Don't demonize nursing homes if you want to improve long-term services and supports, officials say at unveiling of AARP rankings

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Susan Reinhard, Ph.D., RN
Susan Reinhard, Ph.D., RN

States with the best long-term care systems tend to favor home- and community-based options but do not view nursing homes as the enemy, officials said at the unveiling of new rankings Thursday. Minnesota again topped the scorecard produced by the AARP Public Policy Institute with support from The SCAN Foundation and The Commonwealth Fund.

The rankings were based on five dimensions of care: affordability and access; choice of setting and provider; quality of life and care; support for family caregivers; and effective transitions. Minnesota was the only state to rank in the top quartile for all five. This also was the case in the preceding version of the scorecard, issued in 2011.

Washington, Oregon, Colorado, Alaska, Hawaii, Vermont and Wisconsin were the other top performers. They “clearly established a level of performance higher than other states,” the report noted.

The strongest predictor of a state's performance on the scorecard was its percentage of Medicaid dollars going toward home- and community-based services, AARP emphasized in a press release. States with strong HCBS are shaping policies in accordance with seniors' strong preference to remain at home, and these states tend to rely least on nursing homes and be the best at care transitions, said AARP Senior Vice President for Public Policy Susan Reinhard, Ph.D., RN, at a forum on the rankings in Washington, D.C.

However, Minnesota has not achieved its top ranking by viewing nursing homes as something to “strike from the options,” said Loren Colman, assistant commissioner of continuing care for the state's Department of Human Services. Colman said he and his colleagues “partnered” with nursing homes, asking them the question: “What is your future?”

“We had a process where we designed the care center of the future and worked together to identify ways to improve quality and help shape the kind of care center that the boomers may need,” Colman explained.

Partnering with nursing homes also has been important in improving Mississippi's long-term care system, said Kristi R. Plotner, director of the Office of Policy, Planning and Development at the Division of Medicaid, Office of the Governor. Her agency and others explicitly told nursing homes “we are not trying to put you out of business,” Plotner said.

Mississippi is ranked No. 49 and has struggled with a lack of financing, but having a strategic plan has been crucial to the notable improvements the state has achieved, said Plotner. Because grant cycles are so short, it's important to already have plans in place when funding opportunities like Money Follows the Person arise, she stressed. And plans are needed in order to stay clear-headed, she added.

Improving long-term care is like “throwing twenty-one balls in the air and trying to catch them in the right order,” she said. “If you have a plan in place that's possible.”

Larry Minnix, president and CEO of provider association LeadingAge, asked the panelists for tips on getting state lawmakers to tackle long-term care reforms, particularly payment systems.

Emphasize that long-term services and supports touch "every piece of the pie" when it comes to people's health, responded Michael McCormick, deputy director of Aging & People with Disabilities at the state's Department of Human Services. Direct medical care takes up about 10% of the pie and “social determinants” account for the rest, he said.

“That's how we made our argument in Oregon,” McCormick said.

Panelists agreed that creating a strategic plan for what the LTSS system should look like is one of the most important steps. This can help keep initiatives underway even as different political parties come into power, said Colman.

Click here to access the complete scorecard.