AARP’s new Long-Term Services and Supports (LTSS) Scorecard finds that care provided in the United States for older adults and people with disabilities is inadequate. The report finds major gaps in every state, such as the cost of home care, the long-term care workforce and support for family caregivers.
South Dakota has made some progress to improve care options for older adults, including advocacy for family caregivers, supporting additional funding for adult day services, expanding the nursing scope of practice and enhancing nurse delegation. However, the report shows there is still much more to be done to keep up with the rapidly changing needs of an aging population.
“From our own statewide survey related to long-term care and caregiving, we know there is a need to strengthen long-term care for countless loved ones across the country, including in South Dakota,” said Erik Gaikowski, AARP South Dakota State Director. “AARP’s Scorecard shows that there are many roads to meet the needs of all South Dakotans who deserve the very best care, including the 80,000 family caregivers in our state. It’s time to accelerate our efforts, for the sake of saving more lives.”
Other key findings from the scorecard include:
Family Caregiving
- Only six states provide a tax credit for family caregivers’ out-of-pocket expenses. Family caregivers on average spend $7,242 per year on out-of-pocket costs.
- Only seven states, have statewide laws protecting caregivers from discrimination in the workplace that ensure they are not unfairly treated due to caregiving duties outside of work.
- Twelve states have enacted paid family leave laws and 18 states have paid sick day laws, which can be used for caregiving.
- Dozens of states experienced declines in the number of care choices, such as adult day services or home health aides, that help support families managing caregiving.
Home and Community-Based Services
- There has been a surge in older adults receiving long-term care at home, rather than in nursing homes and other institutions. For the first time, more than half (53%) of Medicaid LTSS spending for older people and adults with physical disabilities went to Home and Community-Based Services (HCBS). This is up from 37% in 2009. HCBS includes support for home health care aides, respite services, assistive technology and home modifications and other services. The average annual per person cost of home care in 2021 was $42,000.
- Many states have large numbers of people with low care needs living in nursing homes, indicating a lack of HCBS access and services, and there are differences across race/ethnicities. Nationally, less than 9% of nursing home residents have low-care needs, but in five states 15% or more have low-care needs, including South Dakota with a rate of 22.1%.
Nursing Homes and Institutional Care
- A major workforce crisis exists in nursing home care. Across all states, wages for direct care workers are lower than wages for comparable occupations, with shortfalls ranging from $1.56 to $5.03 per hour. South Dakota does, however, rank among the most competitive states.
- Nationally, more than half of nursing staff in nursing homes leave their job within a year (53.9% turnover rate). South Dakota’s rate of 53.8% is right at that average.
- Gaps in workforce and equity result in persistent problems in care. For instance, about 10% of nursing home residents nationwide experienced a pressure sore. Pressure sores can be life-threatening as they can lead to bone or joint infections, cancer, and sepsis.
- Only nine states, including South Dakota, have enhanced hazard mitigation plans for natural disasters and other emergencies to systematically address the needs of vulnerable older adults and people with disabilities, including for nursing home residents.
“AARP’s LTSS Scorecard shows some progress and innovation, but there’s still a long way to go before we have systems that allow people to age well and independently for as long as possible and support the nation’s 48 million family caregivers,” says Gaikowski. “It’s also clear some emerging issues deserve more attention – from whether nursing homes are prepared to confront natural disasters, to whether they have plans in place to maintain and grow their workforces.”
