Still a long way to go for long-term care

By Chhristina Clem
Washington ranks number 1 overall in meeting the long-term care needs of older residents and people with disabilities, according to a new, state-by-state Scorecard from AARP, The Commonwealth Fund, and SCAN Foundation. While our state edged out Minnesota for the top spot this year, more must be done, at a much faster pace, if we are to meet the needs of our changing demographic.
“Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports (LTSS) for Older Adults, People with Physical Disabilities, and Family Caregivers,”  the third in a series of reports, ranks each state overall, focusing on 5 attributes of an ideal system: Affordability and Access; Choice; Quality; Support for Family Caregivers; and Effective Transitions.
When it comes to helping older Washingtonians live in the setting of their choice, family caregivers take on big responsibilities, many juggle full-time jobs with their caregiving duties; others provide 24/7 care for their loved ones.
They provide the bulk of care for older Washingtonians, in part because the cost of long-term care remains unaffordable for most middle income families.
More than 828,000 state 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. With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly nursing homes – most often paid for by Medicaid.
Even facing tight budgets, Washington is making clear progress to assist caregivers. According to the Scorecard, Washington has taken action to improve the assessment of family caregiver needs by implementing the CARE (Caregiver Advise, Record, Enable) Act, boosting our Support for Family Caregivers score. The CARE Act provides patients the opportunity to designate a family caregiver, notifies the family caregiver when their loved one is to be discharged or transferred to a different facility, requires medical professionals discuss the patient’s discharge plan with the family caregiver, and provides an opportunity for the family caregiver and patient to ask questions about aftercare medical and nursing tasks.
“Unpaid family caregivers provide the majority of support to seniors and individuals with disabilities who need help to continue living at home. These services are estimated at over $10 billion, five times what Medicaid spends on long-term services and supports each year,” says Bea Rector, who is the acting assistant secretary for aging and long-term support at the state Department of Social and Health Services.
“Supporting unpaid family caregivers with information and assessments, respite, caregiver training and support groups pays incredible dividends for the health and happiness of our caregivers, seniors and people with disabilities and it saves taxpayer dollars. Family caregivers are truly the unsung heroes of long-term services and supports in our state,” Rector continues.
The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net. Washington improved in this area by devoting 64.9 percent of the state’s Medicaid spending on LTSS, which helps provide care at home and in the community—the care setting that most Washingtonians prefer, versus 35.1 percent for nursing home services.
However, the state lost ground in their efforts to have Medicaid beneficiaries use home and community based services first before receiving nursing home care.
A program called Community Living Connections seeks to improve that score by linking beneficiaries to community resources and service options, providing individual consultations, and access to family and caregiver support services.
“This Scorecard gives us a snapshot of how well Washington serves our older residents, those with disabilities, and family caregivers—and shows us where we must sharpen our focus to better assist hardworking Washingtonians,” said AARP state director Doug Shadel. “While we are ahead of the curve, we cannot rest on our laurels. There is more work to be done.”
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

Christina Clem wrote this article as a representative of AARP Washington.


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