How Does Your State Perform?
Find out how your state’s long-term services and supports performs.
What is the Long Term Services and Supports (LTSS) Scorecard?
The Scorecard is guided by the belief that to meaningfully manage and improve performance, we must measure it. Unlike research that focuses on a particular aspect of LTSS system performance, the Scorecard compares state LTSS systems across multiple dimensions of performance, reflecting the importance and interconnectedness each has on the overall LTSS system. The goal is to spark conversations, inspire investment, galvanize broad-based coalitions, and focus stakeholders’ attention on the factors that most directly impact consumers and their families.
The AARP Public Policy Institute (PPI) published the first State Scorecard on Long-Term Services and Supports in 2011 and that work continues to the present day with support from The AARP Foundation, The Commonwealth Fund, The John A Hartford foundation and The SCAN Foundation. This groundbreaking project measures state LTSS system performance and ranked states in comparison to one another, seeking to raise the profile of LTSS and drive action both federally and within states. Unlike research that focuses on a particular aspect of LTSS system performance, the Scorecard compares state LTSS systems across multiple dimensions of performance, reflecting the importance and interconnectedness each has on the overall LTSS system.
What’s New With the Scorecard?
- New Vision of High-Performing System
- Changes to Dimensions
- Quality of Life and Quality of Care changed to Safety and Quality
- Effective Transitions changed to Community Integration
- Changes to Indicators
- 12 new core indicators
- 11 indicators with Race/Ethnicity data breakdowns displayed and/or used to calculate scores
- 5 indicators removed or replaced
- Innovation Points
- Performance Tiers
Consumers can easily find and afford services, with meaningfully available safety net for those who cannot afford services. Safety net LTSS do not create disparities by income, race/ethnicity, or geography.
Choice of Settings and Providers
A person- and family-centered approach allows for consumer choice and control of services (including self-directed models). A well-trained and adequately paid workforce is available to provide LTSS. Home and community-based services (HCBS) are widely available. Provider choice fosters equity, and consumers across communities have access to a range of culturally competent services and supports.
Consumers are treated with respect and preferences are honored whenever possible, with services maximizing positive outcomes- including during and after care transitions. Residential facilities and HCBS settings are adequately staffed and prepared for emergencies. Policy-, system-, and practice-level efforts reduce and/or prevent disparities in quality and outcomes.
Family caregivers are recognized and their needs are assessed and addressed, so they can receive the support they need to continue their essential roles. A robust LTSS workforce limits over-reliance on family caregivers. Family caregiver supports are culturally appropriate and accessible to all communities.
Consumers have access to a range of services and supports that facilitate LTSS, including safe and affordable housing. Communities are age-friendly, supported by state Multisector Plans for Aging. Policy and programming that facilitates livable communities also drive equitable communities.
States by Performance Tiers
State performance across overall LTSS and within the five dimensions is ranked and organized into tiers, from better to worse performing, 1-5 from top to bottom.
State Dimensions by Performance Tiers
State performance across overall LTSS and within the five dimensions is ranked and organized into tiers, from better to worse performing, 1-5 from top to bottom. For full detailed methodology and data on state performance, please see the full Methodology.
| Affordability and Access | Choice of Setting and Provider | Safety and Quality | Support for Family Caregivers | Community Integration | ||
|---|---|---|---|---|---|---|
| 1 | Minnesota | 2 | 2 | 2 | 1 | 1 |
| 2 | Washington | 1 | 2 | 1 | 1 | 3 |
| 3 | District of Columbia | 1 | 3 | 2 | 1 | 1 |
| 4 | Massachusetts | 2 | 1 | 2 | 2 | 2 |
| 5 | Colorado | 2 | 1 | 1 | 1 | 3 |
| Affordability and Access | Choice of Setting and Provider | Safety and Quality | Support for Family Caregivers | Community Integration | ||
|---|---|---|---|---|---|---|
| 6 | New York | 2 | 2 | 3 | 2 | 2 |
| 7 | Oregon | 3 | 2 | 2 | 1 | 2 |
| 8 | Hawaii | 2 | 3 | 1 | 2 | 2 |
| 9 | Vermont | 3 | 2 | 2 | 2 | 2 |
| 10 | New Jersey | 2 | 3 | 2 | 1 | 3 |
| 11 | California | 3 | 1 | 1 | 2 | 3 |
| 12 | Rhode Island | 3 | 2 | 3 | 3 | 2 |
| 13 | Connecticut | 2 | 3 | 3 | 2 | 3 |
| 14 | Maryland | 2 | 3 | 3 | 2 | 3 |
| 15 | Wisconsin | 3 | 1 | 3 | 2 | 3 |
| 16 | Maine | 4 | 3 | 3 | 2 | 2 |
| Affordability and Access | Choice of Setting and Provider | Safety and Quality | Support for Family Caregivers | Community Integration | ||
|---|---|---|---|---|---|---|
| 17 | Delaware | 3 | 3 | 1 | 3 | 3 |
| 18 | Nebraska | 3 | 3 | 3 | 3 | 2 |
| 19 | North Dakota | 4 | 3 | 2 | 3 | 1 |
| 20 | New Mexico | 3 | 3 | 3 | 2 | 3 |
| 21 | Pennsylvania | 3 | 1 | 3 | 4 | 2 |
| 22 | Arizona | 3 | 4 | 3 | 2 | 3 |
| 23 | Iowa | 3 | 3 | 2 | 3 | 3 |
| 24 | New Hampshire | 3 | 3 | 3 | 3 | 2 |
| 25 | Illinois | 2 | 3 | 4 | 4 | 4 |
| 26 | Alaska | 4 | 3 | 2 | 2 | 5 |
| 27 | Indiana | 3 | 3 | 3 | 4 | 2 |
| 28 | Virginia | 2 | 3 | 4 | 4 | 3 |
| 29 | Utah | 4 | 4 | 2 | 3 | 2 |
| 30 | Kansas | 2 | 3 | 3 | 4 | 3 |
| 31 | Michigan | 3 | 2 | 3 | 3 | 4 |
| 32 | Ohio | 2 | 3 | 4 | 4 | 3 |
| 33 | Montana | 3 | 4 | 4 | 3 | 2 |
| 34 | Texas | 3 | 3 | 4 | 4 | 3 |
| 35 | Idaho | 4 | 3 | 2 | 4 | 4 |
| Affordability and Access | Choice of Setting and Provider | Safety and Quality | Support for Family Caregivers | Community Integration | ||
|---|---|---|---|---|---|---|
| 36 | South Dakota | 3 | 4 | 3 | 4 | 3 |
| 37 | Arkansas | 3 | 3 | 3 | 3 | 4 |
| 38 | Missouri | 3 | 4 | 4 | 3 | 3 |
| 39 | Georgia | 3 | 4 | 4 | 3 | 4 |
| 40 | Wyoming | 4 | 4 | 3 | 3 | 4 |
| 41 | North Carolina | 4 | 3 | 4 | 5 | 3 |
| 42 | Kentucky | 4 | 3 | 4 | 4 | 4 |
| 43 | Florida | 4 | 3 | 3 | 5 | 3 |
| 44 | Nevada | 5 | 4 | 4 | 3 | 3 |
| 45 | Louisiana | 3 | 5 | 4 | 4 | 4 |
| 46 | Oklahoma | 5 | 4 | 4 | 3 | 4 |
| Affordability and Access | Choice of Setting and Provider | Safety and Quality | Support for Family Caregivers | Community Integration | ||
|---|---|---|---|---|---|---|
| 47 | Tennessee | 4 | 3 | 4 | 5 | 4 |
| 48 | Mississippi | 3 | 4 | 5 | 4 | 5 |
| 49 | South Carolina | 5 | 3 | 4 | 4 | 4 |
| 50 | Alabama | 4 | 5 | 4 | 4 | 5 |
| 51 | West Virginia | 4 | 5 | 4 | 4 | 5 |
- 1st Tier (Best) 1
- 2nd Tier 2
- 3rd Tier 3
- 4th Tier 4
- 5th Tier (Worst) 5
Highest Ranking States
See how the top-performing states across the U.S. are meeting the needs of all residents.
Want to Improve LTSS in your State?
About the Scorecard
The Scorecard features promising practices, emerging issues, and policy solutions. Innovation, a new indicator, moves the needle for many states, revealing clear signs of progress. The inclusion of equity helps identify strong solutions that will benefit everyone.
What Goes into the Rankings?
The LTSS State Scorecard is created from more than 50 unique sources of data across the five dimensions of LTSS. Using these metrics and policies, the Scorecard scores states by looking at how supportive each state is of LTSS systems.
