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2014 State Long Term Services and Support Scorecard



The American Association of Retired Persons (AARP), the SCAN Health Plan, and The Commonwealth Fund produced the second annual State Long-Term Services and Supports (LTSS) Scorecard, which gages system performance from the perspective of service users and their families.  The finest quality of care in a skilled nursing facility should be a guarantee, especially with the influx of senior citizens our nation will encounter within the next ten years. The “Baby Boom Generation” will rapidly increase the percentage of elderly residing in a nursing facility which in turn, will generate a higher demand for excellence in quality of care.   Therefore, the slow pace of improvement must speed up to be better equipped for the aging of the baby boomers.  The LTSS Scorecard is designed to measure how each state performs in its assistance and support for the elderly, adults with disabilities, and their family caretakers.   It is intended to help states improve their LTSS systems so that the elderly and adults with disabilities can better choose and control their lives, in an effort to maximize their welfare and independence. 

State LTSS is measured by assessing the following five multi-dimensional facets, with each comprising of 3 to 6 data indicators:

1. Affordability and Access—Median annual private pay cost for nursing homes and homecare; private long term care insurance in effect; and percentage of adults with a disability or in a nursing home who require assistance with activities of daily living (ADLs), and also receive Medicaid.

2. Choice of Setting and Provider—Percentage of Medicaid and state funded LTSS allocated for home and community based services; percentage of Medicaid used for “receiving services in the community;” home health care aids per 1,000 population; and nursing home units per 1,000 population.

3. Quality of Life and Quality of Care—Percentage of adults with disabilities receiving support from the community; percentage of disabled adults satisfied with their quality of life; rate of employments for adults with ADL disabilities; percentage of patients in a nursing home with pressure ulcers (bed sores); nursing home staff turnover rate; and percentage of nursing home patients who are administered antipsychotic medication.

4. Support for Family Caregivers—“Legal and system support for family caregivers, number of health maintenance tasks able to be delegated to LTSS workers;” and family caregivers who are well rested and have reduced stress.

5. Effective Transitions—Percentage of nursing home patients with low care needs, percentage of nursing home patients who have been admitted to a hospital within six months; percentage of nursing home patients who have severe dementia; percentage of nursing home stays lasting over 100 days; and percentage of nursing home stays lasting 90 days and subsequently, successfully transitioning the patients back into the community.

Each state was evaluated and assessed based on the criteria provided above.  Findings of the study revealed a wide discrepancy in performance across the states, with LTSS systems in fronting states having very distinct characteristics from those in trailing states.  States such as Minnesota, Washington, Oregon, Colorado, and Alaska ranked as the top five states that provide exceptional long term care; whereas Washington DC and Louisiana fell in the bottom quartile. Notwithstanding, all states have much room for improvement.

A concerning aspect of the study disclosed the percentage of “high-risk nursing home residents with pressure sores.”  Across the board, the median percentage of residents with pressure ulcers is 5.8%, a staggering percentage on account of how easily preventable pressure ulcers are. With proper care and observation, states such as California—with 6.4% of residents with pressure ulcers– have the capacity to fall below the median line.  In Louisiana, ranked as one of the worse states for long term care, 9.8% of its nursing home residents suffer from pressure ulcers.  This is a wakeup call to the nation begging the question as to why this is allowed.  It is also indicative that skilled nursing facilities are in dire need of reevaluation.


Pressure Ulcers are 100% preventable and are extremely detrimental to the patient. Nursing home providers should ensure the highest quality of care for you and your loved one. The lawyers at the Law offices of Ben Yeroushalmi, an elite elder abuse and neglect firm, are rigorously battling to protect the fundamental rights for you and your loved one. If you are suspicious of elder abuse or neglect in a skilled nursing facility, please do not hesitate to contact us for a free consultation. We serve cities throughout the state of California.