Tennessee improved its performance to the level of the highest-performing state:
• 46,994 more low- to moderate-income adults with daily living disabilities would be covered by TennCare.
• 6,181 more new users of TennCare long-term services and supports would first receive services in the community.
• 3,075 nursing home residents with low care needs would be able to return to the community within 100 days.
Source: AARP 2014 State Long-Term Services and Supports Scorecard Results
Tennessee needs to improve its long-term care for seniors, and it needs to do it within the next 12 years, a new report indicates.
By that time, the oldest members of the baby boomer generation will be turning 80. And the ratio of potential family caregivers for each person 80 years old or older will have dropped from seven to only four.
As boomers age and family sizes dwindle, the AARP has sought to gauge the outlook of long-term care options state by state basis.
The AARP's scorecard takes into account reams of state and federal data, measuring everything from affordability to quality of long-term care.
Tennessee and Alabama bring up the rear of national rankings, ranking 48th and 50th, respectively. Georgia is ranked 36th.
The report cards are designed to show states what they need to change, and why they need to act quickly.
"Those caregivers need support, and there need to be other services in place so that the system is not overly dependent on family members," said Enid Kassner, vice president for Long Term Services and Supports in AARP's public policy institute.
"The state has to act now. These systems do not arrive overnight."
Jim Shulman, executive director of the Tennessee Commission on Aging and Disability, said the state has been focused on improving quality of care in the long-term care system.
"There are a number of entities partnering together on better access to care, ease of maneuvering the system, caregiver support, and protection of our more vulnerable populations," Shulman said in an email Saturday.
"The overall ranking from the report should make us even more determined to find ways to improve our system in Tennessee."
By "systems," Kassner means a spectrum of adult services and policies that support alternatives to nursing homes without overburdening families. That could mean everything from adult day services to workplace laws that prohibit discrimination against family caregivers.
The scorecard was developed to look at states' systems from the point of view of someone who is looking for services, but also to measure what kind of support is available to family members, who provide most of the for seniors.
Tennessee ranked most poorly in its choice of settings and providers for seniors needing care, and it got a low ranking in its level of support for family caregivers. By contrast, Georgia ranked fifth in the nation for the support it provided such caregivers.
Still, Tennessee has begun moving to improve long-term care options, said Kassner, and some of those strides may not be reflected in the most recent study.
In 2008, Tennessee lawmakers passed the Long Term Care Community Choices Act. The law was meant to restructure how TennCare handled long-term care, providing the elderly and disabled with "a richer set of choices and a simpler process for accessing them," then-Gov. Phil Bredesen said in 2009.
The law created programs that provided funding for seniors seeking care options.
Before that, seniors qualifying for long-term services through the state typically went to nursing homes or didn't get help at all.
Still, there thousands of seniors on waiting lists for such state programs, officials with the Tennessee Commission on Aging and Disability said.
Nationwide, many of the changes AARP recommends will need to happen through state action, Kassner said. And they don't necessarily need to be budget-busters.
One issue in Tennessee that could quickly be improved, she said, is changing state law to allow families to delegate more home care-giving "maintenance tasks" - which could include administering pills or ventilator care - to home-care workers.
Now such workers are allowed only to perform two out of 16 prescribed tasks, meaning family members may have to leave work during the day to help with a loved one's care, even when they have a home health worker. Georgia allows workers to perform 14 such tasks.
"Survey after survey shows that people want to be able to stay in their own homes," Kassner said. "But it's very hard to do that when there aren't systems out there that support people being able to make those choices."
Contact staff writer Kate Harrison at firstname.lastname@example.org or 423-757-6673.