Maine ranks eighth overall in long-term care for older and disabled people, according to a national study released Thursday.
Minnesota leads the nation in care, according to the study, and illustrates how the nation could cut costs by offering better care and coordination. For instance, as many as 200,000 people could be kept out of nursing homes each year — nearly 400 in Maine — if other states emulated Minnesota with better information about home-care options, the report found.
Maine’s scored well in areas such as support for family caregivers, for the percent of low-income adults with disabilities enrolled in Medicaid or other public health insurance and for the percent of private long-term care insurance policies in effect per 1,000 population. But, according to the study by AARP, the Commonwealth Fund and the Scan Foundation, it fared poorly for the cost of private-pay home care, as percentage of median household income.
In contrast, Minnesota ranked first on seven of the 25 measures in the report. The state offers a higher quality of care, better access, more choices of settings and more support for family caregivers than do most states.
What distinguishes Minnesota and other top states is the interaction of government policies and the performance of care providers, the report says. Top-ranking states typically have greater financial flexibility to invest in long-term care because of lower poverty and disability rates, and higher average incomes, the report said. In general, most of the scorecard’s poorest performers are in the South.
The report also singled out coordination by various care providers, such as minimizing movement of patients between nursing homes and hospitals, and assuring that long-term care is provided in the most appropriate setting — often at home.
The nation could save $1.3 billion annually and avoid unnecessary hospital stays for 120,000 people, the report said, by coordinating health services as Minnesota does.
But the report’s authors as well as Minnesota experts say top-scoring states have much work to do.
“Even where we’re good, there’s room for improvement,” said Michelle Kimball, state director of AARP Minnesota. Noting that only 6.6 percent of high-risk nursing home residents in Minnesota get pressure sores — lowest in the nation — Kimball added, “but that’s 6.6 percent too much.”
At the direction of the Legislature this year, the Minnesota Department of Human Services will seek federal permission to change some of the state’s long-term care programs to offer more flexibility, such as focusing nursing home and other high-cost care primarily on the most frail older people.
“We know we have to change the system,” Colman said. “We have to move to the next generation of care — really, to continue on the path we’ve been on for some time, to make long-term care better and more cost-effective.”
That’s precisely what the top-scoring states traditionally have done, said Susan Reinhard, a senior vice president for policy at AARP.
“They try new approaches, then test them to be sure they work, then make more changes,” she said. “It’s a process, and it takes good policy decisions and good application of those policies by the care providers.”
(c)2011 the Star Tribune (Minneapolis)
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