Keep parity for caregivers
For decades, Washington state has been ahead of the curve with our long-term care system, recognizing the growing demand and benefits of providing home- and community-based options for seniors and people with disabilities as an alternative to more expensive institutional care. Tens of thousands of vulnerable residents are now able to live with independence and dignity, receiving care in their own homes and communities.
How disappointing then that state bureaucrats are now proposing to take Washington state backward and undermine our nationally regarded system of home- and community-based long-term care services. Last week the Department of Social and Health Services released its budget proposals for 2010.
Among the proposals that could perhaps do the most damage over the long haul to our system of home- and community-based care are the proposals to eliminate what is known as “parity” for agency home care providers and slash funding for home care agencies.
Currently those needing home care services can choose between two options. Those who have the ability or the desire to hire, fire and supervise their own providers can do so through the individual provider system. Many clients prefer this option so they have more control over who provides their care on a daily basis.
Those who can’t supervise their own care – including many with more acute disabilities – can contract with a private agency, which is responsible for recruiting, training and supervising its caregivers.
Several years ago, the Legislature adopted the “agency parity” statute, which ensures that compensation for individual providers and agency providers increase at the same rate. Since then, as individual-provider home care workers have increased their wages and benefits through collective bargaining with the state, the state has simultaneously increased reimbursement rates for agencies so they can remain competitive in recruiting and retaining qualified workers.
But now bureaucrats propose eliminating the parity statute and slashing funding for health benefits for low-income agency home care workers. At the same time, they propose to reduce agency reimbursement rates by as much as 30 percent. This could leave thousands of caregivers without health care, eliminate choices for vulnerable consumers, and destabilize the home care system. Home care agencies have run the numbers and can’t see how they can stay in business with a cut of this magnitude.
Home care workers generally make $10 to $11 an hour, living on the edge of poverty. Those who work at least half time have access to affordable health care, though with benefits much less generous than those enjoyed by the politicians and bureaucrats (for example, they have only individual coverage, not coverage for their spouses or children). Most can’t afford even modest cost increases.
So here’s what’s likely to happen: As thousands of low-wage home care workers at private agencies see their health benefits worsen and grow more expensive, they’ll leave their agencies and bring their clients to the individual provider system, where they can keep their existing health benefits.
The impact on home care agencies will be devastating. Agencies already suffered a 25 percent reduction because of budget cuts and policy decisions made by the Legislature last year. If their funding is cut further, and if the wages and benefits they pay become substandard to the state-paid individual providers, they will lose the ability to recruit and retain qualified caregivers. Many could be forced to close.
And if home care agencies close, consumers will be left without a critical option in the home- and community-based care system. Those vulnerable clients who need someone to supervise their care will be left at risk. Many clients will end up moving to the individual provider system. Not only could this undermine the care for vulnerable clients who need more supervision, but it would also undermine any savings from the proposal.
The state is facing another serious budget deficit. We need to look at all the options – including increasing revenue and improving the efficiency of public service. Some budget cuts will inevitably be needed, but we should avoid those cuts that fall heavily on the lowest-wage workers and the most vulnerable residents. Forcing home care agencies to close by cutting their reimbursement rates and eliminating the parity statue is a bad choice.