Click to enlarge
A recent state scorecard released by AARP, The Commonwealth Fund and the Scan Foundation has ranked Kentucky last in the nation for long-term care services and support for older adults, people with disabilities and family caregivers.
The report rates state performance based on five basic aspects of long-term care: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and effective transitions. Kentucky was ranked in the bottom 10 in every category.
The study found the cost of long-term care to be unaffordable for middle-income families in all states, but relative to the median income of the state’s older adults, Kentucky’s expenses were higher than most. The average cost for private nursing home care in Kentucky would have consumed 269 percent of the median annual household income for Kentuckians age 65 or older in 2013, as compared to 234 percent on average for the nation. Home care was more affordable, at roughly 92 percent of median annual household income in Kentucky or 84 percent on average for the nation, but still represented an unsustainable cost for long periods.
States with the highest rankings, including Minnesota, Washington, Oregon, Colorado and Alaska, have implemented legislation to enable Medicaid programs to fund more home-care services and to offer more support to family caregivers, said Jim Kimbrough, president of the Kentucky AARP.
As for Kentucky, the state is working on it.
Changes to Kentucky’s long-term care system are already in development, according to Deborah Anderson, commissioner of the state’s Department for Aging and Independent Living, but the shift can’t happen overnight.
“We’ve known for quite some time that we are not balanced,” Anderson said. “We are right at the cusp, but it’s really hard to turn that ship around quickly.”
Anderson said that Kentucky is currently revising its Home and Community-Based Waiver for the Medicaid program, which allows long-term care services administered in home and community-based settings to be covered under Medicaid.
“The changes in that waiver are, for Kentucky, groundbreaking,” Anderson said.
Community meals-on-wheels programs and preventative home visits by nurses are among services that they are working to add with the new waiver, Anderson said. The changes are expected to take effect by next spring.
Kimbrough expects the new waiver will go a long way to improve the community and home-based optionsfor long-term care in Kentucky. Kimbrough said he would like to see the percentage of Medicaid and state-funded long-term care money used for home care services rise from its current 22.1 percent to 50 percent.
In addition to the financial shift in Medicaid spending, improvements to the system will require a change in the mindset of what constitutes good care for an aging population, he added. Roughly 90 percent of AARP Kentucky members report that they don’t want to go into an institution, and most said they are willing to trade the added safety and security of a skilled nursing facility in order to stay in their own homes.
“If something’s wrong with Mom or Grandma, we feel safer when they are in an institutional setting,” Kimbrough said. “We’ve got this tension between what people want and this culture of institutional care.”
Anderson said one of the state’s priorities recently has been to give Kentuckians easier access to information on long-term care services and support in the community. The state is establishing Aging and Disability Resource Centers in each region to field phone and web-based inquiries and provide more localized
assistance, she said. Her department is also adding a toll-free phone line to inform older Kentuckians and their caregivers about what services are available. Anderson said she expects these services to be operating fully by the end of the fiscal year.
The challenge of serving a large generation of aging Boomers is one that faces the entire nation, Anderson said, and it will involve not only the availability of the right long-term care services but also the efficient use of a shrinking pool of resources, as Boomers retire and tax bases decrease.
“I don’t know that any state is fully prepared for it,” Anderson said.
As the state’s aging population grows, private-pay providers will play an important role in enabling older Kentuckians to age at home, she said. That also means working with the medical community in expanding their offerings to include more in-home options.
“There’s a business opportunity there,” Anderson said. “We need the business world to step up to that and to make it available, especially in smaller communities.”
With more than one million people in Kentucky, or 23 percent of the state’s population, projected to be age 60 or older by the year 2020, Kimbrough said long-term care is quickly reaching crisis status. Older Kentuckians are already filling up lengthy waiting lists for services such as home meal delivery, he said.
“If someone’s on a waiting list for meals, it’s because they are going hungry,” he said.
Kimbrough does see additional signs of progress for the state, however, noting that the state legislature unanimously passed a resolution in April to study family caregiving and long-term care supports and services in Kentucky. The Legislative Research Commission is expected to deliver recommendations based on the study by December.
“Our expectation is the study will have recommendations for policy changes that will require legislative action,” Kimbrough said. “If nothing else, we will have a discussion: Do we serve more people the way they want to be served, at home, or do we put more people where they don’t want to be, in an institution?”