How Does Your State Rank?
Exhibit 2 shows overall state LTSS system performance by quartile across all 50 states and the District of Columbia.4 Exhibit 3 presents all states in order of overall LTSS system performance and shows performance across all five key dimensions. High-performing state LTSS systems tend to perform well across all dimensions, while low-performing states have room for improvement in many areas. Complete results for every dimension and indicator are available in the Appendices.
A Note On Methodology
The scoring and ranking methodology in this Scorecard is based on the same methodology used in previous LTSS State Scorecards. As in the 2017 Scorecard, the Quality of Life and Quality of Care dimension is given half the weight of the other dimensions in determining the overall rank, and the Support for Family Caregivers dimension is calculated as a single composite.
Dimensions and Indicators: The Scorecard measures LTSS system performance using 26 indicators (or policy categories) across 5 dimensions:
- Affordability and Access (6 indicators)
- Choice of Setting and Provider (7 indicators)
- Quality of Life and Quality of Care (4 indicators)
- Support for Family Caregivers (12 policy areas, grouped into 4 broad categories)
- Effective Transitions (5 indicators)
Indicators had to be clear, important, and meaningful, and have comparable data available at the state level. These 26 indicators were selected because they represent the best available measures at the state level. While no single indicator can fully capture LTSS system performance, taken together they provide a useful measure of how state LTSS systems compare across a range of important dimensions.
Ranking Methodology: The Scorecard ranks the states from highest to lowest performance on each indicator in the Affordability and Access, Choice of Setting and Provider, Quality of Life and Quality of Care, and Effective Transitions dimensions. Within each of these four dimensions, individual indicator ranks are averaged and those averages are then re-ranked for dimension-level ranks. The Support for Family Caregivers dimension is a single composite across all 12 policy areas, and dimension rank is based on the total composite score. The dimension ranks are then averaged (with the Quality dimension given half weight) and re-ranked to compute the overall ranking of LTSS system performance. In the case of missing data or ties in rank, minor adjustments are made to values used in calculating the average. See Exhibit B2 in Appendix B for more detail.
Measuring Change In Performance Over Time
One of the main goals of this report is to assess how state LTSS systems improved or declined between the 2017 Scorecard and the 2020 Scorecard. However, state ranks at the dimension and overall levels should not be compared directly between the current Scorecard and prior Scorecards. There are significant changes in the methodology and indicator sets, so changes in rank may not reflect actual changes in relative performance.
Change in performance can be measured directly at the indicator level. Baseline year data (typically three years prior to the most current data) are available for 21 of the 26 indicators in the Scorecard. For these 21 indicators, the Scorecard reports both current and baseline data, and identifies meaningful change (either positive or negative). Note that the period of time covered by the data varies by indicator. Some measures have a significant data lag, so the change measured in the 2020 Scorecard may have occurred prior to the publication of the 2017 Scorecard.
To aid in the interpretation of indicator-level change, appendix data tables show current and baseline values for each trended indicator, and also indicate the magnitude of changes with a green check mark for a substantial improvement, a red X for a substantial decline, and a black, two-headed arrow for little or no change. For most measures, a threshold of 10 or 20 percent or more was used. More detail about how change over time is measured, including thresholds for each trended indicator, may be found in Exhibit B3 in Appendix B.
4 The District of Columbia is ranked alongside all 50 states and hereafter will be categorized in the Scorecard as 1 of 51 states.