Elder Caregiving Study

At the LWVWA Convention in 2023, Washington state League members voted to undertake a new study on "Caregiving in Washington State: What exists and what is needed to support seniors and other vulnerable adults and their caregivers?"

With the aging of the population due to increased life expectancies and lower birthrates, an increased proportion of Washingtonians require long-term care to meet their basic needs. This care falls disproportionately on family caregivers, who provide the bulk of care for older adults. These caregivers are also central in ensuring access to health care and community-based social services. Research shows that family caregivers are predominately women, many of whom are employed outside their homes. When long-term care outside the home becomes necessary due to increased disability, the care available is limited, of variable quality, and extremely costly. While this proposal speaks specifically about seniors and their caregivers, these issues have implications for younger vulnerable adults who are unable to care for themselves and expect that most of the findings and recommendations of this study would apply to them as well.

This report is the culmination of that study.

Timeline

  • Dec 22-31, 2024: Study and Consensus questions to Local Leagues.
  • January 7, 2025: Study Committee hosts two state-wide Zoom informational meetings at 1:30pm (Register ) and 6:30pm (Register ). Recording will be available.
  • Jan/Feb: Local Leagues undertake study and consensus; Local League boards submit their League’s consensus results.

Files

Executive Summary

This study focuses on caregiving in Washington state and specifically caregiving for vulnerable adults 60 years of age or older who reside in their own homes and communities. The League of Women Voters of Washington authorized the study at its May 2023 convention. The study was completed in three phases: Phase I: Preliminary review of research and data; Phase II: In-depth interviews with elders, family caregivers and paid caregivers; and Phase III: Follow-up literature review and interviews with administrators in the field of elder caregiving.

Changes in the population in Washington state are consistent with the long-term global and national trend toward growth in the proportion of the population 60 years of age and older. This trend is expected to continue for the foreseeable future, creating both challenges and opportunities. While old age is frequently associated with disability and illness, elders are a source of “wisdom, perspective and experience,” contributing to society as family members, citizens, workers and volunteers.

For more than four decades, Washington state has been a leader in prioritizing home and community-based care for elders. In ratings by national organizations, it is ranked highly and according to state estimates, the state saved nearly $5 billion in tax dollars from 1999 to 2020 by focusing on home and community-based care rather than nursing homes.

Given growth in the number of elders and corresponding caregiver shortages in coming years, this report demonstrates the need to do more to prepare for the caregiving needs that accompany aging. The elder caregiving system is heavily reliant on family caregivers, primarily women, who often struggle to meet the demands placed on them. And the current shortage of paid caregivers promises to get worse over the next few years and decades.

The workgroup identified five overarching areas of concern that threaten Washington’s ability to respond to elder caregiving needs now and in the future.

  1. Most elders want to remain independent in their own homes and communities but frequently lack the resources to do so should they become unable to care for themselves without help. Further exploration is suggested about what it takes for elders to remain in their homes. This might include early retirement planning and savings, positive health practices such as promoting social connections, attention to community infrastructure including housing and transportation, and state and local planning for healthy aging that addresses alignment of infrastructure and services.
  2. Elders and their families face challenges negotiating the elder care system, including accessing information about the complex system of long-term care. Improving access might involve examining ways to streamline and better coordinate the system, along with making information and support more readily available to elders and their families.
  3. Washington’s system of elder caregiving relies heavily on family caregivers who themselves are challenged by conflicting demands, lack of respite care, and short and long-term costs. It may be time to reevaluate Washington’s heavy reliance on family caregivers, including examining the personal costs for caregivers and making support such as respite care more readily available.
  4. There is a lack of paid caregivers to meet current and projected needs. This is a serious challenge expected to get worse in coming years. In 2020, there were six working aged people 25-65 years to each elder 75 years and older. Estimates are that by 2030, the ratio of workers to elders 75 and over will be 4:1. This is expected to drop to 3:1 in 2040 and 2050.
    Recruitment and retention of paid caregivers is hampered by inadequate compensation and benefits, challenging work conditions, immigration policies, infrastructure issues such as lack of transportation, housing, and child care, and barriers to training and continuing education, especially in-person training.
  5. The system works better for the very poor who are eligible for Medicaid and the reasonably well-off who can pay privately. And yet, affluent elders and elders who are Medicaid recipients experience difficulties accessing and retaining care. Caregiving is even more challenging for lower and middle-income elders who lack the resources to pay for it. And, when these elders turn to Medicaid for assistance, they encounter issues with spousal asset limits and Medicaid Estate Recovery (repayment for Medicaid services).

LWVWA Study Committee: Theresa S. Baker (LWV Tacoma-Pierce County), Jeanne Cullen (LWV Thurston County), Jody Disney (LWV Thurston County), Mary-Jo Giamberardini (LWV Thurston County), Tricia Grantham (LWV Pullman), Richard Halvorson (LWV Clark County), and Karen Tvedt, Study Chair (LWV Thurston County)

Reading Committee: Mary Lynne Courtney (LWV Bellingham/Whatcom County), Janet Hyre (LWV Thurston County), and Ann Murphy, Reading Committee Chair (formerly LWV Spokane Area, and newly LWV Clark County)

Technical Reviewers: Dana Allard Webb, Program Manager, Home & Community Services, Aging & Long-Term Support Administration, Department of Social & Health Services (DSHS), Olympia, Washington; Eric Erickson, Executive Director, CDM Caretaking Services, Vancouver, Washington; and Nancy Field, Health Care Consultant, Sequim, Washington

Next Steps

    The LWVWA uses an established consensus process in developing positions on studies. This study is the first step in that process. Next, local Leagues will meet to develop consensus on the issues raised in the study and then adopt a written statement of position on the issues, which the LWVWA Board approves.


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