Comment: State funding cuts would devastate long-term care

Published 1:30 am Saturday, December 20, 2025

By Amanda Lanser / For The Herald

When patients are too sick to be on their own but too healthy to be in a hospital bed, that’s when they come to my care team at Mountain View Rehabilitation in Marysville.

I’ve worked in long-term care for longer than a decade. Skilled nursing facilities like the one I lead fill a critical gap between hospitals and home health care. When I chose my career, I knew that skilled nursing had a fundamental place in the health care spectrum. But now, hospitals are running beyond their capacity and the number of complex health needs is increasing with our aging population. The number of Washington’s seniors will nearly double by 2050 and facilities like ours have already become absolutely essential.

The entire health care system is still feeling the impacts of the pandemic, but the most crippling effect has been on our budget. Many of our patients from all over Snohomish County rely on public Medicaid insurance to access our services — whether that’s physical therapy, wound care, psychiatry, chronic disease, cardiac care, mental health care, or more — but the reimbursement we receive from the government for those services is based on data that are several years outdated.

Unfortunately, inflation does not wait for insurance to catch up. Increased prices on everything from linens to meat to housekeeping and care team wages mean that many skilled nursing facilities are struggling to keep their doors open.

My mother also worked in long-term care; it’s in my blood. I love the people I serve every day, but we also work in one of the most regulated industries in the country. We’re caring for people in their most vulnerable moments and we should be held to high standards. The only way that we can safely care for residents and meet those high standards, however, is to have amazing staff; and that’s another area where we’re running a losing race.

The money we’re paid by Medicaid to pay our staff is, by design, never enough. Although our building is still operational, many skilled nursing facilities have closed and more are on the brink of closing because they cannot balance a precarious budget; they cannot hire enough staff, they cannot care for residents safely, and they cannot pay their utility bills.

When facilities like ours close, everyone who lives nearby loses access to the kind of interim health care that keeps people out of hospitals and allows them to receive support while still in their community. Rural areas are hit the hardest. As our entire state prepares for a rapid increase in the population of older adults as the baby boom generation ages, we cannot afford to have less skilled nursing care available in fewer areas.

The only way forward is for the state Legislature to, at a minimum, maintain the current levels of Medicaid funding we receive. Less is simply not an option, even in difficult budget times

Once upon a time, before the pandemic thrust us into the spotlight, nursing homes felt like a forgotten sector of the health care field. Many people are surprised to learn that skilled nursing and rehabilitation communities like ours are also first-in-line Medicaid housing for appropriate residents. And not every resident who lives here has family or visitors; we are their family. But regardless of what insurance they have or what care they receive, every patient in my building is a person. And every staff member caring for them is a person. We are simply people caring for people.

As we prepare for the impacts of federal Medicaid cuts and anticipate the increased red tape surrounding the regulatory process, things will only get harder. When fewer people are able to get the care they need there will be less care available. We are only five years away from 1 out of 5 adults being over age 65 in Washington; I cannot imagine that we won’t need it.

While most people don’t wake up excited to go to a nursing home, I know I’m doing my job well when someone leaves here having had a positive experience. It means that they received the care they needed at the right place in our broader community for that care to be provided. Building trust is essential to what we do. I’m asking lawmakers to put their trust in teams like ours across the state to do our job well.

Amanda Lanser is the executive director and licensed nursing home administrator at Mountain View Rehabilitation in Marysville.