AARP Ranks Top States in the Nation for Long-Term Care

Minnesota ranks as the top state for long-term services and supports (LTSS), while Kentucky sits at the bottom of the list, according to a report from AARP, the SCAN Foundation and Commonwealth Fund that measures states’ performance of LTSS systems that assist older people, adults with disabilities and their family caregivers.

The State Scorecard evaluates states based on their performance across five dimensions: affordability and access, choice of setting and provider, quality of life and quality of care, support for family caregivers, and effective transitions.

Minnesota ranked in the top quartile of performance for each of these five dimensions. For instance, 73 out of 1,000 people age 40 and older in Minnesota have private long-term care insurance policies, compared to the national median of 44.


The percentage of Medicaid and state-funded LTSS spending going to home and community-based services for older people and adults with disabilities sits at about 65.2% in the state, more than double the nation’s average of 31.4%. And only 7.3% of long-stay nursing home residents in Minnesota are hospitalized within a six-month period, compared to the 18.9% nationwide median.

These factors, along with others, make Minnesota a leader in LTSS performance.

“If all states rose to Minnesota’s level of performance, 1.5 million more personal care, home care and home health aides would be available to provide LTSS in communities nationwide,” the report states.


Following Minnesota in the top-five ranking states for LTSS are Washington, Oregon, Colorado and Alaska, where the dimensions either rank in the top or second quartiles of performance.

Kentucky, however, has been ranked the worst-performing state, with performance in each of the five dimensions falling in the bottom quartile. In the state, 33 out of 1,000 people age 40 and older have private long-term care insurance policies. The percent of Medicaid and state-funded LTSS spending going to HCBS is at 22.1%. And 23.6% of long-stay nursing home residents are hospitalized within a six-month period.

If Kentucky’s performance improved to the level of Minnesota’s, then an additional 31,088 low- and moderate-income adults with ADL disabilities would be covered by Medicaid, the report shows.

Along with Kentucky, the other states in the bottom-five include Alabama, Mississippi, Tennessee and Indiana. These, and even the top-performing states, still have room to improve, the Scorecard states.

“Positive trends exist, but enormous variation among the states continues to affect the millions of people who encounter the LTSS system,” it says.

According to a 2013 report, approximately 8.4 million Americans received paid long-term care services from adult day services centers, home health agencies, hospices, nursing homes and assisted living and residential care communities. And where these Americans live has a “tremendous impact” on the experiences they have with LTSS systems nationwide, the State Scorecard says.

“We still have very far to go. … The cost of LTSS continues to outpace affordability for middle-income families, and private long-term care insurance is not filling the gap,” it states.

Access the full report.

Written by Emily Study

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