How California ranks on long term care and support

Compared to other states, California is doing a relatively good job helping disabled and aging adults cope with the challenges they face living independently or in a long-term care facility, according to a new, comprehensive scorecard of long-term care services in the United States.

California ranked 15th overall among the states based on its performance on 25 indicators in the study by the AARP released today.

But that overall ranking masked a wide divergence in the state’s performance in the specific categories.

California was in the top quarter of states on 10 indicators – mostly those involving affordability, access and choice — and in the bottom quartile on 8 indicators, primarily those involving quality of life and the quality of care that disabled and older adults receive.

“This is the first time there has been a multi-dimensional look at long-term care services and support,” said Susan Reinhard, senior vice president for public policy at the AARP.

The study, two years in the making, was financed by grants from the non-profit Commonwealth Fund and the SCAN Foundation. (The SCAN Foundation is also a financial supporter of

Dr. Mary Jane Koren, a vice president of the Commonwealth Fund, described the scorecard as a tool designed to nudge states to do better.

“Even the very best states,” she said, “have room for improvement.”

Overall, the highest ranking states were Minnesota, Washington,, Oregon, Hawaii and Wisconsin. The five lowest ranked states were Indiana, Oklahoma, West Virginia, Alabama and Mississippi, with Mississippi the worst.

California was all over the map, depending on the category assessed.

The state was 7th overall on affordability and access, in part because home care costs are more affordable here and in part because the state has relatively generous eligibility requirements for public programs. Compared to other states, for example, a high percentage of low-income disabled and aging adults qualify for Medicaid, known as Medi-Cal in California.

California ranked 9th on a selection of indicators assessing the amount of choice people having in selecting a setting and a provider for their care. Within that broad category, the state ranked sixth in the percentage of public spending on long-term care services and support that goes to home and community based services, and 5th on the percentage of new Medicaid patients receiving services first in the community rather than an institution.

California also had by far the most people as a percentage of disabled population directing their own care, in part, perhaps, because the state’s in-home care program is structured to put residents in charge of choosing and managing their own providers.

But if California does well in keeping care affordable and keeping residents in charge of their own care, the state falls down when it comes to the quality of that care and in its support for family caregivers, according to the study.

The state ranked 43rd in the percentage of disabled adults living in the community who were satisfied with life, 40th in the percentage of high-risk nursing home patients with bed sores and worst among all states in the percentage of long-stay nursing home patients who were restrained.

California was 46th in the percent of family caregivers who reported that they usually or always got the support they needed.

Dr. Bruce Chernof, president and CEO of the SCAN Foundation, said the study showed that California had “positive successes and areas for growth.”

Chernof said the state and nation are “on the cusp of something really important” as the population ages and more people need long term care or support. He said he hoped the rankings would prod states to improve the availability and quality of support that older adults receive.

“We believe that measurement is the key to improvement,” he said. “You can’t improve what you don’t measure.”

To see the full report, go here.

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