AARP’s new Long-Term Services and Supports (LTSS) Scorecard finds that more than three years after the COVID-19 pandemic began, care provided in the United States for older adults and people with disabilities is painfully inadequate. The report finds that major gaps persist in every state, including Montana, especially related to Safety & Quality; Choice of Setting & Provider; and Affordability & Access.

 Ranking #33 in the country, Montana has made some progress to improve care options for older adults, including “Assisted Living Supply” meaning assisted living and residential care units per 1,000 population (ages 75+). However, the report shows there is still much more to be done to keep up with the rapidly changing needs of an aging population. Montana dropped six slots since the last score card was issued in 2021, Montana was ranked #27 in the country.

 “The pandemic reinforced the need to strengthen long-term care for loved ones across the country, including in Montana,” said Mike Batista AARP Montana Director of Government Affairs. “AARP’s Scorecard shows that there are many roads to meet the needs of all Montanans who deserve the very best care, including the 112,000 family caregivers in our state. It’s time to accelerate our efforts.”

 Additional key findings from the report include:

 Family Caregiving

* Only six states, including Montana, provide a tax credit for family caregivers’ out-of-pocket expenses. Oklahoma enacted a caregiver tax credit bill in June, after data for the Scorecard was collected. Family caregivers on average spend $7,242 per year on out-of-pocket costs.

 Home Based Services

* There has been a surge in older adults receiving long-term care at home, rather than in nursing homes and other institutions. For the first time, more than half (53%) of Medicaid LTSS spending for older people and adults with physical disabilities went to Home and Community-Based Services (HCBS). This is up from 37% in 2009. HCBS includes support for home health care aides, respite services, assistive technology and home modifications and other services.

o The average annual per person cost of home care in 2021 was $42,000.

o Montana ranked near the bottom at #42 for “Home Care Cost” meaning the median annual home care private pay cost as a percentage of median household income, (ages 65+). 

* Many states have large numbers of people with low care needs living in nursing homes, indicating a lack of HCBS access and services. More than 20% of residents in Montana have residents with low needs, compared to 9% nationally.  

Nursing Homes and Institutional Care

* A major workforce crisis exists in nursing home care. Across all states, wages for direct care workers are lower than wages for comparable occupations, with shortfalls ranging from $1.56 to $5.03 per hour. In Montana, wages are $2.28 lower than other entry level jobs.

o Nationally, more than half of nursing staff in nursing homes leave their job within a year (53.9% turnover rate). In Montana, the rate is above the average, at 63.2%, with Montana, Vermont, and New Mexico experiencing the highest averages in the nation in staffing turnover.

o Staffing disparities are a significant challenge. Residents of nursing homes with high admissions of Black residents receive almost 200 fewer hours of care per year compared to residents of nursing homes with high admissions of white residents.  

* Nationally, only 22% of nursing home residents live in a facility with a 5-star rating; about 33.7% of Montana residents live in a 5-star facility. Gaps in workforce and equity result in persistent problems in care. For instance, about 10% of nursing home residents nationwide experienced a pressure sore. Pressure sores can be life-threatening as they can lead to bone or joint infections, cancer, and sepsis. 

“COVID-19 tested our long-term care systems, and they failed. Now is the time to take the lessons we’ve learned to fix them, for the sake of saving lives,” said Susan Reinhard, Senior Vice President, AARP Public Policy Institute. “AARP’s LTSS Scorecard shows some progress and innovation, but there’s still a long way to go before we have systems that allow people to age well and independently for as long as possible and support the nation’s 48 million family caregivers. It’s also clear some emerging issues deserve more attention – from whether nursing homes are prepared to confront natural disasters, to whether they have plans in place to maintain and grow their workforces.”