A national report found room for improvement in the long-term care options available to the elderly and disabled in Arkansas, which ranked 37th out of 51 in comparison to all other states and the District of Columbia.
AARP found that 43% of states, including Arkansas, showed little to no change in the past few years for most of the areas that the organization assessed, according to the Long-Term Services & Supports State Scorecard issued Thursday.
The report divided the states and the District of Columbia into five tiers, with Tier 1 being the highest quality and Tier 5 being the lowest. Arkansas was placed in Tier 4.
The assessment measured equity in long-term care based on several indicators in five categories:
- Affordability and access to care
- Safety and quality
- Support for family caregivers
- Choices of settings and providers
- Community and integration
The scorecard ranked Arkansas in the third tier for the first three categories and the fourth for the last two.
There is “no magic bullet to reform and modernize long-term care systems overnight,” but the data in the scorecard should be a tool to create policies on the state and federal levels that improve support systems for older Americans and their caregivers, said Susan Reinhard, the senior vice president of the AARP Public Policy Institute, in a Thursday morning video conference call with reporters.
Reinhard also said the scorecard compared states’ long-term care systems to each other because many of the assessed criteria have “no evidence-based national benchmarks.”
“Hopefully getting a little competition going is our best strategy for inspiring action,” she said.
The Arkansas Department of Human Services communications department had not read the report as of Thursday afternoon and could not comment on specific findings, deputy communications chief Keith Metz said in an email.
The Arkansas Health Care Association, a nursing home industry group, also wasn’t able to comment on the report Thursday.
Improvements and stagnation
Arkansas passed its version of the Caregiver Advise, Record, Enable (CARE) Act into law in 2015. As of this year, 43 states have passed the law that AARP created as a model for states to enact.
The CARE Act requires hospitals to fully inform family caregivers about their loved one’s status and needs during and after a hospital stay.
Additionally, the AARP scorecard noted some areas in which long-term care in Arkansas has improved in recent years.
For example, the rate of employment for adults aged 18-64 with disabilities that affect their daily lives, compared to the rate of employment for adults in the same age group without these disabilities, increased from 16.5% in 2018-19 to 19.9% in 2021.
The state also saw an increase in the number of home health and personal care aides per 100 adults with disabilities that affect their daily lives, from 15.6 in 2018-19 to 18.2 in 2020-21.
Arkansas stood out as one of three entities, along with Colorado and the District of Columbia, that have the “most expansive” availability of Medicaid Buy-in, which allows people with disabilities to retain Medicaid coverage while working and earning money, according to the scorecard.
However, the number of people enrolled in a self-directed Home- and Community-Based Services (HCBS) program per 1,000 people with disabilities declined from 5.7 in 2019 to 4.5 between 2020 and 2023.
Many metrics assessed by AARP remained largely stagnant in Arkansas, such as the percentage of Medicaid long-term care spending going to HCBS programs for older people and adults with physical disabilities, and the number of assisted living and residential care units per 1,000 people aged 75 or older.
The scorecard states that Arkansas increased its enrollment per 10,000 people in its Programs of All-Inclusive Care for the Elderly (PACE) from 2020 to 2023 by more than 25%, but Metz said this is not accurate.
The PACE program provides long-term care for people aged 55 and older who are eligible for both Medicare and Medicaid and live in community settings, according to the scorecard. Arkansas’ PACE program has about 500 beneficiaries, and the recorded increase in the report might be due to the coverage extension granted by the federal government during the COVID-19 pandemic, Metz said.
Shortfalls
In the quality and safety category, AARP found that 57% of nursing home residents and 13.4% of nursing home staff were up to date on COVID-19 vaccinations in 2023, ranking 25th and 47th in the nation, respectively.
In 2021, the U.S. Centers for Medicare & Medicaid Services required staff to be vaccinated against COVID-19 in facilities that treat Medicare and Medicaid patients. That requirement expired in July.
Nursing home residents are especially vulnerable to COVID-19, partly because of their age, Reinhard said.
Vaccination rates among nursing home patients depend largely on what nursing home staff say to them about the vaccines, Reinhard added.
“[Some are] encouraging them to get the COVID vaccine because they very much want to protect those that they’re caring for,” she said.
Reinhard also said there is a nationwide shortage of nursing home staff. Arkansas saw a 56.3% rate of average turnover of nursing home staff in 2022, according to the scorecard.
Only 22% of nursing home residents nationwide live in a facility with a five-star rating from CMS, said Rita Choula, the senior director of caregiving at AARP Public Policy Institute.
That percentage of Arkansas nursing home residents was 12.1% in 2021, ranking 31st in the nation, according to the scorecard.
Additionally, 11% of older Arkansans with disabilities who qualified for public housing assistance from 2020 to 2022 were not enrolled in it, according to the scorecard.
Older adults usually prefer to receive care at home rather than in assisted living facilities, and family members are often their caregivers, Choula said.
However, family caregivers are frequently underpaid, if they are paid at all, Reinhard said.
Reinhard and Choula said AARP encourages states to create tax credits for family caregivers. Six states, not including Arkansas, have tax credits for caregivers’ out-of-pocket expenses.
Arkansas is also not one of the 36 states nationwide that has at least one city or county with laws protecting people from discrimination on the basis of family caregiving responsibilities, according to the scorecard.
Reinhard said both state and federal policymakers should make long-term care for older adults a higher priority.
“State action is generally falling short of what the aging populations in these states need so that people can live their final years, or even decades, in dignity with access to the best care possible,” she said.
