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Nowhere To Go But Up

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Last month, the AARP Public Policy Institute released the 2017 edition of the Long-Term Services and Supports State Scorecard.  This is the third edition of the LTSS Scorecard, which measures services and supports for “older adults, people with physical disabilities and family caregivers.” The news was not good for Indiana. The Hoosier state ranked last overall among the 50 states and the District of Columbia. 

The Scorecard measures data across five dimensions of long-term care. Indiana ranked lowest in the nation in the areas of affordability and access, and support for family caregivers. The state ranked 50th in the category of choice of setting and provider.   

Picking up the Pace of Change

The theme of the 2017 Scorecard is “Picking up the Pace of Change.” Indiana has made progress in a number of areas of LTSS, but we lag behind other states in addressing the needs of a rapidly-growing population of older adults and people with disabilities.

Indiana’s Division of Aging held two days of public hearings in July to gather input on the current system of home and community-based services (HCBS). The hearings are part of a study requested by the state legislature. As noted in testimony from Kristen LaEace, CEO of the Indiana Association of Area Agencies on Aging, “the study could not be timelier.”   Consumers, service providers, researchers, volunteers and community advocates shared their experiences and perspectives about what works and what we could do better as a state to address the long-term needs of older adults, people with disabilities and their families.  Consumers expressed appreciation for the services that are available through Indiana’s Medicaid, Medicaid Waiver and CHOICE programs. They shared how access to healthcare and community supports helped support their independence, allowed them to pursue a career, raise a family or care for their loved ones at home. But they also expressed their frustrations with a system that sometimes moves too slowly or is difficult to navigate. Some shared their struggles in finding quality care. We can point to many success stories of people who benefit from home and community-based services, but there is room for improvement.

80 Percent of Indiana’s Spending

These experiences are reflected in Indiana’ LTSS scorecard. More than 80 percent of Indiana’s spending for long-term supportive services is for institutional care. Only 28 percent of Medicaid-eligible recipients of long-term care services first receive those services in the home. People with disabilities are less likely to find employment. There is work to be done to ensure that services are available that promote community engagement and livability. 

Improving LTSS in Indiana requires attention to the costs and availability of care. Quality care is often beyond the financial means of middle income seniors in Indiana. Living with chronic health conditions exhausts the resources of families and drives them toward poverty. There is a workforce shortage for home health and personal care aides. Finding care can be difficult, even for those who can afford it. The majority of care is the uncompensated care provided by friends and family members. How can Indiana help support the burden of caregivers who are often employed outside the home? Real change and improvement in LTSS must address these dimensions of care.

Progress in Indiana

There has been progress in Indiana. The expansion of the Medicaid Waiver program has allowed CICOA and the other Area Agencies on Aging to increase the number of people we serve. There is an increase in person-centered care, and the focus on the needs of the individual. There have been improvements in the quality of care in nursing facilities, which helps reduce hospital admissions and emergency room visits. This year, Indiana made changes to its state-funded home-care program, CHOICE, providing greater flexibility in meeting the needs of consumers, promoting health and independence, and reducing the need for costlier care options. 

Improving long-term supportive services is ultimately a community challenge. It will take a coordinated effort among all stakeholders to do it. Older adults, people with disabilities, family caregivers, service providers, advocates and public officials should see the latest LTSS Scorecard not as a sign of failure, but as a call to action. We know we can do better.  And, there’s nowhere to go but up.

Learn more about the LTSS Scorecard: