Providing long-term care services often proves to be a disjointed, costly endeavor, and we now have another way to rank how well Colorado compares to other states. “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers” is a new report that was released jointly by the AARP’s Public Policy Institute, The Commonwealth Fund and The SCAN Foundation last week. The report looks at four key areas for comparison: affordability and access; choice of setting and provider; quality of life and quality of care; and support for family caregivers. Within these four categories, 25 indicators are measured, some for the first time.
Colorado ranks seventh overall. We rank seventh for nursing home residents with low hospital admission rates and sixth among all states in the overall category of support for family caregivers, with 80 percent of caregivers getting needed support.
The report points out that while some states are performing relatively well on the indicators, there is much room for improvement. The report suggests states could do a better job of increasing access to services and choices by directing state Medicaid programs to serve more people in need and to offer alternatives to nursing homes, which most consumers prefer. These so-called home- and community-based services have been the center of discussion in the long-term care arena, as they are not only preferable to consumers but much cheaper compared to institutionalization. If Colorado were the best state in the nation, improving enough to move up from seventh, that would mean that would mean that 1,695 new users of Medicaid long-term services and supports would first receive services in home- and community-based settings instead of nursing homes and 1,944 nursing home residents with low care needs would instead be able to receive their care in the community.
In the 2010 legislative session, Colorado passed a bill (HB10-1053) calling for a study, now underway, of how alternative care facilities are paid. Currently, Colorado Medicaid pays a flat rate for enrollees living in the alternative care facilities. Because individuals with complicated needs have higher costs, this flat rate often leads facilities to place these individuals in a nursing facility prematurely. Premature placement in a nursing facility costs the state significantly more money, and sometimes decreases quality of life for individuals who would prefer to live in the community. The study will explore the effectiveness of more flexible payment structures on consumer satisfaction, a decrease in unwanted and unnecessary placements in nursing homes, and potential savings for Colorado Medicaid.