Long-term health care crisis looms large

A long-term health care financial crisis is looming for the state’s aging population. The state Legislature, individuals and families must begin to prepare for an age wave of unprecedented depth and duration.

Major reforms and new infusions of funding are needed for long-term health care services and support. That’s the system of care to help the elderly and people with disabilities meet their functional needs, including bathing, dressing, toileting, transportation and eating.

As individuals, we tend to be in denial about the possibility that we will lose our independence and need to rely on others for such basic needs, even though most families have someone in that very situation — a mother, a father, a grandparent or a sibling.

Many people don’t realize that Medicaid doesn’t pay for basic long-term support until the person who needs the services has spent down their savings to near nothing. Ninety percent of adults are uninsured for long-term support and services, even though 70 percent of those 65 and older will need those services in their lifetime.

Long-term care insurance to help pay for a in-home services, assisted living or nursing home care is far too expensive for many seniors. Far too often, applicants are rejected because of their existing health problems. It’s a risky business with a shrinking pool of insurers.

Several factors add to the crisis. The state population is growing older. The percent of Washingtonians 65 and older is expected to nearly double by 2030. And too many baby boomers are not financially prepared to pay for long-term care — 25 percent of people 65 and older have less than $25,000 in savings.

Unpaid family caregivers provide 87 percent of all long-term service and support in Washington, and that care is valued at some $11.6 billion annually. But the supply of unpaid family caregivers is expected to decline by 43 percent over the next 15 years.

Polls show that the majority of voters want state legislators to make long-term care for the aging a higher political priority. It is a nonpartisan issue. But when the talk turns to potential solutions the issue becomes politicized.

The problem won’t be solved overnight. But the 2015 Legislature could start by doing a few different things. Lawmakers should make their temporary Joint Committee on Aging and Disabilities a standing committee, giving the issue the focused, sustained attention it deserves.

State legislators should approve a study to explore ways to fund and boost access to long-term services and support. One idea, more often favored by Democrats, is a type of trust fund financed by a mandatory payroll tax similar to unemployment insurance. Another idea, more appealing to Republicans, is a public-private reinsurance option to offer improved long-term care insurance products by essentially subsidizing insurance companies. This would have the added benefit of reducing the burden on Medicaid. There are probably other ideas that have merit and deserve analysis.

Families will need to keep helping family members. Medicaid will continue to play an important role. But more must be done to develop a high-quality system of long-term care that meets the needs of the elderly and people with disabilities without impoverishing them.