The scoring and ranking methodology in this Scorecard is based on the same methodology used in the 2014 State Long-Term Services and Supports (LTSS) Scorecard; however, there are two significant changes. First, the Quality of Life and Quality of Care dimension is given half the weight of the other dimensions in determining the overall rank; second, the Support for Family Caregivers dimension is calculated as a single composite indicator. These changes are discussed in more detail below.
Dimensions and Indicators: The Scorecard measures LTSS system performance using 25 indicators across 5 dimensions:
Affordability and Access (six indicators) includes the relative affordability of private pay LTSS, the proportion of individuals with private long-term care insurance, the reach of Medicaid and the Medicaid LTSS safety net for people with disabilities who have modest incomes, and the ease of navigating the LTSS system.
Choice of Setting and Provider (six indicators) includes the balance between institutional services and home- and community-based services (HCBS), the extent of participant direction, and the supply and availability of alternatives to nursing homes, including residential care options such as assisted living and the supply of home health and personal care aides.
Quality of Life and Quality of Care (three indicators) includes employment of people with disabilities living in the community, and two indicators of quality in nursing homes. Due to discontinuation of data sources, half of the quality indicators from the previous Scorecard could not be repeated, and no suitable replacements could be found. Because of these gaps, the Quality of Life and Quality of Care dimension received only one-half of the weight of the other four dimensions in determining states’ overall ranks on LTSS system performance.
Support for Family Caregivers (a single policy composite, divided into four indicators) includes supports for working caregivers, person- and family-centered care, nurse delegation and scope of practice, and transportation policies.
Effective Transitions (six indicators) includes measures of hospitalization and institutionalization that should be minimized in a high-performing LTSS system.
The framework for assessing LTSS system performance was developed in consultation with the Scorecard National Advisory Panel (NAP). NAP members are listed in the acknowledgments section of the 2017 LTSS Scorecard report, which can be found on the LTSS Scorecard website www.longtermscorecard.org. The NAP was instrumental in providing and evaluating the merits of the data indicators that populate each of the five dimensions. The NAP also helped refine some indicators from the past Scorecard.
The indicator selection criteria included the following conditions: indicators had to be clear, important, meaningful, and have comparable data available at the state level. Several composite indicators were constructed from a range of data in a related area, enabling us to rank states in areas of performance that would otherwise be difficult to assess. The methodology for each composite indicator is described in the detailed indicator descriptions section below. Indicators are based on data that are expected to be updated regularly, so that change can be observed over time.
The 25 indicators were selected because they represent the best available measures at the state level. No single indicator fully captures state performance, but taken together they provide a useful measure of how state LTSS systems compare across a range of important dimensions.
Ranking Methodology: The Scorecard ranks the states from highest to lowest performance on each indicator in the Access, Choice, Quality, and Transitions dimensions. We average rankings across all indicators within each of these four dimensions and then re-rank to determine each state’s dimension ranks. The Support for Family Caregivers dimension is a single composite indicator, and states are ranked based on the total composite score.
All dimensions are weighted equally with the exception of the Quality dimension, which was given half weight. In the case of missing data or ties in rank for an indicator or dimension, minor adjustments were made to values used in calculating the average.
- For ties: the average rank is given for the computation of the dimension or overall average (e.g., two states tied at third; both get a score of 3.5 for the calculation of the dimension average).
- Missing data: a constant value is added to all ranks so that the average rank for the indicator is 26.