An estimated 56% of people turning 65 will need long-term care in their lifetime, according to the AARP. On average, much of the care is done by unpaid caregivers and friends helping with day-to-day activities. But a program in Washington is designed to help provide seniors to get the care they need.
WA Cares Fund is the first state-run program for long-term care insurance. It is funded by a mandatory surcharge on payroll taxes in Washington state. After contributing for 10 years, Washington residents qualify for benefits, which could be used for various services including: home care, transportation, adult day programs, home modifications and compensation for family caretakers.
Paula Span writes the New Old Age column for the New York Times and KFF News and wrote about this program, which started offering benefits this month. She joins us to share more on why this program is needed and the impact it could have.
Note: The following transcript was transcribed using AI and validated for accuracy, readability and formatting by an OPB volunteer.
Jenn Chávez: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Jenn Chávez. According to the AARP, a majority of Americans will need long-term care at some point in their lifetimes. As people age, many of these needs for help with daily activities and care are met by unpaid caregivers or friends. Insurance coverage for this care is more difficult to access than people might think.
Washington has taken a first-of-its-kind approach to this issue that affects so many people. WA Cares is the nation’s first state-operated program for long-term care insurance, and it began distributing benefits on July 1. Paula Span writes “The New Old Age” column for The New York Times and KFF Health News, and recently wrote about the program. She’s with us now to tell us more.
Paula, thank you so much for joining us and welcome to the show.
Paula Span: My pleasure, Jenn.
Chávez: So, let’s take a step back here. First, how would you define what long-term care is and what it includes? Because it’s more than just what many might think of as traditional health care for older adults.
Span: That’s right. It’s not really referring to procedures, drugs or doctors. It’s referring to the activities of daily living. Do you need help taking a shower? Do you need help getting dressed? Do you need help preparing meals? Most of this care, as you said, is provided by family members and friends. But that can be very onerous on families, especially younger members of the family who are trying also to work. But trying to pay for it in any other way is extremely expensive.
This is one of the last big areas of care that is not covered by any kind of federal or, in most places, state programs. We have insurance for Medicare, for health care. We have Medicaid for low-income people, but you have to be so low-income that it basically excludes the entire middle class. And the private market has pretty much evaporated.
So how are we going to pay for long-term care? That’s what Washington has stepped up to address.
Chávez: You touched a little bit on this just now, but what kind of financial toll can long-term care take on folks who aren’t insured for this type of care? Like you said, sometimes it’s so expensive that it ends up just being taken care of by unpaid loved ones or friends, rather than paying for this care through traditional means, right?
Span: That is who provides most long-term care. We should understand that most older adults want to stay in their homes. They don’t really want to go to a facility like an assisted living or a nursing home. They want to stay in their homes. But in order to do that – it’s called aging in place – you often need some kind of a helper. To either have home health aid, which is like $30 an hour – they are low paying jobs – or to go to a day program, an adult day program, that’s much less expensive than going into a facility. But it’s still hundreds of dollars a week.
Families are just not set up to do this year after year. Yet as older people’s lifespans are extending, it is a responsibility that can go on for years. So it makes it difficult for people to hold jobs, to travel for work, to accept promotions, and there really doesn’t seem to be a way out of it for most middle class people, except just to shoulder this burden.
So Washington, aware of this, has worked for several years to do this first state program for long-term care. And in the U.S. it’s pretty much the only public program for long-term care except Medicaid.
Chávez: What different kinds of care and services are covered under WA Cares?
Span: WA Cares provides a modest benefit, so it’s been criticized somewhat that this is not going to pay for assisted living. This is not going to pay for a nursing home. But that’s not what most people need or want. So, when you get your benefits from WA Cares, you could use it to retrofit your house that you want to stay in: To put grab bars in the bathroom, to put a ramp for a wheelchair, to install or rent a chair glide so you can go upstairs. It would pay for home care, including family members if they’re the ones that are coming to your house and helping you. It can pay for transportation, for an adult day program, and it could pay for a little assisted living or nursing home, but not a lot. It is a modest program, but it’s a start.
Chávez: Could you speak more to how these benefits are funded? By that I mean, how much are people putting into this program and how much will they then potentially get out of the program as they age?
Span: Well, this is what makes it a modest program. It is funded by a payroll tax for all people in Washington who are working. It’s a 0.58% tax. So far, last year, about 3.7 million residents of Washington were enrolled in the program. It’s mandatory. It’s not voluntary. If you pay in that level of payroll tax for 10 years, then you are eligible for a lifetime benefit of $36,500 which is indexed to inflation. So an example from the WA Cares website – which is very instructive – if a 36-year-old now who is earning $50,000 a year, pays in for 10 years, her share would be $291 a year. So it’s pretty cheap. Then with inflation, when that young person is age 75, she can receive almost $100,000 in benefits, $98,000.
Chávez: This is an interesting question to me: Do people have to stay in Washington until they reach old age to be able to access these benefits? Like, what happens if you move away?
Span: Initially, you couldn’t take it with you. You had to remain in Washington. And people who were wanting to move for retirement or for any other reason were not happy with being enrolled in a mandatory program that if they left, they couldn’t use. But these programs, when they’re new, we see how they operate. The political leaders and legislators, administrators say, “OK, we were wrong here, we need to do more there.” They modify it. So this WA Cares has already been modified in a couple of ways, and one way is you can take these benefits with you if you leave the state.
Chávez: You’ve spoken about how this is a first-in-the nation type of program operating this way. Is Washington now serving as a model for other state or federal efforts to address long-term care costs?
Span: I am sure other states, federal, Congress and nonprofits will be watching very carefully to see how it works. There is a lot of interest around the country, it seems to me, more than in recent years, about finding some kind of protection to insure people for long-term care. So other states have introduced legislation: Illinois, Hawaii, West Virginia. It hasn’t passed anywhere else yet. Some states have task forces to study the issue and try to figure out their own responses. Senator Wyden is trying to organize Democrats in Congress to pass some sort of federal legislation. There’s legislation in the House too.
So there is, I think, a growing recognition that this is a big chunk of caring for people that is not covered by pretty much anything for most middle class people, and we need to do something. So whether WA Cares will be a model depends on how it works. But it is helping to fuel a discussion about how we are as a society, where we are keeping our old people alive for much longer – which is a good thing – but we haven’t thought about how to get them the help that they need. How do we do that? There will be continuing discussions, task forces and reports about this.
Chávez: What did you hear from the Washingtonians you interviewed for this story about how they were feeling about the benefits of this program, how it might impact them in their own lives?
Span: I interviewed a few people and then also there were something like almost 800 comments, including a number of people from Washington. So it was a mixed picture because there were people who said, “I don’t want to pay more taxes to do this. I don’t think it’s going to pay off for me. I’ll just save on my own.” But the reality is most people don’t save on their own, and they arrive at this juncture unprotected. Then I did talk to a couple of people who said, ‘“Yes. It is necessary. This is a good start.” It’s not big enough yet. It’s not going to pay totally for long-term care, but the Pacific Northwest has just historically been a leader in caring for elders, and this is yet another step in that direction.
Chávez: Paula Span, thank you so much for your coverage of this and for being with us today to share your reporting.
Span: Thank you.
Chávez: Paula Span writes “The New Old Age” column for The New York Times and KFF Health News.
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