And pace of change must accelerate to meet demographic demands

Louisiana ranks 40 when it comes to meeting the long-term care needs of older residents and people with disabilities, and AARP warns much more must be done, at an accelerated pace, to meet changing demographic demands. Specific areas of concern in Louisiana include affordability and access and support for family caregivers. This, according to a new, comprehensive state-by-state Scorecard from AARP with support of the nation’s leading organizations behind quality long-term care, The Commonwealth Fund and SCAN Foundation.

Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers–the third in a series of reports—ranks each state overall and on 25 specific indicators in 5 key dimensions: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and, effective transitions between nursing homes, hospitals and homes.

Family Caregivers

“The vast majority of older Louisianan’s want to live independently, at home, as they age—most with the help of unpaid family caregivers,” says Denise Bottcher, state director of AARP Louisiana, which serves more than 500,000 members age 50 and older in Louisiana. “Even facing tight budgets, Louisiana is making some progress to help our older residents achieve that goal. However, this Scorecard shows we have more to do, and we need to pick up the pace.”

Today, unpaid family caregivers provide the bulk of care for older Louisianan’s, in part because the cost of long-term care remains unaffordable for most middle income families. In Louisiana, more than 660,000 residents help their aging parents, spouses and other loved ones stay at home by providing assistance with bathing and dressing, transportation, finances, complex medical tasks like wound care and injections, and more. The value of this unpaid care totals about $6.47 billion.

“When it comes to helping older Louisianan’s live in the setting of their choice, family caregivers take on big responsibilities,” explains Bottcher. “Many juggle full-time jobs with their caregiving duties; others provide 24/7 care for their loved ones. With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly nursing homes – most often paid for by the Louisiana State Medicaid program. They have earned some basic support.”

According to the state Scorecard, Louisiana has taken action to improve quality of life and quality of care and effective transitions. But, more must be done.

That’s why AARP fought hard to pass The Louisiana Family Caregiver Act, which requires hospitals to: Provide your loved one the opportunity to designate a family caregiver; Notify you when your loved one is to be discharged or transferred; Discuss your loved one’s discharge plan with you.

Medicaid/Home and Community Based Services (HCBS)

“Louisiana has made some progress to improve long-term services and supports for older adults and people with disabilities, as highlighted in this Scorecard. But, proposals in Washington, D.C. to drastically cut federal funding for the Louisiana State Medicaid program would threaten even these advancements, likely resulting in our most vulnerable citizens losing the lifesaving supports that they count on,” says Bottcher.

The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net. That’s why AARP is also fighting to expand services provided at home and in the community, by shifting funds away from undesirable and more expensive nursing home care. While the inappropriate use of antipsychotic medication in nursing homes has decreased, the Scorecard highlights additional issues related to institutional care in Louisiana: supporting working caregivers, nursing home stays over 100.

While Louisiana does rank 29 in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care provided at home and in the community—the care setting that most Louisianan’s prefer—the Scorecard spotlights significant areas that call for improvement, including quality of life and quality of care, support for family caregivers, and effective transitions. Specifically:

·31.2% of Medicaid and state-funded LTSS going to HCBS for older people and adults with physical disabilities

·5.6% of people with 90+ nursing home stays successfully transitioning back into the community.

·18.1% rate of employment for adults with ADL disabilities age 18-64 relative to rate of employment for adults without ADB disabilities age 18-64.

“This Scorecard gives us a snapshot of how well Louisiana serves our older residents, those with disabilities, and family caregivers—and shows us where we must sharpen our focus to better assist hardworking Louisianan’s,” concludes Bottcher. “Now is the time for policymakers to act.”

Of the 25 Scorecard indicators, many may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched in 2014, to help older Americans live independently, at home, and the family caregivers that support them.

Long-term care (also called long-term services and supports) is a diverse set of services designed to help older people and those with disabilities; services can be provided in a person’s home, in a community setting such as an adult day center, or in a group residential facility like a nursing home.

The full state Scorecard, along with an interactive map of state rankings and information, is available at www.longtermscorecard.org.

Contributed Report