The State Long-Term Services and Supports Scorecard ranked states on 25 indicators that comprise the key dimensions of a high-performing system. The Scorecard is designed to help states raise the performance of their long-term services and supports (LTSS) systems by targeting opportunities for improvement. While the Scorecard started a discussion about state LTSS performance, it did not explain why states ranked high, low, or somewhere in between. Therefore, the AARP Public Policy Institute, with support from The Commonwealth Fund and The SCAN Foundation, undertook a series of case studies to provide a deeper context for understanding state performance for the baseline Scorecard. This paper presents an overview of the findings from the case studies.
We studied three states to learn more about the factors that distinguish a high-ranking from a lowranking state. We conducted site visits to the top-ranked state (Minnesota) and to a middle-ranked state (Idaho, ranked 19th) and a low-ranked state (Georgia, ranked 42nd). While three states were intentionally selected to examine the differences among them, the characteristics of one state do not necessarily pertain to those of other, similarly ranked states. For example, two states may have similar ranks, yet achieve them in quite different ways. Figure 1 illustrates the different dimension ranks achieved by North Dakota (ranked 18th overall) and Idaho (ranked 19th overall).
Nevertheless, in the overview of the three case study states, it is apparent that significant factors differentiate a high-ranked state from a low-ranked one. These factors include state policy decisions and administrative structure, as well as features over which the private sector and consumers, rather than the state, have control. Such features include private pay rates for LTSS, the supply of home care workers, nursing home staff turnover, and measures of life satisfaction. Poverty and disability rates also can affect the challenges that states face. Notably, both Minnesota and Idaho have substantially lower than average rates of disability.