Thousands of elderly in nursing homes imperiled by stark budget choices

Since the 2010 Census, Washington has experienced the nation’s seventh-largest increase in its 65-and-older population.

How will legislators serve an inexorable age wave while meeting their constitutional obligation to increase funding, by billions, for K-12 education?

Over $1.8 billion in state funds alone will be spent on long-term care in the next budget.

A tentative agreement may provide a modest wage boost for 33,000 in-home caregivers. Even small steps such as a 95-cent hourly-increase for entry-level workers, to $12 an hour by 2017, add up to perhaps $90 million. Home care will be a vital part of the future. For example, as the federal government reported in 2012, “Almost half of older women (46 percent) age 75-plus live alone.”

Any new funding will be challenging given a Darwinian budget scenario for 2015-17 recently revealed by the Department of Social and Health Services.

On the bright side, DSHS proposes increasing assisted living Medicaid payments by 5 percent – to an average of $73.58 per day for care, meals, and housing. Assisted living facilities were singled out for cuts twice in the past five years, and no better bargain exists for those servable in this setting.

The roughly 10,000 Medicaid patients in nursing homes are most imperiled.

Washington has abandoned the pretense of cost reimbursement by continually delaying its legal requirement to “rebase” nursing home payments. With payments based upon 2007 costs through 2015, the DSHS proposal would save $58.8 million by, once again, delaying a reimbursement rebase until 2017. Because any state cut loses equal federal funds, the total cut – largely wages – would actually be over $118 million.

Costs already ignored include wage increases since 2007 for caregivers, dietary and housekeeping staff, as well as, effective next January, the Affordable Care Act (ACA) mandate to provide health care. The last is a particularly bitter irony: How can a state government publicly celebrating the ACA be unwilling to pay for the health care of workers serving its own clients’ health care needs?

The DSHS proposal blandly asserts “delaying the rebase would have no impact on clients unless some nursing facilities would choose to close” – in which case “clients would continue to receive services but would have to relocate to a different facility.” It is unfathomable why cuts closing some facilities would not injure all others. Nor are fragile patients easy to “relocate.” And this would be the ultimate bait-and-switch: Nursing homes pay a fee to help keep Medicaid rates current. With that nexus broken, the fee is just a grotesque tax upon Washington’s sickest citizens.

As private long-term care insurance is chiseling and unreliable – if available – AARP has urged consideration of a public insurance program for long-term care services and support, and DSHS proposes study of this and other options. That is welcome. But mere study is not enough.

A collision of demographic needs can only injure Washington’s most vulnerable. Voters must urge policymakers to do right by both kids and those in long-term care, and be willing to support dedicated revenue streams.

Brendan Williams is a long-term care advocate and former state representative.