How Long-Term Care Services and Supports Compare Across the United States

Many Americans have little or no retirement savings. When they retire, the hard, cold reality hits them. They cannot afford to live in the community, where they raised their children. They will have to look for a less expensive place to live. One of the most significant expenses for aging adults is long-term care. If you are looking at different options for where to settle for your golden years, you should explore how long-term care services and supports compare across the United States.

The AARP Public Policy Institute compiles a reference book every year, called “Across the States: Profile of Long-Term Services and Supports.” Over the last 25 years, the book has grown to include thousands of data points and valuable analysis to make sense of the numbers.

The 2018 edition of the AARP reference book contains a wealth of information for people wanting to find a state that offers generous services and support to seniors. You can find information by state about things like:

• The current age demographics and expected numbers for the future
• How many people in the state are disabled
• How much care costs in that state
• Information on the numbers of family caregivers
• Services available in the home and community
• Nursing facilities
• The long-term services and supports which Medicaid provides in that state
• Demographic data about income, poverty and living arrangements
• Private long-term care insurance statistics (95 percent of Americans do not carry this insurance)

We do not have a national system that provides Medicaid-funded long-term services and supports (LTSS). Unlike Medicare, Medicaid programs are different in every state. Medicare does not provide long-term care services, so most people rely on Medicaid to pay for some of all of their LTSS. One state might have all the services you need at little or no cost, and a neighboring state might provide much less assistance. Some people improve their quality of life immensely, by moving to a nearby state.

Differences in State LTSS Programs

The 2018 AARP report is 84 pages long, so we cannot cover all the details in this article. Here are a few of the highlights:

• Some states (including New Mexico) spend 73 percent of their total LTSS funds on home and community-based services (HCBS) for the elderly and disabled, compared to only 13 percent in some other states (Kentucky and New Hampshire). Adequate care services in the home and community can make it possible for a person to continue living at home, rather than having to move into a nursing home.
• Some states are spending less on LTSS and HCBS now than they did in 2011.
• Southern states have higher rates of poverty among older adults than other regions of the country. Fewer than 30 percent of the people age 65 and over in Alaska, Hawaii, New Hampshire, and Maryland live below 250 percent of the national poverty level. This compares to 42 percent of older adults living in Mississippi, Louisiana, Tennessee, New Mexico, Kentucky, Alabama, Arkansas, and West Virginia. Since part of the Medicaid funds come from state sources, a poorer state will have more people in need but fewer dollars to fund the services they need.
• The demographics about people in need encompass more than just poverty. Cognitive difficulties and self-care needs are factors as well as income. These needs vary significantly from one state to the next. Only five percent of older people in Colorado have self-care needs, compared to 11 percent in Mississippi. Only six percent of older people in South Dakota have cognitive challenges, compared to 12 percent in Mississippi.
• Medicaid spent a total of $75 billion on home and community-based care services for older adults in 2013, compared to family caregivers, who provided services worth $470 billion in that year.
• Oregon has 121 units in assisted living and residential care communities per 1,000 people age 75 or older. Louisiana only has 20 units per 1,000 people in this age group.
• Only seven percent of people living in long-term care facilities in Hawaii receive antipsychotic medication, compared to 20 percent in Oklahoma.

You should consider many factors when evaluating where to live when you retire. Get information from multiple sources. Get advice from friends, relatives and social services agencies.

Every state makes its own regulations. Be sure to talk with an elder law attorney near you to find out how your state might differ from the general law of this article.

References:

AARP. “Across the States: Profiles of Long-Term Services and Supports.” (accessed October 31, 2019) https://blog.aarp.org/thinking-policy/across-the-states-profiles-of-long-term-services-and-supports

AARP. “Across the States 2018: Profiles of Long-Term Services and Supports.” (accessed October 31, 2019) https://www.aarp.org/ppi/info-2018/state-long-term-services-supports.html?CMP=RDRCT-PPI-CAREGIVING-082018