Veterans Day provides an opportunity for all of us to thank our military veterans for their service. This time of year is also an appropriate time to increase our awareness of some of the challenges our veterans face. The AARP Public Policy Institute (PPI) wants to ensure that our nation’s veterans get the long-term services and supports (LTSS) they need, and do so while remaining in their own communities.
As the veteran population ages, the need for these services continues to increase. Almost 20 percent of people (and 42 percent of men) 65 and older are veterans, and nearly one-third of veterans live with disabilities, according to the U.S. Department of Veteran Affairs. Hence, the urgency to ensure that they receive information on available services—both as older individuals and as veterans—is critical.
The 2017 LTSS State Scorecard is a report and interactive tool that measures state performance for creating a high-quality system of care in order to drive progress toward improvement in services for older adults and people with physical disabilities, and their family caregivers. As part of the Scorecard project, we are producing a set of “Promising Practice” reports that share information on initiatives around the country from which other states and organizations can learn. As we approach Veterans Day, we’re pleased to announce the release of the fourth such report, “No Wrong Door: Supporting Community Living for Veterans.”
One practice the report highlights is the Veteran-Directed Home- and Community-Based Services (VD-HCBS) program, initiated in 2008 to provide veterans with greater choice and control over their LTSS—specifically to enable them to live in their communities. The program, which has served 6,570 veterans since its inception, operates in 34 states, the District of Columbia, and Puerto Rico. What makes this particularly timely is that the VHA Office of Geriatrics and Extended Care, which runs the program, has announced plans for a national rollout over the next three years. This translates to an expansion of community services for veterans. We view this as a tremendous opportunity for the entire No Wrong Door system to understand the benefits of these services so that agencies can inform veterans and their families.
The VD-HCBS program, which enables vets to manage a flexible service budget and hire family, friends, and neighbors to provide care, has helped a number of participating programs lower hospital-related costs. For example, in Missouri, the VA St. Louis Health Care System documented its success in reducing emergency room visits, hospital admissions, and bed days of care as a result of the flexible spending budgets provided through VD-HCBS.
Our Promising Practice reports are here to accelerate change and improvement, and so states don’t have to reinvent the wheel. The reports include toolkits featuring resources and contacts allowing for idea sharing and possible replication.
As we release “No Wrong Door: Supporting Community Living for Veterans,” we thank and salute our veterans.
If you look at the 2017 Long Term Services and Supports (LTSS) Scorecard, you may notice that something is different in this third edition– housing and transportation indicators are included for the first time. Affordable and accessible housing and transportation options are key components of a livable community. Having options that people can access, regardless of their age, income, physical ability or other factors brings them closer to the community features and services they need to remain engaged in their communities.
AARP’s Livability Index gives higher housing scores to neighborhoods in counties with more subsidized (sometimes known as affordable) housing, as it ensures that people of all incomes can have access to a place to live. One of the elements of a high-functioning LTSS system is that it gives people choices about where to live and receive services. Affordable housing is essential to shifting the delivery of LTSS from an institutional model towards home and community-based care. However, a major barrier to transitioning people out of institutions and back to their communities is the lack of affordable and accessible housing options. The Scorecard includes a measure of the supply of subsidized housing at the state level, an important resource to help individuals with lower incomes and LTSS needs stay in the community and receive services at home or in a community setting.
This Scorecard measure captures the total amount of subsidized housing opportunities—spanning many different programs—divided by the total number of housing units in a state. The total number of subsidized housing opportunities has risen since 2011, but it still falls short of current and future needs.
This chart shows the supply of subsidized housing opportunities in each state in 2015 (blue bars), the improvement from four years earlier (red line), and the gap in affordable housing opportunities (light blue solid area). Nationally, there are more than 18 million renters at or below area median income (most of whom are cost-burdened by housing) and fewer than 8 million potentially subsidized units. There is still an affordable housing crisis in our country.
The solution seems simple – we should build more of this housing. Federal programs such as Section 202 have historically built new affordable housing for older adults with low incomes. However, the federal government has stopped funding new construction of this and similar programs, and fewer affordable apartments are available under these programs. Vouchers have become more popular due to their efficiency, but holders may have a hard time finding appropriate housing and landlords who will accept their voucher in more livable neighborhoods. Those counting on a subsidized unit might find that there are not enough available in a helpful location.
Decades ago, we did not anticipate that people with LTSS needs would stay in their communities, so most of our neighborhoods were not designed for their needs. While communities work to build more housing with “universal design” features, many units may have steps and other barriers that are problematic for those with LTSS needs. This must change if our communities are going to meet the goal of providing options for all people of all ages.
The good news is that there are more opportunities today (the blue bars in the chart) than in the past (the red line) as vouchers have increased and programs such as the Low Income Housing Tax Credit Program build more units. States can help by allocating these tax credits in ways that enhance livability, developing housing trust funds, grants or loan programs, or taking other steps. However, it is clear that government cannot solve this alone, especially when proposals to build new affordable housing meet objections. Building livable communities for all must be a goal for all – not just policymakers, but builders, homeowners, residents and neighbors.
Join Dr. Harrell and other AARP experts for a twitter chat to discuss housing needs and the LTSS Scorecard at 1pm EDT on July 19. Join the conversation using #PickUpthePace and share your questions and insights.
Rodney Harrell, PhD, is Director of Livable Communities for the AARP Public Policy Institute. His expertise includes neighborhood choice, housing affordability and accessibility, transit-oriented development, community redevelopment, sustainable community initiatives and other livable communities issues.
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This is an exciting month for AARP’s Public Policy Institute. We’re set to release our third Long-Term Services and Supports (LTSS) State Scorecard Report on June 14, and this powerful tool is far more interactive and comprehensive than the 2011 and 2014 installments.
A lot has changed since 2011 when we first partnered with the Commonwealth Fund and the SCAN Foundation to conceive of the idea for a scorecard that would measure long-term services and supports for older adults as well as people with physical disabilities and family caregivers on a state-by-state basis.
At the time, I concluded in an article that, based on the report’s findings, even the best performing states had a long way to go to create a high-performing system of long-term services and supports. Certainly many states have made progress since then, and no doubt the 2017 Scorecard will continue to highlight that progress. But there’s also little doubt that the Scorecard will uncover a list of shortcomings and areas for improvement. That’s what the Scorecard was all about in its 2011 and 2014 iterations, and that’s what the 2017 Scorecard promises to illuminate.
Of course, the actual Scorecard release is not the most exciting part. What’s truly exciting is the impact it can have after its release. We’re encouraged by how policymakers and advocates viewed the 2014 Scorecard for what it was: a call to action. Many used the information in the report as a tool to make positive change in their states. With Americans living longer and LTSS demand continually growing, our call to action must be louder and more pronounced than ever.
Thanks to the efforts of all involved in compiling and organizing data for the 2017 Scorecard, I’m proud to say that—no question—it tops the 2014 installment in value as a key tool in the field. So, what’s the same and what’s different this time around? Like the first two installments, the 2017 Scorecard examines state performance across five key categories, or dimensions:
- Affordability and access
- Choice of setting and provider
- Quality of life and quality of care
- Support for family caregivers
- Effective transitions
But this year, we’ve placed an emphasis more than ever on how the results are presented. The information on our website will be truly interactive and engaging than in years past. (The new version of the site, http://www.longtermscorecard.org/, will appear June 14.) Users can easily customize data to suit their needs, no matter what role they play in LTSS and where they’re located. While our accompanying report remains an invaluable source of information, the interactive website has become the true centerpiece of the offering.
Other new additions of which we’re extremely proud: Visitors to the site will have access to videos, called Impact Stories, that show how improving on the Scorecard can impact the lives of real people. Users can also download Promising Practices such as this one as well as Emerging Innovations that states can use as they work to improve the lives of older adults, those with physical disabilities, and family caregivers. Better still, new and groundbreaking content will not stop with the June 14 Scorecard release. We’ll continue to bring you more Promising Practices and Emerging Innovations, as well as releases in our Impact Story video series, throughout the year.
My colleague Jean Accius, vice president for Independent Living/Long-term Services and Supports, who was instrumental in spearheading these changes, summed up their value succinctly when he said, “These concrete tools and innovative practices will help states improve their performance and, ultimately, the lives and well-being of others.” As for the addition of the Impact Story videos this year, he added that they “literally complete the picture—putting a face to the diversity of individuals whom the Scorecard examines.”
Will this year’s Scorecard illuminate shortcomings and challenges in LTSS as it has in the past? Absolutely. (Here’s a teaser: we’ve got a long way to go.) But I’m extremely excited that we’ll also shine a light on a path forward for all caregiving stakeholders.
Susan Reinhard is a senior vice president at AARP, directing its Public Policy Institute, the focal point for AARP’s public policy research and analysis. She also serves as the chief strategist for the Center to Champion Nursing in America, a resource center to ensure the nation has the nurses it needs.