Washington is not ready to meet the needs of a generation of older adults. For those served by Medicaid in long-term care, like assisted living or a skilled nursing facility, only 82% of care costs are being reimbursed by their state-provided Medicaid insurance. As our state faces a rapid growth in the number of adults who will require care, this already precarious system is poised to collapse.
Long-term care communities like assisted living are a solution to the numbers problem of how to meet the needs of so many aging adults with few resources. There are only so many housing options for us as we age and only so many workers to support us — and soon, there will be many, many more of us in need of this kind of care.
The population of Washingtonians age 65 or older is expected to double to 23% of all state residents by 2050; that’s more than half the entire combined population of King, Pierce and Snohomish counties. And yet, our state is already struggling to meet the needs of older residents with challenges in housing, affordability and supporting a trained workforce to provide care in a licensed environment.
Additionally, more long-term care communities across the state, like the ones I oversee in Auburn, Spokane and Tekoa, provide behavioral health, or mental health, services. Assisted living has become part of the fabric of health care that extends beyond the care needs that arise as someone ages.
Long-term care communities keep costs down across the health care system by preventing expensive cycles of frequent hospitalization that only further degrade the quality and quantity of life for patients. Our hospitals are already strained to their limits; we must invest in the services that we will need more of very soon.
If we as a society believe that it is a human right to age with dignity — not just a right of those who can afford it — then we must recognize both the fragility and necessity of our system of long-term care.
In our facilities, almost all of our patients are on Medicaid. The gap in our reimbursement rates — only 82% of costs — persists despite the fact that the state has undertaken studies to calculate exactly how much it takes to provide high-quality care. So far we’ve managed to pay our bills by subsidizing those patients with income from behavioral health services. However, that model is collapsing as inflation and the growing cost of care continue to increase each year.
We are no exception to the impacts of inflation. But while a restaurant can raise the menu prices when costs go up, we cannot. Instead, we must decide between paying staff or replacing outdated flooring or providing a nicer-than-usual meal during the holidays.
Most people are oblivious to long-term care until it affects someone they love. I’ve received more than one call from friends and acquaintances suddenly confronted with the difficulty of finding their loved one a place to live. Most are dumbfounded by the lack of options available in their price range. But it doesn’t have to be this way.
Although lawmakers are confronting an exceedingly challenging budget environment and we are all preparing for federal Medicaid cuts, our state has made promising advances toward a more sustainable funding system in recent years. Finally, it seems like our pleas are being heard. What that means, though, is that there is absolutely no room to go backward. Already, for every hour of care provided to a Medicaid resident, we are reimbursed between $2 and $5 below current wages. Multiplied over millions of hours of care, this math does not add up.
If I could give the staff in our communities anything right now, though, it would first be recognition for the incredibly hard and valuable work they’re doing every day to care for our residents just like they would their own family members. I hope that lawmakers can join me in this effort to respect the value of long-term care workers and the communities that we will need to be there for us even more in the years to come.
