Washington state’s Department of Social and Health Services recently added two new support programs intended to make more services available to more than 850,000 unpaid family caregivers statewide and the loved ones they care for.
The two new programs, Medicaid Alternative Care, or MAC, and Tailored Supports for Older Adults, or TSOA, aim to broaden eligibility for state- and federally-supplied services to help enable the elderly to remain at home and their caregivers to continue to care for them.
“We’re not only providing the support, but the tools so they can keep going every day,” said LeAnne Turnbull, lead at the Southeast Washington Aging and Long-term Care office in Kennewick, the local DSHS affiliate.
MAC’s target group are caregivers 18 and older caring for someone 55 years and older who is eligible for full Medicaid (Apple Health) benefits.
TSOA’s recipients are age 55 years and older who don’t qualify for Medicaid. TSOA can be pursued regardless of whether the individual has a caregiver.
Both programs require the care receiver needing help with some activities of daily life, such as reminders to take medication, bathing, walking, dressing and surface-to-surface transfers.
The difference between the two new programs and existing ones provided through general fund dollars is MAC and TSOA take into consideration the $10.6 billion’s worth of services provided every year statewide by unpaid family caregivers and the needs of those caregivers.
“Caregiving is something that touches every family in some way,” said Bea Rector, director of home and community services within the aging and long-term support administration of DSHS. “The service provided by family caregivers is of incredible value to the state, the family and community.”
As the general population ages, the number of family caregivers in the state of Washington is skyrocketing. Long-term care isn’t getting any cheaper either. Rector reported that in the next 20 years, the 65-and-older population is projected to double, which will increase demand for these services.
Rector said that on average it costs $2,000 per month for in-home care through a private provider and $6,000 to $10,000 for care in a nursing or assisted living facility.
Meanwhile, the value of care provided by a family member amounts to an average of $550 per month — about a quarter of the cost of hiring out in-home care. MAC and TSOA introduce valuable services and supports for these otherwise uncompensated family caregivers and qualified applicants.
“We want to be able to bring those supports and services to caregivers to help them be a success,” Rector said.
“It’s reminding them they need to care for themselves—it’s a care plan for the caregiver too. If the caregiver isn’t healthy, it really impacts the person who needs care,” Turnbull explained. “It’s why area agencies on aging and resource centers are so important, because they can identify the resources for the caregivers. The end goal is to provide them care, so they don’t feel like their only option is other care options.”
Under the new programs, DSHS can serve three unpaid family caregivers for the same cost of one person receiving in-home care from outside providers or living in a long-term care facility.
Due to increasing pressure on their budget, Rector reported some states have had to cut services or maintain waiting lists. Through MAC and TSOA, “we’re trying to avoid this,” she said.
The goal of MAC and TSOA is to preserve access to all care service options by delaying commitment to more expensive, long-term intensive care. “It’s a way of serving more people with limited funds,” Rector said.
“We want to reach these people before they’re calling and requesting a list of local caregivers and facilities,” Turnbull said.
Rector said “it’s figuring out how to serve a person in the setting they prefer and the most cost-effectively” when state and federal budgets are already stretched thin.
Half the battle, it turns out, is helping family members realize they are caregivers who qualify for these services.
“Most people see it as just something you do; they don’t see themselves as caregivers that need help,” said Colleen Keltz, a communications and media representative for DSHS Aging and Long-term Care.
“We help them to understand it’s OK to reach out and seek help,” Rector said.
The eligibility process starts with a simple phone call, so interested persons need not travel to an agency, as is the case with existing programs.
TSOA and MAC program eligibility can be determined over the phone and services and support can be initiated right away. The customary full financial review through Medicaid still can take up to 45 days, but MAC and TSOA don’t have to wait for a determination to begin offering support.
Each regional office DSHS partners with is staffed with trained representatives who conduct the phone screenings, which are comprised of basic questions about the types of care the caregiver is provides and how they feel.
The screenings determine the most effective strategies for the caregiver, such as respite services in the form of massage therapy, or coverage so they can attend their own doctor and self-care appointments, additional trainings, or receive housekeeping and assistance with errands.
Representatives also can recommend self-care and point caregivers to relevant support groups, counseling and training in specific areas, such as how to cope with dementia in the person they’re caring for or how to safely transport them.
For seniors qualifying for the TSOA program, information could be provided regarding area resources for home-delivered meals, medical emergency response systems, and personal care aids that assist with grocery shopping, bathing, medication reminders and other services.
In-home assessments also are available.
Though MAC and TSOA do not directly pay out stipends to caregivers, representatives are able to offer an individualized support for caregivers equal to a set value, based on their assessment.
Essentially, three tiers of service are available through MAC or TSOA for eligible applicants: a one-time service valued at up to $250, $500 per year or $550 per month.
Since the programs’ launch in September 2017, more than 450 people have enrolled in either MAC or TSOA statewide, 28 of those being in Tri-Cities.
Turnbull said Southeast Washington Aging and Long-term Care covers the area stretching from Ellensburg to Clarkston and 117 people are enrolled.
DSHS officials said they hope to serve 8,000 people by the end of the program’s five-year demonstration waiver.
At that time, an evaluation of the programs’ impact will determine if intended goals were met and how the Legislature can work with the state agency to establish a sustainability plan for MAC and TSOA moving forward.
DSHS said it hopes to obtain dollar-matching from federal funds, so for every dollar the state pays into the programs, the federal government will match.
“We are excited to provide these services to the local communities and their people … so they can have the service they need, when they need it,” Rector said.
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