Five states have grown their supply of home health aides by 20% or more, with most of the nation holding steady even as demand increases, according to the 2020 Long-Term Services and Supports State Scorecard.

The report, issued last week by the AARP and the AARP Foundation, the Commonwealth Fund and the SCAN Foundation, calls for solutions that support older adults, people with physical disabilities and family caregivers.

Researchers found that home care services continue to be much more cost-effective than nursing home care, with an average annual per-person cost of roughly $35,000 for 30 hours of weekly care at $23 hourly versus an average cost of $102,000 for nursing home care. 

But home care still exceeds what many older households can afford. Nationally, the report notes, home care costs would consume 80% of an older, middle-income family’s income.

And home-based services may not always be available. Although five states have more home health aides than they did three years ago, three others saw their ranks shrink and the rest of the nation only held steady.

The findings were a mixed bag for assisted living facilities and residential care units too.

“With only incremental improvement across indicators at a time when demographic trends portend a rapid increase in LTSS demand, the Scorecard results suggest that many states may not be well prepared to offer affordable, accessible LTSS choices for individuals in the future,” the authors warned.

Based on 2019 data, the report examines trends in five key areas, with Effective Transitions and Choice of Setting and Provider findings most applicable for home healthcare stakeholders.

In 2019, one of five nursing home residents had low-care needs, meaning they potentially could have transitioned to home- and community-based settings. But just 54% of Medicare skilled nursing residents were successfully discharged back to community living, according to the report. Alaska, Arizona, Hawaii, Oregon and Utah each bested 60%.

The report calls on policymakers and healthcare leaders to reduce “overreliance” on nursing homes by:

  • Offering families options for counseling and diversion programs to direct first-time Medicaid LTSS participants toward HCBS options.
  • Sustaining or creating transition programs such as Money Follows the Person, so nursing home residents who wish to return to the community can do so.
  • Eliminating barriers to home care services, including through federal allowance of nurse practitioners, clinical nurse specialists, and physician assistants to order home health services under Medicare.
  • Expanding home- and facility-based palliative care for those who want to avoid aggressive treatment or burdensome transitions across providers at the end of life.

The 2020 Scorecard ranks all 50 states and the District of Columbia on a set of 26 indicators. Previous versions were published in 2011, 2014 and 2017.