State must address funding for long-term care needs

We’re not getting any younger.

A little less than 14 percent of Washington state’s population is 65 years or older. Four years ago, the U.S. Census Bureau reported that the dependency ratio, the number of people 65 and older to every 100 people of traditional working ages, is expected to increase from 22 in 2010 to 35 in 2030, when the youngest of the baby boomers will have moved into that 65 and older category.

Nor are we well prepared for it.

About 70 percent of those 65 and older will require some form of long-term services and support in their lifetimes. And 90 percent of adults are currently uninsured for long-term care needs, which means that when care is needed they will have to rely on unpaid family care-givers — many of whom will be at or near retirement age — or will have to spend down their life savings in order to qualify for Medicaid, which itself is financially strapped, resulting in cuts to hours of service and flat rates of reimbursement to providers. Insurance providers are finding the business too risky and are pulling out of the market. And what insurance is available is too expensive for many seniors.

“The system is broken and unsustainable,” said Jackson Holtz with the Service Employees International Union 775, which represents elder care workers. And it’s why a network of groups, including SEIU; AARP; the Elder Care Alliance; the Washington Health Care Association, which represents nursing homes; and other groups and agencies, while not always on the same page on all issues, is speaking with one voice to encourage the Legislature to fund further study of the problems and potential solutions in providing long-term care.

About 20 years ago, long-term care providers and the state, recognizing the increasing costs of nursing home care, made changes that provided more affordable options, including assisted living centers, home health aides and adult day care, said Gerald Reilly, with the Elder Care Alliance. Over those 20 years, those options have saved $6 billion, he said.

A similar effort is needed now. Specifically, the group hopes to see a joint legislative executive committee on aging and disability, which recently completed its own report, be reauthorized and continue its work. And the group is encouraged that Gov. Jay Inslee has included $400,000 in his budget for a feasibility study of policy solutions. Potential solutions include a public-private insurance option and an option for a long-term security trust. The long-term security trust could work something like Social Security or L&I’s workers compensation, in that participants would make contributions to insurance through a payroll deduction.

As recommended by the group, reforms will have to support the financial health of seniors, spread the risk to create an affordable system, provide cost-effective, quality care, recognize the roles of public and private insurance, highlight personal responsibility and maintain Medicaid as a strong safety net.

Currently, Hawaii is the only other state that has done any significant study of the issue, Reilly said. “They’re at the vanguard,” he said, so Hawaii’s work is being closely followed.

The Legislature dithered on education funding to the point the state Supreme Court found it in contempt of court.

It shouldn’t wait for another such citation to find the best ways to fund long-term care.

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