Washington Gets High Marks for Serving Older, Disabled Residents

Advocates caution that more work is needed to support families who need long term care

A new report shows that Washington State's long term care system ranks 2nd in the nation, but AARP and other aging advocates caution that budget pressures threaten to turn the clock backwards on Washington's high-quality and cost-effective approach.

The comprehensive state-by-state Scorecard from AARP was issued with support of the nation's leading organizations behind quality long-term care, The Commonwealth Fund and SCAN Foundation. It 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, it also sheds light on key weaknesses in our system and points to needed reform in key areas, including:

  • support for unpaid family caregivers.
  • quality of care in nursing homes.
  • affordability.

Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers—an update of the inaugural 2011 Scorecard—ranks each state overall and within 26 performance indicators along five key dimensions: 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.

"We have a strong track record in our state of finding ways to help people live independently, at home, as they age," says Doug Shadel, State Director of AARP which serves more than 920,000 members age 50 and older in Washington.

"While the Scorecard ranks us 2nd 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."

—Doug Shadel, AARP 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," says Shadel. "While the Scorecard ranks us 2nd 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."

"It's critical that we don't turn the clock backward on this success. Throughout the great recession AARP fought back against budget proposals to reduce home and community-based services," says Shadel. "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 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.

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 850,000 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. The value of this unpaid care totals about $10.6 billion.

"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," 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, 60 percent of family caregivers in Washington State face a degree of stress and worry. Washington needs to do more to support family caregivers.

That's why AARP is fighting to expand the Family Caregiver Support Program. This program provides support for caregivers like counseling, referrals and respite so they can have time to take care of their own needs as well as their loved ones. Research shows that it allows people to remain self-reliant and delays their need to turn to the Medicaid program for support.

The Scorecard also points to the quality of care in nursing homes as a key area of improvement for Washington State. 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. 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 1000 age 40+ 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 State:

  • The median annual nursing home private pay cost is 2½ times the median income of people age 65+.
  • The median annual home care private pay cost is nearly 90 percent of median household income for people age 65+.

Without private insurance many people are forced with no other option other than to spend down to poverty to qualify for Medicaid assistance. AARP supports legislation to study alternative financing options. The bill passed the Washington state House last session and will likely to be considered again in 2015.

"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. "With the age wave upon us, now is the time for policymakers to act."

The full state Scorecard, along with an interactive map of state rankings and information, is available at www.longtermscorecard.org.

Contributor Jason Erskine directs communications for AARP Washington, a nonprofit, nonpartisan membership organization. For more information, visit www.aarp.org/wa or watch AARP WA: Who We Are, a short video highlighting AARP Washington services and activities.