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But the LTSS Scorecard, she says, is forcing every state to look at the difficult issue by compiling stats that the states cannot ignore. Then, by ranking the states publicly in so many

data-driven categories, AARP is essentially setting off a competition whose ultimate goal is to encourage all to improve. The overarching problem, of course, is that the U.S. has no national

plan for long-term care, says Reinhard. So each state must step in and try to dig into the issue on its own. And, from time to time, signs of progress have sprouted as a result. For

example, Reinhard says, since the LTSS Scorecard started, most states now focus their long-term care budgets on home-based and community-based care — where most prefer care and the dollar

goes further — not nursing home care. That, she says, is real progress.  And, yes, COVID certainly played a role in directing this change. But in a nation with 48 million family caregivers,

the sheer weight of COVID has simply been too oppressive for the long-term caregiving system to quickly recover, Reinhard says. “COVID-19 tested our long-term care systems — and they

failed,” she says. For example, she says, as a result of COVID, adult day care centers nationwide remain in serious decline. Many of these centers, which give adults a safe and familiar

place to be during the day, closed during the pandemic and never reopened. These centers not only benefit the clients, they also give family caregivers a break during the day. “When you

close a business like this, it’s hard to reopen,” she says. She compares this situation to the many restaurants that shuttered during COVID and never resumed service. Not only were they

unable to stay financially afloat, but they were also unable to attract staff to return when the pandemic subsided. Adult day care centers — many of which are small businesses — suffered a

similar fate, she says. “We have to reinvest in operations like this that suffered because of COVID,” she says. Even then, there are improvements to be made. The LTSS Scorecard offers these

key recommendations for states to improve their support for long-term care: * BOLSTER THE WORKFORCE. Nursing homes and in-home care workforces need to improve recruitment and training and

increase pay in order to attract and retain skilled workers. * EXPAND INNOVATIVE MODELS. Effective nursing home models with smaller facilities and private rooms can improve the quality of

care and the quality of life. * ADDRESS INEQUITIES. Make investments that close the gaps in access to quality care facilities. * SUPPORT FAMILY CAREGIVERS. Prioritize support for family

caregivers with paid leave and tax credits to assist with financial needs. * INVEST IN CAREGIVER INFRASTRUCTURE. Increase support and training for home health aides and home visits and

update key Medicaid regulations. * BUILD COALITIONS. Support age-friendly health systems that allow individuals to live independently with things like affordable housing and accessible

transportation. * SUPPORT INNOVATION.  Create comprehensive aging plans that can offer new approaches with things like smaller, more guest-friendly nursing homes. * MANDATE EMERGENCY PLANS.

Develop sound emergency preparedness plans in every state to support nursing home residents in times of crisis.