By Fran Cronin
I thought I was doing my 86-year old father a favor last year when I moved him from New Jersey to live near me here in Massachusetts. But it turns out I may have been wrong.
According to a new report, New Jersey outperforms Massachusetts in affordability as well as in overall “long-term services and supports” for the elderly and physically disabled.
In fact, Massachusetts falls to the bottom of the heap when it comes to providing support to family caregivers. As the primary caregiver for my father, I am not surprised. Although my father lives in an assisted-living facility, his needs are more demanding than the care I give to my two children. My schedule is chock-a-block with trips to my father’s assorted doctors, making phone calls and running errands.
The report – which includes a state-by-state scorecard — was co-authored by AARP’s Public Policy Institute, The Commonwealth Fund, and California’s SCAN Foundation. Its 108 pages painstakingly examine four key dimensions of LTSS — Long-Term Services and Support — performance on a state-by-state basis. They include affordability and access; choice of setting and provider; quality of life and care; and support for family caregivers.
After much data-crunching, the Scorecard — as the report is known — confirms what many of us already know from experience: Variation in health care delivery is as broad as our nation is wide, and the gap between the top performers and the bottom-feeders is large enough to jeopardize the wellbeing of many of the 24 million adults who are over 65 or disabled.
One major systemic weakness highlighted by the report: the power of Medicaid. It states: “[Medicaid] affects the extent to which people with LTSS needs who want to avoid entering nursing homes are able to do so, by facilitating or hindering the choice of alternative settings, such as assisted living and supportive services in the home.”
In moving my father from a New Jersey hospital to a Massachusetts rehab facility and then to assisted living, the question always posed with each transition –- prior to discussing need — was about my father’s Medicaid coverage. Medicaid allowances controlled the length of my father’s hospital stay. They controlled our choice of rehab facility and length of stay. And they ensured that Medicaid would not support my father’s residence in an assisted living facility.
Dr. Juergen Bludau, director of the Center for Older Adult Health at Brigham and Women’s Hospital, expressed deep frustration with the lack of coordination and efficacy of elder care services in our medically intensive Boston area. Continue reading