Oregon continues to rank third among the states in delivering services and supporting long-term care for older adults and people with disabilities, according to a new national study released Thursday.

But the study also found that like all states, Oregon could improve on several aspects, among them the affordability and quality of care, and support for family caregivers, who provide up to 90 percent of care.

Oregon ranked among the top five states, however, in offering older adults home and community alternatives to more expensive nursing homes and hospitals. It also ranked first in providing transitions that minimize the often-traumatic effects on older adults of moving from home and community-based care to nursing homes and hospitals.

“The fact that we have focused on home and community-based services, instead of nursing homes and institutional care, has benefited our citizens and taxpayers with less costly options,” said Rick Bennett, a lobbyist for AARP Oregon, based in Clackamas.

“There are areas where we continue to do well and areas where we need improvement.”

The study was issued eight months before a state group, which Bennett sits on, is required to submit a report to lawmakers about the future of Oregon’s system of long-term care.

The national study, a follow-up to one done in 2011, was a joint project of the national AARP, the Commonwealth Fund, and the SCAN Foundation. The current study compared states based on 26 indicators in five categories.

“States will continue to be the major laboratories of experimentation,” the report said. “Where you live is still the best predictor of the services you will receive when and where you need them.”

Both studies listed Minnesota, Washington and Oregon as the top three states overall, and all five Pacific states are in the current top 10.

“No one is saying that if you rank high, you are perfect,” Susan Reinhard, AARP senior vice president for policy, said at a conference call with reporters.

What is encouraging, she said, is that states improved even during the recent economic downturn.

“What gets measured gets improved,” said Melinda Abrams, Commonwealth vice president for reform.

How states got involved

Medicare, the federal program of health insurance for people 65 and older and for some younger people with disabilities, does not pay for most long-term care. Medicaid, the joint federal-state program of health insurance for low-income people, pays only for long-term care for older people who spend down their assets such as savings. Oregon is among the leading states spending a greater proportion of that money on alternatives to nursing homes.

With the large number of post-World War II baby boomers entering their 80s in a dozen years – the age when people begin to require care – “we need to build and invest in a better system now,” said Dr. Bruce Chernof, president of the SCAN Foundation.

Oregon’s system dates back to the late 1970s, when Oregon Project Independence was founded to provide housekeeping and personal services for older adults as an alternative to nursing homes. Lawmakers created the Senior Services Division in 1981; it’s now known as the Aging and People with Disabilities Division within the Department of Human Services.

“We have built a system over 35 years that values independence, dignity and choice,” said Michael McCormick, director of the division.

“The scorecard provides a valuable road map for Oregon to focus its improvement effort.”

AARP Oregon’s Bennett said lawmakers are looking for direction for the next steps.

“The Oregon model has served our residents and taxpayers well over the past 30 years,” he said. “The question is how we maintain needed services at the same time we face limited resources.”

Cost outpaces income

Limited resources are what most middle-income people have as they plan for long-term care, the report concluded.

For Oregon in 2013, the report found that the median annual household income for older adults was $38,428 – but that the annual cost of a private room in a nursing home was $92.710 (244 percent) and the annual cost of home care for 30 hours per week was $32,760 (86 percent). Meanwhile, based on 2011 statistics, just 48 of every 1,000 people age 40 and older were covered by private long-term-care insurance.

The comparable national averages were 246 percent of the median annual income for nursing home care, 84 percent for home care, and 46 per 1,000 covered by private long-term care insurance.

“The concern Middle Americans face is that you will run out of resources in a matter of months,” AARP’s Reinhard said, before people have to resort to state Medicaid programs.

Although Congress took a step toward a national insurance system, it repealed it in 2013 and created a study commission instead. The commission did not reach a consensus on financing.

But Chernof – who was its chairman – said there is a federal role in measuring quality of care, setting standards for direct-care workers and establishing a uniform assessment of physical and mental needs for each older adult who requires care.

“Right now, you need more training as a cosmetologist than as a home-care worker,” he said.

In many states, including Oregon, direct-care workers are gaining skills and being paid more in what AARP’s Reinhard said is the nation’s fastest growing occupation.

Aid for caregivers

An estimated 90 percent of care to older adults and people with disabilities is provided initially by family caregivers. In Oregon, there are an estimated 620,000 such caregivers, who are unpaid.

Oregon scored relatively low on this indicator, largely because of spending cuts in respite care that offer relief for family caregivers, and education and training for caregivers. Also, nearly 60 percent of caregivers express a degree of stress and worry, attributable partly to the cuts.

AARP Oregon’s Bennett said only in the current budget have lawmakers started to restore those services.

The national report said that the ratio of potential family caregivers to those who require care will shrink dramatically from the current 7 to 1 to 4 to 1 by 2030, and 3 to 1 by 2050. In Oregon, the ratio was 6.9 to 1 in 2010, but is projected to decline to 2.8 to 1 by 2050.

The national AARP’s Reinhard said less expensive alternatives to nursing homes must spread across the nation.

She also said individuals have a responsibility to consult with family members, modify their homes to accommodate disabilities, and plan for the future they want.

“This is not all related to what public policymakers can do,” she said. “But they can do a lot – and together, we can do even more.”

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