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.
I won’t be able to survive if these cuts happen I have heavy care!!!!
Government is inefficient so I am sure there is a lot of wasted tax dollars. Those need to be ferreted out and stopped before they begin looking to cut lowly funded Medicaid programs.
I’d be willing to forego an increase over the next biennium for no cuts now to the daily rates and the Meaningful Day program.
I’m trying to get my caregivers a decent living wage, while also staying afloat myself.
This is shameful for DSHS to even consider cutting our pay.
We shall mobilize our chapter to rally against these oppressive laws. You cannot find a motel for $60 yet we get paid $80-$90 for all inclusive care of the most vulnerable population this is another demonstration of systemic oppression and we shall marshal our 180 coalition providers to oppose it to its demise it deserves.
This will absolutely lead to so many of us close the homes. We are currently straining so not sure what cutting down rates will do to the system that is already struggling
Well said.
Thank you!!!!
Is the cut our reward for working hard and diligently serving the most vulnerable population during this pandemic? Is this our REWARD? I hope not. Please give us the increase we so deserve.
If we are already struggling to pay staff before this since the rising minimal wage which is fair for the worker but not covered in cost of DSHS payments, which is why we rallied to have the payments plus ability to have 8beds, then COVID happens which stopped move ins, loaded us with more of a workload, people passed, non availability to do tours which affected our bottom line and you want to cut? That is our loved ones care and our future care. Quality staff is only achievable by competitive pay which gives quality care but means we need higher payments not less.
I agree. We are already struggling with paying higher rate for caregivers for them to stay with the difficult job and provide the needs of their families. If funding will be cut or reduced, that would lead to closure of so many AFH. I hope the government will be able to see the care we are doing to these and coming vulnerable adults.
These potential cuts to AFH’s will impact our home to the tune of $37,000-$50,000, severe enough that our viability will come into question. If we close, 6 residents with developmental disabilities will have to find other places to live, and all of them do not have family available to take them in, meaning that the State will likely be put in the position of finding housing for some number of our residents. And, importantly, that likely will cost the State more than if they funded us appropriately. It will be pretty short-sighted of the State to make cuts only to have to, in some cases, end up paying more to address the problems the cuts will case.
I am a new adult family home owner and operator and I have witnessed the lack of funding and cost of care for Medicaid residents, and I have to say, the daily rate does not meet the rate of care. If cuts are in the future, I will not be able to admit Medicaid residents. DSHS expects “First Class” care and living, but are only willing to pay for “Budget/Low” cost for care and living. I have only been open for about six-months and I’m considering closing my doors and doing something else. The challenges and care needed for Medicaid residents is not worth the cost. If I remain open, I am seriously considering only admitting “Private Pay” resident. This is very sad news-even sadder for the families who need the support and care for their love ones.
Amen
This isn’t right. My facility will not survive with these cuts, and it will make it even harder for me to hire caregivers and provide appropriate care for my residents.
DSHS reducing the daily rate will put the residents at risk of losing their current housing.
We offer a lot of the same services that SNF however we are compensated with much lower daily rate. DSHS is already saving big money by having AFH’s provide the services instead of the resident being at a SNF. If a AFH has to close, the residents will have limited options when it comes to housing, therefore the resident will stay in the SNF longer costing the DSHS more money in the long run.
Let’s get them to think long term.
We all know and agree that the current DSHS daily rates are not feasible to run a profitable business without having a few private pay clients. In reality the private pay clients actually subsidize the state pay clients.
Looks like a lot of houses open to AFH business (3200), so DSHS probably thinking it won’t hurt if only few homes will close… Maybe they will realize if all 3200 homes will close at once and let them provide the solutions to care the residents. or maybe, they already have options if all AFH will close unanimously…
I have been in business for 30 years and have always taken in Medicaid but the last few years decided against it. (I took one in because I loved the family). He has improved in some areas but very time consuming, the state was going to lower my because he’s better? This is nuts. Why should we get paid less for improving the resident’s well being? Why doesn’t the state employees take pay cuts across the board not just a furlough day occasionally and sometime with pay too. Our cuts won’t just be for a day but for months. John you are doing such a great job in everything. You work so hard for us. I appreciate you so much. Thank you.
If they are trying to correct budget , they need to be creative.
No taxes to be paid by provider on any Medicaid / All /even those who contribute to their own care payment
( client participation ) And no employer paid contributions for employees, in adult family homes .
Some of us may be licenced for 5-6
And only take care of 4-5
I personally have inky 4 clients / so loosing a client at the beginning of this pandemic / coupled with no tours / admissions / I am technically taking from my savings to pay for care and costs for my state clients.
We all know private pays balance the books, if you take Medicaid.
I have been in business 10 years and everyone of my private pay transitioned / or were allowed to transition / that’s only fair and integral.The commitments / and our word is kept no matter what our budget. It will come to / no Medicaid accepted at all.
I can not keep the passionate / educated staff without the money ,
It’s time the state really knew what kind of work force we are picking from / and those who are good , we want to retain as long as possible for the residents well being as well as the Health and stability of the business
THANK YOU ???????? TO ALL OF YOU PROVIDERS AND CAREGIVERS FOR ALL YOU DO and AS WELL THISE OF YOU WHO ADVOCATE ON OUR BEHALF
3 percent of 3,000 dollars is – 90 $
X- 6 clients is 540 a month , which is 6,480.00 a year.
We would be better off to not pay tax on gross revenue for these clients and no employer contributions on wages.
Let’s say you have all 4,000.00 clients
That’s 120x 6 -720$ a month
That’s 8,640.00 a year
This is not good
Nor should we loose any money
We certainly can’t hire employees
And then decide we want to lower their wages
Soooo
How is they can lower our wages ?
Tax cuts for providers or
Don’t lower rates
I have been in business for 33 years! It’s hard to take Medicaid clients because we don’t get fair compensation for our hard work with them. But I’ve always felt that people who need to be on Medicaid deserve a wonderful, caring place to live as much as anyone else. So I’ve always been willing to care for them if the daily rate is not too low. Also, we keep them when they need to convert from private pay. We providers work hard with our residents and we somehow survive visits from hostile licensors who manage to torment us for hours and now this crazy state insults us with a possible rate decrease!!! In all my 33 years as a provider I have never been more insulted and upset! Maybe it’s time to retire and leave this state!
Washington
Nursing Home Daily Rate (AVG): $285.00
AFH Daily Rate (AVG): $90.00
We fight hard and advocate quality care & services to our patient, for a rare chance of $120/day.
First of all, We work 7 days a week 365 days a year and no holiday pay, no vacation and now you want to cut our pay that’s already low. How we can afford a caregiver? If you guys cut our pay. We end up closing our home.
I am ok with no rate increase for this year but please no cut.
It’s already difficult as it is.
Nearing the end of our 18th year of operation as a DD specialty home in a rural area with all 5 of our residents enrolled in Medicaid, this proposition was enough to keep me up at night! We would have closed our doors years ago, except for the fact that we operate as a nonprofit 501(c)3. However, the loss of the Medicaid Personal Care program would most assuredly mark the end of our home. We barely survived the first dozen years of our operation, when our average daily rates were at $52 consistently year after year. Only after the dedicated work of John Ficker and his team at the AFH council, have we now creeped up to an average daily rate of $78. This devastating cut would likely mark the end for this longstanding home. To cut the “arm of service” and expect that the programs will endure, seems astoundingly short-sighted in my opinion. Perhaps it’s time for some of the state employees from Olympia to take a field trip and see for themselves the difference that Adult Family Homes throughout the state are making.