Opinion: State neglects funding of long-term care

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The focus of the 2015 legislative session is on funding K-12 education, to a level that will avert further Washington Supreme Court sanctions. The session’s subplots include funding salary increases, finding revenue for the first big transportation package since 2005, and the fate of a bold climate agenda Gov. Jay Inslee has offered.

Lost in the shuffle is the nursing home care that more than 17,000 Washingtonians depend upon.

The most recent federal report showed Washington had the nation’s second-most physically impaired nursing home population — 74.4 percent of patients needed help with at least four of the five “activities of daily living”: bathing, dressing, eating, toileting and transferring (moving about). Even the percentage of patients reporting “moderate or severe pain” was fifth-highest in the U.S.

This comparative infirmity is a result of Washington’s success in developing lighter-care options. Only six states have a lower proportion of their 85-and-older residents in nursing homes. Indeed, today there are some 2,300 fewer Medicaid clients in Washington nursing homes than there were a decade ago, despite the fact Washington’s aged population has grown considerably since then.

Given this data, it is quantifiably safe to say no state values its most vulnerable citizens, almost two-thirds of whom are women, less than does Washington. The state has continually suspended the legal requirement to keep Medicaid reimbursement to nursing homes somewhat up-to-date. For 2015-17, Gov. Inslee proposes moving the cost year from 2007, finally, to 2013.

This will not make the difference one may suppose. Because spending was artificially-constrained, 2013 reflects long years of frozen wages and cuts. Since 2007, for example, four public nursing homes — providing vital rural area care — have closed, with a recent news story showing another teetering. And a privately owned Lakewood facility closed its doors in December. Under the governor’s budget, nursing home reimbursement would only rise 3 percent from the present day by June 30, 2017 — and somehow still be $51.97 per patient per day less than what Oregon today pays to care for a less-impaired patient population.

Further, whether even this meager benchmark would be met is doubtful: The proposed budget sunsets some payment add-ons while continuing contrivances authorizing the state to avoid costs. The budget would also continue denying, into 2017, funding toward the Medicaid share of cost of capital projects, even renovations that, as the capital authorization law describes, are necessary to “protect the health or safety of the facility's residents” or “avoid closure.” No funding has been provided for projects under that law since 2010 – surely the intent cannot be to let nursing homes crumble into ruin?

It is incongruous to talk about economic justice in Olympia and then provide funding that artificially depresses caregiver wages. Furthermore, reimbursement ignores the 2015 Affordable Care Act (ACA) requirement that almost every nursing home — those with 50 or more full-time employees — provide affordable health insurance to their staff. As roughly two-thirds of patients are the state’s own clients, it’s a further irony that the health care costs the state ignores include those of caregivers themselves. If the ACA is worth celebrating, why will the state not fund its mandates?

Rather than fund care, the state seemingly intends to harry caregivers into higher standards of efficiency. Despite Washington ranking among the nation’s 10-best states for survey results, the state would assess patients another $8.2 million in bed fees to investigate their care. What’s the crisis? Substandard care citations fell in Washington by 67 percent from 2008-12, even as reimbursement was cut; in 2012 such a deficiency citation was almost twice as likely in Oregon and up to 15 times more likely in other states But surely there is more to quality care, and supporting those providing it, than simply avoiding wrongdoing, or sanctioning it can we not lift our sights?

A state confronted with its need to do better by its kids must do better by its senior citizens.  Finding a dedicated source of revenue for long-term care now could shore up this safety net presently and into the future.


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About the Authors & Contributors

Brendan Williams

Brendan Williams

Olympia attorney Brendan Williams was a Washington state representative from 2005-11.