OpenPlacement Blog

Senior Care Scorecard (INFOGRAPHIC)

The Senior Care Scorecard aka "The Long Term Scorecard" is a collaborative study done by AARP, the Commonwealth Fund, and the Scan Foundation. Its results form multidimensional state scorecards on long-term services and supports for older adults, people with physical disabilities, and family caregivers. California has the 8th largest economy in the world–but you might be surprised how it measures up against the top states for Long Term Care.

Please like and share this Infographic if you find it helpful, and feel free to comment and share your thoughts or any experiences you’ve had below—we’d love to hear them! Also, check out our other helpful Infographics here.

long term scorecard

The Senior Care Scorecard aka "The Long Term Scorecard": Be Informed For Your Loved Ones


The Senior Care Scorecard aka "The Long Term Scorecard" is a collaborative study done by AARP, the Commonwealth Fund, and the Scan Foundation. Its results form multidimensional state scorecards on long-term services and supports for older adults, people with physical disabilities and family caregivers.

Senior Care Scorecard Acronyms

LTSS: Long Term Services and Supports

HCBS: Home and Community-Based Services

Best and Worst Overall

1st: Minnesota

2nd: Washington State

3rd: Oregon

4th: Colorado

5th: Hawaii

9th: California

51st: Kentucky

California's Scorecard

Choice of Setting & Provider: 2nd

Affordability & Access: 14th

Effective Transitions: 22nd

Quality of Life & Quality of Care: 24th

Support for Caregivers: 24th

The State of Nursing Homes

  • Nursing Home Care Is Not Affordable

Nursing Home Private Pay Cost as Percentage of Income:

  •  CA, 2010: 224%

  • CA, 2014: 241%

  • National Average: 234%

Quality Of Care Is Difficult to Assure

In 2013, 6.4% of nursing home residents in California are High risk with pressure sores, compared to 5.9% Nationwide. 

Excessive Hospital Admissions

Excessive transitions between nursing homes and hospitals are disruptive to patients and their families, and costly to the system. States can minimize these transitions by providing better care in nursing homes. 

Percentage of Nursing Home Residents Hospitalized in 2010:

  • CA: 21%

  • Top 5 States: 10%

  • Bottom 5 States: 28%

Too Many Residents with Low Care Needs

States in which a relatively high proportion of nursing home residents that have low care needs may not be taking appropriate steps to transition these individuals into HCBS settings. 

Percentage of Nursing Home Residents With Low Care Needs in 2010:

  • CA: 11.4%

  • Top 5 States: 4.6%

  • Bottom 5 States: 23%

The Status Of Home Care

Home Care Is Costly

Though Home Care is more affordable than Nursing Home Care, it is difficult for families to sustain for long periods of time. 

Home Health Private Pay Cost as Percentage of Income:

  • CA, 2010: 82%

  • CA, 2014: 84%

  • National Average: 84%

Quality Is Not Guaranteed

Like with Nursing Care, the quality of Home Care is not guaranteed. The Number of hospital admissions in 2010 reflects this. 

  • CA: 23.6

  • Nationwide: 25.5

Support For Caregivers

Caregivers play a crucial role in the lives of people with LTSS needs. Because most caregivers are employed, ensuring both access to leave, and protection from discrimination, is critical in helping them avoid burnout and keep working. Thus caregivers may retain their own health and financial security.

Assessment of Legal and Support Systems for Caregivers (Score out of 14.5)

  • CA: 6.8

  • National Average: 3

  • National High: 8

Only 62% of caregivers in California and Nationwide feel without much worry or stress, with enough time, and well-rested. 

State Policy Is The Key To Making A Difference

In order to improve the states' overall LTSS scores:

1. States need to make an effort to provide LTSS to low- and moderate-income adults with disabilities through their Medicaid or other state-funded programs


2. States need to balance spending on LTSS, shifting services away from over-reliance on nursing homes, to support more funding of HCBS.

Some Details:

Shifting care to home- and community-based services is critical. Regardless of age or type of disability, the desire to remain in one's home is nearly universal. 

  • The top 5 states allocated an average of 62.5% of LTSS dollars to HCBS.

  • The bottom 5 states allocated an average of 16.7% of LTSS dollars to HCBS

Of people already in nursing homes, a measure of high performance is the percentage of residents successfully transitioned out to a home setting

  • The top 5 states transition 13.1%

  • The bottom 5 states transition 5.3%

What We Need To Make These Policy Changes

  • At the Federal level: A rational approach to guide the states, and the establishment of standards for LTSS systems performance below which no state can fall. 

  • At the state Level: Willingness to experiment, innovate, and challenge the status quo. Also, a commitment to the rights of older people to live with dignity in the setting of their choice, and supported by services. Finally, the need to build Medicaid programs that serve as a safety net.

The Time For Change Is Now

The Scorecard clearly shows that where one lives has a tremendous impact on the experience that people and their caregivers will have when the time for LTSS arises.

But things are looking up! Overall, LTSS scores are improving generally, both nationally and at each state level.

We need to maintain this momentum, and accelerate change, in order to meet the needs of the aging boomers.