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Washington’s Best-in-the-Nation Long-Term Care System is at Risk

When it comes to long-term care, Washington state ranks 2nd in the nation. That’s according to a recently released report issued by AARP in conjunction with the Commonwealth Fund and the SCAN Foundation.

The report, “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers,” provides a detailed comparison of how Washington measures up compared to other states on numerous indicators related to long-term care affordability and access, choice of setting and provider, quality of life and quality of care and support for family caregivers.

Most states are still spending most of their resources on nursing home care while offering few options for people to stay in their own homes and communities. Not Washington. Here in the Evergreen State, 63-percent of all Medicaid and state funded long-term care funding is going to home and community based services – that’s compared to a median rate for all states of 30-percent.

That’s good for people and for the state budget. People can stay independent with the help of a home care worker, meals on wheels, adult day health and other supports – rather than feeling like nursing home care is their only option. And fewer people using Medicaid to pay for expensive nursing home care means big savings for the state – up to $1 billion over the past decade.

The news is in and it’s good – if you need long-term care, Washington is one the best states in the nation to live in. But there is a caveat – our best in the nation status is at risk. In recent years the state legislature has cut back on home care hours and other supports that people need to stay out of nursing homes. We are turning the clock backward. With fewer home care hours, less support and higher health care costs, more and more people will give up on their struggle to remain in their own homes and settle for expensive nursing home care because they feel it is their only option.

To maintain our best in the nation status and continue our popular and cost effective approach, lawmakers in Olympia need to make it a priority to preserve funding for home care, family caregiver supports and the array of supports funded through the Senior Citizens Service Act. Funding these services is an investment that has and will continue to pay off.

But while the new report scores Washington’s long-term care system second only to Minnesota, there are still many areas that need improvement – particularly in the areas of affordability and quality.

As many are acutely aware, people who pay privately for home care or nursing home care are at risk of quickly exhausting their resources – because these services are incredibly expensive. While these services are expensive in every state, the Scorecard report showed the average cost of nursing home care in the Washington is 221-percent of the average annual household income of Washingtonians age 65 and older - ranking us 23rd in the nation.

Though less extreme, the cost of home care services is also unaffordable for the typical user, averaging 93% of household income for older adults in the state – putting us at 30th in the nation. Moreover, fewer people in Washington than in other states have private long-term care insurance to protect them from these costs. On this front, Washington ranks 18th in the nation.

Quality is another concern, but there is little national data to compare how well states are serving people in their own homes or in the community. In Washington, we know there has been a recent steep increase in consumer complaints against Adult Family Homes – an issue that lawmakers addressed last legislative session. In nursing home settings, the Scorecard ranked Washington low compared to many states on the percent of high risk nursing home residents with pressure sores (29th), the percent of long stay nursing home residents who were physically restrained (16th) and the turnover rate for employees in nursing homes (44th). So when it comes to protecting our most vulnerable residents in nursing homes clearly there is more work to do.

The recently published Scorecard is cause for celebration – much good work has been done in Washington to promote high quality, person-centered long-term services and supports. Our struggle now is to improve our weak spots and maintain our investment in cost effective home and community based services so we stay at the top of the chart.

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