A new report shows Washington’s long-term care system ranks second in the nation, but AARP and other aging advocates caution that budget pressures threaten to turn the clock backward on Washington’s high quality and cost effective approach.
The state-by-state “scorecard” from AARP was issued with support of The Commonwealth Fund and SCAN Foundation, national organizations that are advocates of long-term care. The report finds that Washington does better than most states in providing choices and opportunities for people to stay in their own home or communities and to avoid expensive or unnecessary hospital or nursing home stays.
While the report gives Washington an overall high ranking, AARP officials said it also sheds light on key weaknesses in the system and points to needed reform in key areas including support for unpaid family caregivers, quality of care in nursing homes, and affordability.
“Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers” (longtermscorecard.org) is an update of the inaugural 2011 scorecard, AARP officials said It ranks each state overall and within 26 performance indicators along affordability and access, choice of setting and provider, quality of life and quality of care, support for family caregivers, and effective transitions. New indicators this year include length of stay in nursing homes and use of anti-psychotic drugs by nursing homes, which can raise serious concerns about the quality of institutional care, according to AARP.
“We have a strong track record in our state of finding ways to help people live independently at home as they age,” said Ingrid McDonald, advocacy director of AARP, which serves more than 920,000 members age 50 and older in Washington. “Since the mid-1990s, our state has been very intentional about moving people away from expensive institutional care and toward more cost-effective and popular home and community based services. While the Scorecard ranks us second in overall choice and quality, it is notable that we rank 34th in the country in long-term care spending per capita. As a result, our system is both better and cheaper than other states.”
McDonald said the state must avoid going “backward on this success. Throughout the great recession, AARP fought back against budget proposals to reduce home and community based services. These cuts would simply push people back towards expensive nursing home care. We anticipate more budget pressure in 2015 and once again will urge lawmakers not to make decisions that are penny wise and pound foolish.”
The new scorecard reports that Washington is doing well serving people in the community but illustrates there is more work to be done and we don’t have time to stand idle. For example, the report shows that Washington ranks 38th in the nation on a measure of caregiver well-being.
Unpaid family caregivers provide the bulk of care for older Washingtonians, in part because the cost of long-term care remains unaffordable for most middle income families. In Washington, more than 850,000 residents help their aging parents, spouses and other loved ones stay at home by providing assistance with bathing and dressing, transportation, finances, and medical tasks such as wound care and injections. The value of the unpaid care totals about $10.6 billion, according to the study.
“When it comes to helping older Washingtonians live in the setting of their choice, this silent army of family caregivers assumes the lion’s share of responsibility,” said McDonald. “Many juggle full-time jobs with their caregiving duties. Others provide (24-hour) care for their loved ones. With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly nursing homes (that are) most often paid for by Medicaid. They have earned some basic support.”
According to the state Scorecard, 60 percent of family caregivers in Washington face a degree of stress and worry. The state needs to do more to support family caregivers, McDonald said.
AARP is calling for an expansion of the Family Caregiver Support Program. The program provides support for caregivers such as counseling, referrals and respite so they can have time to take care of their own needs. Research shows that it allows people to remain self-reliant and delays their need to turn to the Medicaid program for support, McDonald said.
The Scorecard also points to the quality of care in nursing homes as a key area of improvement. Washington ranks in the middle on indicators such as residents with pressure sores and use of antipsychotic medication, and significantly lower than most states in the area of nursing home staff turnover rates. McDonald said AARP is working with nursing home provider associations and the State Long Term Care Ombudsman to improve these indicators and ensure quality of care for all vulnerable elders in our state.
Paying for long term care is a growing challenge. The Scorecard reveals that only 66 people out of 1,000 age 40 and up have private long term care insurance policies. Without insurance, the cost of care is prohibitive. According to the Scorecard, care is particularly expensive in Washington:
• The median annual nursing home private pay cost is more than two times the median income of people age 65-plus.
• The median annual home care private pay cost is nearly 90 percent of median household income for 65-and-up age group.
Without private insurance, many people have no other option other than to spend down to poverty to qualify for Medicaid assistance. AARP supports proposed legislation to study alternative financing options, McDonald said.
“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 hard-working Washingtonians,” said McDonald. “With the age wave upon us, now is the time for policymakers to act.”
Long-term care (also called long-term services and supports) is 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.