What happens if you, or a loved one, cannot do things that keep you healthy, active and safe? Becoming disabled or having less ability to do certain things can happen to anyone at any age. Accidents or a chronic illness may result in a situation where you may have difficulty with “activities of daily living”. Preparing meals, dressing, showering or taking a bath, going to the toilet and cleaning yourself after, walking easily, being able to clean your house or apartment, taking your dog out for walks, driving, shopping for food –it’s a long list! We may take our abilities for granted until we can’t do them anymore.
Video transcript in English
When activities of daily living become difficult, many people find others who step in to help: spouses, siblings, adult children, other family members, even friends and neighbors. These are “family caregivers”, and their support allows people to continue to live in their own homes and avoid the high costs of professional caregivers or having to move to a residential facility like a memory-care unit or a nursing home.
Just how important are these free services offered by family members, friends, neighbors and others?
Services like these, whether given by family members or professionals, at home or in a facility, are called “Long-Term Services and Supports (LTSS)”. According to a 2022 Health and Human Services report, over half of Americans turning 65 today will require LTSS.
The cost of care for LTSS given by professionals, or in a facility:
The average American turning 65 today will incur over $120,000 in future LTSS costs and may have to pay much of that out-of-pocket. A 2023 KFF report stated “the overwhelming majority of adults say that it would be impossible or very difficult to pay the estimated $100,000 needed for one year at a nursing home (90%) or the estimated $60,000 for one year of assistance from a paid nurse or aide (83%).” Traditional Medicare doesn’t cover long-term care, while some Medicare Advantage plans offer only limited coverage for services like meal delivery.
Medicare does NOT cover LTSS. It’s important to know that Medicare health insurance, which many individuals rely on for health care after age 65, does not cover or contribute to the costs of in-home help for activities of daily living or care in a facility such as a nursing home or memory-care residence.
Medicare does cover temporary care in a rehabilitation facility when your physician orders it for recovery from accidents, surgery, stroke and heart attack, and similar medical reasons. It may also cover short term rehabilitation care in your home after you are released from a hospital or rehabilitation facility. All services are based on medical need and are time limited.
Medicaid or Medicare, Which Covers Long-Term Care? compares which program covers which services and under what circumstances.
In Washington State we have an agency focused on LTSS, the Aging and Long-Term Support Administration (ALTSA). Washington State has several programs that may help families reduce the costs of long-term care.
To find which of the programs and services below you are eligible for, contact Community Living Connections by phone toll-free, 1-855-567-0252, or on their website.
ALTSA has a website page listing the types of services that support people to stay in their own home (these are often called Home and Community-Based Services).When it’s not possible or desirable for you to stay in your own home many people use residential care. Some types of residential care are paid for by Medicaid, if you are eligible. Information about types of residential settings, state supervision of residential facilities, and tools to search for and compare residential options are listed on ALTSA’s page about Long Term Care Residential Options.
Ways to reduce the cost of long-term care:
Washington State Medicaid (Apple Health)
Long-Term Services and Supports are available for some individuals under Washington Medicaid/Apple Health. There are financial criteria to qualify, including looking at income and assets. In many cases, those who own their own home and are without significant debt are deemed ineligible. To check the eligibility requirements see the Washington State Medicaid Long-Term Services and Supports for Adults booklet.
Note: WA State offers the Specialized Dementia Care program at some assisted living facilities for people who qualify for long-term care under Medicaid.
The package of specialized dementia care services includes (in part):
- Care, supervision, and activities tailored to the specific needs, interests, abilities, and preferences of the person.
- Coordination with the person’s family to ensure the person’s routines and preferences are honored.
- Dementia-specific training for staff.
- Awake staff twenty-four hours a day.
- A safe outdoor environment with walking paths and access to a secure outdoor area.
- Intermittent nursing services, help with medications, personal care, and other support services.
LTSS for Military-connected Individuals:
Veterans can access long-term care through the U.S. Department of Veterans Affairs.
TRICARE, health insurance for military members and their families, does not cover long-term care but can provide some services and supports, similar to those Medicare does cover. Some military members may be eligible for the Federal Long Term Care Insurance Program.
Private Long-Term Care Insurance:
These insurance policies can be purchased at any time and are meant to last for a lifetime. The cost of these policies is determined by a recipient’s age, health, and location, and rates go up over time. These can be expensive and difficult to find but may be worth looking into.
Not all Long-Term Care Insurance companies operate in the state of Washington – to see a list of all approved agencies, view them at the Office of the Insurance Commissioner. The Office of the Insurance Commissioner has an online booklet called A Consumer’s Guide to: Buying Long-Term Care Insurance and Other Ways to Pay for Long-Term Care that can answer questions and explain the process for signing up for insurance.
Washington State Long-Term Care Partnership Program
Many families liquidate (get rid of, or use up) assets in order to be eligible for Medicaid LTSS services, and to address the issue, the state created the Long-Term Care Partnership Program. The program is a partnership between long-term care insurance companies and the state of Washington Medicaid program, so that families can keep many of their assets, yet receive Medicaid Services for LTSS. Under these policies, assets are protected up to the amount of benefits paid under the policy. For example, if the Partnership Policy paid $100,000, then Medicaid would allow you to keep $100,000 in assets, yet you’d still qualify for government LTSS as long as you meet all other qualifications. This is a movable policy, as Washington participates in a “reciprocity” agreement with several other states. See the list of long-term care insurance companies approved to sell Partnership policies in Washington state.
WA Cares Fund:
A newer option that helps with the expenses of long-term services and supports is the WA Cares Fund, a public, long-term care insurance program. All Washingtonians who get a paycheck have a small percentage of their earnings go to this fund automatically, just like Social Security and Medicare tax is withheld from a paycheck. The program went into effect in July of 2023.
- Most Washington employees will have .058 % of their paycheck placed in the WA Cares Fund. WA Cares website has an online calculator so you can check out the actual dollar amount. Everyone contributes at this same low rate, regardless of income.
- Exceptions: Federal employees do not contribute. Employees of tribal entities only contribute if the tribe decides to have their employees contribute.
- If you are self-employed you can choose to contribute to the fund.
- After paying into the system for 10 years you can withdraw from the fund. There are exceptions to the 10 year rule if you are retiring soon or have an emergency need for LTSS.
- Funds can be withdrawn beginning in July of 2026.
- WA Cares funds can be used if you live in another state.
- Funds can be used to pay for many services and supplies: paying a relative to care for you, making your home safe and accessible, transportation, food delivery, durable medical equipment to help you stay safely in your home, and more. Funds can also be applied to the cost of residential (facility) care.
You will have to create an online WA Cares account and submit an application
- If you have contributed to the fund for 10 or more years, you will receive up to $36,500 (adjusted for inflation) to pay for your long-term care.
- If you need to access WA Cares funds earlier, because of retirement or emergency need, you will get less.
Help for your family caregivers
If you plan to get in-home supports from family members or others, using your benefit from the WA Cares Fund can take some tasks off their list, or pay them for their time. That’s a big help because even though family caregivers help out of love, the time and out-of-pocket costs of caring for you can have an impact on their financial situation.
