A comprehensive state-by-state scorecard from AARP, the Commonwealth Fund and SCAN Foundation ranked Delaware 28th overall when it comes to meeting the long-term care needs of older residents and people with disabilities.

AARP warned more must be done, at an accelerated pace, to meet changing demographic demands.

Specific areas of concern in Delaware include support for family caregivers, in particular the area of nurse delegation and nurse practitioner scope of practice.

“Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers,” the third in a series of reports, ranked each state overall and on 25 specific indicators in five key dimensions: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and, effective transitions between nursing homes, hospitals and homes.

Unpaid family caregivers provide the bulk of care for older Delawareans in part because the cost of long-term care remains unaffordable for middle income families. In Delaware, more than 123,000 residents help their aging parents, spouses and other loved ones stay at home by providing assistance with bathing and dressing, transportation, finances, complex medical tasks like wound care and injections and more.The value of this unpaid care totals about $1.58 billion.

An important step in the right direction toward better support for family caregivers is to give nurses more authority to heal. Delaware ranks 41st out of all states on this indicator. Nurse practitioners should be able to practice their education and training. This would help Delaware family caregivers more easily access quality care. The scorecard ranked Delaware as having “reduced practice authority.”

Another area that would improve support for family caregivers is nurse delegation. Currently in Delaware, home health aides are limited on tasks they are permitted to perform. For example, they are not allowed to manage medications. Nurse delegation would allow registered nurses to delegate some tasks to health care workers under their supervision. This would remove a burden from the family caregiver who often can’t be home to perform a variety of tasks such as medication management.

Nurse delegation and nurse practitioner scope of practice ranked 41st among all states, signaling a need for improvement.

A stronger predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net. AARP is working to expand services provided at home and in the community, by shifting funds away from low-quality nursing homes and more expensive nursing home care. Inappropriate use of antipsychotic medication in nursing homes has decreased, as has the number of patients with pressure sores.

Delaware ranks 35th in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care provided at home and in the community — the care setting that most Delawareans prefer — the scorecard spotlights areas that call for improvement, specifically the percent of adults with disabilities at or below poverty receiving Medicaid.

Of the 25 scorecard indicators, many may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched in 2014, to help older Americans live independently, at home, and the family caregivers that support them.

The scorecard reveals that in less than 10 years, Boomers will begin to turn 80, placing new expectations and demands on a still imperfect long-term care system. Further, this generation will have far fewer potential family caregivers to provide unpaid help.

Long-term care, also called long-term services and supports, is a diverse set of services designed to help older people and those with disabilities; services can be provided in a person’s home, in a community setting such as an adult day center, or in a group residential facility like a nursing home.

The full state scorecard, along with an interactive map of state rankings and information, is available at longtermscorecard.org.