Our system of paying for long-term care services is badly broken. Medicare
does not pay for long-term care in assisted living or in a nursing home,
which many people don’t realize till it’s too late. Private
long-term care insurance is purchased by fewer than one in ten people.
Medicaid that pays for most long-term care costs in the US can require
big financial decisions for asset protection planning, for those lucky
and smart enough to get the right kind of advice. For those who don’t
get the right advice, Medicaid eligibility requires that they almost completely
impoverish themselves before qualifying under strict asset and income rules.
Nonetheless, Medicaid costs and all long-term care expense continue to grow[SW1] – and the crisis will only get worse as the baby boomer population
Care and support services outside of a nursing home for seniors and disabled
citizens is effectively
not part of the broad social safety net in the United States, that provides
doctor and hospital care through Medicare and retirement income through
A difficult task falls on those elderly and disabled who need help with
daily living activities, to provide for their own care and meet their
own needs – particularly on “orphan elders,” with no
friends or family nearby to help – and especially on caregivers
Caregiving can be a brutally exhausting job, both physically and emotionally.
Often it can even be financially draining too, when caregivers need to
miss or quit their jobs. A high proportion of caregivers spend their own
money for help and assistance for a loved one.
Now, Washington is the first state to establish a taxpayer-funded, universally
available, long-term care benefit. It will be available to help both needy
seniors and disabled and their dedicated, hardworking caregivers. It’s
similar to Medicare and Social Security, which feature universal requirements
The benefit is $100 per day, for a lifetime maximum of $36,500, though
the benefit cap amount is indexed to grow with inflation. Those eligible
are people with disabilities who need help with daily living activities
and have paid into the system for 10 years (or just three years, in the
case of catastrophic illness).
The coverage can be used for a wide range of needs, as determined by the
recipient, for his or her own benefit.
It’s funded by a universal, mandatory tax on all working people of
only 58 cents per $100 of income – that’s just over half of one percent. [SW2] This tax is expected to cost the average Washington wage-earner about
$18 per month or a little more than $200 per year.
While $36,500 won’t provide for someone for life, it can help needy
individuals pay for whatever is required, such as for outside caregiver
help, to compensate family for their help, accessible home retrofits such
as a ramp, transportation to and from medical appointments, and other
disability related purposes.
It can help someone stay out of a nursing home or care facility longer,
so it’s expected to save Washington State Medicaid dollars, that otherwise
would pay for expensive nursing home care when someone can’t to stay
at home any longer.
Advocates say that it’s important for everyone to begin to see care
needs of the elderly and disabled as a shared, communal responsibility,
instead of just an individual need. This legislation was a result of a
long, consensus-building process of education, advocacy, and compromise.
Critics call it a government overreach and one more objectionable tax.
Supporters say it doesn’t go far enough.
Remember that if you need long-term care, an elder law attorney may be
able to help you get the care and services you need, while saving more
of your own money for you to keep – especially if you are headed
toward expensive nursing home care.
The long-term care crisis is happening now, and it’s going to get
worse. 70% of Americans will need some kind of long-term care after turning
65. This program for universal family care may be a model for changing
in coming years.