Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers - the third in a series of reports - ranks each state overall and on 25 specific indicators in 5 key dimensions: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and, effective transitions between nursing homes, hospitals and homes.
"Washington state has always led the way on health care, and now AARP confirms that we are number one when it comes to supporting seniors, adults with disabilities and their family caregivers. It proves that our state's long-term care policies foster individual dignity and choice so people can be cared for at home and in their communities," Governor Jay Inslee said. "All of these important gains are now threatened because of actions in Congress to repeal and replace the Affordable Care Act with deep cuts to long-term care services and supports. As Medicaid is the largest insurer of these services, many seniors will lose coverage. I will fight to make sure our seniors and others are getting the services they need so that Washington state can continue to be the best in the country," he said.
SEGMENT 1: FAMILY CAREGIVING
“The vast majority of older Washingtonians want to live independently, at home, as they age—most with the help of unpaid family caregivers,” says Doug Shadel, state director of AARP Washington, which serves more than 958,000 members age 50 and older in the Evergreen state. “Even facing tight budgets, Washington is making clear progress to help our older residents achieve that goal. However, this Scorecard shows we have more to do, and we need to pick up the pace.”
Today, 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 828,000 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.
“When it comes to helping older Washingtonians live in the setting of their choice, family caregivers take on big responsibilities,” explains Shadel. “Many juggle full-time jobs with their caregiving duties; others provide 24/7 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 – most often paid for by Medicaid. They have earned some basic support.”
According to the state Scorecard, Washington has taken action to improve the assessment of family caregiver needs. But, more must be done.
That’s why AARP Washington fought for the Caregiver, Advise, Record, Enable (CARE) Act which was signed into law in 2016. The Act requires hospitals to:
- Record the name of the family caregiver when their loved one is admitted.
- Notify the family caregiver when their loved one is to be moved or discharged.
- Give instructions of the tasks the family caregiver will need to perform while caring for their loved one at home.
“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, Acting Assistant Secretary for Aging and Long-Term Support at the 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,” said Rector.
SEGMENT 2: MEDICAID/HCBS
“Washington has made strong progress to improve long-term services and supports for older adults and people with disabilities, as highlighted in this Scorecard. But, proposals in Washington, D.C. to drastically cut federal funding for Medicaid would threaten these advancements, likely resulting in our most vulnerable citizens losing the lifesaving supports that they count on,” says Shadel.
The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net. While the inappropriate use of antipsychotic medication in nursing homes has decreased, the Scorecard highlights additional issues related to institutional care in Washington like the percentage of residents with low care needs in a nursing home.
While Washington does rank #2 in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities which helps provide care at home and in the community—the care setting that most Washingtonians prefer—the Scorecard spotlights areas that call for improvement, including choice of setting and provider. Specifically, a need to improve the percent of Medicaid beneficiaries who first receive LTSS in the community, because it is more difficult to return home after a nursing home admission.
“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,” concludes Shadel. “While we are ahead of the curve, we cannot rest on our laurels. There is more work to be done.”
Of the 25 Scorecard indicators, many may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched in 2014, to help older Americans live independently, at home, and the family caregivers that support them.
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 http://longtermscorecard.org.
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About AARP: AARP is the nation’s largest nonprofit, nonpartisan organization dedicated to empowering Americans 50 and older to choose how they live as they age. With nearly 38 million members and offices in every state, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, AARP works to strengthen communities and advocate for what matters most to families with a focus on health security, financial stability and personal fulfillment. AARP also works for individuals in the marketplace by sparking new solutions and allowing carefully chosen, high-quality products and services to carry the AARP name. As a trusted source for news and information, AARP produces the world’s largest circulation publications, AARP The Magazine and AARP Bulletin. To learn more, visit www.aarp.org or follow @AARP and @AARPadvocates on social media.