The Blue Cross and Blues Shield of Massachusetts Foundation has issued a new report, “Long-Term Services & Supports (LTSS) in Massachusetts: A Primer on LTSS Coverage, Access, and Affordability,” that paints a comprehensive picture of the state of long-term care in Massachusetts. It concludes that the state does a better job than most others in providing care for its older residents needing assistance and younger adults with disabilities, but that there’s still room for improvement especially with regard to racial and economic disparities.
Here are some of its findings:
- Massachusetts has leveraged federal Covid-19 relief funds to expand funding for home care, including raising compensation and increasing training for home care workers.
- Massachusetts has expanded its One Care and Senior Care Options (SCO) programs that combine Medicaid (MassHealth) and Medicare dollars to provide coordinated care to beneficiaries.
- Massachusetts was ranked fourth in the nation by the AARP LTSS 2023 State Scorecard Report, but has some of the highest nursing home and home care costs in the country.
- The AARP Scorecard ranks Massachusetts last on hospital admissions for people receiving home care and 30th for hospital admissions among nursing home residents.
- More than 820,000 Massachusetts residents between the ages of 18 and 64 report living with a disability.
- Just over a quarter of Massachusetts residents receive their health care coverage from MassHealth. While just 13% of these beneficiaries receive LTSS, they account for 49% of annual MassHealth spending.
- Together, nursing home and home and community based LTSS account for 37% of MassHealth spending.
- Approximately 8% of Massachusetts residents have private long-term care insurance.
- Cost of care in Massachusetts ranges from $20,000 a year for adult day health to more than $160,000 a year for a private room in a nursing home.
- While figures for sources of LTSS spending in Massachusetts are unavailable, the authors of the study assume they are similar to those nationally which are: 44% covered by Medicaid, 19% by Medicare, 14% out-of-pocket, and 8% private insurance. (Charity and other public sources of funding make up the balance.)
- In Massachusetts, 84% of LTSS care is provided by nearly 780,000 unpaid informal caregivers. They constitute 11% of the Massachusetts population.
- In 2021, paid caregivers in Massachusetts received a median hourly wage of $17.59, below the living wage standard in the state. Of these caregivers, 85% are women and 59% people of color.
A recording of a webinar presenting a summary of these results is available here.
What these raw numbers don’t show is the difficulties families have in finding appropriate care for loved ones. This is reflected in a recent front-page story in The Boston Globe, “Home service, nursing care shortages leave patients waiting.” While Massachusetts has done an admirable job of expanding MassHealth coverage and creating many types of programs, both the eligibility rules and the types of care available under each program are extremely complicated. The state of long-term care not only creates an undue burden on families, but also delays discharges from hospitals resulting in extra costs and fewer beds for those who really need them.