New AARP Scorecard: Indiana Ranks #27 in the Country for Long-Term Care Services and Supports for Older Americans, Including Family Caregivers

Report Finds Systemic Gaps in Indiana in Support for Family Caregivers

AARP’s new Long-Term Services and Supports (LTSS) Scorecard finds that more than three years after the COVID-19 pandemic began, care provided in the United States for older adults and people with disabilities is painfully inadequate. The report finds that major gaps persist in every state, including Indiana, especially related to support for family caregivers.

Ranking #27 in the country, Indiana has made improvements to care options for older adults, including a dimension that is new to the Scorecard – Community Integration. However, the report also shows there is still much more to be done to keep up with the rapidly changing needs of an aging population.

 “The need to strengthen long-term care became very apparent during the pandemic,” said Sarah Waddle, AARP Indiana State Director. “In the years since the last Scorecard, Indiana has made progress in nine indicators towards meeting the long-term care needs of Hoosiers and their families. But we need to accelerate our efforts and AARP’s Scorecard shows that there are many roads to getting older residents the very best care that they deserve.”

Over the last three years, states improved care options for adults, people with disabilities and family caregivers, those providing unpaid care to loved ones, despite many realities that profoundly challenged our long-term care system. Major gaps persist in every state especially around support for family caregivers, the long-term care workforce and equitable long-term supports and services for all.

Additional key findings from the report include:

Choice of Setting and Provider

  • While dozens of states experienced declines in the number of care choices that help support families managing caregiving, Indiana saw several performance indicators increase including a significant growth in the supply of assisted living facilities and a slight expansion in the supply of adult day services.
  • Nationally, there has been a surge in older adults receiving long-term care at home, rather than in nursing homes and other institutions. For the first time, more than half (53%) of Medicaid LTSS spending for older people and adults with physical disabilities went to Home and Community-Based Services (HCBS). This is up from 37% in 2009. HCBS includes support for home health care aides, respite services, assistive technology and home modifications and other services. Here in Indiana, the state made marginal progress with 23% of Medicaid LTSS spending going toward HCBS. This still remains severely below the national average.
  • Across the states, the average annual per person cost of home care in 2021 was $42,000.

Affordability and Access

  • Eleven states, including Indiana, had state policies that improved presumptive eligibility for Medicaid HCBS at the time of data collection, making it possible for people to go home to receive care after being in the hospital rather than having to be admitted to a nursing home while their eligibility for Medicaid payments is being determined.

Support for Family Caregivers

  • Indiana went from 51st to 39th in Support for Family Caregivers, with the improvement being driven by growth around nurse delegation.
  • Indiana nurses are able to delegate 15 out of 22 of the listed tasks. It’s important that information gathering continues in order to guarantee that education for Hoosier nurses around delegation continues and that it is happening across the entire state.
  • In order for Indiana to improve its support for family caregivers, it is going to take more than just action from the Governor’s administration. The Indiana General Assembly will need to address various policy areas that may include nurse scope of practice and paid family leave.



Below are key recommendations from the report and AARP that would strengthen support for long-term care and aging at home:

  • Prioritizing saving time, money, and increasing support for the 48 million family caregivers, who are the backbone of the long-term care system, providing over $600 billion in unpaid care, such as tax credits and other mechanisms to address health and financial needs. 
  • Investing in all aspects of Home and Community-Based Care infrastructure, such as increasing support and training for home health aides and home visits, supporting the ability to access and use medical devices and equipment, and updating key Medicaid regulations and payment models.
  • Bolstering the nursing home and in-home care workforce, with improved recruitment and training, increasing pay, and expanding the ability of trained nurses, aides, community health workers and other paraprofessionals to take on some aspects of care. States can choose to enact and enforce staffing and related care standards.
  • Addressing inequities by investing to close the staggering gaps in access to quality care and facilities and staffing shortages. 
  • Building multisector plans for aging, coalitions and age-friendly health systems, and consider the wider needs to allow individuals to live independently in their homes and communities, such as having affordable and accessible housing and transportation, improved community design, and comprehensive emergency preparedness plans. 
  • Ensuring every state in the nation has a sound emergency preparedness plan to support nursing home residents, in particular, in times of crisis – including natural disaster.

The Scorecard includes a series of 50 indicators focused on 1) affordability and access; 2) choice of setting and provider; 3) safety and quality; 4) support for family caregivers; and 5) community integration, using data from a variety of publicly available sources, such as the Centers for Medicaid and Medicare Services, American Community Survey, and Bureau of Labor Statistics.

The LTSS Scorecard is funded by AARP Foundation with the support of The SCAN Foundation, The Commonwealth Fund, and The John A. Hartford Foundation and has been updated every three years since 2011.

To view the full Scorecard and state-by-state information visit


State Rankings:

  • Tier One: 1: Minnesota; 2: Washington state; 3: District of Columbia; 4: Massachusetts; 5: Colorado.
  • Tier Two: 6: New York; 7: Oregon; 8: Hawaii; 9: Vermont; 10: New Jersey; 11: California; 12: Rhode Island; 13: Connecticut; 14: Maryland; 15: Wisconsin; 16: Maine.
  • Tier Three: 17: Delaware; 18: Nebraska; 19: North Dakota; 20: New Mexico; 21: Pennsylvania; 22: Arizona; 23: Iowa; 24: New Hampshire; 25: Illinois; 26: Alaska; 27: Indiana; 28: Virginia; 29: Utah; 30: Kansas; 31: Michigan; 32: Ohio; 33: Montana; 34: Texas; 35: Idaho.
  • Tier Four: 36: South Dakota; 37: Arkansas; 38: Missouri; 39: Georgia; 40: Wyoming; 41: North Carolina; 42: Kentucky; 43: Florida: 44: Nevada; 45: Louisiana; 46: Oklahoma.
  • Tier Five: 47: Tennessee; 48: Mississippi; 49: South Carolina; 50: Alabama; 51: West Virginia.