Pennsylvania, which has a larger percentage of people over 65 than the national average, is not the best state to grow old in, according to a recent AARP report.

The state was ranked 42nd overall in the new study on long-term services and supports for older people. Even worse, it was 46th in terms of affordability and access to long-term care."Our long-term services are among the most expensive in the country in Pennsylvania," said Ray Landis, advocacy manager for AARP Pennsylvania.The AARP's report, "Raising Expectations 2014," is an update to the first report on state-by-state care for the elderly, people with disabilities and caregivers, published in 2011. Data from 2009 to 2013 was collected for the recently-published report, which was supported by The Commonwealth Fund and The SCAN Foundation.Across AARP's five metrics, Pennsylvania's highest ranking was 25th in the choice of setting and provider for long-term care. The state ranked in the bottom half of the study's other categories: quality of life and care, support for family caregivers and effective transitions.Christina Reese, a spokeswoman for the state Department of Aging, said she didn't think the report gave Pennsylvania enough credit. She said the state is in the process of launching initiatives aimed at improving long-term services to the elderly.More fundsIn June, the Department of Aging and Department of Public Welfare announced they will receive $94 million in federal funding through the Balancing Incentive program. Among other things, this money will serve nearly 1,800 additional elderly Pennsylvanians with in-home or community-based care.Another program launched early this year by Gov. Tom Corbett, the Long-Term Care Commission, is currently evaluating the state's long-term care system and how it can be improved. The commission has held six public hearings in various regions of the state to gather input from different communities. Another hearing is scheduled for July 14 in Philadelphia.Last year, PublicSource reported that the amount of lottery funds directed to agencies on aging had decreased, even as lottery revenue increased.By law, at least 27 percent of state lottery revenue should go to state and county agencies on aging, to pay for programs such as PennCARE, which help keep senior citizens in their homes. PennCARE funds "personal care aides, adult day care and meal delivery, among other home-based care," according to an AARP article.Less money for nursing homesLandis said fewer lottery funds have been directed to home-and-community based services in recent years."They've pulled over $300 million out in each of these last six (or) seven years to fund nursing homes," Landis said.Diane Menio, the executive director of Philadelphia-based Center for Advocacy for the Rights and Interests of the Elderly, said the Center objects to the allocation of lottery funds to nursing homes."We're not saying nursing homes aren't important. They are," Menio said. "But we think nursing homes should be paid for with general funds, not lottery funds."She said preserving those lottery funds for their intended use home-and-community based services is one of the Center's chief objectives.Home-and-community based services such as help with transportation, shopping and meal preparation are designed to keep seniors in their homes longer, according to the report."We try to educate the public and professionals. We will help anyone who calls us," Menio said. "We educate them about what their rights are, what's available, and how to access services."The Pennsylvania Caregiver Support Program, funded in part by the lottery and in part by the Older Americans Act, provides eligible caregivers with a couple of different assistance options, Landis said. The program is income based and provides qualified caregivers with monthly reimbursements for respite care and supplies. In certain circumstances, the program provides grants for home improvements, such as a shower handrail or an electric stair lift.Staying at homeSteve Gardner, associate state director of communications for AARP Pennsylvania, said whenever they conduct surveys, 90 percent or more of respondents say they never want to live in a nursing home. According to the AARP national report, this desire to stay at home is universal, regardless of age or type of disability.Because long-term care is so expensive, more than 1.8 million family caregivers in the state help their relatives to dress, bathe, and eat.In 2011, Pennsylvania's caregiver program expanded to more closely resemble the federal program, which does not require caregivers to live in the same home as the person they're caring for, or to be their direct blood relatives.Landis said the AARP would like to see the state better serve family caregivers, and become less dependent on expensive nursing homes."Our feeling here at AARP Pennsylvania is that we really need to do more," Landis said. "We need to increase lottery support of the family caregiver program, so more of the family caregivers that are taking care of their relatives can participate in it."PublicSource is an investigative news organization that collaborates with newspapers and radio throughout Pennsylvania. Learn more at publicsource.org.