Published in the Woonsocket Call on September 2, 2018

Across the States 2018: Profiles of Long-Term Services and Supports, by Ari Houser, Wendy Fox-Grage, Kathleen Ujvari, of AARP’s Public Policy Institute, was released days ago. The jampacked 84-page AARP reference report gives state and federal policy makers comparable state-level and national data culled from a large number of research studies and data sources, some of the data gleaned from original sources.

AARP considers the 10th edition of Across the States, published for the past 24 years, “the flagship publication” to assist policy makers make informed decisions as they create programs, and policies for long-term services and supports (LTSS). State-specific data “is easily found, “at your fingertips,” claims AARP.

Across the States, released August 27, 2018, includes a myriad of aging topics include: age demographics and projections; living arrangements, income, and poverty; disability rates; costs of care; private long-term care insurance; Medicaid long-term services and supports; family caregivers; home- and community-based services (HCBS); and nursing facilities. Each state profile is a four-page, user-friendly, print-ready document that provides each state’s data and rankings.

Looking at Trends

AARP Public Policy Institute researchers have identified four trends in reviewing state data. Of most importance to Congress and state legislatures, Across the States gives a warning that America’s population is aging. The nation’s age 85 and over population, those most in need of aging programs and services, is projected to triple between 2015 and 2050, a whopping 208 percent increase.

But, by comparison, the population younger than age 65 is expected to increase by only 12 percent. The under age 65 population, currently, 85 percent of the total population, is projected to be 78 percent in 2050. Bad news for propping up the Social Security system with the worker-to – beneficiary ratio declining.

Across the States researchers say that the demographic shift of an increasing older population will have an impact on family caregiving. “The caregiver support ratio compares the number of people ages 45–64 (peak caregiver age) to the number ages 80+ (peak care need),” notes the report. Today, there are about 7 people ages 45–64 for every person age 80. By 2050, that ratio will drop to 3 to 1.

America’s older population is also becoming more diverse, reflecting overall trends in the general population. Across the States researchers note that the Hispanic population age 65 and over is projected to quadruple between 2015 and 2050.

Finally, Across the States report notes that State Medicaid LTSS systems are becoming more balanced due to the increase of state dollars going to fund home and community-based services (specifically to care for older people and adults with disabilities). But, this trend varies in level of balance, say the researchers, noting that: “The percentage of LTSS spending for older people and adults with disabilities going to HCBS ranged from 13 percent to 73 percent in 2016. While 40 states became more balanced, 11 states became less balanced for older adults and people with physical disabilities in 2016 compared with 2011.”

Taking a Closer Look

Across the States notes that the age 85 and over population is projected to significantly outpace all other age groups when the aging baby boomers begin turning age 85 in 2031. In 2015, people ages 85 and older made up 2 percent of the US population. By 2050, they are projected to represent 5 percent. By contrast, in the Ocean State the age 85 and over population was 2.7 percent of the state’s population. By 2050, look for the oldest-old population to inch up to 5.4 percent.

Throughout the nation the cost for private pay nursing facility care is well out of reach of most middle-income families. Across the States notes that in 2017 the annual median cost for nursing facilities is $97,455 for a private room and $87,600 for a shared room. But, in Rhode Island the annual cost is higher, with a private room costing $ 104,025 and $ 101,835 for a shared room. The researchers say that for the cost of residing in a nursing facility for one year, a person could pay for three years of home care or five years of adult day services.

Because of the high costs, most people go through their life savings paying for costly care and ultimately have to rely on the state’s Medicaid program. Nationally, the percent of Medicaid as primary payer in 2016 was 62 percent (61 percent in Rhode Island).

According to Across the States, family caregivers provided $470 billion worth of unpaid care in 2013, more than six times the Medicaid spending on home and community-based services. In Rhode Island, 134,000 provided 124 million hours of care annually with an economic value $ 1.78 billion. But, AARP’s report warns federal and state policy makers about the stark demographics in America’s future that will for the nation’s “Oldest Old” to scramble to find a caregiver, due to a shortage. Will state’s have the financial resources to fund programs and services to make up for this demographic reality.

For a copy of Across the States report and Rhode Island specifics, go to: http://www.aarp.org/content/dam/aarp/ppi/2018/08/across-the-states-profiles-of-long-term-services-and-supports-full-report.pdf.