Sunday Feature on Health in THE SEATTLE TIMES, July 9, 2006:
Tooley, 56, holds her 88-year-old mother's hand. Over the next two decades, the number of state residents 65 and older will double, to 1.65 million.
At their stage in life, Pam Tooley and her friends don't swap tips about raising kids anymore. They talk about how emotionally draining and complicated it can be to find good care for frail parents. And that leads to worries about their own old age.
A few years ago, Tooley's mother became too confused to continue living alone. So Tooley moved her to a nearby assisted-living facility in Renton with a good nursing staff, using proceeds from the sale of her mom's home to pay the monthly fee of $3,000 for rent and care.
All was fine until new owners stopped accepting residents on Medicaid because it doesn't pay enough. That means even residents like Tooley's 88-year-old mother, who've been living there for years and paying privately, will have to move if their personal savings run out.
The experience has scared Tooley, who thought she and her husband were financially ready for later life. Now, given predictions about longer life spans and rising health-care costs, she wonders how long their money will last. And if it doesn't hold out, who will care for them?
"As the baby boomers age, if they can't support themselves, it's going to be such a drain on the public," said Tooley, 56, a federal-government retiree who lives in South Seattle. "It's going to be a huge amount of money."
Pam Tooley checks mother's fingernails.
Photos by John Lok/The Seattle Times.
Huge is Right
Today, Washington often is touted as having one of the best long-term care systems in the nation, one that's cost-effective and offers choices.
But over the next two decades, aging baby boomers will double the number of state residents 65 and older to 1.65 million. As a result, budget analysts estimate that the state's Medicaid long-term care budget — given the rising costs of care and increased caseload — will triple, from slightly less than a billion dollars in 2005 to $3 billion in 2030.
But the impact will start to hit in 10 to 15 years. Demand could overwhelm the system, and if quality slips, residents could be at risk for abuse and neglect, say some experts.
It's a problem happening not just in Washington but across the country, with efforts under way nationally to keep people physically independent longer and to slow the demand for Medicaid.
"The money is not going to be there," said state Rep. Dawn Morrell, chair of the state's Joint Task Force on Long-Term Care Financing and Chronic Care Management. "If you look at the numbers, it's just not possible. We have to look for solutions."
Though older adults in the future are expected on average to have higher incomes and greater financial resources, their assets are still unlikely to keep pace with the costs of health and long-term care, according to a task force briefing paper.
The task force, created by the Legislature last year, is supposed to figure out how to manage this staggering demographic reality and produce options for lawmakers to consider by January. Discussions are in an early stage, but here are some of the questions being asked:
• What's needed to assure the long-term care system meets population needs in every geographic region?
• What's the best way to sustain public funding of long-term care?
• What laws should be changed or eliminated to reduce care costs?
• What will help individuals pay for their own care?
"We have a little wiggle room, before the big wave hits, which is why I'm encouraged," said Nora Gibson, a task-force advisory member and executive director of ElderHealth Northwest, a nonprofit provider of aging services. "We do have some time to plan."
Basically, it comes down to two choices: Cut future services for elders and the disabled in order to keep the budget stable, or find a way to put more money into the system and increase long-term-care services to meet the need.
The first scenario would mean baby boomers have to assume more responsibility for their own elder care, by saving more money, tapping into home equity, buying long-term-care insurance or relying on their families.
If the long-term-care system is expanded, that likely would require creating a new revenue stream, such as a social-insurance type of tax that would function like Medicare or Social Security.
The state also is participating in a national awareness campaign called "Own Your Own Future" to educate citizens about what it means to grow old and how to plan for it.
As a start, Gov. Christine Gregoire is expected to send a letter this week to every household with a person aged 50-70.
"Many people, myself included, do not like to think about getting older," writes the governor, " ... or the possibility that at some time in the future we may not be able to do all the things we take for granted — routine tasks such as bathing and dressing.
"But the hard truth is that most of us will need some type of long-term care. ... "
The campaign also will run public-information spots on radio and television.
Nancy Dapper, executive director of the local Alzheimer's Association, is especially surprised at the lack of understanding about how big the dementia problem is going to be and the need for care it will create.
Task-force work sessions and town-hall meetings are open to the public.
The first town hall, at Puyallup's senior center, was dominated by providers and the caregivers union, with providers complaining that Medicaid reimbursement rates are too low, forcing providers to accept fewer poor people and more who can pay their own way. The rest of this year, the task force will continue to look at three key areas: how well the current long-term-care system works county by county, how best to prevent and manage chronic disease, and new ways to pay for long-term care.
Washington's system is considered a model because, over the last decade, the state was able to shift elder care from nursing homes to less-expensive alternatives such as small adult-family homes and in-home care.
As a result, nursing-home expenditures represent 45 percent of the state's long-term-care budget, compared with 82 percent in the early 1990s. But the state can do even better, say long-term care experts.
Many problems being felt now have actually been around for years — particularly in adult-family homes and in-home care. Some resident advocates say this kind of care has been underfunded and gets less regulatory oversight than nursing homes.
"We have the essential services, but we need more and better quality," said Louise Ryan, assistant state long-term-care ombudsman.
Other worries include the lack of accessible consumer information and whether there is a stable, qualified work force and long-term-care options in certain geographic areas. Various task-force advisory members also have called for more complaint investigations and giving consumers a bigger voice in rule-making, and have questioned how well Adult Protective Services does its job.
Meanwhile, looking after their parents is forcing many baby boomers to confront their own aging.
"It's one of those things you really don't want to think about," said Tooley. "It kind of sneaks up on you."
One of the remedies she and her friends joke about is starting a commune. Perhaps, they would buy a big house, where they would live together and contribute to the common good. Wouldn't that be a pleasant way to live, observes Tooley.
By
Marsha King
Copyright © 2006 The Seattle Times Company
Tooley, 56, holds her 88-year-old mother's hand. Over the next two decades, the number of state residents 65 and older will double, to 1.65 million.
At their stage in life, Pam Tooley and her friends don't swap tips about raising kids anymore. They talk about how emotionally draining and complicated it can be to find good care for frail parents. And that leads to worries about their own old age.
A few years ago, Tooley's mother became too confused to continue living alone. So Tooley moved her to a nearby assisted-living facility in Renton with a good nursing staff, using proceeds from the sale of her mom's home to pay the monthly fee of $3,000 for rent and care.
All was fine until new owners stopped accepting residents on Medicaid because it doesn't pay enough. That means even residents like Tooley's 88-year-old mother, who've been living there for years and paying privately, will have to move if their personal savings run out.
The experience has scared Tooley, who thought she and her husband were financially ready for later life. Now, given predictions about longer life spans and rising health-care costs, she wonders how long their money will last. And if it doesn't hold out, who will care for them?
"As the baby boomers age, if they can't support themselves, it's going to be such a drain on the public," said Tooley, 56, a federal-government retiree who lives in South Seattle. "It's going to be a huge amount of money."
Pam Tooley checks mother's fingernails.
Photos by John Lok/The Seattle Times.
Huge is Right
Today, Washington often is touted as having one of the best long-term care systems in the nation, one that's cost-effective and offers choices.
But over the next two decades, aging baby boomers will double the number of state residents 65 and older to 1.65 million. As a result, budget analysts estimate that the state's Medicaid long-term care budget — given the rising costs of care and increased caseload — will triple, from slightly less than a billion dollars in 2005 to $3 billion in 2030.
But the impact will start to hit in 10 to 15 years. Demand could overwhelm the system, and if quality slips, residents could be at risk for abuse and neglect, say some experts.
It's a problem happening not just in Washington but across the country, with efforts under way nationally to keep people physically independent longer and to slow the demand for Medicaid.
"The money is not going to be there," said state Rep. Dawn Morrell, chair of the state's Joint Task Force on Long-Term Care Financing and Chronic Care Management. "If you look at the numbers, it's just not possible. We have to look for solutions."
Though older adults in the future are expected on average to have higher incomes and greater financial resources, their assets are still unlikely to keep pace with the costs of health and long-term care, according to a task force briefing paper.
The task force, created by the Legislature last year, is supposed to figure out how to manage this staggering demographic reality and produce options for lawmakers to consider by January. Discussions are in an early stage, but here are some of the questions being asked:
• What's needed to assure the long-term care system meets population needs in every geographic region?
• What's the best way to sustain public funding of long-term care?
• What laws should be changed or eliminated to reduce care costs?
• What will help individuals pay for their own care?
"We have a little wiggle room, before the big wave hits, which is why I'm encouraged," said Nora Gibson, a task-force advisory member and executive director of ElderHealth Northwest, a nonprofit provider of aging services. "We do have some time to plan."
Basically, it comes down to two choices: Cut future services for elders and the disabled in order to keep the budget stable, or find a way to put more money into the system and increase long-term-care services to meet the need.
The first scenario would mean baby boomers have to assume more responsibility for their own elder care, by saving more money, tapping into home equity, buying long-term-care insurance or relying on their families.
If the long-term-care system is expanded, that likely would require creating a new revenue stream, such as a social-insurance type of tax that would function like Medicare or Social Security.
The state also is participating in a national awareness campaign called "Own Your Own Future" to educate citizens about what it means to grow old and how to plan for it.
As a start, Gov. Christine Gregoire is expected to send a letter this week to every household with a person aged 50-70.
"Many people, myself included, do not like to think about getting older," writes the governor, " ... or the possibility that at some time in the future we may not be able to do all the things we take for granted — routine tasks such as bathing and dressing.
"But the hard truth is that most of us will need some type of long-term care. ... "
The campaign also will run public-information spots on radio and television.
Nancy Dapper, executive director of the local Alzheimer's Association, is especially surprised at the lack of understanding about how big the dementia problem is going to be and the need for care it will create.
Task-force work sessions and town-hall meetings are open to the public.
The first town hall, at Puyallup's senior center, was dominated by providers and the caregivers union, with providers complaining that Medicaid reimbursement rates are too low, forcing providers to accept fewer poor people and more who can pay their own way. The rest of this year, the task force will continue to look at three key areas: how well the current long-term-care system works county by county, how best to prevent and manage chronic disease, and new ways to pay for long-term care.
Washington's system is considered a model because, over the last decade, the state was able to shift elder care from nursing homes to less-expensive alternatives such as small adult-family homes and in-home care.
As a result, nursing-home expenditures represent 45 percent of the state's long-term-care budget, compared with 82 percent in the early 1990s. But the state can do even better, say long-term care experts.
Many problems being felt now have actually been around for years — particularly in adult-family homes and in-home care. Some resident advocates say this kind of care has been underfunded and gets less regulatory oversight than nursing homes.
"We have the essential services, but we need more and better quality," said Louise Ryan, assistant state long-term-care ombudsman.
Other worries include the lack of accessible consumer information and whether there is a stable, qualified work force and long-term-care options in certain geographic areas. Various task-force advisory members also have called for more complaint investigations and giving consumers a bigger voice in rule-making, and have questioned how well Adult Protective Services does its job.
Meanwhile, looking after their parents is forcing many baby boomers to confront their own aging.
"It's one of those things you really don't want to think about," said Tooley. "It kind of sneaks up on you."
One of the remedies she and her friends joke about is starting a commune. Perhaps, they would buy a big house, where they would live together and contribute to the common good. Wouldn't that be a pleasant way to live, observes Tooley.
By Marsha King
Copyright © 2006 The Seattle Times Company
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