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Editor’s note: In the hard copy version of the Senior Scene and the online version, we ran an article from Ingrid McDonald, Washington’s Advocacy Director for AARP.  This is a follow up with additional information about the effect of the proposed cuts and AARP’s response and suggestions.

Urgent Advisory: The 2011 Special Session and Risk of Deep Cuts to Long Term Care Services

To address a $1.4 billion budget deficit, the Governor has asked state agencies to submit proposals for reducing spending by in the 2011-13 biennium.  These proposals will form the framework for a budget proposal that state lawmakers will consider in a Special Session beginning November 28th 2011.

Current proposals would completely eliminate long term care services for more than 17,000 people, a 29% cut from current levels. This proposal turns the clock backwards on decades of progress towards providing client centered long term care services, consumer choice and cost containment through rebalancing.  A recent AARP report rated Washington’s long term care system 2nd best in the nation. That status is now clearly at risk.

The mechanism for this proposed cut is a change in the functional ability eligibility requirement for Medicaid funded long term care services. According to the proposal, only people who require extensive assistance with most daily activities and are medically complex, including people with major cognitive issues, will retain services.  Beneficiaries who need intermittent assistance, or who need supervision rather than hands-on assistance, will no longer be eligible.

Services would be eliminated for the following people:

  • 11,700 people will lose homecare assistance
  • 1,000 people who live in Adult Family Homes
  • 2,700 people living in assisted living facilities
  • 1,000 people living in boarding homes
  •  450 people living in nursing homes

In addition to these cuts, 1,000 people would be impacted by the elimination of Adult Day Health.  By definition, with very few exceptions, the people who qualify for these Medicaid funded services have less than $2,000 in assets and less than $2,022 per month in income. They already contribute on a sliding scale to their own care. They cannot afford to cover the full cost of their care on their own. Where will they go and what will they do?

What will happen if Washington asks vulnerable adults to fend for themselves?

  •  Family caregivers will not be able to pick up the slack. Many long term care clients have no family or have only long distance support.  A recent AARP report found that the average caregiver is a 49 year old woman who is still working and who also spends 20 hours per week providing unpaid care to her mother for nearly five years.
  • There will be more calls to law enforcement, 911 and Adult Protective Services. People who can sometimes get out of bed but not always or who can’t walk up and down the stairs in front of their house or who can’t cook – are not safe in their own homes and are at risk of injury and self neglect. Without supportive housing or home care help many will find themselves in crisis, and when friends or neighbors notice they will respond by calling  911 or APS.
  • People will decline faster and utilize more expensive health care services. Without appropriate support, the health status of this population will decline. Washington will see an increase in expensive emergency room visits and hospitalizations and more people qualifying more quickly for higher levels of care.
  • Thousands of caregivers will lose jobs. For every person who loses home care assistance, a home care worker loses income and in the event that was their only client, loses their job. With fewer paying residents, some long term care facilities will lay off their employees or shut their doors. In this recession, keeping people employed must be a top priority.

What is the alternative? Raise revenue.

AARP agrees with the many organizations urging the legislature to send a referendum to the people so the citizens of our state can decide whether they want to close tax loopholes or otherwise raise revenue to avoid painful cuts.  In addition, we are urging the legislature to fully explore all possible options to offset long term care cuts by maximizing federal funds or raising fees – here are some examples:

  •  Community First Choice (CFC) – Washington State is eligible to receive a 6 percent increase in the federal matching percentage (FMAP) for home care services that is available through Section 2401 of the federal Patient Protection and Affordable Care Act. The Department of Social and Health Services included CFC in their budget proposal to the Governor but due to federal rules they will not be able to pursue this option if the functional ability cut is enacted. Washington should aggressively pursue this option which could generate tens of millions of dollars in new revenue.
  •  Adult Family Home License Fee – Adult Family Homes should pay for the full cost of their oversight as all other long term care providers do. Last year the legislature moved in this direction by increasing the license fee from $100 per home to $100 per bed in FY 2012 and $175 per bed in FY 2013 plus initial fee of $2,700. The legislature should accelerate this increase so that these providers are fully funding their own oversight and savings can be used to mitigate cuts.
  •  Maximize Safety Net Assessments – Last year the legislature passed a nursing home safety net assessment. To mitigate cuts, the legislature should consider upping this assessment to the federal maximum and look at what other providers, including home and community based long term care providers, could be similarly assessed.

What You Can Do

 1)      E-mail the Governor to express your concern

Click here or paste this into your browser: http://www.governor.wa.gov/contact/default.asp

 2)      Call your state lawmaker

Call the Toll Free Legislative Hotline:1-800-562-6000

 3)      Share your story

Help us share the people behind the numbers, e-mail your story to aarpwa@aarp.org


Contributing Author by — October 4, 2011 in Everything Else
Tax-Aide Seeking Volunteers for the 2012 Season

By Larry Maxcy

AARP Tax-Aide Volunteer

Are you good with numbers? Or maybe math isn’t your thing, but you’re looking for a way to volunteer and give back to your community? Then the AARP Foundation’s Tax-Aide program is looking for you!

AARP Tax-Aide, the nation’s largest free, volunteer-run tax preparation and assistance service, is seeking volunteers across the state to help Washington taxpayers who are seeking assistance preparing and filing their 2011 tax returns.

AARP Tax-Aide volunteers receive free tax training and are reimbursed on a limited basis for qualified program-related expenses. Volunteers should be computer literate, since most AARP Tax-Aide sites provide e-filing for faster tax returns. While it is helpful if you have some experience in tax preparation (even in doing your own taxes); it is not absolutely necessary. We ask our volunteers to provide four to six hours per week from the first week in February until April 15 if at all possible.

We also have openings for volunteers who don’t want to prepare taxes, but who have technical or computer backgrounds, as well as for people to assist with scheduling and intake matters.

Last year, more than 1,100 Tax-Aide volunteers helped over 80,000 taxpayers across the state. They join the more than 35,000 Tax-Aide volunteers across the country, helping millions of taxpayers each year.

For more information on how you can join the AARP Foundation Tax-Aide team, visit our Web site at www.aarp.org/tavolunteer8 , or call our toll-free number, 1-888-OUR-AARP (1-888-687-2277). The deadline for applications is December 15, 2011.

Tax-Aide is a program of the AARP Foundation, offered in conjunction with the IRS.

Contributing Author by — September 26, 2011 in Everything Else

Ingrid McDonald/AARP Advocacy Director

Ingrid McDonald
AARP Advocacy Director

When it comes to long-term care, Washington state ranks second in the nation 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.

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 that status is at risk. In recent years the state legislature has cut back on home care hours and other supports that people need in order to stay out of nursing homes. With fewer home care hours, less support and higher health care costs, more and more people will give up their struggle to remain in their own homes and settle for expensive nursing home care because they feel it is their only option.

To continue our popular and cost-effective approach, Olympia lawmakers 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.

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.  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 percent 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.  For more information, visit www.aarp.org/wa.

 

For a related story click here.

Contributing Author by — September 26, 2011 in Everything Else

The very first email that flashed up on my computer monitor came June 9 and said  “Tacoma Police Department needs volunteers for their Active Mall Shooter exercise to be held August 12.”  Anyone that was interested should send an email.  That sounded like a lot of fun, so I signed up.

In my mind I saw the entire exercise unfold, with me in an active, starring role.  Since the mall is closed for this after-hour exercise all stores are closed, but I’m one of 50 volunteer “shoppers” for this scenario.

A man wearing a black ski mask jumps out.  He starts firing randomly.  All of us volunteers dive for cover, some start to run towards the doors.  There is chaos, women are screaming, people are shouting.  Everyone is trying to see where the shots are coming from.

Since I’m in the starring role, I call 911.  I am whispering to the dispatcher what is going on, and all of the vital information the police need.  The police mobilize.  The swat team moves in.  The shooter grabs a group of us.  We’re being held hostage.  The police swat team frees the volunteers, take down the shooter and everyone gets home in an hour.  That’s what always happens on television.

July came and went.  No email.  Did they forget about me?  Did they decide I wasn’t suitable for their exercise?  Okay, I’ll give up the starring role.  Finally I receive details on time and directions for the exercise.  And for added impact, the day before the exercise volunteers were asked to let them know if they could not make it and an alternate would be called.

The day of the exercise I woke up with a severe head cold.  My head ached.  My throat hurt.  I ached all over.  I cannot go into work this sick so I go back to sleep.  I wake up at noon.  I’m still not feeling better.  Back to sleep.  I wake up at 5.  Am I well enough to go?  I still have to go into work to catch up so should I participate in the exercise?  WAIT A MINUTE!  It’s the POLICE department!  They have my name!  They know who I am!   I sent emails saying I’d be there!  I even re-verified the day before!  What if I don’t show!  They’ll be on the lookout for me!

I decided I should go.  I showered, put on my jeans and the required sneakers and a jacket.  By the time I got into my truck, I had a fever and was sweating.  This was not a good start.

Locating a parking space was a whole lot tougher than locating the sign-up tent.  There was a mass of uniforms:  Police, fire, K-9 handlers, the K-9 dogs, the SWAT team – impressive!  I managed to park illegally with the blessing of an officer participating in the exercise.  Walking towards the tent, lost in a sea of police… well I started to get nervous.  I could feel my heart beating faster.  I could feel myself panic.  Oh NO!

Now WAIT A MINUTE!  I am here as a volunteer!  I didn’t DO anything!  Calm down.  You are NOT in trouble.

I give my name at the sign up tent and am handed a yellow nylon “vest”.  The vest really wasn’t a vest.  It’s more like a flimsy football jersey with a white faded number, no sleeves, and if you were tall enough, it would be cropped right above your belly button.  I pulled my vest over my head.  It fit like a shirt on me.

There was a table loaded down with various snacks, donuts (of course), and a cooler with juices and water.  I silently cursed myself for being sick.  All these great treats and my head is throbbing.

Waiting for the start of the exercise, police and volunteers alike stayed with their respective groups.  I looked around at the different vests.  There were vests lettered ‘CONTROLLER’, ‘OBSERVER’, ‘SAFETY, ‘PIO’, so many I forgot half of the labels.  Who WERE these people?  In the middle of my musing we’re all called around the tent, volunteers and police alike.  We’re all given the briefing.  Everyone entering the mall must check their weapons; no guns, no knives, no ammunition; you are then scanned with a wand metal detector; and finally prior to stepping through the mall door, you are given a pat down.

It’s time to start.

Five volunteers were given a script to follow, five volunteers were having make up applied since they were gunshot victims and the gunman was a police officer.

The group of us walked through the food court–away from the ‘shooting’ area so we weren’t scanned or patted down–to the other side of the mall.  Then we waited.  The gunshot volunteers went into the mall, through the wanding and putdowns, and disappeared into the mall.  Those of us not specifically selected to be a victim stood outside of the mall doors.  WHAT??!!  Wait a minute!  I am supposed to be in there!  I have a starring role!

After the victims disappeared, the leaders of our group gave us our instructions.  When they give us the signal, we are to run out into the parking lot as fast as we can.  They will be standing at the back of the lot and we are to scream and run, like we are trying to get away.  The only thing we want to do is to get out of there.  WHAT??!! There obviously is some huge mistake!  I am supposed to be in the mall on the phone with 911!

With so many police officers going through checking their guns procedure and the victims being made up, there was quite a bit of waiting.  Two police officers were assigned to guard the door.  No unauthorized people could enter and if they were authorized, they received a pat down.

After watching this process numerous times, I couldn’t stand it any longer.  I just had to ask, “Why are you going through back-packs and doing pat downs?  They have all checked their guns and have been wanded.  What’s the story?”

“We have to make sure no live weapon gets into the mall.  The only weapons used inside are paint guns.  Although they look like real weapons, they aren’t and we can’t have someone make a mistake.  The volunteers don’t like it when we shoot them with real bullets”.

“OKAY EVERYONE.  PAY ATTENTION.  THEY ARE STARTING NOW.  WE WILL TELL YOU WHEN TO RUN” the leaders yelled out to us.  I looked up.  Police cars screamed into the lot and stopped in various positions.

“RUUUUNNN!”  I took off running as fast as I could.  I reached the leader at the end of the parking lot with a kink in my ankle and a throb in my knees.  I just might be a tad old for this.

Since we finished our part and provided the initial mass confusion for the police, we walked back up towards the mall doors.  We stood behind the first parking lot tire blocks, and watched as the police brought out the victims.

The volunteers with the scripts, began in earnest. Screaming, crying, yelling at the police to help the victims.  It was pandemonium.  The fire trucks raced in.  Medic trucks raced in.  The scripted volunteers were screaming, “Help them!  They’re dying.  Why won’t you help them?  Get someone here now!”

Our group stood watching the whole event unfold with each player doing their part in the play.  Triage was set up in the parking lot.  Backboards were brought out.  Gurneys were rolled out.  Overhead a plane circled the mall providing live video of the entire scene to the command center located in a trailer.  The bomb squad was trying to locate a bomb hidden in a car.  The swat team was making sure the mall was clear.  We even managed to see the shooter taken away in handcuffs.  It was fantastic.

Although I didn’t get the starring role in the exercise, it was a worthwhile experience and one that I absolutely would do again.

Miska, Senior Scene
Contributing Author by — August 24, 2011 in Everything Else