Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers
Major Findings
The states that ranked at the highest level across all four dimensions of LTSS system performance, in order, are Minnesota, Washington, Oregon, Hawaii, Wisconsin, Iowa, Colorado, and Maine.
Leading states often do well in multiple dimensions—but all have opportunities to improve
The leading states generally score in the top half of states across all dimensions. Public policy decisions made in these states interact with private sector actions, resulting in systems that display higher performance. But no state scored in the top quartile across all 25 indicators, demonstrating that every state LTSS system has at least one indicator on which it trails the standards set by top states. Even within dimensions, there is only one instance in which a state ranked in the top quartile across every indicator in the dimension.
Poverty and high rates of disability present challenges
Lagging states scored in the bottom half of states on most dimensions. Among the states in the bottom quartile overall (Mississippi, Alabama, West Virginia, Oklahoma, Indiana, Kentucky, Tennessee, Florida, Louisiana, Georgia, New York, and Nevada), many are in the South, and have among the lowest median incomes and highest rates of both poverty and disability in the nation. This pattern largely holds across all dimensions. Among southern states, only Virginia and North Carolina rank in the top half overall. See Exhibit 3 for the geographic pattern of overall LTSS system performance.
Many states have opportunities to improve
States that ranked in the second quartile (Nebraska, Arizona, California, Alaska, North Dakota, Idaho, Vermont, Wyoming, New Jersey, Illinois, Maryland, North Carolina, and New Mexico) all scored in the top quartile on at least one dimension. With the exception of Alaska (an unusual state because of its unique geography), no state in the second quartile scored in the bottom quartile on more than one dimension. These states all have areas of success, and can also improve to a higher level of performance by targeting their efforts in areas where they lag, and where other states have shown the path to higher performance.