Washington State has consistently ranked among top-performing states in the AARP Long-Term Services and Supports (LTSS) State Scorecard. My colleagues and I are often asked: “How do you do that?”
The reality is that there is no single answer. However, certain notable strategies we utilize have helped fuel our success. Below are some of them. But first, it’s important to understand the breadth of the challenge and the importance of tackling it.
A Challenge that Will Only Get Bigger
Seven out of ten people who reach age 65 will need some level of assistance with daily living tasks at some point as they age. These tasks include things like reminders to take medication, assistance with walking or bathing, transportation to appointments, and shopping. Many people rely on family and friends to provide this assistance. Being a caregiver in this capacity is a rewarding yet challenging job. Without support, it can become overwhelming. Having a family member provide care is not always a viable option, particularly when they do not live in close proximity to the person in need or an illness lasts over a long period of time.
It’s also common for people to pay out of pocket for needed care. However, it’s expensive, and few people are able to afford such services for long periods of time. Once someone has spent down their savings, they often must turn to Medicaid to cover their needs. Thus, as the number of people over age 65 grows, the demand for Medicaid funded long-term services continues to increase.
States like Washington are implementing promising practices designed to support individuals (and their caregivers) who want to continue to live in their own homes as they age. The programs help delay or prevent transitions into nursing facilities as well as individuals winding up impoverishing themselves to qualify for needed services.
Washington State has leveraged data analytics and decades of experience operating state-funded services to demonstrate that targeting low-cost services to individuals and their caregivers can:
- improve health outcomes and reduce stress and burden for the caregiver;
- allow individuals to use their limited resources to maintain themselves in their own homes, reducing avoidable nursing home use; and
- delay or prevent the need to spend down to qualify for Medicaid, resulting in cost avoidance of state and federal funds.
In September 2017, Washington began enrolling individuals in an innovative Medicaid 1115 demonstration waiver initiative. Medicaid’s Section 1115 waivers give states the flexibility to test new and innovative approaches to providing care. To date, under Washington’s waiver, 3,000 low-income individuals have been served—1,000 with unpaid family caregivers.
An important element is having a responsive “ No Wrong Door” system—meaning that individuals get to the right service regardless of which agency they first reach out to—so individuals in need of services can access trusted, unbiased expertise. Here, counseling on the person- and family-centered options available ensures that individuals and their families are aware of those options. Users can receive personalized counseling to help them understand their choices and learn how to use personal and public resources effectively.
Washington State currently spends $2.8 billion (state and federal) a year on LTSS. With the number of individuals needing LTSS expected to double over the next 20 years, states must continue to find innovative ways to meet the needs of constituents in ways that address individual preferences as well as the need to target public expenditures cost effectively.
To learn more about LTSS solutions in Washington as well as other states, go to the Scorecard’s series on promising practices and emerging innovations at http://longtermscorecard.org/promising-practices
Bea Rector is the Director of the Home and Community Services (HCS) Division within the Aging and Long-Term Support Administration in Washington State’s Department of Social and Health Services. She has held a number of leadership positions within the division responsible for planning and administering federal and state services for individuals with disabilities, older adults and their caregivers for twenty years. Prior to that, she spent the first ten years of her career at a large non-profit home care agency.