Most of us know that we are likely to need some type of assistance, whether at home or in a nursing facility, as we age. In fact, 70 percent of Washingtonians 65 and better will require some type of long-term care. Often referred to as long-term services and supports, this level of help becomes a necessity when older adults and those with disabilities are no longer able to perform what’s known as activities of daily living (or ADLs). Long-term care insurance can provide families some financial relief for the hefty cost of care. Yet it is very expensive and more than 90 percent of adults are not covered.

Purchasing long-term care insurance is a significant investment, and many people are too focused on keeping up with current daily living expenses to look that far into the future or add another bill to the mix. Others mistakenly believe Medicare or private insurance will be there with the onset of a chronic illness or injury. The truth is Medicare only pays for short-term stays in a nursing facility for a maximum of 100 days. The same holds true for assistance at home—short-term only. Most health insurance plans, both employer-covered and private pay, follow similar time restraints as Medicare.

So who provides long-term care? Across the nation, the first to step up are family caregivers. In Washington, more than 828,000 residents help their aging parents, spouses, and other loved ones, to the tune of $11 billion in unpaid care—a whopping five times what Medicaid spends on long-term services and supports each year. With every task they undertake, family caregivers save the state money by keeping their loved ones out of costly nursing homes. However, due to the large population of boomers, smaller family sizes, and geographical distance among family members, the number of potential family caregivers is projected to decrease 43 percent by 2030.

When an adult’s care progresses beyond what a family member can provide—or for those who don’t have family to rely on—Medicaid is the next line of defense. The program has become the primary payer for long-term services on behalf of low-income older adults and people with disabilities regardless of their age. To qualify, most must deplete their savings and assets down to a poverty level. Families aren’t the only ones concerned with the cost of care. Washington spends more than $2 billion annually on Medicaid-funded support and services. Current projections estimate a 91 percent increase by 2040, a cost of $8 billion every two years. With the growing age wave, states are trying to prepare for an exponential increase in needed funding.

Washington and several other states are taking steps to help families better deal with their caregiving needs. Hawaii has started a program called Kupuna Care, kupuna being a term of respect for elders. Done properly, this type of support can be a win-win for family and state budgets. AARP Washington and a coalition of nearly two dozen advocates, including the Washington Association of Area Agencies on Aging, have spent the last several years searching for a solution.

“Area Agencies on Aging are on the front lines for those desperation calls when people find out they need long-term care,” says Dan Murphy, legislative chair of the Washington Association of Area Agencies on Aging. “Those calls start with phrases like ‘I don’t know what to do’ or ‘I’ve tried to care for mom and I can’t take any more time off from work’ or ‘we can’t do this anymore’ or ‘we’ve spent the savings, or the proceeds from the sale of the house—now what do we do?’ We are excited to be part of the coalition that is crafting a better solution for Washington State.”

Saying the task is daunting is an understatement. We are inventing an entirely new social system to fix a difficult social problem. Our state also has unique challenges finding ways to fund the program. Other states have considered financing through an increase in personal income tax—not an option here—and our homeowners are already struggling with increases in property taxes.

This year, legislation was introduced to create a program that would be funded by a payroll tax collected from all Washington workers. The proposed program would provide a benefit of $100 a day for 365 days of coverage, providing some relief for family caregivers who currently spend an average of 20 percent of their income on out-of-pocket costs related to caregiving. The program would also alleviate some of the stress on the state’s Medicaid budget.

Possible improvements to the measure are still under discussion including providing the flexibility needed for family caregivers and care recipients to decide on how to best use the money they have put away for care. This would also help families in rural areas who may have a more difficult time finding someone to provide in-home support.

Crafting a viable, robust tool to assist with long-term care is critically important for Washington families and for our state. Pioneering a solution will take time, but advocates are eager and determined to work toward a comprehensive solution.


By:  Cathy MacCaul


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