Tag: home

How to Afford Family Caregiving, Part 4: How Can I Afford Long-Term Care?

Posted on by Barb Koumjian

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.

Tips to Help Parents Reinforce Positive Behaviors at Home

Posted on by Nicol Walsh

Changes in routine, especially during school breaks, can be challenging for families, but using Positive Behavioral Interventions and Supports (PBIS) at home can help create calm, structure, and stronger relationships. PBIS focuses on teaching expected behaviors, using clear communication, and reinforcing positive actions instead of relying on punishment. Families can build supportive routines, model emotional regulation, and use simple strategies to guide behavior at home.

A Brief Overview

  • Positive Behavioral Interventions and Supports (PBIS) is a strategy schools use to teach children about expected behavior.
  • A key PBIS principle is that punishment fails to teach what to do instead. Adults can model calm responses and self-regulation with tools like self-care and mindfulness.
  • Behavior is a form of communication. When children act out, they may be trying to express a need, feeling, or frustration they don’t yet have the words for.
  • The easiest way to change a behavior is to point out what a person does right. Remember this catchy phrase, “5-and-1 gets it done,” to ensure five positive interactions for each negative interaction.
  • Families can use school-based PBIS strategies at home to create safe, consistent, and predictable environments.
  • PAVE provides a video with key information to help families and schools analyze a child’s behavior and develop a positive behavior support plan: Behavior and School: How to Participate in the FBA/BIP Process.
  • If you come up with some great behavior support strategies this summer, be sure to share them with the school in the fall!

Introduction

Changes in routine and seasonal transitions can cause emotional upheaval for families. A few strategies, described below, might help families keep things chill this summer and beyond.

These ideas come from education, where research has helped teachers see the benefits from using Positive Behavioral Interventions and Supports (PBIS). PBIS has been implemented in more than 26,000 U.S. schools. The PBIS framework has been shown to decrease disciplinary removals and improve student outcomes, including grades and graduation rates. When done well, PBIS provides positive social skills, communication strategies and “restorative justice,” (working it out instead of punishing) and may prevent 80-90 percent of problem behaviors.

PBIS is often part of a broader approach called Multi-Tiered System of Supports (MTSS), which helps schools and families work together to meet academic, behavioral, and emotional needs through different levels of support.

Positive support makes learning easier

PBIS research highlights problems with punishments, which are called “aversive interventions.” Research shows that a punished child is likely to go into an emotionally dysregulated state (fight/flight/freeze) that actually blocks learning. Chances are low that the child will know what to do next time because the punishment didn’t provide a learning opportunity.

PBIS teaches what to do instead – and how to do it. Adults who calmly guide children and youth toward a new way of problem-solving can interrupt or prevent an escalation and help the child make better and better choices moving forward.

Keep in mind that adults need to stay regulated to help children. PAVE provides resources to help adults work on their own self-control and support their children:

Behavior is a child’s attempt to communicate

Simple, consistent, predictable language is critical for teaching and reinforcing behavior, says Kelcey Schmitz, who works for the University of Washington School Mental Health Assessment, Research, and Training (SMART) Center.

“PBIS is a game changer for children and youth with behavior challenges and their teachers and caregivers,” Schmitz says. “In fact, everyone can benefit from PBIS. Behavior is a form of communication, and PBIS aims to reduce problem behavior by increasing appropriate behavior and ultimately improving quality of life for everyone. The same approaches used by schools to prevent problem behaviors and create positive, safe, consistent and predictable environments can be used by families at home.”

Schmitz, an MTSS training and technical assistance specialist, provides the following specific tips for creating a successful PBIS home environment.

Support Positive Behavior before there is a problem

PBIS is set up with three layers – called tiers – of support. The parent-child relationship is strengthened by loving and positive interactions at each level.

Tier 1 support is about getting busy before there is a problem. Much like learning to wash hands to prevent getting sick, expected behavior is taught and modeled to prevent unexpected behaviors.  Parents can look at their own actions and choices and consider what children will see as examples of being respectful, responsible, and safe.

Tiers 2 and 3 are where adults provide more support for specific behaviors that are getting in the way of relationships or how the child or youth functions. In a school setting, Tier 2 is for students who need a social group or some extra teaching, practice, and reinforcement.

Tier 3 support includes a Functional Behavioral Assessment (FBA) to find out why the behavior is occurring, and an individualized Behavior Intervention Plan (BIP). PAVE provides a video: Behavior and School: How to Participate in the FBA/BIP Process.

Any student may access supports that include aspects of Social Emotional Learning at all three Tiers. At home, Tiers 2 and 3 naturally will be more blended and may include support from a community provider. Note that targeted interventions in Tiers 2-3 work best when Tier 1 is already well established.

Define, teach, and routinely acknowledge family expectations

Discuss how you want to live as a family and identify some “pillars” (important, building-block concepts) that represent what you value. Talk about what those pillars look, and sound like in everyday routines. To help the family remember and be consistent, choose only 3-5 and create positive statements about them. Here are a few examples:

  • Speak in a respectful voice.
  • Be responsible for your actions.
  • Be safe; keep hands, feet, and objects to self.

Identify a couple of “hot spots” to begin. Challenging behaviors often occur within routines. Perhaps mornings or mealtimes create hot spots for the family. After discussing 1-2 ways to be respectful, responsible, and safe in the morning, teach what each looks like. Have fun with it! Set up “expectation stations” for practicing the plan and assign each family member one pillar to teach to the rest.

Behaviors that get attention get repeated. Notice when a child does the right thing and say something about each success: “I noticed you stopped to pick up your shoes in the hallway. Thanks for putting them away and keeping the walkway safe for others.” The easiest way to change a behavior is to point out what a person does right!

Remember this catchy phrase, “5-and-1 gets it done” to ensure five positive interactions for each negative interaction. When the expected behavior becomes routine, the reinforcement can fade away.

Create engaging and predictable routines

Children crave structure and routine. Adults may look forward to a relaxing evening or weekend, but kids often need regular activity and engagement. Consider that either the kids are busy, or the adults are busy managing bored kids!

Use visuals to create predictability. A visual schedule can display major routines of the day with pictures that are drawn, real photos, or cut-outs from magazines. Create a schedule together, if possible.  Parents can ask a child to check the schedule – especially when moving from a preferred to non-preferred activity. It’s hard to argue with a picture!

Set the stage for positive behavior

Teach, pre-teach, and re-teach. Children need to learn behavior just like they learn colors and shapes. A quick reminder can help reinforce a developing skill: “When we get in the car, sit up, buckle up, and smile!”

Give transition warnings or cues to signal the end of one activity and the beginning of another: “In five minutes, it will be bath time.”

First/then statements set up a child for delayed gratification: “First take your bath; then we can play dolls.”

Focus on Go instead of Stop. Children often tune out words like No, Don’t and Stop and only hear the word that comes next, which is what an adult is trying to avoid. Tell a child what to do instead of what not to do: “Take your plate and put it in the sink.” Save Stop and No for dangerous circumstances that need a quick reaction.

Choices prevent power struggles: “Would you rather play for five more minutes or get in the bath now?”  “Feel free to choose the pink pajamas or the green ones.”

While these strategies may not eliminate all problem behaviors, they create consistency, predictability, and a more positive atmosphere. They teach new skills to help children get their needs met. The solid foundation will help even if challenging behaviors persist by creating a bedrock for additional layers of support.

Final Thoughts

Supporting positive behavior at home doesn’t require perfection—just patience, consistency, and a willingness to learn alongside your child. By using clear communication, setting routines, and teaching expected behaviors, families can create a calm and connected environment where everyone thrives. These strategies not only make summer smoother but also build skills that carry into the school year. If you come up with some great behavior support strategies this summer, be sure to share them with the school in the fall! Working together, families and schools can create strong, supportive systems that help every child succeed.

Learn More

Discipline and Disability Rights: What to do if Your Child is Being Sent Home

Posted on by Nicol Walsh

Learning the skills to maintain expected behavior and follow school rules is part of education. All students learn social, emotional and behavioral skills. Students with disabilities may get extra help in these areas of learning. Some have individualized behavior support plans.

When the pre-teaching and interventions fail to stop a behavior from causing a problem, the school might call a parent to say, “Take them home.” What happens next could depend on how well-informed parents are about the rights of students with disabilities.

This video provides key information about what to do if your child is being sent home. The first thing to ask is, “Are they being suspended?” If the answer is yes, the school is required to file specific paperwork. If the answer is no, a parent has choices and may support better long-term outcomes by carefully documenting what happens next.

Below are links to resources referenced in the video: