Florida is essentially tied with Maine for the highest percentage of residents age 65 and older — roughly 21%, vs. 16% for the U.S. population. And about one in 10 people in The Sunshine State are 75 or older, the highest percentage in the nation. So how is it possible that, according to a recent data-driven report, Florida ranks dead last for long-term care services and supports?
Tim Russert, the late host of NBC’s “Meet the Press,” famously said about the 2000 presidential election: Florida. Florida. Florida. Based on The 2020 Long-Term Services and Supports State Scorecard produced by the AARP Foundation, The Commonwealth Fund and The SCAN Foundation, I’d say: Florida? Florida? Florida?
“It’s not a surprise,” said Jeff Johnson, state director for AARP Florida, speaking of his state’s cellar ranking in the Scorecard. “We’ve been in the bottom tier for as long as we’ve been doing Scorecards and I’ve been here 20 years.”
Johnson said that Florida has an “overreliance on nursing homes,” calling them “a first, and often only, option for long-term care.”
One caveat: Data for the new Scorecard — the fourth edition — was analyzed in 2019, before the COVID-19 outbreak . That said, the researchers were exhaustive in culling statistics to compare state performances of their long-term services and supports systems for older adults, people with physical disabilities and family caregivers.
I’ll spare you some of the wonky methodology, but will tell you that the 2020 Scorecard looked at five broad categories: Affordability & Access; Choice of Setting & Provider; Support for Family Caregivers; Effective Transitions (which includes data on transitioning from hospitals to nursing homes and successful discharges to the community) and Quality of Life & Quality of Care.
Florida ranked in the bottom of the four quartiles of states in the first three of those categories and was in the next-to-worst quartile for the other two.
Looking at 21 trend indicators that went into the rankings, the researchers found that Florida had little or no change in 17 over the past three years, a substantial decline in two and a substantial improvement in two.
Susan Reinhard, who directs AARP’s Public Policy Institute and headed the scorecard team, thinks it’s important to put Florida’s results in context and look at how well the nation is providing older adults and caregivers with long-term care services and supports.
“With every Scorecard, we say: ‘We’ve made some progress. We need to do more,” Reinhard said. “This just gets more evident as the population is aging.”
Overall, Reinhard said, the U.S. is doing “fair” for long-term services and supports.
Here’s why Florida ranked so poorly, what that means if you or a loved one will need long-term care there and prospects for future long-term care in the state:
Affordability & Access (cost of nursing homes and home care; percentage of adults 40+ with long-term care insurance ; percentage of people on Medicaid and access to long-term care resources): Florida nursing homes are pretty pricey; the state ranked 39 for the cost as a percentage of median household income for people 65+.
In Florida, Johnson said, compared with many other states, nursing homes are expensive and older adults have lower incomes.
“People think of Florida as beach condos and living large off retirement savings and certainly there are people here like that,” said Johnson. “But there are many people who had median incomes when they worked and stayed here or retired here. Some are living on just Social Security.”
Context: According to the Scorecard report, “the cost of nursing home care is unaffordable for middle-income Americans in every state.” The average annual per person cost: over $100,000 a year in a private room. The most affordable states for nursing homes: Kansas, Missouri, Oklahoma, Texas and Utah.