaller facilities and private rooms.

Addressing inequities by investing to close the staggering gaps in access to quality care and facilities and staffing shortages.

Virginia Scorecard

The Scorecard includes a series of 50 indicators focused on 1) affordability and access; 2) choice of setting and provider; 3) safety and quality; 4) support for family caregivers; and 5) community integration, using data from a variety of publicly available sources, such as the Centers for Medicaid and Medicare Services, American Community Survey and Bureau of Labor Statistics.

This article originally appeared on Staunton News Leader: AARP: Virginia #28 in the country for nursing home care, services