On Friday June 5th the Aging and Long Term Supports Administration announced a proposal to cut the rates paid for long term care services in adult family homes.
Adult family homes are on the front line of the pandemic. Most adult family home providers live with their families in the same home with the residents they serve. For three months they have been living in isolation without access to COVID testing or personal protective equipment (PPE). They have been managing the perpetually changing guidance from CDC, DOH, DSHS, CMS and local health jurisdictions. They have implemented additional infection protocols and are required to make additional reports to the state. This extra work has strained existing providers and their resources. The thought that these providers could sustain a cut to their funding is to ignore the reality of this challenging situation.
Our members had been hoping for communication related to the easing of visitor restrictions, guidance for resuming group dining, access to COVID testing, access to PPE, proper admission protocol, and a litany of other issues that are currently unresolved. Unfortunately, the only communication being offered from the state to these hard-working families is the threat of a rate cut. Current Medicaid rates are well known to be less than the actual cost of care (DSHS pays more for an employee to stay in a hotel than it pays for the daily care and service of many AFH residents). Seventy-five percent (75%) of homes rely on Medicaid as a payment source. Currently, nearly 60% of beds are filled with Medicaid funded residents, for an average of 3.3 Medicaid funded clients per home.
We are concerned not just what this will mean for our members, but also for Washington’s nationally recognized long-term care system. These types of cuts will reduce the number of available caregivers, beds, and facilities in communities across the state. These types of cuts will result in limited access to care for the poorest and most vulnerable. This will happen at the same time the baby boomers enter their mid-seventies and the demand for care and services continues to grow. Over the last year or two, more than 20 skilled nursing facilities have already closed. Many due to bankruptcy related to serving a high number of residents with low Medicaid rates. These cuts will lead to fewer services, lower quality, and limited access.
The long-term care workforce shortage was being described as at a crisis before COVID. It has been recognized that these are low wage jobs requiring significant training and a limited career path. Sincere efforts to grow the workforce and overcome these challenges will be undermined if we cannot offer caregiving staff a living wage and access to benefits like healthcare.
As a result of this pandemic, AFH providers have been asked to take on more. There will undoubtedly be new rules, increased expectations around infection control, visitor screening, helping residents access the community, and a host of other changes to help manage these settings considering COVID-19. Cuts to the already low rates as we increase expectations will undermine efforts to deliver quality care.
A significant portion of our members are immigrants and people of color. The people we serve are elderly or disabled. These populations are already marginalized. They struggle with higher rates of poverty, additional health disparities, and reduced access to services. We fear that because both providers and residents fall into these categories, there will be no voice objecting. Cuts to this sector will exacerbate the disparity and inequality we are struggling to correct.
We object to both the handling and content of these proposals. Now is the time to ensure we invest in providing care to the most vulnerable. Now is the time to support those giving care. Now is the time to honor our heroes serving in long-term care, not make devastating unilateral cuts.