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Where Long-Term Care Works

Washington leads all states in helping residents age in place



Long-term care varies nationwide.

En español | More than 9 in 10 Americans want to live at home or with a relative — rather than in a nursing home — for as long as possible. But experts predict that more than half the population, after turning 65, will develop a disability so severe they’ll need assistance.  

Whether and how they’ll get that assistance depends greatly on where they live. Some states are better at providing the services and support necessary to help older adults and those with disabilities who want to continue living in the community, and their family caregivers. In states that do it well, that’s good for those who need care.

Washington is the state that does it best, according to a scorecard compiled by the AARP Public Policy Institute, the Commonwealth Fund and the SCAN Foundation. The Evergreen State ranked consistently high in four of five areas in which states provide support for people needing long-term assistance or their family caregivers. 

That’s because Washington officials have made support for home and community-based care a state priority, policy experts say. The state has provided a wide range of options — including adult day care, assisted living and adult foster care — to meet the needs of its growing older population. By 2030, 21 percent of Washington’s population is expected to be age 65-plus, compared with 15 percent now. 

Susan Reinhard, AARP senior vice president and director of the AARP Public Policy Institute, says states are making progress in providing long-term support, but “with 10,000 people turning 65 every day, it’s imperative that we pick up the pace of change.” 

Here are some lessons states can learn from Washington about helping people age in place.

Offer control over who provides personal care. While most states allow the person receiving personal care to decide whom to hire for such tasks as bathing, dressing and meal preparation, Washington provides more discretion. There, 53 of 1,000 people with disabilities direct their own care; nationwide, the average is about 27 per 1,000. 

Answer calls for help more quickly. No matter what state agency a consumer calls for information or resources such as personal care services, adult day programs or home health care options, they will get help through Washington’s No Wrong Door program. Although most states have a similar program, policy experts say Washington provides high quality training to staff so you get your questions answered. That means agencies not only direct callers to the right place, but there is also a coordinated approach to determining eligibility for public assistance.

Rebalance Medicaid spending so more people can age at home or in the community. Washington state directs 65 percent of its Medicaid long-term care spending to home- and community-based services rather than to nursing homes. Nationwide, the average is 41 percent. Providing services at home and in the community has led to $4.4 billion in savings for the state and federal government over the past 18 years, according to the Washington State Department of Social and Health Services. Those savings are reinvested to develop additional long-term care resources.

Encourage nursing home stays to be temporary. While about 1.4 million people live in a nursing facility, many would prefer to return to their homes and communities. In Washington, 12 percent of people who have been in a nursing home for at least 90 days are able to return to their or a relative’s home; nationwide the average is about 8 percent.

Allow home health aides to provide more medical care. Although 47 states permit an aide (as opposed to a family member) to be trained to perform some health maintenance tasks under a registered nurse’s supervision, Washington is among the least restrictive. For example, in Washington, trained aides can give shots such as insulin injections. In a dozen states, home health aides cannot even give patients a pill.

Give family caregivers a set of instructions when patients leave the hospital. In many states, family caregivers receive little information from hospitals about how to care for patients after they are discharged. That often leads to medical emergencies and return hospital admissions. 

Provide more housing alternatives than nursing homes. Nationwide, about 52 of 1,000 people who are 75 or older reside in an assisted living facility. In Washington, it’s 103. 

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